Confidential Report of Medical Examiner
This item is a form for Agnes von Kurowsky reporting on her health and physical ability.
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OCR Page 1 of 5D. Has the applicant ever suffered from any
D no -
disease or functional derangement of the
respiratory system? If yes, state particu-
lars.
E. What is the chest circumference?
E
35 mucher
Upon full inspiration ?
36
"
Upon full expiration?
33
,
III. The Circulatory System.
A. What is the temperature of the body ? (If
III. A
98.2
over 99° in the mouth, try another day.)
B. Give the rate and other qualities of the pulse.
B
84 - normal
Record blood-pressure.
Syd 120 - Diart 28
C. Does it intermit, or become irregular or un-
C no
equal?
D. Does physical examination reveal anything
D
no -
whatever abnormal in the conditions of the
heart or blood vessels
E. Has the applicant ever suffered from any
E
no.
disease of the circulatory system? If yes,
describe.
IV. The Nervous System.
IV.
no -
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.
but
V. The Digestive System.
V.
no
Has the applicant any disease or functional de-
rangement?
A. Of the stomach?
A
no-
B. Of the intestines?
B
no
C. Of the liver ?
C
no
D. Has there been or is there any tendency to
D
Slight
chronic constipation
E. To diarrhea?
E
no
-
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