Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
[Report of the Medical Officer of Health for Wandsworth, Metropolitan Borough]
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Report of the Medical Officer of Health, 143
| Number and age of Patients. | Patient's relatives living and dead :—(I.) Father and Mother ; (II.) Brothers and Sisters ; (III.) Uncles and Aunts. | Patient's husband if remarried give particulars for deceased husband or-husbands. | Patient's children. | N umber of patients childless. | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Whether affected or not. | I. | II. | III. | ||||||||||
| Age. | No. | Living. | Dead. | Living. | Dead. | Living. | Dead. | Living. | Dead. | Living. | Dead. | ||
| ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | ||
| ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | |||
| ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | |||
| 2 | ... | ... | ... | ... | I | 1 | ... | ... | ... | ||||
| ... | ... | ... | ... | ... | ... | ... | 1 | 1 | |||||
| ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | |||
| ... | 4 | 1 | 17 | ... | 1 | ... | |||||||
| ... | ... | ... | 1 | 1 | |||||||||
| ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | ||||
| ... | 14 | ... | ... | 4 | ... | ||||||||
| ... | ... | ... | 1 | ||||||||||
| ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | ||||
| ... | 1 | ... | ... | ... | ... | 1 | ... | ||||||
| ... | ... | ... | ... | I | 11 | ... | ... | ||||||
| 14 | ... | ... | ... | ... | ... | ... | ... | ... | ... | ... | |||