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Heilman, Mrs. Charlotte M. (2 of 2)

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I e. F. Has the applicant ever had any of the dis- F Operation, chairage of eases of the digestive system. If yes, de- 1916 scribe. Inquire particularly regarding ap- 17. pendicitis. - VI. The Genito-Urinary System. VI. M A - acid A. The specific gravity and reaction of the T urine? B. Is any albumen present, by heat and acid, or B none by Heller's test? Both tests required. bobabai quini 10 C. Is any sugar present by Fehling's tests or by C no - See report advised C fermentation? IIX IIX D. Results of microscopic analysis, if necessary. D E. Is there any derangement of the bladder E No aldatugor F. Of the kidneys? F No VII. No model VII. The Cutaneous System. 101 : Has there ever been or is there any disease or fallow 01 suem functional derangement of the system VX soubni of visalit atamil> B VX TO gessarb VIII. The Organs of Sense. VIII. M A. The sight. Does the condition of the eyes No 01 aworal atast atadi atA IVI A jort batavos indicate that they should be examined by TO goods a specialist? and to dileori rast B No miss 01618 pacola B. The hearing. Any discharge from ears? C. Other senses. of IIVX C. No s ni doilw dillaod to nogiv S noit 1180 adt oldenos IX. Have there been any cases among the parents, IX. bns isoued all mubes brothers or sisters of the applicant of : A No A. Consumption? SEPA IIVX B No silt asil ILIVX B. Insanity? C. Is there any predisposition, hereditary or ac- C. No biodget bed adt XIX quired, to gout, rheumatism, cancer, arte- XIX rial disease, diabetes, or nervous disorders, especially headaches, insomnia, nervous exhaustion, chorea or epilepsy? If yes, nature. SND lount TO -0109 mil ni no that X. A. If the applicant is a woman, is she now suf- X. A No fering or has she ever suffered from uter- vd assi LDA ine or menstrual disorder? (It is desirable 4 that particular attention be given to this lo inquiry, as the climate overseas bears heav- 2 ily on those thus affected.) - J act 0 +

Page data

Page
77
Source index
0
Type
photo
Media ID
6cfcc1936979c6b4
Size
unknown

Document data

ID
2661622
Core
doc
Type
document
DTO data 
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Context sent to Scholar

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