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Traver, Ida v. S. No. ii TRANSIT AND BURIAL PERMIT (40291-3M-9-25) -7 TO BE USED FOR TRANSPORTATION OF DEAD HUMAN BODY BY COMMON CARRIER STATE OF ILLINOIS 6) Transit Permit No.^ter.. . _4. .. DEPARTMENT OF PUBLIC HEALTH This Permit, properly filled out and signed, must be presented with the Undertaker's Certificate to the Railroad, Express or other Transportation Agent before a dead human body legally can be shipped by common carrier. _.CERTIFIED COPY OF DEATH RECORD '✓ •-- 6NAME OF DECEASED -._ SEx - AGE years, months, 7 days; COLOR ,I/1/ 4' PLACE OF DEATH ; ; (City, Tot6r Tswns ) .— `/ (County) (State) DATE OF DEATH �Cjti CAUSE OF DEATH (in full) .. l¢, )"/,,, Physician MEDICAL ATTENDANT OR CORONER. Z� ADDRESS OF ATTENDANT '• ; ^ (City, Town, or Township) ".. (County) (State) This is to certify that a *certificate of death setting forth the bove information has been filed with me in accordance with An Act to Provide for the Registration of Births, Stillbirths and Deaths in the State of Illinois. Signature of Local Registrar - Address of Local Registrar /}/" Registration Dist. No `� d Date I ./ �7I 6 *In case of disinterred bodies a proper application for disinterment may be accepted in lieu of a certificate of death. PERMIT FOR REMOVAL AND BURIAL Must be countersigned by the Lo1rthAuthority when s'caused by a Communicable Disease. PER�I`.SSION IS HEREBY GRANTED TO eyer- '--~-"'' jam \\� , CrA (Name of undertaker) �/ residing at ^. { .. holder of State Embalmer's License No J— %� (City) (Count tate) _— to remove the body of ! ...._.. , (des d above) from to: r._-•��7'`.' (City) (County) (State) (City) . • (County)•• (Stat 0 for burial in Cemetery. :. communicable . a) The cause of death is a disease, and a certificate has been filed with me by said undertaker certi- non-communicable ig o fying that the said body has been prepared by him in full compliances ith`the Rules Governing Transportation of the Dead in Illinois. -;, 'Vaf (Signed) i�JJJJy� (' oILr., Kcal Registrar. �. Address-- C' `!"AG Registration Dist. No tesDATE !� �—�" 19_ •. O ,•• NAME OF ESCORT / ADDRESS e o -, This portion of the Transit Permit must be detached at the perforated line below by the Baggage Agent and delivered ato the person who will accompany the corpse to its destination. When shipped by Express and without escort the above por- tion must be detached by the Express Agent and by him attached to the Express Way Bill covering the remains, to be delivered with the remains to the person to whom the body is consigned. iq STATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH-SPRINGFIELD iV OFFICIAL ROVES GOVERNING THE TRANSPORTATION OF THE DEAD IN ILLINOIS. As adopted by the Illinois State Board of Health,December 16,1914,and amended June 23,1915,and as amended and reaffirmed by the State Department of Public Health,July 1,1917,as further amended October 1,1917,and June 1,1918. Based on An Act to Create and Establish a Board of Health in the State of Illinois,in force July 1,1877,as amended by an Act in force July 1,1907;on An Act to Provide for the Registration of all Births,Stillbirths and Deaths in the State of Illinois,in force July 1,1915,and on An Act in Relation to the Civil Administration of the State Government,and to Repeal certain Acts therein named,in force July 1,1917. To Health Authorities,Transportation Officials,Undertakers,Embalmers,and Others Whom It May Concern: The following rules governing the transportation of dead bodies in Illinois,adopted by the Illinois State Board of Health on December 16,1914,and amended June 23, 1915,were amended and reaffirmed by the State Department of Public Health on July 1,1917,and further amended on October 1,1917,and June 1,1918. RULE 1. No dead human body shall be transported by common carrier in Illinois unless accompanied by a Transit and Burial Permit issued by the proper registration official(a local registrar),and every dead body so transported also shall be accompanied by a person in charge(an escort)who shall be provided with a passage ticket for self and a full first-class ticket marked"corps"for transportation o°the body. The Transit and Burial Permit shall set forth at least the following data: (a)A certified copy of the following data from the death certificate;name of deceased,sex,age, color,place of death,date of death,cause of death,name of medical attendant or coroner,address of attendant or coroner;same to be certified by the Local Registrar with whom the original certificate of death has been filed. (b)A permit for removal or burial setting forth at least the following:name of person to whom permit is granted, residence of said person,number of embalmer's license held by said person,name of decedent,place from which body is to be moved,place to which body is to be moved, name of cemetery or other place in which body is to be buried or otherwise disposed of,whether disease causing death is a communicable or non-communicable disease;all of which shall be over the signature of the Local Registrar with whom the original certificate of death has been filed. It is further required that when the disease causing death is a communicable dsease,the permit shall be approved(countersigned)by the local health official at the place where the death occurred. The name of the person (escort)who will accompany the body to its destination shall also be stated in this section. Attached to the Transit and Burial Permit,there shall be a Transit Label which shall set forth at least the following:(a)the undertaker's certificate certifying on oath that the body of the decedent therein named has been prepared by the certifying undertaker in strict accordance with the Rules Governing the Transportation of Dead Human Bodies in Illinois and giving the name of person to whom the body is consigned,the address of the consignee,the cause of death,whether the disease causing death is a communicable or non-communicable disease,date of death,place of death,number of the license held by the certifying undertaker,the signature and address of the undertaker,all which shall be duly sworn to before a Notary Public; (b)the route and description of ticket,all of the data therein called for to be inserted by the station baggageman to whom the body accompanied by the transit and burial permit is presented for transportation. The baggageman shall then detach the Transit and Burial Permit from the Transit Label,turning the former over to the person who will accompany the corpse to its destination and attaching the latter(the Transit Label)securely to the end of the coffin box. Provided,that,when a body is to be transported by common carrier from any city to a cemetery within or immediately adjacent to such city,a transit permit will not be required,but in any such case a body shall not be accepted for transportation by common carriers unless accompanied by a burial permit issued by the Local Registrar of the place where the death occurred or the body was found. When a body is shipped by express and without escort,the Transit Label shall be securely attached to the end of the coffin box and the Transit and Burial Permit shall be attached to and accompany the express way-bill covering the remains and upon arrival at destination of the body the Transit and Burial Permit shall be delivered with the body to the person to whom the body is consigned. RULE 2.-The transportation of the dead from smallpox,diphtheria,(diphtheretic sore throat,membranous croup),scarlet fever,(scarlatina,scarlet rash,duke's disease), poliomyelitis(infantile paralysis),cerebro-spinal fever,epidemic meningitis,bubonic plague,asiatic cholera and typhus fever,shall be permitted only under the following conditions: The body shall be thoroughly embalmed with an approved disinfecting fluid by arterial and eay.ty injection;all orifices shall be closed with absorbent cotton,the body shall be washed with an approved disinfecting fluid and placed at once in the coffin or casket,which shall be immediately closed. The coffin or casket,or the outside case containing the body, shall be metal or metal lined,and hermetically and permanently sealed. Embalming and other preparation must a done by a licensed embalmer holding a license as such issued by the Illinois State Board of Health,or,if issued subsequent to June 30,1917,by the State Department of Registration and Education. If the body is prepared as above provided,and is enclosed in a hermetically sealed and metal lined coffin or casket,the coffin or casket may be provided with a plate of glass of sufficient dimensions to disclose the face. The glass must be heavy plate glass and must be fitted in the casket in such manner as to be water and air tigot and not removable,and must be protected by an extra cover of wood or metal to prevent breakage in transit. In all cases where bodies are forwarded under Rule 2,notice must be sent by telegraph by the shipping embalmer to the health officer,or when there is no health officer, to other competent authorities at destination,advising the date and train on which the body may be expected. The coffin must not be opened after reaching its destination. (As amended June 1,1918.) RULE 3.-The transportation of bodies dead of any disease other than those mentioned in Rule 2 shall be permitted under the following conditions: (a) When the destination can be reached within twenty-four hours after death,the coffin or casket shall be encased in a strong outer box made of good sound lumber not less than seven-eights of an inch thick,all joints must be tongued and grooved,top and bottom put on with cleats or cross pieces,all put securely together. (b) When the destination cannot be reached within twenty-four hours after death the body shall be thoroughly embalmed by a licensed embalmer holding a license as such issued by the State Board of Health or,if issued subsequent to June 30,1917,by the State Department of Registration and Education,and the coffin or casket placed in an outside case constructed as provided in paragraph(al Rule 3. (e) All bodies of persons dead from diseases not enumerated in Rule 2,and which are to be transported by railroad from the State and County Institutions at Dunning or Oak Forest to Chicago,shall be accepted for transportation when such bodies are wrapped in sheets saturated with a solution of bichloride of mercury in the strength of an ounce of bichloride of mercury to the gallon of water,and enclosed in strong cases of air-tight and water-tight construction. There shall be no transfer of the dead body from such case to a casket or coffin or other container,while in transit,in any railway car,station,baggage or express room,or in any place where there may be exposure _ to the public.._The casereferred-ta-iathie--paragra;;-,-after-thebody-haa.been removeeitherefrom,shallbe thoroughly washed or disinfected with a solution of bichloride of mercury in the strength of one ounce of bichloride of mercury to the gallon of water,and shall not be used again for any purpose tither tlicTlls arrouter case for interment in a Chicago Cemetery. Railways shall not receive the box referred to in this paragraph unless the requirements herein set forth have been strictly complied with. RULE 4.-No disinterred body dead from any disease or cause shall be transported by common carrier unless approved by the State Department of Public Health and by the health authorities having Jurisdiction at the place of disinterment,and Transit Permit and Transit Label shall be-required as provided in Rule 1. Disinterment permits and reinterment permits must first be obtained from the Local Registrar at the place of disinterment. - The disinterment and transportation of bodies dead of diseases mentioned in Rule 2 shall not be allowed except by special permission of the State Department of Public Health and of the health authorities at both the place of disinterment and the point of destination. All disinterred remains shall be enclosed in metal or metal lined boxes and hermetically sealed(soldered);provided that bodies in a receiving vault when prepared by licensed embalmers shall not be regarded as disinterred bodies until after the expiration of thirty days. RULE 5.-The outside case may be omitted in all instances when the coffin or casket is transported in hearse or undertaker's wagon. RULE 6.-Every outside case shall bear at least four handles,and when over 5 feet 6 inches in length,shall have six handles. RULE 7.-In the transportation in or through Illinois of bodies shipped from points outside of Illinois,transportation officials will be governed by the Official Rules of the State Department of Public Health,which are based on rules adopted by the Conference of State and Provincial Boards of Health of North America. Before selling tickets,railroad agents shall carefully examine the transit permit and note the name of the passenger in charge,and of any other person proposing to ac- company the body,and shall see that all requirements have been complied with. The transit permit in such cases shall specifically state who is authorized by the registration official to accompany the remains. In all cases where bodies are forwarded in accordance with Rule 2,notice must be sent by telegraph by the shipping embalmer to the health officer,or when there is no health officer,to other competent authority at destination,advising the date and train on which the body may be expected. RULE 8.-An approved disinfectant fluid shall contain not less than five per cent of formaldehyde gas. The term"embalming"as employed in these rules shall require the injection,by licensed embalmers,of not less than ten per cent of the body weight,injected arterially in addition to cavity injection,and twelve hours shall elapse between the time of embalming and the shipment of the body. RULE 9.-All rules and parts of rules conflicting with these rules are hereby repealed. The foregoing rules having been adopted by the State Department of Public Health of the State of Illinois and ordered published,have the force and validity of law from and after July 1,1917,by virtue of the authority vested in said State Department of Public Health by Section 2,Chapter 126a,Hurd's Revised Statutes of Illinois. Under the provisions of said section and of the Administrative Code,the State Department of Public Health has"the general supervision of the interest of the health and life of the citizens of the State,"and is empowered"to make such rules and regulations"as it"may from time to time deem necessary for the preservation or improve- ment of the public health,"and it shall be the duty of all police officers,sheriffs,constables and all other officers and employees of the State to enforce such Rules and Regulations. By Order of Springfield,Illinois,June 1,1918. ISSAC D.RAWLINGS,M.D.,Director.