Board of bealtb
baverbill, Dass
Typhoid fever Case Card. Vear
Case No.
Reported.
by
(Date)
Date of physician's first visit.
Date of patient's going to bed.
Name of patient
age
years
Residence when taken sick
from
to
Previous place of residence.
from.
to
Character of residence, private house, boarding house, hotel, flat, store, basement, barn, other.
Any newcomers in household within three months
Any newcomers in household had typhoid fever?
When?
Were newcomers associated with typhoid patien ts?.
Where?
or privy in yard?
W. C. in house?
Is house screened?
Flies?
Is garbage can covered?
(Few, many, swarming)
General sanitary condition of residence-good-fairly good-rather bad-bad?
In neighborhood?
Previous cases of typhoid in house?.
from
Occupation
place.
to
at school
place of business
Water, at home.
(Within 30 days prior to onset)
Bathing in streams, lakes.
Food, within 30 days prior to illness; where taken
Milk, how used
In hot tea or coffee only
Beverage
In cereals
Source of milk supply, including cream and skim milk
Uncooked fruit and vegetables
Where?
Ice cream.
Source
Raw shell fish.
When?
Previous attack of typhoid.
Source of ice supply
Temporary absences from Haverhill within 30 days prior to onset.
with suspected cases
Association with patients in febrile stage.
One year
Association with persons previously had typhoid within six months.
Association 30 days prior with persons in contact with patients in febrile stage.
Treatment of stools and urine of patients.
Other precautions
Inefficient
Etficient
Fairly efficient
(OVER)
