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I
03R MADIR3MA
D. Has the applicant ever suffered from any
D Suspicion of tuberculosis
disease or functional derangement of the
respiratory system? If yes, state particu-
was at Sanatorum Saranae Lake
lars.
1909, Not proven to be tbe. No
M
IspiboM
lo
Symptoms sunce.
E. What is the chest circumference
E
T
Upon full inspiration?
read
Upon full expiration ?
III. The Circulatory System.
A. What is the temperature of the body (If
III.
A
98.41
dous
over 99° in the mouth, try another day.)
135/85
-06
B. Give the rate and other qualities of the pulse.
B 68
Record blood-pressure.
135/85
difidado
C. Does it intermit, or become irregular or un-
C No
****************
equal?
silt constrisupos bed nov oveH a
D. Does physical examination reveal anything
D No
7911 :
whatever abnormal in the conditions of the
10 seggeib Julw noil
heart or blood vessels?
M
E No
10 muibom Parro
E. Has the applicant ever suffered from any
disease of the circulatory system? If yes,
describe.
:
IV. The Nervous System.
IV.
N.
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 re-
garding headaches, insomnia, nervous ex-
haustion, chorea or epilepsy and insanity.
11
11
sult al A
V. The Digestive System.
Hipe
V.
No
Has the applicant any disease or functional de-
el a
rangement?
10 noit
A. Of the stomach?
A No
B. Of the intestines?
an
B No
sdi
ar Ismonda gridt
C. Of the liver ?
No
11 and to
C
4
noinigo sista bas vilut
D No
.
D. Has there been or is there any tendency to
2
chronic constipation ?
E. To diarrhea?
E No
J
2
0
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"ocrText": "I\n03R MADIR3MA\nD. Has the applicant ever suffered from any\nD Suspicion of tuberculosis\ndisease or functional derangement of the\nrespiratory system? If yes, state particu-\nwas at Sanatorum Saranae Lake\nlars.\n1909, Not proven to be tbe. No\nM\nIspiboM\nlo\nSymptoms sunce.\nE. What is the chest circumference\nE\nT\nUpon full inspiration?\nread\nUpon full expiration ?\nIII. The Circulatory System.\nA. What is the temperature of the body (If\nIII.\nA\n98.41\ndous\nover 99° in the mouth, try another day.)\n135/85\n-06\nB. Give the rate and other qualities of the pulse.\nB 68\nRecord blood-pressure.\n135/85\ndifidado\nC. Does it intermit, or become irregular or un-\nC No\n****************\nequal?\nsilt constrisupos bed nov oveH a\nD. Does physical examination reveal anything\nD No\n7911 :\nwhatever abnormal in the conditions of the\n10 seggeib Julw noil\nheart or blood vessels?\nM\nE No\n10 muibom Parro\nE. Has the applicant ever suffered from any\ndisease of the circulatory system? If yes,\ndescribe.\n:\nIV. The Nervous System.\nIV.\nN.\nHas there ever been or is there any disease or\nfunctional derangement of the brain or\nother parts of the nervous system If yes,\nstate particulars. Inquire particularly re-\ngarding headaches, insomnia, nervous ex-\nhaustion, chorea or epilepsy and insanity.\n11\n11\nsult al A\nV. The Digestive System.\nHipe\nV.\nNo\nHas the applicant any disease or functional de-\nel a\nrangement?\n10 noit\nA. Of the stomach?\nA No\nB. Of the intestines?\nan\nB No\nsdi\nar Ismonda gridt\nC. Of the liver ?\nNo\n11 and to\nC\n4\nnoinigo sista bas vilut\nD No\n.\nD. Has there been or is there any tendency to\n2\nchronic constipation ?\nE. To diarrhea?\nE No\nJ\n2\n0"
}