8. Has the applicant any rupture?
9. Has the applicant varicocele, hydrocele, internal or external
piles, fistula in ano, or any cutaneous disease?
If so, describe the disease, and state to what extent the applicant
is afflicted.
10. Has the applicant any defect in the functions of the brain or
nervous system?
If so, describe the disease, and state to what extent the applicant
is affected.
Has the applicant ever had an epileptic fit?
Is he subject to these attacks?
11. Give the measurements of the applicant’s chest:
At rest.
At full inspiration.
At full expiration.
12. Is the applicant’s respiration full, free, and unobstructed in
both lungs?
If not, state to what extent obstructed.
13. State the frequency of the action of the applicant’s heart:
When sitting.
When standing.
When standing after brief exercise. (The applicant should be
required to hop on one foot the distance of about 12 feet.)
14. Are there indications in the heart’s action of organic,
muscular, or nervous derangement?
If so, describe fully.
15. Are there indications that the applicant is addicted to the
excessive use of intoxicating beverages, tobacco, or narcotics in
any form.
If so, describe fully.
16. Has the applicant any form of disease or disability which is
likely to unfit him for the performance of the work of the position
for which he applies?
17. State whether the applicant is capable of prolonged, severe,
mental and physical exertion, and equal to the demands of a very
exhausting occupation.
18. Are you a regularly licensed physician, and duly authorized by
the laws of your State to practice medicine?
19. Of what medical institution are you a graduate?
This space is to be filled out by the applicant in his own
handwriting, in the presence of the physician.
(Signature of applicant) ................
I certify that I have made a thorough examination of the
above-named applicant, that each and all of the above answers are
in my own handwriting and are true, and that the applicant wrote
his signature just above in my presence.
(Signature of physician) ....................
(P. O. address of physician) ................
Date, ............., 190..
CHAPTER VIII.
THE EDUCATIONAL TEST.
Subjects and Weights and Specimens of Previous Questions Asked.
Public-domain text, read in full here on John Shaqi.
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