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I
I
et.
a
RED
Mann
N
M
a
S.
F. Has the applicant ever had any of the dis-
F no
n
eases of the digestive system. If yes, de-
scribe. Inquire particularly regarding ap-
N
pendicitis.
VI. The Genito-Urinary System.
VI. yes - pyelitis (facillus coli
1.015 acid
D
an
A. The specific gravity and reaction of the
A
urine?
5
B. Is any albumen present, by heat and acid, or
by Heller's test Both tests required.
B negative to back
C. Is any sugar present by Fehling's tests or by
C no
fermentation? the a Benedict
ust
D. Results of microscopic analysis, if necessary.
scopie efayeaked tests - their eacts privacy
D Have done several micros
D
E. Is there any derangement of the bladder?
two in good Daborally
F. Of the kidneys ?
time not at this
VII. The Cutaneous System.
didfirenently
J.
VII. none
X
Has there ever been or is there any disease or
functional derangement of the system?
VX
VIII. The Organs of Sense.
VIII. Cuntrally meg.
A. The sight. Does the condition of the eyes
A normal
indicate that they should be examined by
a specialist?
examinal several times
B. The hearing. Any discharge from ears?
by specialist - Dalonot glasses
B C nothing abnormal
C. Other senses.
nothing abnormal nort
IX. Have there been any cases among the parents,
IX.
silt
brothers or sisters of the applicant of
:
A. Consumption?
A One sinter died of t b.
B. Insanity ?
B One bratter has Oa healed
C. Is there any predisposition, hereditary or ac-
t. C b. physician levin - (so a practicing
quired, to gout, rheumatism, cancer, arte-
rial disease, diabetes, or nervous disorders,
especially headaches, insomnia, nervous
Faster had panalysis
his
exhaustion, chorea or epilepsy? If yes,
state nature.
X. A. If the applicant is a woman, is she now suf-
X. A Has Functions are
mister is living +well - is 64
fering or has she ever suffered from uter-
ine or menstrual disorder (It is desirable
normal,
that particular attention be given to this
inquiry, as the climate overseas bears heav-
ily on those thus affected.)
Page data
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- Type
- photo
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Document data
- ID
- 2661588
- Core
- doc
- Type
- document
DTO data
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"ocrText": "I\nI\net.\na\nRED\nMann\nN\nM\na\nS.\nF. Has the applicant ever had any of the dis-\nF no\nn\neases of the digestive system. If yes, de-\nscribe. Inquire particularly regarding ap-\nN\npendicitis.\nVI. The Genito-Urinary System.\nVI. yes - pyelitis (facillus coli\n1.015 acid\nD\nan\nA. The specific gravity and reaction of the\nA\nurine?\n5\nB. Is any albumen present, by heat and acid, or\nby Heller's test Both tests required.\nB negative to back\nC. Is any sugar present by Fehling's tests or by\nC no\nfermentation? the a Benedict\nust\nD. Results of microscopic analysis, if necessary.\nscopie efayeaked tests - their eacts privacy\nD Have done several micros\nD\nE. Is there any derangement of the bladder?\ntwo in good Daborally\nF. Of the kidneys ?\ntime not at this\nVII. The Cutaneous System.\ndidfirenently\nJ.\nVII. none\nX\nHas there ever been or is there any disease or\nfunctional derangement of the system?\nVX\nVIII. The Organs of Sense.\nVIII. Cuntrally meg.\nA. The sight. Does the condition of the eyes\nA normal\nindicate that they should be examined by\na specialist?\nexaminal several times\nB. The hearing. Any discharge from ears?\nby specialist - Dalonot glasses\nB C nothing abnormal\nC. Other senses.\nnothing abnormal nort\nIX. Have there been any cases among the parents,\nIX.\nsilt\nbrothers or sisters of the applicant of\n:\nA. Consumption?\nA One sinter died of t b.\nB. Insanity ?\nB One bratter has Oa healed\nC. Is there any predisposition, hereditary or ac-\nt. C b. physician levin - (so a practicing\nquired, to gout, rheumatism, cancer, arte-\nrial disease, diabetes, or nervous disorders,\nespecially headaches, insomnia, nervous\nFaster had panalysis\nhis\nexhaustion, chorea or epilepsy? If yes,\nstate nature.\nX. A. If the applicant is a woman, is she now suf-\nX. A Has Functions are\nmister is living +well - is 64\nfering or has she ever suffered from uter-\nine or menstrual disorder (It is desirable\nnormal,\nthat particular attention be given to this\ninquiry, as the climate overseas bears heav-\nily on those thus affected.)"
}