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F No has 8 F. Has the applicant ever had any of the diseases of the digestive system? If yes, describe. Inquire particularly regarding appendicitis. 1913. no perfect recovery. 15.10 VI. C VI. The Genito-Urinary System. M A. The specific gravity and reaction of the urine ? A 1018. acid 5 T S. B. Is any albumen present, by heat and acid, or B none by Heller's test? Both tests required. C C. Is any sugar present by Fehling's tests or by C. Home fermentation ? D. Results of microscopic analysis, if necessary. D nor memory E Mo bluoW, E. Is there any derangment of the bladder? + F no Solain unia F. Of the kidneys? VII. The Cutaneous System. VII. no. noy old VIX 01 Has there ever been or is there any disease or me J. functional derangement of the system? VX soubni of B blnoW VX - VIII. The Organs of Sense. VIII. IVX no met 93A JVX 5 A. The sight. Does the condition of the eyes-in- A dicate that they should be examined by a Visalil it specialist? . 11 B. The hearing. Any discharge from ears? B. No. C Normal C. Other senses. IX. Have there been any cases among the parents, IX. brothers or sisters of the applicant of: A. Consumption? A Mather died of tuberculoris of tlement. B. Insanity ? B Bo. C. Is there any predisposition hereditary or ac- C. Ns. quired, to gout, rheumatism, cancer, arterial disease, diabetes, or nervous disorders, es- pecially headaches, insomnia, nervous ex- haustion, chorea or epilepsy If yes, state 6) nature. X. A. If the applicant is a woman, is she now suf- X. A no fering or has she ever suffered from uterine or menstrual disorder. (It is desirable that particular attention be given to this inquiry as the climate overseas bears heavily on those thus affected.) 2

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    "ocrText": "F No has\n8\nF. Has the applicant ever had any of the diseases\nof the digestive system? If yes, describe.\nInquire particularly regarding appendicitis.\n1913. no perfect recovery.\n15.10\nVI.\nC\nVI. The Genito-Urinary System.\nM\nA. The specific gravity and reaction of the urine ?\nA\n1018. acid\n5\nT\nS.\nB. Is any albumen present, by heat and acid, or\nB none\nby Heller's test? Both tests required.\nC\nC. Is any sugar present by Fehling's tests or by\nC. Home\nfermentation ?\nD. Results of microscopic analysis, if necessary.\nD nor memory\nE\nMo\nbluoW,\nE. Is there any derangment of the bladder?\n+\nF no\nSolain unia\nF. Of the kidneys?\nVII. The Cutaneous System.\nVII. no.\nnoy old VIX\n01\nHas there ever been or is there any disease or\nme\nJ.\nfunctional derangement of the system?\nVX\nsoubni of B blnoW VX\n-\nVIII. The Organs of Sense.\nVIII.\nIVX\nno\nmet 93A JVX\n5\nA. The sight. Does the condition of the eyes-in-\nA\ndicate that they should be examined by a\nVisalil\nit\nspecialist?\n.\n11\nB. The hearing. Any discharge from ears?\nB. No.\nC Normal\nC. Other senses.\nIX. Have there been any cases among the parents,\nIX.\nbrothers or sisters of the applicant of:\nA. Consumption?\nA Mather died of tuberculoris of tlement.\nB. Insanity ?\nB Bo.\nC. Is there any predisposition hereditary or ac-\nC. Ns.\nquired, to gout, rheumatism, cancer, arterial\ndisease, diabetes, or nervous disorders, es-\npecially headaches, insomnia, nervous ex-\nhaustion, chorea or epilepsy If yes, state\n6)\nnature.\nX. A. If the applicant is a woman, is she now suf-\nX. A no\nfering or has she ever suffered from uterine\nor menstrual disorder. (It is desirable that\nparticular attention be given to this inquiry\nas the climate overseas bears heavily on those\nthus affected.)\n2"
}