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I
F. Has the applicant ever had any of the diseases
F No
' bires
of the digestive system? If yes, describe.
Inquire particularly regarding appendicitis.
IZ
M
10
VI. The Genito-Urinary System.
VI.
.
D
A 1020 - hair
5
A. The specific gravity and reaction of the urine?
B to
a
B. Is any albumen present, by heat and acid, or
by Heller's test? Both tests required.
C No
C. Is any sugar present by Fehling's tests or by
fermentation?
D
Ame made
D. Results of microscopic analysis, if necessary.
No
E. Is there any derangment of the bladder?
E
F
to
F. Of the kidneys?
No
VII.
VII. The Cutaneous System.
Has there ever been or is there any disease or
functional derangement of the system?
VX
07
VIII. The Organs of Sense.
VIII.
IVX
A. The sight. Does the condition of the eyes in-
A
Normal irsim t eyesends
dicate that they should be examined by a
specialist?
Normal. - to
B. The hearing. Any discharge from ears?
B
C. Other senses.
C
Normal
IX. Have there been any cases among the parents,
IX.
brothers or sisters of the applicant of:
M
A. Consumption?
A
B. Insanity ?
past
B to
A
-
C. Is there any predisposition hereditary or ac-
C
quired, to gout, rheumatism, cancer, arterial
XIX
disease, diabetes, or nervous disorders, es-
pecially headaches, insomnia, nervous ex-
haustion, chorea or epilepsy? If yes, state
nature.
00
No
X. A. If the applicant is a woman, is she now suft
X. A
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.)
10
10
5
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- Type
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Document data
- ID
- 2661362
- Core
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- Type
- document
DTO data
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Context sent to Scholar
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Page context
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"ocrText": "I\nF. Has the applicant ever had any of the diseases\nF No\n' bires\nof the digestive system? If yes, describe.\nInquire particularly regarding appendicitis.\nIZ\nM\n10\nVI. The Genito-Urinary System.\nVI.\n.\nD\nA 1020 - hair\n5\nA. The specific gravity and reaction of the urine?\nB to\na\nB. Is any albumen present, by heat and acid, or\nby Heller's test? Both tests required.\nC No\nC. Is any sugar present by Fehling's tests or by\nfermentation?\nD\nAme made\nD. Results of microscopic analysis, if necessary.\nNo\nE. Is there any derangment of the bladder?\nE\nF\nto\nF. Of the kidneys?\nNo\nVII.\nVII. The Cutaneous System.\nHas there ever been or is there any disease or\nfunctional derangement of the system?\nVX\n07\nVIII. The Organs of Sense.\nVIII.\nIVX\nA. The sight. Does the condition of the eyes in-\nA\nNormal irsim t eyesends\ndicate that they should be examined by a\nspecialist?\nNormal. - to\nB. The hearing. Any discharge from ears?\nB\nC. Other senses.\nC\nNormal\nIX. Have there been any cases among the parents,\nIX.\nbrothers or sisters of the applicant of:\nM\nA. Consumption?\nA\nB. Insanity ?\npast\nB to\nA\n-\nC. Is there any predisposition hereditary or ac-\nC\nquired, to gout, rheumatism, cancer, arterial\nXIX\ndisease, diabetes, or nervous disorders, es-\npecially headaches, insomnia, nervous ex-\nhaustion, chorea or epilepsy? If yes, state\nnature.\n00\nNo\nX. A. If the applicant is a woman, is she now suft\nX. A\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.)\n10\n10\n5"
}