CO885-(21-23) — Page 119

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