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D
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-
pendicitis.
VI. The Genito-Urinary System.
VI.
A. The specific gravity and reaction of the
A
1025 - acid
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.
fermentation?
D. Results of microscopic analysis, if necessary.
D
negative
E
E. two
a
E. Is there any derangement of the bladder?
F. Of the kidneys ?
F
two.
+
5
VII. The Cutaneous System.
VII.
us.
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
normal.
IX. Have there been any cases among the parents,
IX.
brothers or sisters of the applicant of :
A. Consumption?
A
no.
B. Insanity ?
B.
no.
C. Is there any predisposition, hereditary or ac-
C
no.
quired, to gout, rheumatism, cancer, arte-
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 Has had some
fering or has she ever suffered from uter-
ine or menstrual disorder? (It is desirable
menstrual irreqularity
that particular attention be given to this
inquiry, as the climate overseas bears heav-
for which she has been treated
ily on those thus affected.)
successfully
6
5
Page data
- Page
- 87
- Source index
- 0
- Type
- photo
- Media ID
- 5328b06e751c9a25
- Size
- unknown
Document data
- ID
- 2661393
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Page context
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"ocrText": "D\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-\npendicitis.\nVI. The Genito-Urinary System.\nVI.\nA. The specific gravity and reaction of the\nA\n1025 - acid\nurine?\nB. Is any albumen present, by heat and acid, or\nB\nno.\nby Heller's test ? Both tests required.\nC. Is any sugar present by Fehling's tests or by\nC.\nno.\nfermentation?\nD. Results of microscopic analysis, if necessary.\nD\nnegative\nE\nE. two\na\nE. Is there any derangement of the bladder?\nF. Of the kidneys ?\nF\ntwo.\n+\n5\nVII. The Cutaneous System.\nVII.\nus.\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\nno.\nC. Other senses.\nC\nnormal.\nIX. Have there been any cases among the parents,\nIX.\nbrothers or sisters of the applicant of :\nA. Consumption?\nA\nno.\nB. Insanity ?\nB.\nno.\nC. Is there any predisposition, hereditary or ac-\nC\nno.\nquired, to gout, rheumatism, cancer, arte-\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.\nA Has had some\nfering or has she ever suffered from uter-\nine or menstrual disorder? (It is desirable\nmenstrual irreqularity\nthat particular attention be given to this\ninquiry, as the climate overseas bears heav-\nfor which she has been treated\nily on those thus affected.)\nsuccessfully\n6\n5"
}