48 



EPIDEMIC DISEASES TRANSMITTED BY MILK. 



Previous residences... from to 



Subsequent residences from to. 



Temporary absences from D. C. within 30 days prior 



Number of occupants Ages 



who have had typhoid When? 



Newcomers in house within three months prior 



had typhoid ?...... 

 Servants 



White: Resident Typhoid?. 



Non-resident.. Typhoid? 



Colored: Resident Typhoid?. 



Non-resident Typhoid?. 



Typhoid at homes of servants When? 



Disposal of sewage ... W. C. in house..... 



W. C. in yard Privy . . Location 



General sanitarv condition of residence 



OCCUPATION. 



Place 



Other cases 



... from 



to 



WATER WITHIN 30 DAYS PRIOR. 



Solely Principally 



Occasionally 



FOOD WITHIN 30 DAYS PRIOR. 



Where taken 



Milk (how used) From ; 



Boiled? Pasteurized? 



Ice Cream? Where?. 



Uncooked fruits and vegetables 



Shellfish 



CONTACTS. 



Association 30 days prior with patients in febrile stage 



with suspected cases 



with persons who have had typhoid within 6 months 



1 year 



2 years 



3 years : 



4 years 



5 years ... 



Association 30 days prior with persons in contact with patients in febrile 



stage. 

 Treatment of stools and urine of patients 



