USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1920-1921 > Part 48
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OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
County
Middlesex
State
Mass.
Registered No.
55
City or Town
Chelmsford
No.
St ... .Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Mary Ann MacElroy
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No ..
Billerica Rd.
St.,
Ward.
(If non-resident give city or town and State)
Length of residence in city or town where death occurred
5
years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH.
Aug. 20, 1921
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY, That I attended deceased from
aug.
13
1977, to.
Aug 19
19.
that I last saw her
alive on
aug 19,
1922 .. 1 .... ,
and that death occurred, on the date stated above, at
.m.
The CAUSE OF DEATH was as follows : Gastric Carcinoma Foxaemia
(duration)
1 yr . + mos,
+ ds.
CONTRIBUTORY.
( SECONDARY)
(duration)
... yrs ...
.. mos.
...........
.ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?
no
Date of.
Was there an autopsy ?
200.
What test confirmed diagnosis ?..
Clinical Exam
(Signed)
Leonard C. Durithoff
M.D.
(Address) ..
Chelmsford Center
Date ..
Aug. 22, 1991
(Month)
(Day)
(Year)
Informant
Adam MacElroy
(Address)
Chelmsford ,Mass.
15
Sugr2 1921 Justice h. no one
(Month) (Day) (Year)
REGISTRAR
21 I HEREBY CERTIFY that a satisfactory stan dard certificate of death was filed with me BEFORE the burial or transit permit was issued; Justice h. More
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Pine Ridge
Chelmsford
(Cemetery)
(City or town)
DATE OF BURIAL
Aug. 22
1921
20 UNDERTAKER Walter Perham
ADDRESS Chelmsford
Official -position.
Gron Bleck
Date of issue of permit 8/22/21
Permit
No
4 COLOR OR RACE
white
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
married
5a If married, widowed, or divorced
HUSBAND-f-
(or) WIFE of
Adam F. MacElroy
6 DATE OF BIRTH
Jan ..
( Month)
28
(Day)
1.861 (Year)
Years 6 Months
23
Days
If LESS than 1 day, ........ hrs. or ....... min.
If STILLBORN, enter that fact bere
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
at home
9 BIRTHPLACE (City) Mayfield, Nova Scotia ( State or country)
11 BIRTHPLACE OF
FATHER (City)
Mayfield, Nova Scotia
(State or country)
12 MAIDEN NAME
OF MOTHER
Nancy Grant
13 BIRTHPLACE OF
MOTHER (City)
Nova Scotia
(State or country)
Archibald McLane
12-'20-100,000
137
(City or Town)
(Usual place of abode)
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, Civilengineer, 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 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 mine, 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 DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None. 1
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: Ccre- brospinal fever (the only definite synonym is "Epidemie 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; "Cancer" 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- eurrent) 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 symptomatic), "Atrophy," "Col- lapse," "Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., 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.
KCIUKI UT LENIIL INI CO V
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attendcd during his last illness, at the request of an undertakeror 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 as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . ..- Gen. Laws, Chap. 46, Sec. 9.
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 town where 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 containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate of the attending physician, if any, as required by law, or in lieu thereof a certificate 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, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certi- ficate. . . . The person to whom the permit is so given and the physi- cian certifying 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. - Gen. Laws, Chap. 114, Sec. 45.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. - Gen. Laws, Chap. 38, Sec. 6.
. . . He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. -Gen. Laws, Chap. 38, Scc. 7.
RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observanee 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-302
The Commonwealth of Massachusetts
138 Powell
CERTIFICATE OF DEATH OF NON-RESIDENT
....
( City er town)
1 PLACE OF DEATH
Registered No.
County
middlesex
State
Magas
Novowell Gew. Hos
12 210.St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number) Parkhaus
(a) Residence.
State
masa
City or Town. helmetnord No.
(If in the Army or Navy of the United States, give rank, organization, etc.) Hig St.
(Usual place of abode)
Leogth of residence io city or town where death occurred years months
days
How long in ULS., if of foreign birth? years
months
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
bringe
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH (month, day, and year) 9. 7, 1865
7 AGE 56 Years
Months
Days
If LESS than
1 day, ........ hrs. or ........ min.
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED
(b) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer
Lowell Shop
Chelmsford
9 BIRTHPLACE (city or town (State or country) malade.
10 NAME OF FATHER domande
18 Where was disease contracted if not at place of death ?
Did an operation precede death? . Date of weg 10, 1921"
Was there an autopsy?
What test confirmed diagnosis
(Signed)
M.D.
8-25152 (Address)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL Forefathers Chalme /2000 aug 2010 21
15 Filed aug 2 , 21/
Registrar, of city or town where death occurred
Filed 0
19
Registrar of city or towo where deceased resided
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and ye Duquel 23 1921.
17 I HEREBY CERTIFY, That I attended deceased from 16, Que 23 19
21
that I last saw h was alive on ....
123
19.
21
and that death occurred, on the date stated above, at 9 ys .. m. The CAUSE OF DEATH* was as follows :
* 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.) I jonephrases witho
(duration). ... yEs.
mos. ds.
CONTRIBUTORY
(SECONDARY)
Terminal To
ammonia
(duration)
.yrs.
mos.
ds.
1
11 BIRTHPLACE OF FATHER (city or towh) (State or country) males
12 MAIDEN NAME OF MOTHE Martha Dutton
13 BIRTHPLACE OF MOTHER (city or tomtolle (State or country)
I hor Parkhurst
MARGIN RESERVED FOR BINDING
2 FULL NAME 3 SEX m. PARENTS 14 Informant (Address) carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, 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 (a) Trade, profession, or particular kind of work ..
(Place of death)
Registered No.
53
(Place of residence)
howell
City or Town
Willia Barrett
16
Chelmsford
20 UNDERTAKER W. Perchance
ADDRESS Chelmsford.
vvi- 'ler the Medical
tion is very important, so that the relative healthtuiness vi various pursuits can be known. The question applies to cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, c. 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,""
"Forcman," "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 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 homc. 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 "Epidemie 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 _.
(naine 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 need 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."
"Ancinia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" (“Con-
genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Urcmia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or iniscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. 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 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
following COMUMLIVRO MINU 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 discase, as A death upon the street, or onc 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 303. 6-'18. 50,000.
FORM R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
County.
City or Town
Chelmsford
No.
St ..............
... Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
achoal & Bullard
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No
( Usual place of abode)
Littleton Road
St.
Ward.
(If non-resident give city or town and State)
Length nf residence in city or town where death occurred
7
years
months
days.
Hnw Inng in U. S., if nf foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
17
I HEREBY CERTIFY, That I attended deceased from
20
. to
Ling 30
21.
19
19
that I last saw her
alive on
arka. 25
21
and that death occurred, on the date stated above, at
The CAUSE OF DEATH was as follows :
General arteriosclerosis
Sehral
(duration)
.. yrs ..
mos ..
ds.
CONTRIBUTORY
(SECONDARY)
(duration)
.. yrs ..
......
mos ..
.ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?.
no.
Date of.
Was there an autopsy ?
no.
What test confirmed diagnosis ??
Kulum I. Scolonia
M.D.
(Signed)
( Address) ..
Clubsford, matt.
Date
Sieht. 1
1921.
(Month)- (Day) (Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Rural Com
Walpole Mano
(Cemetery)
(City or town)
DATE OF BURIAL
Sept, 1921
Informant (Address ) Chel
Filed (Month) (Day) (Year)/
REGISTRAR
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me lectic R. Acoace BEFORE the hurial or transit permit was issued
Official position
4 porou bleck
Date nf issue nf permit 9/1/2
Permit
No ...
H
12-'20-100,000
3 SEX Female 7 AGE 87 PARENTS 14 15 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 (h) Name of employer
MARGIN RESERVED FOR BINDING
Years
Months
Days
If LESS than 1 day, ........ hrs. nr ....... min.
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind nf work
at home
9 BIRTHPLACE (City)
Sandwich
(State or country)
10 NAME OF
FATHER
Hiram Burpee
11 BIRTHPLACE OF
FATHER (City ).
(State or country)
Grantham mans
12 MAIDEN NAME
OF MOTHER
acheck Hoster
13 BIRTHPLACE OF
MOTHER (City)
Pumney
(State or country)
n. H.
szora
Burpee
The Commonwealth of Massachusetts
139
State
mark.
(City or Town)
Registered No ...
1921.
4 COLOR OR RACE
white
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Vidro
5a If married, widowed, or divorced HUSBAND of (or) WIFE of
Jegrett Bullard
6 DATE OF BIRTH
July ( Month)
19.
(Day)
1834 (Year)
19
11a.
m.
Clara, 30
(Day)
(Year)
20 UNDERTAKER
Hatten Perham
ADDRESS
Chelmsford
DEATH
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. Butin 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 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 mine, 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 DEATH, state occupation at beginning of illness. If retired from business, that fact 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 DEATH (the primary affection with respect 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 pneumouia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified. is indefinite); Tuberculosis of lungs, men- inges, peritoneum, 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, 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 symptomatic), "Atrophy," "Col- lapsc,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., 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.
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his lastillness, at the request of an undertakeror other authorized person or of any member of the family of the deccased, 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 dicd, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. ...- Gen. Laws, Chap. 46, Sec. 9.
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 town where 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 containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate of the attending physician, if any, as required by law, or in licu thereof a certificate 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, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certi- ficate. . .. The person to whom the permit is so given and the physi- cian certifying 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. - Gen. Laws, Chap. 114, Sec. 45.
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