40 
TYPHOID FEVER IX DISTRICT OF COLHMBIA. 
In our study of cases the following blank form was used, and all the 
facts called for by this form minutely investigated for each case. 
United States Public Health and Marine- Hospital Service — Hygienic Laboratory. 
Typhoid peter — Case card. 
Name, . Date of investigation, — — . Case No. . 
Age, . Male or female, . White or colored, . Married or single, 
. Probable date onset of disease, . Date definite s^miptoms, . 
Name and address of physician, . 
RESIDENCE. 
Eesidence when taken sick, ; from to . 
Previous residences, ; from to . 
Subsequent residence, ; from to . 
Eesidence when infection was contracted, . Aumber of occupants, 
Ser^nnts, — — . 
White — 
Eesident, . 
Xonresident, . 
Colored — 
Eesident, . 
Nonresident, . 
Connected with city water system? . 
Connected with city sewerage system? . 
Privy? . Location, . 
Privy vs. well, . 
Water-closets in house? . Water-closets in yard? . 
Screens? . Flies? . Mosquitoes? . Ants? . Eoaches? 
Bedbugs, . Eats? . Mice? . Other vermin? . 
General sanitary condition, . 
OCCUPATION. 
Place, ; from to . 
Drinking water, . Sewage, . Other cases, . Flies, etc., — 
WATER. 
Kind used thirty days prior to onset of illness: 
Boiled, . Filtered, . Bottled, ; kind, . Soda water, 
where, . 
Ice: 
Source, . In or for drinking, . 
FOOD. 
MTiere taken thirty days prior, . 
Milk, thirty days prior, ; from . Boiled, — — . Pasteurized, — ^ — 
Ice cream, . 
Milk used since illness; from . Bottles, . 
Plncooked fruits and vegetables, thirty days prior, ; from — . 
Oysters, . Clams, . Crabs, . , Lobsters, . Other shellfish, 
Fresh- water fish (Potomac), . 
