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Show X Ho [For Candidates] P B I V A T . E . American 25oaro of €omttiig£ioni?r£ for foreign 2^$£ion& [The following inquiries have beat suggested by one of tke missionary physicians of the American Board, .after consultation with an experienced physician at home, as helpful toward securing a full statement as to the health of candidates for missionary service abroad.] QUESTIONS IN RELATION TO HEALTH. To be answered by the person proposing service under the American Board of Commissioners for Foreign Missions. i . Give name at full length and residence. ^ f ^ i o ^ J^ o ^ W q ^ /J^ylL^c^y ^^a q^~y*yjJULUcX cu^_, ^ A ? < y , ^ y<y&)*y*Ay*y*~*2. Have you ever suffered from * (a) Neuralgia, Bad Headaches, Dizziness, Persistent Pain in the Back, Fits, Paralysis, Apoplexy, Insanity, or Sunstroke ? "Hey, (b) Habitual Cough, Asthma, Chronic Catarrh, Spitting of Blood, Consumption, Shortness of Breath, Palpitation of the Heart, Dropsy? A t e yyipCyy^XX ^rX^ X^c^y-cy^^ a. W k e A - o ^ ^Uyx.<y-i*yt?- ( fiJcc-*-e^L,^ycXZy J (c) Liver Complaint, Piles, Varicose Veins, Rupture, Rheumatism, Dyspepsia, Constipation of Bowels, or Dysentery? 3. Are you now suffering from, or subject to, any disease, malformation or weakness; or have you had any severe disease (except the usual diseases of children) other than those stated in above answers; or received any serious injury, or undergone any surgical operation ? Have you any defect of eyesight or hearing ? A CyoXyXtyX&yX- e - W ^ ^ - V *4- AL^ol^y<y» . ft y^^^-faf? ^ t ^ J U c - ^ ^ - - ^ ^y'tyy^yX , 4. As far as you know, are your brain, nervous and muscular systems, heart, lungs, abdominal, (and urinary organs J in a healthy state ? yijULA - Yty^yXys Uj^J^yLytxyiyyyy yyc^yAy^y^ACiy^, , 5. Are you now, and have you always been, abstinent as regards the use of alcoholic liquors, of tobacco, and of opium ? 6. Have you ever been under the professional care of any physician ? If so, state when, what disease, and give address of physician, if living? ^ _^. ep *%y) - *y, yyytX~*-^, XXyt H <^^^^f^XH?k, /5 cv-^<~^?£, / 70 S 3fe£ET Stf, C^<Je^<^ 1Jy.f 7. Give name and residence of some intimate friend to be referred *o for information on this point. 9uAUytA&ty*L fyt.fyiyOy^A % f O 'hyyz-^y+X*.LyXX Cc~e„ C ^ c e * ^ ( » r ^ f , / " ^ 4 e * > « * ^ - - ^ ' ."»• **£4~~a \ *^ 8. Have you ever applied for a life insurance policy? If so, was your application granted, and by what company? ~* 9. Have you ever had, or do you now have, any difficulty in sleeping at night ? 10. Does brain work in the evening prevent sleep at night? If so, to what extent? 11. Plow many hours were you accustomed to spend in study each day when pursuing your education ? and how many hours are you able to spend in study each day now ? 12. What amount of physical exercise, and in what form, does your health require you to take daily? Do you enjoy walking? 9 cu^, ^ / ^ i c . 9 jU^~o -*y&^**y^ y^^y XL«*y^-*y~y~**-^4 <^ot ^ . y ^ y ^ >3fer e44>y^£«A>~~xy ^(Mt-^^-t „ ^ Ay*-yy^1 ^f^y^yA\yty^yCy , 13. Does your experience lead to the conclusion that you can cheerfully acquiesce in the decision of a majority? or does this necessity, when met, produce mental perturbation and discontent ? yy -*~<J . 14. Is your temperament such as to lead to the belief that you can easily adapt yourself to the new and strange conditions of life in a foreign field ? |
