Document B56a6eKZBDr6gOmpMrRGYrZKJ
Na me
- - , `0/ De p t .. D iv. o r Wo r k s:
(FOR CONFIDENTIAL USE OF MEDICAL DEPARTMENT)
MEDICAL EXAMINATION
SO C O N Y - VACUUM OIL COMPANY
IN C O R P O R A T E D
Service Stat ion
Po s it io n Appl ie d f o r :
Salesman
Da t e :
Aug. l o , I 933
Na m e : Co u n t r y o f B ir t h :
S a ffa lo , N.Y.
Sex :
M ale S i n g l e :.
c o l o r : W hite Y es Ma r r i e d :
d a t e o f b i r t h : ^e?q(*)^ Ag e : 27
W id o w e d :
Div o r c e d :
h is t o r y O F: Tu b e r c u l o s is . P n e u m o n ia . O r g a n ic He a r t Dis e a s e . Ne p h r it is . Dia b e t e s . Rh e u m a t is m . Sy ph il is . Go n o r r h e a , Me n t a l d is e a s e . Ep il e p s y , o r O t h e r S e r io u s S ic k n e s s e s ( d e s c r ib e , g iv in g d a t e s a n d d u r a t io n )
S e r io u s In j u r i e s o r O p e r a t i o n s ( d e s c r ib e ) :
No
U s e o f Al c o h o l :
No
Ha b it Fo r m in g Dr u g s :
Us e o f To b a c c o :
M ildly
No
S m a l l po x Va c c in a t io n : C h ild h o o d
e n t e l l i g e n c e : Normal
MOUTH:
OK
EYES: Vis io n . R . 2 0 / 20
g e n e r a l A p p e a r a n c e : ^ ^ - ^ ^ 1^- P h y s i c a l A g e :
Te e t h :
OK
To n s il s :
^7
L . 2 0 / 20
Wit h Gl a s s e s . R. 2 0 /
H e ig h t : 5 ~ 7 s W e ig h t : 1 ^ 5 Te m p. : 9& C
OK
No s e :
OK
L. 20/
D i s e a s e : No
EARS: He a r in g . R.
20 Pf
URCULATORY: He a r t . S iz e :
L
Normal
20 Ft .
Mu r m u r s :
Dis e a s e :
No
No
Dis e a s e :
No
Pu l s e Ra t e :
70
Ar t e r i e s : Coiiiores s i t i l e b l o o d P r e s s u r e : S y s t o l i c : U S
D i a s t o l i c : SO
-U N G S: Re s o n a n c e :
Dis e a s e :
No
Normal
Ra l e s :
No
C h e s t Me a s u r e m e n t : e x p ir a t io n :
3^
In s p i r a t i o n :
36
3 A S T R O -IN T E S T IN A L : DISEASE
EXTREM ITIES: DISEASE:
No
No
He r n ia :
No
H e m o r r h o id s :
No
Appe n d ix :
De f o r m it y
f Uppe r Ex t . : 1 Lo w e r Ex t . :
ho
Normal
Va r ic o s e Ve i n s :
SACK
/ Uppe r : 1 Lo w e r :
No Normal
Ul c e r s:
S pin e :
Fl a t Fe e t :
Normal
No
NERVOUS SYSTEM : STIGM ATA OR D ISEA SE:
None
REFLEXES Normal
Ar g y l -Ro b e r t s o n :
Ro m b e r g :
Tr e m o r s :
ENDOCRINE GLA ND S:
G ENITO-URINARY: U RINALYSIS: A l b u m in ; -ABORATORY T EST S:
Sugar :
Not taken
Wa s s e r m a n :
-YMPHATIC SYSTEM:
No g la n d u la r en largem en t
EKIN (3CARS. TUMORS. DISEASE) i
OK
Ca s t s :
Sp . Gr .: S pu t u m :
Ve n e r e a l
Va r i c o c e l e ; No
o r Ot h e r Dis e a s e :
._ -'O
X-Ra y :
Me n s t r u a l H is t o r y (i f in d ic a t e d ) :
SUMMARY:
BATING: 1 ,A !______
IB X
2
3
4
F o l l o w In s t r u c t i o n s o n F o r m P-M -4 " In f o r m a t i o n f o r Ex a m in in g P h y s i c i a n s .*-