CASE CARD 549 
19. State Source of Milk Supply and Name of Dealer. Was Milk Habitually 
20. 
21. 
22. 
23. 
24. 
25. 
28. 
29. 
30. 
al. 
32. 
33. 
Drunk? Was it Occasionally Used, as in Tea or Coffee or in Ice Cream? 
i | 
bale 
Give Number of Persons Living in Same House or Apartment........... 
Also Give Number in Whole Building in Case of Hotel, Apartment House, 
to Bed... ccc ce ee ee cece eee e eee be neces eens nenenees 
Ce a ee 
i 
. Give Names and Approximate Dates for Cases among Friends (Include 
Schoolmates).... 0... ccc ccc cece cee ee cen een eee eee en eee eeeeeeas 
Did Patient Attend any Social Gatherings where Food was Served within 
Two Months before Illness? If so, Gives Dates............. 00.00. ee eee 
Describe Sanitary Condition of Premises. Note Especially Outdoor 
Privies, Cesspools, Wells and Refuse Piles........... 0.0.0.0. cece eee eee 
Is House Well Screened?.. 0... 0... ccc cee een crete eee neee 
Had Patient a Separate Room?.... 2.0.0... ce ccc cee eee teens 
Had Patient a Trained Nurse or was Nursing done by Member of the Family 
Where Stools and Urine Disinfected? If so, Describe How this was Carried 
Out and Note Length of Time Continued........... 0.000. c cece eee eee 
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Remarks. To Include any Facts, Statements or Comments not Included 
in the Foregoing that May Throw Light on the Source and Mode of Infec- 
Cr er ee ee ee 2 ee ee re ee ee ee ee ee ee) 
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Information Given DV ce ce ccc etter ee tee tne eeees waeee 
Information Obtained by..... 0.0.0.0... 0. eee eens cece eee ec eeaaee 
Date of Obtaining Information................6. been cece snecaseece 
