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I
C
B
1
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-
ho symptoms
pendicitis.
VI. The Genito-Urinary System.
VI.
no
A. The specific gravity and reaction of the
A 1028. aced
C
urine?
B. Is any albumen present, by heat and acid, or
B no
by Heller's test ? Both tests required.
C. Is any sugar present by Fehling's tests or by
C. no
a
fermentation ?
D. Results of microscopic analysis, if necessary.
D no casts: no pus ich
E amaphasurates
E
E. Is there any derangement of the bladder?
no
a
F. Of the kidneys?
F. no
+
VII. The Cutaneous System.
VII. no
Has there ever been or is there any disease or
functional derangement of the system?
VIII. The Organs of Sense.
VIII.
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
C. Other senses.
C no
IX. Have there been any cases among the parents,
IX.
no
brothers or sisters of the applicant of :
A. Consumption ?
A
lenness
B. Insanity
B
C. Is there any predisposition, hereditary or ac-
C. no
quired, to gout, rheumatism, cancer, arte-
i
rial disease, diabetes, or nervous 'disorders,
especially headaches, insomnia, nervous
exhaustion, chorea or epilepsy? If yes,
state nature.
X. A. If the applicant is a woman, is she now suf-
X. A no
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.)
6
Page data
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- 136
- Source index
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- Type
- photo
- Media ID
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Document data
- ID
- 2661393
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "I\nC\nB\n1\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-\nho symptoms\npendicitis.\nVI. The Genito-Urinary System.\nVI.\nno\nA. The specific gravity and reaction of the\nA 1028. aced\nC\nurine?\nB. Is any albumen present, by heat and acid, or\nB no\nby Heller's test ? Both tests required.\nC. Is any sugar present by Fehling's tests or by\nC. no\na\nfermentation ?\nD. Results of microscopic analysis, if necessary.\nD no casts: no pus ich\nE amaphasurates\nE\nE. Is there any derangement of the bladder?\nno\na\nF. Of the kidneys?\nF. no\n+\nVII. The Cutaneous System.\nVII. no\nHas there ever been or is there any disease or\nfunctional derangement of the system?\nVIII. The Organs of Sense.\nVIII.\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\nC. Other senses.\nC no\nIX. Have there been any cases among the parents,\nIX.\nno\nbrothers or sisters of the applicant of :\nA. Consumption ?\nA\nlenness\nB. Insanity\nB\nC. Is there any predisposition, hereditary or ac-\nC. no\nquired, to gout, rheumatism, cancer, arte-\ni\nrial disease, diabetes, or nervous 'disorders,\nespecially headaches, insomnia, nervous\nexhaustion, chorea or epilepsy? If yes,\nstate nature.\nX. A. If the applicant is a woman, is she now suf-\nX. A no\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.)\n6"
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