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t
Ella
P
F. Has the applicant ever had any of the dis-
F no
eases of the digestive system. If yes, de-
scribe. Inquire particularly regarding ap-
pendicitis.
VI. The Genito-Urinary System.
VI.
normal
A 1009 - acid
E
A. The specific gravity and reaction of the
urine?
B. Is any albumen present, by heat and acid, or
B no
by Heller's test? Both tests required.
bahnlon?
con
C. Is any sugar present by Fehling's tests or by
C no
fermentation?
D
not made
D. Results of microscopic analysis, if necessary.
E. Is there any derangement of the bladder?
E
no
J.
F. Of the kidneys?
F
no
normal
VII. The Cutaneous System.
VII.
Has there ever been or is there any disease or
no
functional derangement of the system
VX
sd MX
VIII. The Organs of Sense.
VIII. no defect noted
A. The sight. Does the condition of the eyes
A no
indicate that they should be examined by
a specialist?
B. The hearing. Any discharge from ears
B no
LIVX
C. Other senses.
C no
IX. Have there been any cases among the parents,
IX.
brothers or sisters of the applicant of :
A no
A. Consumption?
B. Insanity?
B yes, a sister waspusancal intervals
In abmu 16 years
C. Is there any predisposition, hereditary or ac-
C.
quired, to gout, rheumatism, cancer, arte-
no
rial disease, diabetes, or nervous disorders,
especially headaches, insomnia, nervous
exhaustion, chorea or epilepsy? If yes,
bassal
state nature.
X. A. If the applicant is a woman, is she now suf-
X. A
no, has always
fering or has she ever suffered from uter-
ine or menstrual disorder? (It is desirable
that particular attention be given to this
inquiry, as the climate overseas bears heav-
ily on those thus affected.)
during last year has been
meushnal function, until
been regular as hi
amewhat irregular
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- Type
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Document data
- ID
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- Type
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"ocrText": "t\nElla\nP\nF. Has the applicant ever had any of the dis-\nF no\neases of the digestive system. If yes, de-\nscribe. Inquire particularly regarding ap-\npendicitis.\nVI. The Genito-Urinary System.\nVI.\nnormal\nA 1009 - acid\nE\nA. The specific gravity and reaction of the\nurine?\nB. Is any albumen present, by heat and acid, or\nB no\nby Heller's test? Both tests required.\nbahnlon?\ncon\nC. Is any sugar present by Fehling's tests or by\nC no\nfermentation?\nD\nnot made\nD. Results of microscopic analysis, if necessary.\nE. Is there any derangement of the bladder?\nE\nno\nJ.\nF. Of the kidneys?\nF\nno\nnormal\nVII. The Cutaneous System.\nVII.\nHas there ever been or is there any disease or\nno\nfunctional derangement of the system\nVX\nsd MX\nVIII. The Organs of Sense.\nVIII. no defect noted\nA. The sight. Does the condition of the eyes\nA no\nindicate that they should be examined by\na specialist?\nB. The hearing. Any discharge from ears\nB no\nLIVX\nC. Other senses.\nC no\nIX. Have there been any cases among the parents,\nIX.\nbrothers or sisters of the applicant of :\nA no\nA. Consumption?\nB. Insanity?\nB yes, a sister waspusancal intervals\nIn abmu 16 years\nC. Is there any predisposition, hereditary or ac-\nC.\nquired, to gout, rheumatism, cancer, arte-\nno\nrial disease, diabetes, or nervous disorders,\nespecially headaches, insomnia, nervous\nexhaustion, chorea or epilepsy? If yes,\nbassal\nstate nature.\nX. A. If the applicant is a woman, is she now suf-\nX. A\nno, has always\nfering or has she ever suffered from uter-\nine or menstrual disorder? (It is desirable\nthat particular attention be given to this\ninquiry, as the climate overseas bears heav-\nily on those thus affected.)\nduring last year has been\nmeushnal function, until\nbeen regular as hi\namewhat irregular"
}