SOURCES OF THE CONTAMINATION OF MILK. 47 



Place of work, business, or school 



Physician while ill 



Health before attack 



Out of town (date) 



Patient discharged by physician (date) 



( Chills Pain in Bowels Tongue 



„ ,. J Vomiting Nosebleed Delirium 



symptoms Headache Diarrhoea or Eruption 



l^ Fever Constipation Spleen 



[reverse.] 

 typhoid fever. 



Examination No 



Widal reaction : 



Made? Date when \ Date when "| Date when 1 



{YesorNo) Positive J Suggestive / Negative /. ... 



Complications 



Drinking Water fJown^f^Ply Milkman 



-..,, , ,. , fA.M Source of cream and 1 



Milk delivered \ p ^ ^^^^^ ^^^^ ^^^^^^. | 



Previous cases in the house 



Has patient visited other cases? 



Privy or water closets Plumbing 



What probable sources of infection 



What possible sources of infection 



Remarks 



A more elaborate blank for data is employed by the Hygienic 

 Laboratory, U. S. Public Health and Marine Hospital Service, 

 in the study of typhoid fever in the District of Columbia (29): 



PUBLIC HEALTH AND MARINE HOSPITAL SERVICE — HYGIENIC 



LABORATORY. 



TYPHOID FEVER CASE CARD. 



Date of investigation Case No 



Name 



Age Color Sex Nationalitj' 



Probable date of onset Date of definite symptoms 



Name and address of physician: 



Residence 



Residence in D. C — 



Residence when taken sick from to.. 



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