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F
C
(A
038 MADIR3MA
+
D. Has the applicant ever suffered from any disease
D no
or functional derangement of the respiratory
system? If yes, state particulars.
E. What is the chest circumferecnce?
E Ben
in
Upon full inspiration?
Upon full expiration
27thrin
in
III. The Circulatory System.
a
A. What is the temperature of the body? (If
III. A 98
over 99° in the mouth, try another day.)
C.
B. Give the rate and other qualities of the pulse.
Record blood-pressure.
B 78 refular onle
Homm.
C. Does it intermit, or become irregular or un-
C. no
equal?
D. Does physical examination reveal anything
D ho
whatever abnormal in the conditions of the
heart or blood vessels?
E. Has the applicant ever suffered from any dis-
E no
ease of the circulatory system If yes, de-
scribe.
IV. The Nervous System.
IV.
no
Has there ever been or is there any disease or
functional derangement of the brain or other
parts of the nervous system ? If yes, state
particulars. Inquire particularly regarding
headaches, insomnia, nervous exhaustion,
chorea or epilepsy and insanity.
V. The Digestive System.
V. no
Has the applicant any disease or functional de-
rangement?
A. Of the stomach?
A no
B. Of the intestines
B ho
C. Of the liver ?
C no
D no
I
D. Has there been or is there any tendency to
chronic constipation?
E no
g
E. To diarrhea?
J
W
of
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Document data
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"ocrText": "F\nC\n(A\n038 MADIR3MA\n+\nD. Has the applicant ever suffered from any disease\nD no\nor functional derangement of the respiratory\nsystem? If yes, state particulars.\nE. What is the chest circumferecnce?\nE Ben\nin\nUpon full inspiration?\nUpon full expiration\n27thrin\nin\nIII. The Circulatory System.\na\nA. What is the temperature of the body? (If\nIII. A 98\nover 99° in the mouth, try another day.)\nC.\nB. Give the rate and other qualities of the pulse.\nRecord blood-pressure.\nB 78 refular onle\nHomm.\nC. Does it intermit, or become irregular or un-\nC. no\nequal?\nD. Does physical examination reveal anything\nD ho\nwhatever abnormal in the conditions of the\nheart or blood vessels?\nE. Has the applicant ever suffered from any dis-\nE no\nease of the circulatory system If yes, de-\nscribe.\nIV. The Nervous System.\nIV.\nno\nHas there ever been or is there any disease or\nfunctional derangement of the brain or other\nparts of the nervous system ? If yes, state\nparticulars. Inquire particularly regarding\nheadaches, insomnia, nervous exhaustion,\nchorea or epilepsy and insanity.\nV. The Digestive System.\nV. no\nHas the applicant any disease or functional de-\nrangement?\nA. Of the stomach?\nA no\nB. Of the intestines\nB ho\nC. Of the liver ?\nC no\nD no\nI\nD. Has there been or is there any tendency to\nchronic constipation?\nE no\ng\nE. To diarrhea?\nJ\nW\nof"
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