USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1919 > Part 16
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30
(naine origin; "Caneer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affeetion need not be stated unless important. Example: Measles (disease eausing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toins or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" ("Con- genital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," ." "Inanition," "Maras- inus," "Old age," "Shoek," "Uremia," "Weakness," ete., when a definite disease can be ascertained as the eause. Always qualify all diseases resulting from ehild- birth or misearriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ete. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of hcad - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated
under the heat itement . menclatu ~~~ the -
sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, ete.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, ete.
4. Deaths under circumstances unknown, as A person found dead, etc.
-
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN.
R 303. 6-'18. 50,000.
2/3
Chelmsford (City of town)
Registered No. 48
Township
Chelmsford
... or Village.
or
.Ward St., ...........
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Charles So
Engram Balser
(a) Residence.
No.
Central SV
(Usual place of abode)
Length of residence in city or town where death occurred 250
years
months
-
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
married
6 DATE OF BIRTH (month, day, and year) June 25-1868
Days
26
If LESS than
1 day, ........ hrs.
or ........ min.
(b) General nature of industry, .. .
business, or establishment in
Brain Truck
9 BIRTHPLACE (city or town) ..
Nr. Hadley annapolis C,
(State or country)
Una Serie
10 NAME OF FATHER
Caron Balser
11 BIRTHPLACE OF FATHER (eity or town).
Mr Halle
(State or country)
U.S.
12 MAIDEN NAME OF MOTHER Sarah armstrong
13 BIRTHPLACE OF MOTHER (eity or town)
(State or country)
nova Scotia
Informant
This C.I.Balser
15 Filed Same 23, 19 3. 1919 Edward S. Rffing
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) June 20
1919
17
I HEREBY CERTIFY, That I attended deceased from
May 29
, 1919, to
June 20
, 1919
that I last saw h. alive on
, 1919.
and that death occurred, on the date stated above, at
7.30 P.m.
The CAUSE OF DEATH* was as follows:
rogressive
Pernicious
Anaemia
-
.
(duration)
5
.. mos ..
ds.
CONTRIBUTORY.
(SECONDARY)
(duration)
... yrs ...
.............. mos ...
.......
ds.
18 Where was disease contracted
if not at place of death?
×
Did an operation precede death? WWW. Date of Y
Was there an autopsy ?.
no
What test confirmed diagnosis ?
Blood test.
(0 / (Signed)
Masa Stoward
.. ,
M.D.
/23.19/9 (Address)
Chequeford Mass.
* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES. state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Green Cem, Carlisle
20 UNDERTAKER
arthur C. marshall
DATE OF BURIAL Ame 24 1919
ADDRESS
Servingto
R
MARGIN RESERVED FOR BINDING
1 PLACE OF DEATH
County ..
Marie
2 FULL NAME
3 SEX
Male
4 COLOR OR RACE
white
5a If married, widowed, or divorced
HUSBAND of
(01) WIFE of
7 AGE
Years
Months
50
11
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
Chauffeur
particular kind of work
which employed (or employer) .....
PARENTS
14
(Address)
Chelmsford
of certificate.
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be
so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back
carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,
(c) Name of employer
& Cushing Co
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
State.
Mass
City.
No.
.. , ......
(If in the Army or Navy of the United States, give rank, organization, ete.)
St.,
......
.. Ward.
(If non-resident give eity or town and State)
.
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by !! S. Census and American Public Health Association]
-cement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, etc., of_
(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection nced not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" (“Con-
genital," "Senile," etc.),
"Dropsy," "Exhaustion,"
"Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the causc. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," ctc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine definitely. ª Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY
PHYSICIAN.
R 15. 10-'18. 5,000.
1
FORM R-301
N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH
10-'IS. 100,000.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
OFFICE OF THE SECRETARY - DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
County huddlece
City or Town.
no chelmsford
No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
@dmand Wellian Champagne
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No.
St.,
Ward.
(Usual place of abode)
Length of residence in city or town where death occurred
years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX m
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5a If married, widowed, or divorced HUSBAND of (or) WIFE of
6 DATE OF BIRTH
( Month)
(Day)
(Year)
7 AGE
Years
Months 15 Days
If LESS than
If STILLBORN, enter that fact here
1 day, ........ hrs.
If STILLBORN, state period of uterogestation. ... mos.
19
........ min.
8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work (b) General nature cfindustry, business, or establishment in which employed ( or employer ) ..
(c) Name of employer
9 BIRTHPLACE (City )
Mr. Chelmsford
mates.
(State or country)
10 NAME OF
FATHER
alphonse Champagne
11 BIRTHPLACE OF Trois Sévères FATHER (City ). (State or country) P. 2:
12 MAIDEN NAME OF MOTHER Deine Bruneca
13 BIRTHPLACE OF MOTHER (City). (State or country)
14 alphonse champagne
Informant
(Address ) no Chilinsfood
Filed
(Month) (Day) (Year)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
2
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY, That I attended deceased from
, 1919. 21, 1919
that I last saw halive on
5, 1919.
and that death occurred, on the date stated above, at 1/20
.m. The CAUSE OF DEATH was as follows : maras mus
( duration)
yrs.
mos ..
ds.
CONTRIBUTORY
(SECONDARY)
(duration)
yrs H.
mos ..
ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?.
Date of
Was there an autopsy ?
What test confirmed diagnosis ?.
(Signed)
M.D.
(Address) Au Checons ford Man
6
2.
Date
( Month)
(Day)
(Year)
19, PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
Chelmsford June 23 1915
(Cemetery)
(City or town)
20 UNDERTAKER
2. Cebut
ADDRESS 17 arken
21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued. Edward J. Robbins
Official position .. Tom Clash
22 Date of issue of burial or transit permit al June 23, 19/9
MARGIN RESERVED FOR BINDING
PARENTS
found
214
49
St.
Ward
State
mars.
Registered No. ........
(If non-resident give city or town and State)
1919
22
1919
15 Same 23, 1919 Edward S.Retting
1
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
LApproved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many eases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal minc, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- . cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING NEATH, state occupation at beginning of illness. If retired from business, that faet may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
$
Statement of cause of death. - Name, first, the DISEASE CAUSING NEATH (the primary affection with respcet to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of .... ...... (name origin; "Caneer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatie), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia, " "PUERPERAL peritonitis," etc.
State cause for which surgical operation was undertaken.
(Recommendations on statement of cause of death approved by Com- mittee on Nomenclature of the American Medical Association.) .
Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.
Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
EXTRACTS
FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international classification of causes of death], where contraeted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Acts of 1910, Chap. 322.
No undertaker or other person shall bury a human body . . . until he has received a permit from the board of health or its agent, . . . or . .. from the clerk of the eity or town in which the person died; . . . no such permit shall be issued until there shall have been delivered to such board, agent or clerk, . . . a satisfactory written statement con- taining the facts required by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. . . . The person to whom the per- mit is so given and the physician wlio certifies to the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, Sec. 38.
Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased died, his name and residence, if known, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed to have come to their death by violence. - Revised Laws, Chap. 24, Sec. 8.
RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health Physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
FORM R-303
Thr Commonwealth of Massachusetts
MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
(ISSUED UNDER THE PROVISIONS OF REVISED LAWS, CHAPTER 24)
County
Middlesex
State
wars.
Registered No ..
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(a) Residence.
No
Golos Road
St.
.Ward,
(Usual place of abode)
Length of residence in city or town where death occurred 22
years
months
days
How long io U. S., if of foreign hirth? 22 years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
2 1919
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH
7200.
(Month)
21 1839
(Day)
(Year
7 AGE
79
Years
7
Months
11
Days
If STILLBORN, enter that fact here
If STILLBORN, state period of uterogestation
mooths
If LESS than I day, ...... hrs. or ....... min.
8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work .. (h) General nature of industry,
RED chard
Home Mason
9 BIRTHPLACE (City)
(State or country)
11 BIRTHPLACE OF FATHER (City ) ...
(State or country) England
12 MAIDEN NAME
OF MOTHER
Martha Morrison
13 BIRTHPLACE OF MOTHER (City ) ... (State or country)
england.
Date
Month)
(Day)
(Year)
19 PLACE OF BURIAL, CREMATION, or REMOVAL
DATE OF BURIAL Mo Chelmsford fully # 191.
(Cemetery)
(City or town)
Month) (Day) ( Year)
ADDRESS
Filed (Month) Dayy ( Year)
REGISTRAR
21 Burial per issued by.
nit Edward J, Robbins Official position.
Tom Club
22 Date of File, 4.1919 issue.
Permit No ..
1-18-'19. 25,000.
2 FULL NAME 3 SEX Male 10 NAME OF FATHER . PARENTS should be carefully supplied, MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms, N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information for extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side business, or establishment io which employed ( or employer) (c) Name of employer
H
(See reverse side for description for unknown person)
18 Where was injury sustained if not at place of death ?..
(Signed)
J howard funk
, M. D.
(Address)
101 Manualth, Lowral.
Medical Examiner for
3
1919
14 Daniel 1. Farrow
Informant.
(Address)
Korth Chelmsford
15 July 4, 199 Edward & Rolling
Chelmsford
No.
grotere Road
City or Town
Thomas.
90
arrow
(If in the Army or Navy of the United States, give rank, organization, etc.)
( If non-resident give city or town and State)
4 COLOR ØR RACE
5 SINGLE, MARRIED, WIDOWED OR
DIVORCED (write the word)
16 DATE OF DEATH.
tule
17 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: probable
Pulmonary Jubaen trois. Valmonary
Sudden death write pulmonary
Laumorrhage.
20 UNDERTAKER
William It Saunders Small, Mais.
MARGIN RESERVED FOR BINDING
215
EXTRACTS
FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a stand- ard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international elassification of eauses of death], where contracted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . -- Revised Laws, Chap. 29, Secs. 10 and 1, as amended by Aets of 1910, Chap. 322.
No undertaker or other person shall bury a human body . until he has received a permit from the board of health or its agent, . . . or . from the clerk of the eity or town in which the person died; . . no such permit shall be issued until there shall have been delivered to such board, agent or clerk, . . . & satisfactory written state- ment containing the facts required by law to be re- turned and recorded, which . . shall be accompanied by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as herein- after provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. The person to whom the permit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the elerk or registrar may require. - Revised Laws, Chap. 78, Sec. 38.
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.