13 
TYPHOID FEVER CASE CARD. 
In our study of the cases the folloAving form Avas used, and all 
facts called for by this form Avere carefully iiiA^estigated for each 
case. This form varies someAvhat from that used last year. 
Puhlic Health and Marine- Hofiiiital t^errice — Hygienic Lahoratory. 
TYPHOID FEVER CASE CARD. 
Date of inA’estigatioii, — . Case No, . 
Name, . 
Age, . Color, — . Sex, . Natiouality, . 
Probable date of onset, . Date definite sj’mptoms, . 
Name and address of physician : 
RESIDENCE. 
Resident of District of Columbia, years, months. 
Residence when taken sick, ; from to . 
Previous residences, ; from to — — . 
Subsequent residence, ; from — — to . 
Temporary absences from District of Columbia within 30 days prior 
Number of occupants, . Ages, . 
Number of occupants who have had typhoid, . When, . 
Newcomers in house within three months prior, . 
Newcomers in house had typhoid? . 
Servants, 
White — 
Resident, . Typhoid? . 
Nonresident, . Typhoid? . 
Colored — 
Resident, ^ . Typhoid? . 
Nonresident, — — . Typhoid? . 
Typhoid at homes of servants, . When? . 
Disposal of sewage, . Water-closets in house? . 
Water-closets in yard? . Privy? . Location, . 
General sanitary condition of residence, . 
OCCUPATION. 
Place, ; from to . 
Other cases : 
WATER WITHIN THIRTY DAYS PRIOR. 
solely ; principally. 
occasionally. 
FOOD WITHIN THIRTY' DAYS. 
Where taken, . 
Milk (how used), ; from . 
Boiled ? . Pasteurized ? . 
Ice cream? . Where? . 
Uncooked fruits and vegetables, . 
Shellfish, . 
