243
Robert Carungis
28
Father alive. 50.
Engineer. Mother dead. Died of spinal disease at 20.
Age. Occupation.
Family History
Have you Ever Suffered from Rheumatic Fever? Never
Have you ever had spitting of blood? Never
Have you Ever Suffered from fits of any kind? Never
Have you ever suffered from Piles? No
Are you ruptured? No
Have you ever Suffered from Malaria? No
Have you Ever Suffered from Indigestion? Yes
Have you Ever suffered from Sore Eyes? Yes
Where was your last illness & the nature of it? 1877. Congestion of lungs.
I hereby certify that to the best of my knowledge the answers to the above questions are correct.
Signed Robert Carungis
July 11th 1884
ravie
243
Rofert. Carungis Discon
28.
Father alive. 50.
Engineer. mother dere. 20rd of spinal desiase
dead deed
age. occupation.
Family History
Have you Ever Saffered from Rheumatic Ex Never
heret.
Have you ever had spelling of blood?
rever.
Have you Ever Suffered from fets of any kind
!
Never
Have you wer suffered frons Piles?
Have Yow
Jow
Are you ruptured?
Have you her Safferts from Madaches?
Have you Evet Jeffered for
wet served abroad??
Что
rever
revel
Eddiness?
Jes
Revet.
Have you
Ever suffered from
Sore
Jes?
Wheir was yout
last illness & the rating
1877. Congestion of lungs.
of it!?
Sherely certify that to the best of my knower theliff the answers to the above questions
correct.
are
Signed Hobest. Carnages
July 11th 1.4
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