Fitehbuig Boaid of ealth
TUBERCULOSIS
4 CITYS
Number,
Date of record,
Location,
by
Reported to local Board of Health
Reported to state Board of Health
Name of patient,
Married. Single.
Age
Place of Birth,
Date of Birth,
Occupation,
Duration of illness,
Previous or present cases of tuberculosis in house or family,
Number of persons in family
over fourteen years of age,
Number of persons in family under fourteen years of age,
Care of sputum,
Isolation,
Ventilation
Cleanliness,
Heating,
Disposition to co-operate,
Means in view,
Sources of partial aid,
apply for aid,
Settlement as reported by Overseers of Poor,
Patient does
Disposition of case,