48 EPIDEMIC DISEASES TRANSMITTED BY MILK. 



Previous residences ..Irom 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 Ivocation 



General sanitary condition of residence 



OCCUPATION. 



Place from to 



Other cases 



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 



Digitized by Microsoft® 



