NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
APPENDIX. VOL. II.
201
FORM No. 21.—( Continued. )
Names of European Non-Commissioned Officers, &c., attached to Black or Native
Corps, who have been treated, but who are not to be included in the preceding
Return.
(This portion of the Return is only applicable to Stations where there are Black or Native
Troops.)
Rank. Regt.
No.
Names.
Diseases.
Date of
Admission
Date of
Discharge.
Date of
Death. Remarks.
Drafts joined during the Week.
From
Date of joining.
Rank and No.
Remarks on Health of
Men.
Men Invalided during the Week.
Date of being Invalided.
Rank and No.
Left the Station for Date of Departure.
The following Venereal Diseases are included in this Return.
Remain-
ed.
Admit-
ted.
Dis-
charged.
Remain-
ing.
Remarks.
Primary Syphilis...
(Hard Chancre
Indurated Bubo
Soft Chancre
Suppurating Bubo
Phagedenic Sore
Sloughing Sore
Secondary Syphilis
Particular forms
of disease to be
specified.
Gonorrhœa
Balanitis
Stricture of Urethra
Orchitis
Total...
202
APPENDIX. VOL. II.
FORM No. 21.—( Continued. )
Remarks on the prevailing Diseases and Sanitary Notes on the State of the
Regiment, its Quarters, &c., and on any Special Causes of Diseases ;
with brief statement of post mortem appearances in fatal cases.
Cases entered under Class V., Order 4, and those returned as "not yet diag-
nosed," to be invariably noticed.
Return showing the Strength, Admissions and Deaths, &c., of Women and
Children during the Week.
S t r e n g t h .
D a i l y S i c k .
N o . o f d i e t s
d u r i n g w e e k .
Diseases.
Total.
Women ...
Children . . .
Women.
Remained
. . .
Admitted
. . .
Discharged ...
Died ...
...
Remaining ...
Children
Remained ...
Admitted ...
Discharged ...
Died ...
. . .
Remaining ...
(F
o r e i g n S t a t i o n s .
)
W E E K L Y R E T U R N O F S I C K
O F T H E
S t a t i o n e d a t _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
F r o m _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 8 7 .
T o _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 8 7 .
F o r t h e P r i n c i p a l M e d i c a l O f f i c e r
a t
203
APPENDIX. VOL. II.
FORM No. 22.
W. O. Form 463.
Sanitary Branch,
Army Medical Department.
SANITARY REPORT for the Month of
Regiment
.....................
Barracks
....................
Station .
Average Strength .....................
Average Daily Sick.
...................
Remained in hospital last report ....................
Admitted into hospital during the month .........
...
Discharged from
do.
do.
................
Total Deaths
do.
do.
........................
Number in hospital on last day of month .........
...
1. State of barracks, huts, or tents and
of guard-rooms and cells, particularly with
reference to over-crowding, and the state of
ventilation.
Mean cubic space per man, for the month,
in barracks, huts, cells, and guard-rooms.
Mean superficial area per man per month
in barracks.
2. State of latrines, urinals, and ash-pits,
and of ablution and bath-rooms, and
w a s h - h o u s e s .
3. State of drainage and sewerage, and
general sanitary condition of the vicinity of
the barracks and station.
186
204
APPENDIX. VOL. II.
FORM No. 22.—( Continued. )
4. Means of cooking, and condition of
barrack kitchens.
5. Rations of the troops, with special
reference to their quality and any change in
quantity during the month.
6. Water-supply—its source, quality, and
sufficiency.
7. Quality of the drinks and other Canteen
supplies.
8. Clothing of the men—whether it is
suited to the climate of the station, the season
of the year, and the state of the weather.
9. Duties of the troops.—Do they appear
to have exercised an unfavourable influence
on health.
Average number of nights in bed.
10. Hospital accommodation.—Special
notice to be taken of the state of ventilation
and of any over-crowding of the beds, with
explanation of the causes which rendered
the latter necessary.
Average cubic space to each man in occu-
pied wards, for the month.
M O N T H L Y
S A N I T A R Y R E P O R T
W . O . F o r m 4 6 3 .
205
APPENDIX TO VOL. II.
FORM No. 22.—( Continued. )
11. Character of the prevailing diseases,
and if apparently influenced by any of the
preceding conditions.
12. Special prevalence of any diseases
among the Civil population in the vicinity of
the barracks, Camp, or station.
13. Statement of any recommendations
bearing on the health of the troops, which
have been made to the Off icer Commanding,
—with the results.
Commanding—————
Surgeon
,4-1
of——————— Station————— From————
To———————
B B
206 APPENDIX TO VOL. II.
FORM NO. 23.
Actuat route marched by the from to
DATE.
Name of village
(If on board ship, give
name of vessel, or state if
by rail or transit.
DISTANCE
TRAVELLED.
Remarks.
Year. Month. Day.
Miles. Furlongs.
—
European
Commis-
sioned
Officers.
Native Commis-
sioned and
Non-Commis-
sioned Officers
and men.
NATIVE FOL-
LOWERS.
Men. Women.
Strength of troops at starting ... ...
Do. at end of march ...
Sick admitted dur-
ing the march.
By cholera ..
By other diseases.
Discharged ... ... ... ... ... ...
Died
By cholera ... ... ... ...
By other diseases ... ... ...
Remaining ... ... ... ... ... ...
207
APPENDIX TO VOL. II
FORM No. 23.—( Continued.)
Nominal Return of Casualties amongst troops only during the march.
Corps. Rank and Names.
Age.
Diseases.
D a t e o f A d m i s s i o n .
D a t e o f D e a t h .
D u r a t i o n o f D i s e a s e s .
Remarks.
Diary of occurrences and observations on the march of
from
to
Subjects to be referred in each day's Report.
1. Date and hour of commencing march.
2. Hour of arrival at next encamping grounds,
3. Le ngt h of ma r c h.
4. State of road.
5. State of weather and direction of prevailing winds.
6. Condition of men.
7. State of encamping ground and quality of soil.
8. Its distance from the native villages.
9. Whether sickness, and of what nature, prevails in the neighbouring villages, or
along the line of march in advance.
10. Source of water-supply and its quality.
11. Whether any sick have fallen out by the way, their number, and diseases.
12. Daily state of sick.
Camp at
or travelling by rail or transit, and if by sea,
name of vessel.
Daily Return of Sick Native Commissioned and Non-Commissioned
Officers and Men.
DISEASES.
Alterations.
A. D. A. D. A. D. A. D. A. D. A. D.
Remained ... ...
Admitted ... ...
Total... . . .
Discharged ... ...
Died ... ... ...
Remaining . . .
To be continued in manuscript.
Date
FORM No. 23.—( Continued. )
Summary of the foregoing
Date.
PROGRESS REPORT.
MODE OF PROGRESS.
SICKNESS AND MORTALITY AMONG NATIVE
COMMISSIONED AND NON-COMMISSIONED
OFFICERS AND MEN BY SPECIAL DISEASES.
Remarks.
Marched from.
H o u r o f d e -
p a r t u r e .
Arrived at
Hour of a r r i -
val.
B y s e a .
B y t r a n s i t .
B y R a i l .
B y R o a d .
C h o l e r a .
F e v e r s .
D y s e n t e r y .
D i a r r h œ a .
O t h e r d i s -
e a s e s .
T o t a l .
A. D. A. D. A. D. A. D. A. D. A. D.
M a r c h i n g R e p o r t
o f t h e
F r o m
T o
F o r w a r d e d .
R e c e i v e d .
2 0 8 A P P E N D I X T O V O L . I I .
FORM No. 24.
W. O. Form, No. 151
.
Classified Return of Wounds and Injuries received in action on the ____________________________at ____________________________
N. B.—Separate Forms should be used for (1) Officers and for (2) Non-Commissioned Officers and Men.
[This Form may be used for various pur p oses where Returns of Wounds and Injuries are to be made, the headings being altered according to circumstances.]
Regions of the Body Wounded or Injured.
ADMISSIONS
WITH WOUNDS OR INJURIES.
DEATHS
CONSEQUENT ON THE FOREGOING WOUNDS AND INJURIES.
T o t a l W o u n d e d o r
I n j u r e d .
Projectile or Weapon by which the
Wounds or Injuries were inflicted.
A m o n g T o t a l
W o u n d e d o r I n -
j u r e d .
Projectile or Weapon by which the Wounds
or Injuries were inflicted.
C a n n o n B a l l .
S h e l l .
G r a p e S h o t .
R i f l e , M u s k e t ,
P i s t o l B a l l .
S w o r d , L a n c e .
B a y o n e t .
O t h e r o r u n -
d e t e r m i n e d
m e a n s .
C a n n o n B a l l .
S h e l l .
G r a p e S h o t .
R i f l e , M u s k e t ,
P i s t o l B a l l .
S w o r d , L a n c e
B a y o n e t .
O t h e r o r u n -
d e t e r m i n e d
m e a n s .
All Wounds and Injuries ... ... ... ... ... ...
1. Wounds of the Head ... ... ... ... ... ...
2. Wounds of the Face ... ... ... ... ... ...
3. Wounds of the Neck ... ... ... ... ... ...
4. Wounds of the Chest ... ... ... ... ... ...
5. Wounds of the Abdomen ... ... ... ... ... ...
6. Wounds of the Back and Spine ... ... ... ... ...
7. Wounds of the Perineum and Genital and Urinary Organs,
not being Wounds of the Peritoneum.
8. Wounds of the Upper Extremities ... ... ... ...
9. Wounds of the Lower Extremities ... ... ... ...
10. Wounds with direct injury of the Large Arteries, not being
cases of compound fracture.
11. Wounds with direct penetration or perforation of the
Large Joints.
12. Wounds with direct injury of the Large Nerves, not being
at the same time cases of compound fracture.
N. B.—The Classification will be continued by the expansion of each of these 12 heads, so as to show the precise character of the Wounds and Injuries.
Surgeon.
Classified Re-
turn of Wounds
and Injuries re-
ceived in action
on the________
at____________ From______t o_____
W . O F r o m 1 5 1 .
A P P E N D I X T O V O L . I I .
2 0 9
FORM NO. 25. W. O. Form, No. 151 A.
Classfiied Return of Wounds and Injuries of every kind received in action at ____________________ Admitted into the Hospital
of the ___________ between the_______of __________ and _____ of __________ 18_____
N. B.—Separate Forms should be used for (1) Officers and for (2) Non-Commissioned Officers and Men.
[A separate Form may be used for Gunshot Wounds as distinguished from other Wounds.]
Regions of the Body Wounded or Injured.
R e m a i n e d o n t h e _ _ _ _ _ 1 8 _ _
S i n c e A d m i t t e d .
AMPUTATION.
O t h e r O p e r a t i o n s .
D i e d .
D i s c h a r g e d t o D u t y . TRANSFERRED.
R e m a i n i n g o n t h e _ _ _ _ _ _ 1 8 _ _ _
P r i m a r y .
S e c o n d a r y .
E x c i s i o n .
T o o t h e r H o s p i t a l s .
T o E n g l a n d .
All Wounds and Injuries ... ... ... ... ... ... ... ... ...
1. Wounds of the Head
. . . ...
. . . ... ... ... ... ... ... ...
2. Wounds of the Face ... ... ... ... ... ... ... ... ... ...
3. Wounds of the Neck ... ... ... ... ... ... ... ... ... ...
4. Wounds of the Chest ... ... ... ... ... ... ... ... ... ...
5.W o u n d s o f t h e A b d o m e n ... ... ... ... ... ... ... ... ...
6. Wounds of the Back and Spine ... ... ... ... ... ... ... ...
7. Wounds of the Perineum and Genital and Urinary Organs, not being Wounds
of the Peritoneum ... ... ... ... ... ... ... ... .. ...
8. Wounds of the Upper Extremities
. . .
. . .
. . .
. . .
. . .
. . .
. . .
9.W o u n d s
o f
t h e L o w e r E x t r e m i t i e s
... ... ... ... ... ... ...
10. Wounds with direct injury of the Large Arteries, not being cases of com-
pound fracture ... ... ... ... ... ... ... ... ... ...
11. Wounds with direct penetration or perforation of the Large Joints ... ...
12. Wounds with direct injury of the Large Nerves, not being at the same time
cases of compound fracture ... ... ... ... ... ... ... ...
N. B.—The Classification will be continued by the expansion of each of these twelve heads, so as to show the precise character of the Wounds and Injuries.
Surgeon.
C l a s s i f i e d R e t u r n o f W o u n d s a n d I n -
j u r i e s o f e v e r y k i n d
r e c e i v e d i n a c t i o n
a t _ _ _ _ _ _ _
W. O . F o r m 1 5 1 A .
210
A P P E N D I X T O V O L . I I .
APPENDIX TO VOL. II.
211
FORM No. 26.
W. O. Form, No. 151, B.
Classified Return of Operations performed, and of Deaths following them between
the _______ day of __________ and the ________________
day of ________ 18 ___ in the ________________Hospital at __________
Nature of Operations.
Operations per-
formed.
Deaths following
the foregoing
Operations.
Primary. Second-
ary.
Primary. Second-
ary.
TOTAL . . .
. . .
. . .
A M P U T A T I O N S .
UPPER
EXTREMI TI ES.
Shoulder-joint
...
...
...
Arm
. . .
...
. . .
. . .
Fore-arm ..
. . .
. . .
. . .
_____________________________
Thumbs ...
...
. . .
. . .
Fingers ...
. . .
...
. . .
L O W E R E X T R E M I T I E S . Hip-joint ...
. . .
. . .
. . .
At upper third
...
Thigh ... At middle third
...
At lower third
...
Leg . . .
. . .
. . .
. . .
. . .
Ankle-joint
...
. . .
...
Medio-tarsus
. . .
. . .
. . .
Tarso-metatarsus ...
. . .
. . .
Toes
...
. . .
. . .
. . .
______________________________
E X C I S I O N S .
UPPER
EXTREMI TI ES .
____________________________
______________________________
______________________________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
L O W E R
E X T R E M I T I E S .
______________________________
______________________________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
______________________________
EXTRACTION OF BALLS AND OTHER
FOREIGN BODIES
. . .
. . .
. . .
TREPHINING
. . .
. . .
. . .
. . .
LIGATURES OF ARTERIES
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
OTHER OPERATIONS
. . .
. . .
. . .
H . M . ' s . R e g t .
C l a s s i f i e d R e -
t u r n o f O p e r a -
t i o n s , & c .
F r o m
T o
W . O . F o r m
1 5 1 , B .
212
APPENDIX TO VOL. II.
FORM
(Form G.)—For Regimental Hospitals.
ADMISSION AND DISCHARGE BOOK.
N o . o f C a s e .
R e g . N o .
RANK
AND NAME.
(If the Soldier
is Married, write
"M." under his
name.)
COMPLETED
YEARS OF
DATES.
Age
(last
Birth-
day.)
S e r v i c e .
INJURED,
or
ATTACKED
by Dis-
eases, &c.
ADMITTED
into
Hospital.
DISCHAR-
GED from
Hospital.
DIED OR RECOVER-
ED, when and
where (Write
" DIED" in case
of death, and "R"
for recovered.
Regiment
or
Corps.
APPENDIX TO VOL. II.
213
No. 27.
(NOTE.—When the Regiment or Corps moves
to New Quarters, leave two Compartments with-
out entries, and write therein the names of the
Garrison, Station, or Barracks at which the
Regiment arrives, with the date of arrival.)
DISEASES.
(a ) Primary.
(b) Secondary.
Also
Operations.
DURATION
OF CASE,
from
period of
Attack to
Recovery
or Death.
WHEN DISCHARGED FROM
HOSPITAL.
OBSERVATIONS.
State briefly the circumstances
in or by which the Sickness
was induced ; and in cases
of Death the results of post
mortem examination ; insert
also Reference Number to
"Case Book" in which any
of the cases are recorded at
length.
STATE OF HEALTH.
(Whether Healthy
or otherwise.)
Destination.
C C
FORM No. 28.
(Form I.)
MEDICAL CERTIFICATE BOOK.
MEDI CAL CERTI FI CATE BOOK.
Extract from the "ADMISSION and DISCHARGE BOOK" of the _________ Regiment.
No. of Case ___________
No.of
Case.
Reg.
No.
RANK AND NAME.
Completed Years of
DATES.
DISEASES.
(a) Primary.
( b) Secondary .
Also Operations.
Regimental No. ________
(If married, write M
under his Name.)
Age (last
Birth-day.) Service
Injured or
attacked
by Diseases.
Admit-
ted into
Hospi-
tal.
Discharg-
ed from
Hospital.
Died or Re-
covered. When
and Where*
Rank and
____________
Name ___________
Disease ______________
Date of
Extract___________187
Duration of
Case from period
of Attack to
Recovery or
Death.
When Discharged from Hospital
.
OBSERVATIONS.
(State briefiy the circum-
stances in or by which the
Sickness was induced, and
in case of Death the results
of post mortem examination.)
Extracted from Admission and
Discharge Book of the above
Regiment this__________day
of _____________ 187___ by
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
State of Health.
(Whether Healthy
or otherwise.)
Destination.
Man l eft at _______________
Particulars of Discharge, &c.,
filled in, and Extract trans-
mitted to _______________
_____ this _____________ day
of ______________187____by
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
in charge of ______________
____________________
Man left at ___________________
* Write DIED in case of Death, and R for Recovered.
in charge of __________________________
MEMORANDUM.
When a Regiment leaves any of its Sick in the charge of the Medical Officers of another Regiment, or sends them to a General Hospital, this Form (filled in with the
particulars of each man's Regimental Number, Name, Age, and Service, the Dates of Attack of Illness and Admission into Hospital, Disease, &c.), is to be left or sent with
the man by the Surgeon of his Regiment ; and on the termination of the case the Medical Officer having the man in charge will complete the entry by filling in the parti-
culars as to Discharge, &c., and forward the Form, at the earliest opportunity, to the Surgeon of the Regiment to which the man belongs.
This Form will be used on any other occasion for conveying information respecting a sick soldier from one Surgeon to another ; or from the Regimental Surgeon to the
Director-General.
214 A P P E N D I X T O V O L . I I .
APPENDIX TO VOL. II. 215
FORM No. 29.
(Form L.)
MEDICAL CASE BOOK for Non-Commissioned Officers and Men of
the ——— Regiment.
Regimental No._______
Age last Birth-day________
Station _________________
Name______________________________
Completed years of Service ________________
Time on the Station __________________
Day
of
Month.
Completed
Day of
Disease.
Particulars of Case and Prescriptions.
Diet.
216
APPENDIX TO VOL. II.
FORM No. 30.
W. O. Form 833.
Monthly Return of Staff Medical Officers doing duty with
from to
187 .
Rank.
NAMES.
Stations.
Date of arri-
val in the
Command.
Married or
Single; if Mar-
ried, No. of
Children.
How employed.
If on leave, the
cause and period
to be stated.
Monthly Return of the Regimental Medical Staff of
from to
187 .
R e g i m e n t . S t r e n g t h .
N o . o f S i c k .
NAMES AND
RANKS OF
MEDICAL
OFFICERS.
M a r r i e d o r S i n g l e ;
i f M a r r i e d N o . o fC
h i l d r e n .
S T A T I O N .
D a t e o f a r r i v a l i n
t h e C o m m a n d .
NUMBER UNDER
CHARGE OF EACH
MEDICAL OFFICER.
Remarks.
If on leave, the
cause and
period to be
stated.
M e n .
W o m e n .
C h i l d r e n .
Treated.
N O T E . — T h e S u r g e o n a n d A s s i s t a n t S u r g e o n s t o b e a l w a y s a c c o u n t e d f o r ; a n d w h e n a n y
are absent, "Sick," or on account of "Private affairs," it is to be stated, and the period
from _______ to _______ to be inserted against the name ; and if the cause of absence
be ill-health, the Disease and period of sick is to be mentioned. It is also required that
the number of Officers, Women and Children, of the Regiment, be inserted in Red ink
in the respective order of Staff or Regimental. When the Surgeon or Assistant Surgeon
is at home the period of absence from the Service Companies must be inserted against
h is name.
APPENDIX TO VOL. II. 217
FORM No. 30.— ( Continued. )
W. O. Form 833.
Distribution Return showing the number at the Station, the proximity of the
Hospital and the names of Medical Officers doing duty.
STATIONS.
FORCE.
N o . o f S i c k .
Distance
and posi-
tion of
Hospital.
Medical Officers,
and the parti-
cular charge
assigned.
NUMBER UNDER
CHARGE OF EACH
MEDICAL OFFICER.
Regiment. Strength.
M e n .
W o m e n .
C h i l d r e n .
Treated.
NOTE.—When the sick are not accommodated near the Station of the Regiment, mention
to what Hospital they are sent.
* * * The Stations should be separated from each other by a Red or Black ink line being
drawn across the page.
Surgeon.
Monthly Return of Medical Subordinates attached to
from 1 st to
187 .
RANK AND NAMES.
Age. State of
Health. Efficiency. Character. Remarks.
Surgeon.
W . O . F o r m 8 3 3 .
M O N T H L Y R E T U R N o f M e d i c a l O f f i c e r s o f w i t h d i s t r i b u t i o n o f T r o o p s a n d p a r t i c u l a r a l l o t - m e n t o f D u t i e s f r o m t o 1 8 7 .
R e c e i v e d 1 8 7 .
T o b e f o r w a r d e d o n t h e 1 s t o f e a c h m o n t h .
218 APPENDIX TO VOL. II.
FORM No. 31.
Classification of the Diseases, Wounds, and Infirmities of Invalids during the
year ending 31 st December 18 .
N.B.—In this Return from Regiments and Depôt Battalions at home, only those Invalids
who have been discharged the service are to be included. Regiments serving
abroad should include in this Return men passed by the Board as Invalids to be
sent home.
Class. Order.
Diseases and Defects.
A G E S .
Total.
Un d e r 2 0 .
2 0 . 2 4 —
2 5 — 2 9 . 30—34. 3 5 —3 9 .
4 0 a n d u p w a r d s .
I.
N. B.—Orders and names of
diseases to be filled in ac-
cording to revised Nomen-
clature.
II.
III.
IV.
V.
Total..
FORM NO. 32.
(Form E.)
Register of Invalids arrived at Invalid Depot.
D a t e o f A r r i v a l a t D e p o t .
R e g i m e n t .
RANK AND NAME.
(If married write
"M " under the
Name.)
A g e .
Actual Service.
Character
and Num-
ber of
Good Con-
duct Bad-
ges.
Nature and Ex-
tent of Disabi-
lity as report-
ed by Regi-
mental or Staff
Officer.
S t a t i o n w h e n c e I n v a l i d e d . If requiring Hospital
treatment, date of.
N o . o f M e d i c a l R e g i s t e r a n d o f C a s e .
Opi ni on of Pr i n-
c i p a l Me d i c a l Of f i c e r .
H o w d i s p o s e d o f .
Remarks.
Total
Years. Stations.
Period
in
Years.
Admis-
sion.
Dis-
charge Death.
A P P E N D I X T O V O L . I I .
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220
APPENDIX TO VOL. II.
FORM No. 33.
(Form F.)—For "Medical Histories Book."
MEDICAL HISTORY.
Regiment
or Corps.________________
Regimental Number___________ , Name_____________________
Enlisted
on
GENERAL REMARKS.
at
On his Habits and Conduct in the Service,
Temperance, &c.
Birthplace Parish
Country.
County
Age (last Birthday)
Former Trade or Occupation
T h e r e s u l t s o f e a c h s u b s e q u e n t E x a m i n a t i o n t o b e r e c o r d e d i n a l l
c a s e s o f t r a n s f e r t o o t h e r R e g i m e n t s .
Height
. . .
... inches.
Circumference of
chest (over the
Nipple) ...
...
inches.
Spirometer ...
. . .
inches.
Weight
. . .
. . .
lbs.
Rank and Dates of
Promotion, also
Dates of Transfer
to other Regiments.
Dates of Punish-
ment, and whether
Corporal or by Im-
prisonment.
Dynamometer ...
lbs.
Small-Pox Marks...
Vaccination Marks
When Vaccinated
Hair
. . . . . .
Pulse (regular) . . .
beats.
Respiration
. . .
inspirations.
Muscular Develop-
ment
...
...
The above was his state
when examined on__________________
(Signature)_________________
FORM No. 33.—( Con tinued.)
(Form F.)— Continued
MEDICAL HISTORY.— ( Continued. )
Station, Garrison,
Barrack, General
Hospital, &c.,
with Date of
Arrival. *
No. in Admission
and Discharge
Book
Dato of
Diseases.
(a) Primary.
( b) Secondary.
Duration
of
Diseases.
Completed
Years of
Treatment.
Class of Reme-
dies.
OBSERVATIONS.
Circumstances
in or by which
Disease was
induced.
Attack.
Recovery.
Year. Mo. Day Year.Mo. Day.
Days.
Age. Service.
In addition to the record of sickness, the date of the following events should be recorded :—(1) Death and Cause of Death in the Service.
(2) Discharge on Pension or Temporary Allowance for Life or for a Term of Years ; also of Death and Cause of Death while on Pension or Tempo-
rary Allowance. (3) Discharge by Purchase or other cause of the kind. (4) Promotion to the rank of Commissioned Officer. (5) Capture,
Desertion, &c.
* This column should be filled up in all cases when the Soldier remains any length of time at the Station, even if he has no attack of Sickness
while there.
N.B.—In case of Native Soldiers, after Age add Caste, and instead of Hair substitute Colour.
A P P E N D I X T O V O L . I I .
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