PUBLIC RECORD OFFICE
Reference :-
C.O. 885
22 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC:
COPYRIGHT PHOTOGRAPH-NOT TO
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flaming the neck and the plug. A culture tube inoculated with some fluid should be forwarded in every case; if seen during life, that taken from the spinal canal; if not, that taken from one of the cerebral ventricles.
HISTORY FORM OF SO-CALLED VOMITING SICKNESS CASES.
A complete history recorded daily is requested, the daily condition and symptoms of the patient being noted down fully for reference.
Name
Age
Sex
Colour
health?
Variety of latrine
6. Temperature
7. Pulse
8. Respiration
9. Headache
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Morning and evening daily
four hourly where possible.
rate and character
(a) rate and character
(b) If cough is present state nature and if painful (c) If expectoration is present state character and kindly send a specimen to the Bacteriologist
general or localised
frontal
occipital
continuous or intermittent
Are they all in good
10. (a) Pain elsewhere
Premonitory symptoms.
Date of Visit
Number of persons living in the house.
Method of water supply
Method of drainage, if any
Method of disposal of waste and offensive matter
Sanitary conditions in and surrounding dwelling.
1. Incubation period
Was there a history of
Malaise
Nausea
Headache localised or general
Loss of appetite
Any other symptoms
2. Mode of Invasion"
Sudden or gradual
Was there a history of chilliness
Pains local or general
Kindly give dates on which each symptom appears or disappears.
flushed
sunken
rigor
convulsion
Give date of onset
3. Symptoms during illness
1. Facies
2. Eyes
pupils
pinched suffused
ecchymosed
sunken
sclerae jaundiced
normal
contracted
dilated
equal or unequal
was photophobia present
was optic neuritis present is power of vision affected
3. Tongue
4. Decubitus
5. Skin
dry or moist
coated or clean
dorsum and edges
any other feature noticeable.
dorsal or lateral
general flexion
(or local, such as knees)
dry or moist
any eruption, if so
nature and distribution
day of appearance
duration
state of skin jaundiced
giving date of appearance of jaundice.
(b) whether caused or increased by touch or move-
ment?
(c) Epigastric pain? If present?
and if present whether increased by vomiting (d) If loin pain is present?
11. (a) Nervous symptoms (if present)
convulsions
(general or local)
coma delirium
irritability
paralysis
(distribution)
rigidity
retraction
(of neck or other parts)
A specimen must be sent from each case seen
12. Cerebro-spinal fluid
13. Nausea or Vomiting
14. Urine
15. Diarrhoea
16. Hæmorrhage
day of commencement
with or without effort
Kindly send specimen to the Bacteriologist and speci-
mens of any change in the matter vomited.
colour
quantity daily
whether albumen present
Kindly send specimen to Bacteriologist also of any
change in urine.
date of onset
number and character of stools
Kindly send specimens to the Bacteriologist
from mucous membranes
quantity and character.
17. Was thirst a marked feature?
18. In fatal cases state duration of illness.
Where the patient is alive when seen, a tube of blood, as for Widal's test, should be taken, and also smears of blood. Also some 3-4 cc. of the cerebro-spinal fluid. Method of obtaining, see below.
To collect blood for Widal's reaction: Congest a finger from the proximal to just above the distal interphalangeal joint; with a Hagedorn or other needle (sterilized) prick a little above or to side of the root of the nail. If blood does not flow freely, it can be made to do so by flexing the terminal joint. Having broken both ends of the blood tube, apply one end to the drop of blood. When one-third to one-half a tube full has been collected the tube is very gently warmed