ARTIY SERVTCII TONCES I OFFICE 0F TFSI Cl{18,q', C}{EI!{ICAL ri.iAnFAP,B SEIWICE Gravelly Point, Vlashington 25, D. C, + I SPECIA], No. O]T,DEI?S 25 June ) 19Ll+ ) 152 ) 1. Ihe Cliief of CL:emical- $la.rfare Serr,'ice commends the offi-cers enlisled men who voluntarity submitted 'bo tesr:s conducted. by the L1ed.ica1 Dj-vision, These rnen parti-cipated beyond the call of d,lty b]'subjeciing thernseh'es to pain, discornfort, and possihle per.nanent in;ury for the advarrceLtent of resea-rch in prolection for ou.r a::med forces. Those named below knovringly subnif,ted to exposure to chemical agents for some period during the months and ciesignated: Septeniber and October, Iil:,3 PVT. EAn.l t. ALBXANDIIR, JR, 35701+l+60 PVT. EDr,[.a.RD -q. AIT],[A]i, 33783trl9 PVT. CI{1\F"tiis H. IL}JDF-US, J-R", 191.90665 PVT. rrliin'IDELL 1.11. BAI{En, 399f5fi1 PVT. JOI$J "r. IIERZELLTI, 13128126 PVT. BrtLY B" BTGGS, 1531t3tt PVT. ED]TARD fr'. BORO'iSIfrr 1112?BB? PVT. GEORGE L. BR0'rri,ililll, 1217011rI PVT. l',ilil,TER E. BUTfI'JSKY, U17l+719 PVT. CASOI'I J. CALL'T;4IAY, JR, IJ-+I922OB PYT. C-r,IiOIrT CFL,T,., r)]l.36627 PVT. FRi'NK B. CA\rAi{;:i{-.}FI, 11091921 PVT. ltfllf;"iM 1". CFTUPKAe L3127969 PVT. i,lrllll.ilvi J. Cl.r'il.f, 12153623 pvT. ,'.",tT:R E. COI:\r.:.N, 329(.3757 PVT. .ilFREn ,\. COOPER, 3296ilr35 P\iT. ,:i. CUS;INOe 33782765 lir. D1Tr,,Ey, I7L76378 TFIOIVI",S N. DiGJ.ET'"1{0, 3685622I THO]{,.S PVT. PVT. BF"NEST IrvT. P-'iUL FVT. PVT. Jl1.1.&S G. UODD, 35756Lr+6 C. I-roirTmy, ilr15L717 Ij,.iR}ISHJJ,i; JRo 357562T6 PVT. rlifl,Lt".I/ B. ECIfliR?, 32915563 PVT. KtrlT J. EBEli, 3?g3g806 PVT. V'ifitf :'ti ]Li. IJPES, I2L26987 PVT. STiiNIEY G. !'fsifiR, 3378-?A7 PVT. ,I.I,FRED F. F'BIGENDREGERg 337B2IgA PVT. TER.RAIL C. PR;.]iIKS, U15I+718 FF,,],}JCIS t'i r\i S. kv '\' W \/ \ OCCitiS 4500-189 'zg65Lz5L{.':"filrtril:s'd rrrdT,;c ilgJ,n:is 'a- -\anYuti Itg5rgl 995T60rru 'ucoicNr"'S 'c STA',rlu f Boettuef 'uutlis 't Hcuscf Be8rg5lf 'glg'dou 'T rTI\'l[oo Lz595e{"'ccn'l[iru sifiii' ]1c c T/ fz8B e€ 'ii,trod.Id 't Nl'rrrr.rll tgzto[5t 'gvia 'I iu<]i 'sru[r.i '[ ijctcrA ftSoSTlT 06g5itar'ttcsg'riia' H'ii?,',.iiciu ll6r50tT 6?if 'l'iosug,tJ',,r.I' c i,,{Tl-'ITrJfi rTfllSTlT'.l.gti'tu;'g J,ul{$ou a:zSfiifSr 'Nsiufirc "f ol{tift1:; gSegeTti'sii:{,tr,.' : s i{,fT.II/ri 0B6eeB9i tJ,.t{r'n riTnl;'d tic"I'-rt'scf rr6tgost 'umTnrt 'Ji i{i,ir'Jnu L96I60tru'irnnTol,'r ",i'r Srri,$i}iJ t50o9iTf i.LxsrtgTficci,,i';.f snrTnl] ll i]Nolm:il 99e99\9€'utritrl[' ol,t:i{lUC}'{'.tri Cfiri,:o BLo$<;51; L B5ezzr.'ti[Y:{rEilu' c HriAT-,r TgoBzSLe tSi"{trTTrri,ci{'T 0TOli,"il -rtC ii ) CC t, L L/.u.! ' u,J, TTu.'iiilcft 'li ,lSmiod 5!g8l9sr ot'iosnt''igYlit isilfnT,i lT0cgSli 'iiurliratiiT 'r J,uuiioH 5floiTer 'srrnlil 'c (]Nb.-IIn oZZ€ LgZ{.' Ei'u /'gT llk'IH}'rug Y t6TlirdT tu:qsrgr i .d i'f'tiffi[y g8grisrtT 'HNiEr )i,3';f 000l5Ttt 'Ugl'iili'Ifl 'T UYfog 6l66gtt6 (ff '-[ETSNl,trr 'Ti ,ruguou 91ltTiTFt'liugrtr g3ilLTfT 'zJi;T HlgNttrul 's 8[tt]5896 'lfi],fltisf 'r ruHfi rHVs OirgTTfi'.vr.ns':r.u Jugslv oSTTtzS€ 'm'ulcH 'li Oft5fggg 'N';'IOH BItlgsTLI'td,i?ii.{.{oH' sTTO9r5et 'VtrVCgH 'r f,tucg 'ij s l'[iCC oHyl[OH i{V-iiYd6Y €\6zetct tro til'H.',; ruuqou 55o{g6e€'NOsr'8uvH Mj,tur nsI.d:l\,E 'T 0IOii?Ti 5z>^5155e SLtt&zet sl[Cl{i\VH 'trtoi'tl;tu 'l Niiof "i BeBgt5Zt NFICf fZa6Eiltt'.IttG[UN'j],, CrTVi'{00 517g\tTt tullTsi['.:'f; ]vL'ri;r!]\l rY',dHct,''l \6z657zt ou'iguut 'N t^[vrrrr,{i gt€gorer'tig';rgt'v tll5T aunr 5a 'Sill3 lo '?,5I# .o.S S. 0, #L52, 0c CsrS, 25 June 19LL FVT. SCHFt,^uBe 3296h817 "TESSE pvT. cl",ttlDtl it. sHrLL, Jn, 3l+809373 pvl'. zEltoi\l R. sIEPKo{;sKi, 367'irl+9l PVT. I'i',NKI,TN C. $]\IITI{, J7$28I33 PVT. ;:.LFFitrD STRI,USS o 32962Q35 PVT. THO}{,'i:.S L. TiIIC}i, 12100028 PVT. CH:.nLLS lir. TI-lOlVl,S, 11,t095896 PVT, I{ARRY C. TRilrt, 39208190 fl/T. Lnlits F,. I'RrcE, 35802357 PVT. 1ri'ILLI:,lt J. ir;-li liLK'.N, 32963029 pVT. FR,NCiS l:. rf,ir:IsH, 13I?[6?8 pvr. p.,\ul F. 't[.i,LTst?s, 376L5659 PVT. lilItlf il,{ C. r,li,.,;r/ER, L3I33L95 PVT. ROBIIRT !iI. 1l,iI{iI!lJtR, 3BL0EB68 PVT. Britm 8.. tr^iHlTE, 187.7)4776 PVT. RrCr{AiiD t. WICIGNS, 3835161+1 PVT. R.OY fvrfc, 32960h11 pvT. FR"ilK J. T.1'rllrirl$: 3523LL77 PVT. l'iUrltrT0l{ L{. YiILLfir.lWS, 16668015 PVT. JCSEPH V. WfLSOi'i, JR, Ll+15h?66 PVT. BBI/ERIY K. IVJNSTON, JFi, 33639635 PV.T. FiLl,l'ICIS C. 'iifTK0',. SKf, 13128025 PVT. SIlll,tEY 1,r,jOI,FSCIli, 35856785 PVT. GIiORGE i"i, YUDi, 1109i+:f5)-r October, November, Decenber, 191+3: ano Janr.irry, l9hL. PVT. J,ril',{ES *. P:;YTON, 3h811209 PVT. F,OY'vll. EIfi.Ll'jZnLLrlRe 3376339?. PVT. PIIUL iL.MIl,T0l'i, 33$jll.l-7 PVT. CHTSTER J. BRONSKT, 33689618 PVT. C;IRLOS 1,. BOSTOI\I, 3970\779 pVT. 1,,!r"LCOT,t{ p. H0itir,fl, 3:-370306 PVT. liiILLIi:"1.[ L. L,[0SBY, 366?8107 PVT. .IOSEPH C. L{NIER. 381+9662l.+ PVT. JAY F, Yi!-froUT, 38l+3186? PVT.JOE ;i. PVT. lEol'i F,rT. RUfZ J. CILINI\i , 397A'U768 Lilillsol'I, 38)+68683 E. Iirl{i,}r, 33?63jl0l+ F. t',4OORn, 3}+8f.2518 PVT. 1r'j'Itl,f,\I{ PVT. THOl,{iS J. N.f,Vl}T, 35ril}336 PVT. jjolli:.ID ',1i. COi\j]r,,rAY, 36829976 PVT. J0i-il,J P. JOt\InS, 3I+BtZ"37l PVT. LEO .ir. TI{IB."!UL,T, 3I3676].t9 PVT. DUDLEY J. TRTJGE, 3\lj\72g6 PVT. tlEllBERT C. tii'.r,RE, 337\gtg6 PVT. ,ifLFRilD I;. CltUSllR, 3757.2062 PVT. R:\LPH T. iriAY, 39706173 -3 - S. O. #I52, 0c Crffi, 2! June i'VT. 19lrJ+ FI,JDI].RfCK ,'. H0O\,rIiR, 33790332 PVT. :',LFittiD i,EL'i-C'i: ,i, JR, 3970L778 PVT . .:iUl It; l.fUttllis r 3 970lrll3 7 PV?. FH-l'lJF' i:';. Bd,i,DLUY, 35?67083 PV'I. PVil. \,I-l.i.,Lf.i'i.,i S;\Nll!-:nS, 3970I92 B l. ?I1I3C]DI}'LD , J8l+8il+f PV-T. LESLIE B. t1,l,It, 3g861l+10 FVT. ROBERT li. liCLGriIi$, )g7O1.g2I\ PVT. Iittrut J. Kr SSiliGliR, 3E[i:g293 G[R;'ii,D 5 PV'l. D,r''LLl\S F. t{fLI,}rR, 3767EA96 PVT. J,ICK U]. JO}n1SU'CI,J, 3986ti95 .I. ll;,.DCI.E, 31}(t1j62 i{. },iURiiOCil, i9701890 FT/T.. r/l-l{CE}iT PVT. Elotl,iil IYT. CHr'iRtIlS PVT. .TiUGENE R. HC,;,rl.ltDr 366799+3 I,t. LI/tlii.ilJ0H0LiSE, 3376- 399 .1imI,tIItG?oN, pvT. itiF-ny G. 3157Li85 PVT. IL\RRY K. SlflEl,f,,li, 3373Ca91 lvl. LCRlili R. llOCKi{OUT, 3667g5g9 October, llovember, T-)eccmbcr, pFC. ]91+j n. t. }{,i:RT]Nr 355lr0l+1O KII-liP;:.'iiliCK, 36?285{;B PVT. ISriDOFll BEIlTiiiiTI-t'.Lt 3369(:362 lFC. RcBEF,T F-CTIIERT pvr . lEO ,. . .B0ri,lti, 31-1661"5[ FVT. G;'rBi?iEL ,I. F-;RI'; '1'L, 38h8?13J-t fvT. l,i,i,Fi.vlfi .:.. l{olitlil.l: 3g70\77i+ FVT.. ROI]ERT ;. 3RrEir, )351"35t.O PVi. C,.ni\ll,li C. t],i,i.1.:,I-t].,lOe i35t]l0llB PVT. ,icillJ W, CBOIITS, 31y59it129 PVT. r?,'ilrl FI. L'rop,SElf, 337c199i*5 FV'1.',,Y:11,1:^JiD S. l{OillT}ll, }3753-195 Pi/?. iinLi.Rl E. I'lfRirFl',luir ,j97C19E9 pvf . ir.icH'-r,*D li. i.riill, 3'i57:,\,q2 PVT. E:.rilil H. KLLI;; 11357h82 PVT" R,.1.I,'iCND J. l'{-LIHEiiy 3970L955 j'VT. J, Di.ViS, i970[783 . Pllf Ll IPS , :3 7lJlLi15 iryT. p,ilssnil u. I,,ilixiall, 33763387 irVT . P\iT. 'Ii1T,l,I::.1,{ C fl^. r1I-l;S F GEOR0E i.-YT. W,..LTIjR P,. L{ciQiIGI{1', ),?5,II2O F. ?illJ-"ilifsiil r 36866166 jrVT. Lx,i"lLTiiR C . SFl,tFXi.Jll-IilGL, 397A6116, PVT. .CURTI-S i'. RCGERS, 3lt912';25 PVT. CEiP.l,tS F. FlliTT, 3J-?6713U PVT. BO}D i,. BOREI{, 3gg7"7Efl4 pvr. l,trlvri\i ri. p,ODriEy, Jn, T7(D375 PVT. E'I,,ER T. ,r,DELr,1'1, 3767lap8h j'VT. ll4,.X D. r;LDitr"IDGE, 39701666 -h- s. 0. #r52, 0c c1r'5r 2$ June 3;il+b PVT. 'D0l'lr:rLD i,. I,EL:'iltlD , ;DVT. tiOBER! B. 37572277 FVT, CHJ.RI,}iS I']. I/EEKS, 36757556 PVT. NICHOI,IS I{. }{ISCIL]NI, 397AT909 PVT.JOifl R. D','.NDFJi,, 3136753L PVT. FF"EDERTCK ij. E,',TrCXir 3I39BII3 fl/T. D.",lti D. C0X, 355919J6 PVT. F,ltUB!,N H. 1,{rJBLIIY, n, 31r8il175lFVT.'JOH H, TOi?.R-ES, J97OL93B PVT. J;iCK rr,r'. COYr 3970l+769 SEltECi,L, 397A1929 P\IT. C--,RRott I1l. HjrliSElJ; 397Olfl92 PVT. JUIIUS C. DrLL, 3li812l+87 PiTT. FRr^,NK I.I. HI{FFi\ER, 33829965 PVT. l4rclr",Et L[IttE?, 33829967 PVT. DENTOI{ D. NOF.rirS, ,1376.$0 PVT. 'IEST,III C. COILINS, ,JZ)J7553 ivT. LEO S. II.L'DFORD, 3\82\651 PVT. JOB Ii'. PEIINEBI,KBR, Jn, ,78hA0 FVT. Tllill,ilirs F. HONE:],, JB$1B7OB :vT. rn- c. .D,iir1is, 3376339r PVT. FRED 'i'i, October and H0IIERK!,IIP, 36679528 Novernber o l-9h3 PVT. F,R;illK V, HirfR, 37571782 t{/?. 'iLl,H F. HOO, -?9701998 iVT. ED,i;i.q"D t. J,ll,{IiIJ, 31379328 P-JT. FRED l{cDU lFlU s 3LrB?63?.Lt c,',ir,"11111t, l$[B]J03 'Dl,'T, FR,:!lJii 17. .r,ri\til , 33697337 ,{T. DOIJ_.LD r)VT. .i,Hillfir C, Ffilfr,ROS, 3g96l")+li PVT. R013fl.i l{'rjV.'.l, 38li87li.66 flrr. tct'j L:t,$, 3g7aLg2r .rirT. clf,vli t. OGi.ETt_ItE, :]tBL22g5 lryT. J-',Y F. i,EllEP.rCIiLfi, 33753\A9 ?VT. ..itGLIST, V.,Gl,ill'lI, 3l-37 95olr, January 191+Lr FVT, R,iLi'H C. 1itmDRO, 32BL7BJ+2 PVT. .r:rricHfE ,ULT, 355\ggg23 fl/T. ROBERT r. Bi"RKrlEe 336814h3 FVT. I{.\nRY R. BE}Ji',ilR, JRe 3:l+8pl+60 ivr. J.:fl,{ES E. BEi.ii, 362W7AI r'VT.RiRol,ll E. BF.EILTER, 36866)t6o FVT. JOSEPH K. BUR.iSZ, 33UB661B .'jVT. 'flllfi,Iri :. C,".RITOCK, 12206275 PVT. P,OEERT i. CROrili, 35223928 r{iT. c,:..RL Il. D,:lirISe 38l+6h1?3 -5- s,o, #L52, oc c.r,ris, 25 Jur,e Lgbh I'VT. STf,I/E'DIROA, 3l-21"18031 PFc. LEON J. DUI{}JE, 328[BB3] pvT. 'fltt-tAi,i l,ri. CRUBE, 3563b873 PVT. lliiF"ilERT HAZZAI].D , 3271+6A28 pvT. y[t,LiAt{ L. HrLTori, 327b738L FVT. LEVI IRON, 3&r6blt95 PVT. Jol,;lJ S. KCZAK, 313)682A Pi/T. IiAri.VIIl I'. LEVii{il, 3278157)r s/sGT. BERNAiil K. i,{Ai',x, i6511180 PVT. ThoolloilE E, iiifZ,lriEl,,, 35532\.7b PVT. GEORGE H. i{ATrU*S, 33L635O7 Pvr. Joi{l,i PYATAK, 3e989857 PVT. r,llLLIAI4 ,SAI'JLr0VAL, JTl, 32703057 PVT'. PETER F. SCEPPq, 3?-8L327)r pvT. AI,ffiRT D. STEAitliS, JR, 32.837513 PVT. JoHrl TOIIY, 35r\Lr52 PVT. LEOII A, -i/AIIGli/,11, 32866250 PVT. GE0RGE ii,. V/El-lJBEnG, 32867799 PVT. R.ICI{ARD ild. 3!JB925B 'TONI'i, 3?7B2A9I PVT. PHITIP YOS;KOIVITZ, PVT. lilli{Ry E. ALAIiRICK, 33567L28 pvT. FmDERICI( L. BATLEY, 375592t0 PVT. FRAIIKLIII i{. BAUltEllr,,liAN, 3292L69t PVT. ir,Tltl.l,-tri C. BEAitD, 3629LL36 pVT. RAytfolID H. BEIiNE'lr, 35528676 pvT, tiiAp,co t3Il\i$cHrNI, 32755)rg1 PVT. CUR?IS illtOGAN, !"+732333 PVT. ]ii\.4A1';UEi, UliRL0 , )29278\)r, PVT. THOMAS J. CAsiiilii, T',l62BA7 PVT. Oiiv'AL P. DAHL , 37';6BUO5 PVT. hRIJOLD B. l-rEL,/i;,D!Jii, )35b5658 F,VT. GERALD J. fr0OiJ/rl.l, 32.63)5(,3 PVT: VICTOR A I'ERrlUirFfriii] , 32982L93 PVT: HAF:iiY E. l{,'tl}rliiS, l3h!7i]91 PVT; TADDi]: J. H]'].1DR]CK,S, 35Ci69)I\5 s/sGT, OliAitLES H. HrBijI'l'TS, 15089832 PVT; Jollll E. JOillJSON, )3)+73353 pvT. O0rilrclJ F. LEl.itfoN , J2g25g5b PVT. liILLIAir{ K. tr{cBRiE}J, 312E806L PVT. VIF.GII I,i; LITTLE, 3{rdr3Jl9 PrrT. KEI'rNETll p. l,4URpHy, 36726627 PVT. cn0riGn PoPovrctl, 35718918 PVT. IIAROLD L. F-OSEr 376l-',d238 FVT. nDivrrRD C. SAUBERT, 3667i$7 PVT. G{,EN]IO}J t. TO0PS, 356SSZgt sGT. i,Lrct"iAtil sFrrl'trO , 3250676c PV?. HIRBEIIT J. VEIi!O?E, 3L3T8592 FVT'.. S/.}.4UEL,'!EIliSlBrN, 32776792 PVT. }]AROLD fAPLA, 32603966 PVT. ioHt'i lt. ZEl,iFEd,, 72L9t806 -6- 5.,t. #L52, oC CVvS, 2; .June I9l+4 January and February, 19lrl+ cApT IfRAI,IK C. LATTIT{]R1, d),72680, tr,iC I,ST LT i,rnRNER L, LOE;'TENSTETN, a52973L, I$C I,ST LT ARTHUR R. }]EDi.,UND, AL5)J6737, WC , T/SOI SA[{L.EL K]},,I}.18,L1 {,C.}1 32ABfi9L I{OELE Ui. liRl\ir.sTRONG, 38205201 SGT KEI.i\]E]}i G. LJUCH}IOLZ, 362L69I0 SGT C;"RL G. I,CARLATT, 33'4L93A2 s/scT sGT CJ-AllfB r. iinLLS, 336b72L5 TEC L TjAROLD J. KEND.AL:L, 3L266605 TEC L JAlviES F. Iiri,LER, 3t600101+ ruC l+ KEIiI'iETti E, S1'O[]E, 37A37890 TEC L rircHOLAS r'. RADEL, 35683583 ruC l+ '/ilTLLf-l\4 J. HIDEK, 3il+2297)J CPt GECRGI C. 5 Jirl,,iES SIIITH, 36277)+56 i. rtKERS, 33417283 TLC 5 Jotjlr lr. it]!RKSDT\LE, 336321+7L rEC 5 BIBKIEY L. COl'iliER, 336,26].+ll 5 ROBE1i,T P. PJii{n/ilrnR, 36299739 TAC 5 JOHN tjrr. McCLi,Itf, 151h0107 rEC 5 RrJSS,ilt P. I'dHITtOrlt, 376L0579 TEC 5 ED['lu\]l A iil,iTOCI(, 375571+35 TEC 5 LLOYiI L. iiiil,L;iCBo 33)$?-9h2 TEC TEC PFC JAJUES E. AIIDNRSOI\I, 3J$8}653 PI'C TTl0i','I/;S C. L:iilRCH, 35l.1fir.t95 PFC RiCH,iRD E. tr]:i],'ils, 35I[I)O8O PFC iilELDON L. FLECI{, T57AV2 p]lc JEROT'iE J. /C[,R],ii i\], 375h6h0r PfC ClLi?fli',i0il L. ljIlrIlORN, 37557266 PIO PI'C I'FC Pi'C LEROY li. CLril?.K , 3R, T6325\0 JOliXi ,r. SfiFLITOI,I, 331123013 lir.HOLD ?. C;iFi,Si)}i, l6)+60373 DUlfr:.LD KRf-qTL.liSil'J, 3L3I3599 PFC D0jir,,LD G. FfiriKERT.clJ, 351L0061+ P;IC CHESTER KCI,AL, 35T397}J7 PFC ltu, H. L/itr.r. iS, ,j77398L FFC Ell}ET RODRIGUEZs .IR, 18155871 PFC Gfu.NT IV'ILSOI\I9 35739L93 PFC E]lir''ri,f{D JO}JES, 32BB220lr PFC T,NDF.EITY TOIICSKY, 3ilzltZg PFC l(ElilrjlTH I'. l'riEG:r.ltlD, 32783L5\ PVT. JOE N. IsLrtIR, 376678L)+ FVT. GE0nG:E iiii. CdX, 3E\37579 P\rT. O IS ,S. iiILLI;.hlS, :lr803h67 FirT. JFSSE .,. 0L.'"5S, 36657501r" PVT. GE()RGX G. C/,Ttu,1\{BOI\5, 3666A2lrLL -7- s. o. #L52, oc clnis, 25 June l9lrh PVT. CLYDE I,IAI\$FrELD, 3\77)J2IIB PVT. CIIARLES E. PRICE, 3ilr)r8535 PVT. FR.ANK nUFFrNi, 3279A857 Pr/T. SOIOI\,{ON I{ASH, 3}30BBl+7 PVT. DONALD t,. BBLL, 375571t52 pvr. C. ROBERT P-VT. /,.PNOLD SELTNGER, l'Ltblzzo L. 1',Tlt1ERElL,t 3I3L91O6 PVT. JOSEPH L{. K.LAR, 3fi96}32 PT/T. FRA}.ICIS L. LE}']T2, 33669993 p\iT. GEORGE rrr. liEliNrcK, 331p2975 PVT. DEIIZIL A. MAnsHe 38L561+01 PVT, i'nANCrSCo, Vrl,A, JR, 38513L60 pvr. D. ],',LOSKO, ARTI1UR PVT. IiENRY pvr. JAhfES I'. 32789915 hTLLrAl\lS, L7LO6267 ri. RrrcHEr, fu77397l PVT. CALVIII l;tr. I'{cD0NALp, 3fi)$LL5 PVT. ROLAND E, SPEF"IiJ, 366ilr221 February and"March, 19[lr, CiiPT FRTAICIS cApr Alir'HoNY P. MCALT]ERI A3A2B93, L. DC CII{TLDOnA, 0L9o7l+5, MC 15T SGT RO}';ERT L. SNOI{IBARGER, 2A5L9593 cnm Bl,Sii,E ii. RISIIER, LJ!JI 37O6973i P. R.,].r.1\r"ER, T2flJ872 mc l-r prr"gn FETKnvicz 3L295332 )+ iirri,Doll J. iu"r.DStO:t.iy., J99AA735 ltlt I IJt/ l-r tHOldrtl; E. I'COL:R, J7WfibO IJL] l+ LAi;F-Ei,CE i{. pCirCli,:[]J, 36116110Lr1 T'IJC l+ Cl,lX t. i)riiilllL$ , )9273539 SGT i11LLLAx1 , J. lEC .T J]:\: TI]lN TEC 1 i,tr TEC -LIIU FIC 5 ;oull c. H. utii"I'HY , ]:3fi5h]+ 5 l,Hri,LrP ti. I-i L,J,, 36)t9r7?.6 5 vJ,.x sl$,{tnlsoN, 32898635 5 RunorlH r.;. srE.l-ltBERG, 32896562 5 ,rrmREr p. lrrTEZORlj;n, T66E763 5 .irr:s rlJDRASK,',; , 3b92O)$2 5 ARtrNorolt Hl:tRlJrESEN, 13170063 r,'illii\iK S. II'T,GINTII, 32895286 PFC JOSBPI{ DePI}{TO, lirxoN PFC IriILi,IrJ!{. PFC BUD J. A. PFC 'riVALLl,CE i{. -t-.t'u ROY J'-T U GEOIiGE P}'C oroRGE P}'C ilcl'UilD PFC HOBE;iT pFn GEtu.LD i I 32E9ilB15 , 31269296 fiiiCKETT, 36818i66 i,.. tiAli'i{INS, 368L9755 DTFFEI'IBAC}1, 33509C70 D. lr,iicGEE, 37)$2609 J. HRTCTK, 329?!5CB t. QUEI;}]Y , 35ll.r?.3L5 J. GLiS:rR" 355rfl88 A. i)ESJr,RirU, IU537OB l- s,o, liL52, 0c cv./s, 25 June l9lrli l. FliC LOU PFC DrlrE PJ,YBUnN 35659A60 C. CCOCH, 366?3'7A)+ pFC LISTER G. BA]?TLETT, J'R, 3L?-6BL O ,plr-Lt JtsEii: s. sltvljRnh:.]T, l5c6u22 J. KoV,,rCH, 355iL796 J. P,AHX, 358AA297 PFO .tOSltrPH PFC i''i:lLll"1*1 PFC GrORGri C. IAYE, 337$95LLt PFC '\/INOSl',jT lii. ]'ROPER, 32B52jLZ PVT RCi,Al{D DEFOSSE, 31201I+tl PVT \IiCTOR .]. SCIiIMAIJSKI, 367LI76TT PV'il,iNTH,Jlff tItsERTI, 32Bii,57C)B FVT CR,VI}.] D. HEllBliRT }7379L89 FVT TLCTOR S. .!trSTiN0, 33779785 PV? DONIJD R" C/'RPiflTER, 37\58659 PiiT g;;Y;1{ 0. i:rRIfi-{T, 3j6)+87L1 PVT i;irl,Riill0ii S. l,{i)F"TOfir 3LL77L23O P1,1T OSC:.ri P. CHP,ISTL,I,j: .TR, 3fllrL3)+2 PVT EtliiLpJ-, .I. PISr.liO , 3',289973] PV? ELLIij iini\iJ,',1\iIij, 3378Ci"79 PVT R{IBERT, Li. Ly'fTltE, 32gl,3i}1"9 PVT JOSEIH C'. , IrTLj'R, Sza9lh.5j PVT F,i'LIL MESIiIlte 3273ir031 P-/T ).,lt.Li.L ! rl-Lul,:, 3275'':( 53 PVT lirl!trF:T r:. ()1.:11:r :5(:,02))3 PVT Gl,OVEli r. ?ir.i?IirRr 35BAA()89 PVT Dlr,lill' }{;.RRIS, iR, 35L\2b62 PVT J,.],iEi F. ',^t FD, 36'l\75\tr P\,rT EijGEI{E l.,4ILLER, 33508OI{B PVl' CIrF"IljTO.trilER Pl--{I.Fi:E}?" JR, 327'i8695 PVT LB0N i,. DU0ti;,Rl'lE, 3131+h110 PVU JLTHI{ C. Vl,}tsKrlii, 35800227 PvT Li ;;]tll}l0n r/. tr4ccll,Lr)ii, J29'L852:2 PVT Ciiilri,ES tli. GIitSClI, 3352'.2308 PJT lll,.RYvTl' r. Iji US, J{'B:9711. ripril and iria;., l!i1[ rh C:'-tt l,r. ,'rOT,IE, L6a7682.a cPL PirrLrP r. coT?, 2o\2792A CPL Gittuli,D L. ts01:itlllutJ:f, 3f19951r8 / , FjrSiE, 33L669a6 CPl, lluILLI: j',,1 V5 rnN.lrlir}i E. ltos'ii'illl, :Jta92?36 i'f i Byt;:Jt'.[iIN. Ri]sSO, 3dtao'79L r/i rio J. irrTziilir,-Lf , 3277\777 T/5 PFC .l,"mns ij. iryils,llt , ?-oL+6r653 BiifiJ,,l[i'] H.J"{BUF"GEI?. 3232AD-9 -9- s.o. #L52, oc cq,ts, 25 June 191+i+ EI:IL T, Rr7,Zr, 37603373 pirc FFJ.i{cIS J. .aISCHOI'}., ll17B0B0 FI'C DOUri,trC DIl..RO, 31032318 PFC S. PFC PITILIF Py-C Dllr'',,E]. L. ii,i.P'OTTI, 32A278])O CiilJivl, 1+)$039J PVT S:,]'iTO II(IRDON;'RO t 322fi5\] FVT ;,RTHIJR L. /iLBIoN, 363h6028 pvT RIGrliri.LD G. 'riirr,LKER, 38fu263 PVT JOHN I.. 1'.{Ci':}IDRE'NS, 33777\03 PYT YNGIUII 3. ITOLK, 36T8937L PVT iIt,YlJE i,. DIJG/,N, 33il+9796 PVT Fi.,OYl L" 'LIOF-l'Ji-l';G, 32207)J63 PVT LI; rtVIN Ii. FhIGHIT 3glg)fiog PV? BrLLY ii0lDi,ii,l[, 3\35921]2 PVT '!',[,PJ ;.. FUTLE;i, ]ff56o51 p1,r? lrEi?.,LEy c. vio0lrrf.,.jiDr 3L2*79)l PVT Lr,'Cl.iil'lcll S. SI\iYl)ilR, 28A662L PVT DOI'IJ}JIC ;,. I'ISJCIiIEI,J.I, 325O34+I pvT rtr-Ltioti _j.. rtE.,I/ERS, 3JLgLg53 PVT ;,fi1'HOI'JY l{. 1!t,,I)CH-SX, 373118353 PVT FLOYD ... I3ROiCi, lldrl+lO5P Pl,rT' Vlli0rlNT Fj. Cl.l,,lmltl, 32WBE?"5 Pl'T .,L,ilEiiT' G. ilI"NCO, L22AL]B7'l PiT Gr.Ei. jri0 ,:'. 1'1.0C,"d,Qll, 3?-902262 li,:.1?,'.Cfiio, 3?-90687)] Pr/T,,ILCl:iTE J.-u'rrftilCiiI, ltl. PVT ,]OH}l 32'3tl.297lPVT GIj0litGE BilR;lICI"TirE i'", 372)+!9)tL Pi/T tDr,{;"jiD J. iji-i} , 32%59EL Pl/T I,IBOFIIO L. F,,LS;.ii,iC, 1220819f FVT iiROY E, POT,EL:I,, 3931t3L27 PVT Dr]i,iir:li0 lLi;. TEII.I)O},{INIr 32LLn6)r U/ LJ gT jJ I Jis Ur oe- J i]o 23 zLB* llni,ri i, Ii* i:', cllr, 1Bo22E5[J T./5 i',,l't H. I(,.,u, s,-l(r, 39L55?62 t/r+ SGT SIIO }{IG:',SH.[ , 3937eAL3 T/5 rs.'r s, s,.KT , 39Lr7L2r T:/5 RrKiC lrtrSi{ri,, T5V, 39377869 r/5 lt,,son,nu yil,{r,sHrr/,, 39377993 T,/Li \i{ILLIE }l,r.Y:.SHI , 39L6)$3A I'FC RIIL.CFiI Li;.TSlIinATO' 39A7%77 FI'11 G-F,Ci.GE Il'i(UI, :9 ,C5916 Irr'C ROY liill'StiDl', 390t1711+5 CPL TOKIO , S,.F,Jr 39155752 i'/r; r',](LR-- il. K- lil.;,OTO: 39A79198 T,/l-r fS.t.htU Oc;,ir{i, 3907?5ELt. FVT J.,,I,[ES xt. ]inrr!]{i,ni', )9L51t333 IFC I'P,.ED S. l,1..SlS,i0TA, 39L57393 PifC i{r'.TSllo },t-TSUlvi0T0, 39082550 PFC Ji.CK Fi. T'Silllr.l'1; , i9A.E27Ia -10- l-'e I s.o. #L52, oc clrtrsr 25 lrtne rgltL' PVT X,LSARU T/,NAKA' 39l{:2725 ^ PVT NOBUYUKU llilr.NbGh, 3900:086 PFO FIiAIJK i{. 0SI1IT", l90rll+9h pVT J_/ CK EUKUSI1INUi , 39002290 . cnoncn sHrl,{.r'ttolrvir, 39o7Bi5B T/l+ ti*'FRY K';TAOKA' 2928-\?07 cPL r,iiIRU Ii,I{AI, J923L79L. -"9"r5'1t33 FFC EDarN K' MrYi\Kr icr . T/5 rrl; GEORGE ' LRAr, lgt6\2??^"- nosonu I{rYoKEi 39r5-)+78L PFC TED KUSTJMOTO, 20928693 ^ vT GEORGE KAJiMUR/i, -1 0^17837 Pr/T YT,CHI MIYI,KE, 39l-6l-$-56 PVT TSUTOI\IU I\;rKI, 39O76t39.3, . PVT TOSHIO SIIIIU'Di\ 39OO'61+b ' PFC S;.TORU I{-r'Yl'SE, 39AL21ZB PVT S,.M 1,,. ITAYA, 39080766 3923LLI+I PFC S,,TORU Sl KIIMA cPr JOHNNTE SATO,' 39303979 CPL ROY;]-L M. KAI:EKO t 2a949,I5' PVT Toht Itu''TSti1,{OTO t 3%'6269-5 PVT MrrsuRr MORIiT-r': 39229821+ By order of the Chief of the Chemlcal lMa'rfare Serrrice: IIERROLD E. Colonel, Chernj-cal- lrVarfar"e Service As sis tant -11-2t+-9291\*lr?00 Refernece be at_, COItll'DL:lliTIr,L Camp 1,,'oll ers -ine(s):-]-$cff,Teparlure any if _____]91*4, Reason tor deray in depavtu.re, par-belovr .: il Tex wil I CIIORGE J DOLL, I{a jorr_TC, TO. ! j:-l \ rRl*Y SI-I;VICb E0RC!S Headquarters Camp lrolters Camp l.oltei's, ! Inilials: Tcxas t'' r/+r1 -'/l '/ s r't Date: 5 Ap:" 44__ Autn:-Iffi-u-{ffiEr' s0 No 94) l8 April XTRACT --:z 'ir Ilr -)i L9l++, .)r 2. The follov'rlng named. ELi of or-gns as indice"ted Camp V','olbers Tex :ire placed on lemp duty for a period of approxi.nately one month and wj-II proceed Lo Ecigr wood Arsenal, Ilhryland al such li-ne as -;rill ena-ble them lo rpt lo lhe C0 Hq Det No i Edgewood Arsenal liaryLand nol Ialer than 2j apr 44: NA}E Git...Dii SHO HIGASHI LOUIS B]iSSIIO SGT IjJU l+ L8022gl+8 i{N,LIE R Tdu mnl t-JU l+ TTJC 4 L8022858 39L64530 390795e4 3?L55752 39L55262 39L54L2L 39377869 39377993 39079L98 39079377 TANAISCHI TJILLIS N HAYASHI ISAI',U OGAI'iI TOKIO ASARI PAUL H KAI.IASAKI ISA0 SgSAI(I SAI{ARU YAi\,iASH .1 .,a\ E ITA ) ( lEC Tlic 5 qlrrE AKIRA B IfuNEliOTO RIH/I CHI }tI' TSU}"iOTO 5 PFC GbORC.E T FUI{UI ROY S IvIITSUDA proper sta. r+ LJtv rfa, fi Upon compleli-on Plrc 390069116 PFC 39007Lt+5 oil lhis ORCN nffiavt CPL RNfiO IIISHII,IiTSU lr.n r+SItl H6-To Del Rc l,lLed Depb Del loled Sla llosp Det, liled Dept Sta llosp Def l,{ed Dept Sta Hosp Dept Sla Hosp Hq Co RC Hq Co RC Hq Co RC llq liq Co RC Co RC l{q Co itC Det Med Dept Sta Hosp Def lvled Dept Sta Hosp Hq Co RC t,emp d.uby Nhe above narned lil',{ vrill ret to thelr Speciai equiprnerrl other lhan g;:s niasks will nol be taken. f'ati-gue uniforms vvill be taken fol use j-n recreaLional aclivities. v'rill furnish lhe necessary T. FD wiIL pay in advance bhe nonetai'y trt.vel alw prescribed in Sec II Par 2 C5 nTI 35-L52A cialecl 2L Jan t+4 a/r l$3.00 per rlr for ral for 14 lii,,l for 4 days eaoh .ior lhe r"ouncl Lrip, TDN, 2L2/t+Ct+25 FSA Lg!z-l+4 I-5080 P 182-A2. Aulh: Confiden ial Ltr Hq $t$vC *,SF filc liG 29L,2 (General) subject: rr0rdersrr claled 6 epr Lp[, TC -)i -)t oFFrcrAL' By order of '/ n' . / .4o^r,VrLr"- -)i Colonel FL;iGtlL: ftp n,/./"a*" I fv --/ +f S/,iii Ir. . . i x10,, i3 l?il;."*o' .. , ,.', n. i\t, . BIAFORII, 1 t' Captain, *rGD, r',,*\T \\"JtAdjutent. \'lj't*' t T0 DTSTRIBUTIOI'J: t F0 2 C0 FIq Del No I 2 Cc BrSvC nSF Edgewood Arsena,l l,,laryland 2 each El,il 2 C0 Hq Co RC C0li!'IDllil'1r"I, I File 2 C0 Del tuied Dept SLa Hosp S;.Li f BIAFORIj, J. CTTD .IDA m VUU! ,JU I A.t'ri.rr-i:t Fecc:d TO conr--anc'jng 8Esli,i3 lll of ilospi ia',t.izaticn" Officer izetrr co ?znd Reinforcement Bn.,}i"F* g?z iis r;-Il-i---rrr-= ^-tr-'i.r{1.-;*J/ \JJ,ri,,_ r?7 , (As":) rrnft) F"bl, Lou-is *,-- -*r--,z.- rilry :€ -,--.:tras/sh, j, l..,j.i: .i.trlL,; (-t.i.J.t j (p.rriL; Army 18c22 948 -;-.-- -* i1i :il.) Arrqv Bg ETli'-ii Js';Ge)-m:r-.FE;;-T;,?i-- - 121,Tar.=4€ -=;LL,rjr, -@;-,_:r_r_* oi SJr'.',JJ t.oGe ur r'r)irv:r-i. r(:r.,J ilosp 2. l. ,=3.76-th ,Qo_l?hd Reinfercernen'f _Fn., ApO B7Z tTS iFc.ne"r \ii46 -9&ae 1Dii,; -*-.- Diagnosis: 1' Fheuncnia, right lorver Lobo, sever organism prohably stre:otccoccue 2. Pleuritis, acute, serofibrinou$, :rroderate severe riEht pleu.ra, non-tuberculous organisn probably streptococcu6, secondarlr to I LlneolDity:1_Zyes 5. .Add':-tj-,rnal and changea -di:gnosir.u opor;.tions; '15 .,'sr - 6 AnriL 46 PeniciLl.jn 5 550 QCO units \, I f -,f u 4" Rehabilltation trai.;ri.ng; 5n \ I i Conp) ai::'i; wiiich b.ar,re u utJv vvv ulrlL None bsel i;:r'estj.6eteC: 6' Hekdpd,I (Cl"s nol) :-equi,,,: gle.ssr:s, w,ricir (rffiffi) 7, Pro-f i l-o Se ri"r.i not) Lssu:do : BCcrft A B, (wer"e P U 2 L L 1 HE S Suflix' 11 1X Reeonmsrded Assig:r.emcnt Lini-sa-!io:rs : General Service: None r. \. /"/t/ lJ.;re l ;IADE, J; '-r"tr^,: lst LT ":1C I June 1946 ;j'\-:,j;-f-,if f.Ic;.\- ,ti;:,; l I 1 w. I II I II- Ittsnd'trrd F()rm 89 (Re\'. Aug. 1950) BuRxau oF THE Bt'DcET CtnctrlAR .4.*32 , ,.ltt lllt NEPORT OF MEDICAL HISTORY Fol utE ollty rio ftLL ilol Bf RcrEtsfo Io L 4. t*u t AD$Rt Ss \S,i umt/.t, drtet or R rtg l{}3-ot Pnsolls - 1: l' D, aitg ot ttu, n, zoilz and 8l qt6\ j 3 GRAo€ A!'rD coMpot{ENr oR postltoN -t 5. PURPoSEoF ExAMtNAflor{ IDE{TrFrcA'iloN xo. 't- '..'' r.!.: .) /t t C i: /' ( ri'r,t tt. T HAS ANY BLOOC RELATION ( FAltilLY HtsroRY RELATION I STATE CF HTALTH AGE IF DEAD, CAUSE OF DEATH (Chac& cach jrem) i RELATTCN{S) XAt] IUB€RCULOSIS HAD SYPIIILIS HAD DIABETES I HAD CAHCER -- -1--::,'---_+ IIAD XIDITEY TROUELE I{AD HEART TROUBLT I I HAt t iN:AilE BEEN 20. HAVE YOU EVER HiC (-aR HA,f Yoir NOh l)ir.i (Check each itern) ct ltll ol eath iicrn; ch?ck E: l.it r (Chec& each rrem) i ScARLEI FEVtR. tRYa:rPiLrS i DTPHTHTRiA '- -' r I iiBi RCULOSIS i"EU;;rc ;.8* 'srr.rc.:irilis' I T .4rllinlirl, RI'iEl MATISM : - - -- --i nlr A-srrrsr.--F{rrEqEn;-r*.- CHILDREN 1 eot,- (Cfieck each irem) No Ea 5 TUMOR. GROWTH. CYST- CTNCIK \o' ."-, ; rool teoueiE RLPTUII€ jqpu.*"'c'rri-- r Vlir/ir rv u,;rsl PII-'.S O;1 RECTAL DISEASE rnrcrrn i on p, "pxl [^r-rr,:n xilnrv siorlr oa elJoD ' t I f-I --]-i 2!. - iiJIt:. iallT. ,,1 OII Llf HtR DEFORHITY ,.,..t.',_, _. __ _ wr,nn AN akrlrrcrAl FYE --+1I 1 wonl -. WORN .;. FrAkrNG Aros STUTIF']'D OF A 3RAC€ CR BAC( SUPPCP] PAST THRE€ YEARS: WIIAT lS Ttla LQN,;,. rT ?irla)D YOU iTEi ) ANY OF ThEST. JOBI] I'{C NT HS ? -- -i e,u"rti't. f---iie*"crirRo.BLE;;;;i -l .- -t'-+-----*1 -; EXCESSIVE TRICK ' SHOijLOfR OR Y()u EVER'- _ 8 I _.._ OISORD€R f"xovosr soRr - i ncE x !RiNKIN6 urr- HABIT TENDENcTEs THL FOLLOWING COMPLTTE ilAD A \TGINAL D]SCi.]ARGE BF-Tti TRIATTU FOR -CTA\I11ER€O 23. How MANy joBS HAvr- yoi-.i iiAD tN THt irl OR t.ECi FINST,R OR TOE 22 FIMslis,)NLY A HAr?E ettN pR[GliNt I rredr) OR 1ERflIFYIHG IIGHTMIRES l- iolir-";;;Ga;rd;;;- PArni Ycr, i:vfR (('h€ckeael FR'OT'\T -. ' :.iPRT]SIOII CR EXCESS{VE WOFRY - I l-ct: or f,:[\loRY oR AMNE5IA - I rit ,:Ai i sli \t I irar r:v:n ,--rt **,'., ] o: FnRALYSIS lnr. \ttrtLtilc\ EPIL€PSY OR FITS . I cAR. TRAlil. s€A. oR alR slcxNES$ j TRoUBLE SLEEP HG 'REoUENT i :---. I REctHT GAtN oR Loss oF wEr(:rr L'-];()F ARV HAYF . ilviJ, '.; l'.:i_r \AL ltsCi . ; r,r, : ri -r:-, I l, I ;l:,:ii.l I i r -, ' o*inn,i,, a* *nr,u*,rt I t- lir,ts \tl\FPtAL fIStlSE t t rN oR ArBdsrN ifi tiR,\E ,BCILS i i --f SLjGAR (Chec& erctr irem) TRICK OR LOCKED Kti€E et otsrt oF lvtENstRUAYrclR -l- -** FERloDs i riirrnvll BrrwEEN ... --l-..-... i DURATION CF PERIODS HAO PAiITF?L MFNSTRCA.T ION ._-*-- t , I Drlr€ HND IRRFGT]I AR MT NSTR:-ATION 0u*,i'tt ]"r"".- f ,r.s,r, CoG- 25. WHAT Is YC.rR USUAL 'TMIL( Occ!PATION' oF LAST ffFrOD I 26. AR€ You (Crlec& oric) I I E *,o- n *.o , f] *n "**o M) ??rf Vg lq :rk'f GK umnT 2? am mu ma?a; ?Wind. [thuwusaf i Inc-Ivar?; MIST 1W: I 5111117)?; .L . . . I - Imam?! - 29 an. HAVE um um Mum-Era arm . -. . 29. IM- YU- mm: 871' Mr" (?rst. Aft"- detail[#14105 34-. arcs-.35: OF U) vn. "up and arr- dr?tmm . 31 MAI-IE YO.) ?3617 arr? :nljm: 5? I411 (If ya. 31M: ru-uun MM Ilnradu I I 32. mu . 1'1? I z. :o ?In: If". duct-ab: and mu ago a! wh -rI: ?urn/I .. u- I 33 will JR A or I'I'Iunmryil A "hue. r-H saunas! I u-w {If spam" ulna-v. thy. arm" Maul IN mien-r. and adding- a! harp-Pu: nr 31 um :Iw mars. ?n m. ,m pm:- THU. [m a; amraw uortu ur yr- q-n- ?y qud'lnra?nnulg) . 35 hh-Lu'bvu 1? . 31".".ij Cl'th'd on but"? - Til-f MST 5 vfurrw [If you. gm? cum I 0 ;mm- nufalrros n! flu-punt. rhm. - - - a V. and dorm!? wv - 1? HHF. vm mum, Mm "mam cam-- 1: Inch . 1-7. HAVE YOU HUNTID FUR MILITARY nru-um- ?ow duh and "down for momma) I 33. um! m. I .I3 am?- tam-Anmr? tr.? wuuar SERVICE OF ?I?Lth GR (H yrs. datr. Imam". and, type or .mertds: win-Um: humuable I "the; [Plan hunqr?hlc. lar un?rnus or 1111'n-rPr NIL-dams, I4th mv? mil on no mu "Ur-mm: an ?anagram-a l?tl? um?n; Ina-m v' . (My-w .mmv what Mudguards.) ohm-n. un?whm nmnunr. than. way] I GI"er mar I w: Iv-Hv'mma Ihmunmgmum lat?.11 o; I MIT-mum 3 hymn; .. ash tunlcsuurmn Amy; LII-non w: a "mu: 0F an ulchL 51mm: mu or Hind-Esme Mu ru- grams - Wm: .11 mn? ms at Bantam?? .- [Emu?uni .- K, u. I5 1:5 5110 f, - In. Marin - Mum" am running rH' mm: unmarri- MI Hue-mu: (Io-uhmum mu: ?Tin?um IUSSELE HOENES. cm. do a um: I ?crumm- - In: 0411? out Snnderd Fofur 8lt {Rrv.Jusr l9t6) &lg6ri of the gudnrt ,*iTPORT OT MEDICAL TXAftIINATT*,d A*trf iRev. ) Cnrcrilr lltil€---ilrDolf, nlHE 't {,o rus . tltta il Rf D, ' twn, c&y or zeac rad a orrE ,S,cta) t?.: or"" , DITE '?. li. 9. TOTIL YE^RS GOVFF{tl€r,iT of 13. P!ACf $RTH Of Ex*an.tr6* c (7" /'t F6U*/,4> :i' 7. s€x s S€RVtCt ltr'tal'+t SIRTH rxo , A0BRESS oF rExT Or"ll<. Xlrt /-er"4a {q. B*.srrte it-'j Exrtaslli6 Frcruw o8 €xAHti.En. ^tD ADoiEsE ,*qgA.PJSFl@!:$I.F1-nqusta&Irtgt-oc'ipr6r-w -- tz. nernC cLlt{tctt EYr[0lTtot{ t8. H€ 0. ft€ct( FACE T HE n rHls c^p^clTy (fdd) LAST 9X iloxfirs (Drrcribc Get)/..bnorm.ttttt id doaail Entot it.m numbu "-ttimnttlrrats i/ nrccsgrjr.)balcr @mfrenz. Lontrnur tn ,tam 71 tid u3a tdditiontl Ar{o sc^LP 10. slnusEs ll. $ourH xro ?Hto^T ed .dndLi I r!d,ro.! 2e eARS*GtNEpALtInt. -- (n,ll ktr(kt it.a 70 aad : t t t3. onuHs (Pnf$atio*J ys}di ftu,r! oil aldna A{. f- YES_GEilEnAL -.' --- -_ ' - td.r 1t.e;9,60 nal atl . i i i 26. PUPU.S ( fXmIAg and, te.tisn\ e7. ocLiLrR uoTlLtTY i t'eiardl euatkl i lO. :'i"{f::1"'I')__J____j --j ----l i tbrito'ititt,.,l(.j vAScuLAR sysr€M --.T* .;*..;. -...:--i1-:1''.9:f '-" '" etr6) I ]-]--T--.rdr@o! drdr! I I. spI*f,, orx€R lt, lDtNTlrytn€ eoDy HARKS. sc Rs. TATT@5 tqqr.trbrt*s t.rt. t^6a .kd ;r\ i NgUnOLOCta r PELnc (F.ma!u onty, te rril hoa O- Rctlon*g lc?'l {-Neanutors[c ilal G H T z 3 :il$***a i .r-.,," "^" *,,"ou, o^,,;l-----l -____-__-__-i-__.l 14. o€nrA! (Ploct cpptoptbtc trmbolt dhoe r{' I r4$3c1,r"osxELETAL dol.! i flvre rxrr lnrcrl_ R I l LYMPHITICS a2. psvcxrrlnic ll. 6 t i 16. F€Er ll*o*.*r*.*;,rsrll*il,fl.(.vh4li. ,s. sx$r. --:-----1 .;-;;*. {--lr' - ill" ^ott u rE , j (Coatrnua rn i oE numba ol tpoa and X--Mb.tnt latl X X X- Ilcplae{d bt d.aluru 4 s j e 6 .ir $ zs rr-r6ffi-1" itca 7jl lma uai rTt'",ai* l lo ln Xtj-FitcC htrtO.,ba(lctt isclgc r}l.dmcnlt rl rz lll{l5tds lo .L r0. It ,---G- REMARXS Af,D AO{NTICI{AL OOITAL DEFECTS TT+D Dls€TsES i-' J- f* ,'t - f- " ,.v ,r/r r:r'' uroiAl0rY ffiDltet r. SpeclFlC cnAVtTY l. ALtUHtr{ -i p ,; C. SarGAi. *t ,4 r _ _*__-__4r_r.E;__ ,(t, U$ll LYSIS: Ft' tt T,*E - o _ ft," :t,.,/,4{t.,! lLU MrcRoScoPE L. -42J-'1,, II, EKG 't l't l* aS. c8€sT X.aAr ( placc, d&tt, film numbcr ard reutt\ ocA ttA$0iErErTs ffro oTHtrt FtilDtt6t 51. Heionr 55. surLD: 16, TEiiP€BATUlf (Cftc* m) Bl,OOo PRt93{tii d Lart Li.a) {.{rr __++,_- PULS€ B. tnER fxtncrs I c. (/rr 4 l/.ofl kg{') 2 4 FftttL IE 7/; iEFiAgflOr LH. D. REcurraxr rallr. AFfE tr*.nglrc 3 Utst. *Eri Ylsbr Drv. PRISil COflV CT rctorxololTp{ 64. C?LOC VnrOr f fal "*C ""a *r"frl G. t*9::*lt!ic; r (rot t'rc) 61" FuLrS(p ytslox vtsro* II. ttcd tad A{rorcrsl€R BI'T {T'tal utcd aud un6eRgcttD 'f,url lt. R€D LEXS TE3T 7a /ll gv WY DTPfH P€icEPI}orl t{riAocul^R FBYCIIoi.oCTCAL AriO (Tcl, ea rrd lasFt PgYc*OrcI,Oi tc6l'c, ^5 r.If? yv tL tlOTtS lrs sv lr5 (Cbrriat..O Ats st€rlfrcrlrr on trrERvrL HsroRy -f _, ---1 \v' ,/ / t"t' 1 I ( ?{. $.lalAit Of DcFEgrs Aio DttGtSEs Eaalta{l{\a0't3-+utrrfr Uu .U{hr'6l (i!. dbgnoul,r'l L, ,tiocr} $GctrLlgq. .8. 4 u,c...e? r\ Cll ll*rrom norcrtrD (sFtri/r) *. rfi**r iiaRf, l' F. S',&f guruneo, tjgr orsqurr-lFytlE DEFECIS trilE OF P}WNSAX TYlED.ga ;ftiTED rlrrE d * , rlil- TtFEoa ii$rrro ?,';. '.:". *rii :. or mrrrrro* rt vsgei u*fi""r. n- Tv,tooa ffrrm rtrg {l GrrEC*t !y lrtx iurlEl WPEb Oil PiilTEO n ${YSrcAL tt{YtcrAi orlri oi r++bnil CAPT; l"{C '/bLy.----= U3. I rurErs tir,'': llrc'6$tE!t .' @nflF{r fi,r?tr(: 6ncErrF-{ j.?tt*908 HEADQUARTERS Deseret Test Center Fort Sqlt Lqke Douglos citv 13, utqh JUL. AMCPl,{-DEAO Sgt. Maj. Louis g 1e63 Bessho RA 18022948 Hq. Comd., SHAPE APO 55, New York, N"'Y. Dear SMAJ Bessho: Your letter of 26 June L963, addressed has been referred to me for reply. to the Conrnanding General It is indeed a pleasure to Learn of your assignment to Deseret Test Center. The eenter is a fairl-y new organi-zaELon engaged in extracontinentaL testing of chemical and biol-ogical weapons and sysLems. tr{hiLe aetual-ly an Army organLzati-on, it is staffed by members of alL services. It is a CLass 1I Activity assigned to the U.S" Army Materiel- Conrnand. There are pubLic quarters on Fort Douglas but the number is so Limited the waiting period is quite l-ong. However, housing in Salt Lake City is p1-entifuL, either rentaL type or for purchase. There are no educational faciLities available on Fort Douglas. There is inclosed a brochure r,fiich I hope will provide you wiLh sufficient information about Salt Lake City and Fort Douglas. You will be assigned to Lhe Administrative Office r,/hich is staffed by approximatel-y seventeen military and civilian personnel" The functions are quite Eypical of an Administrative Office in a smatl TD type organ!-zation except thaL maintenance of personnelrecords is accompLished at Dugway Proving Ground as a support functiono You wilL serve in the capacity of Headquarters Sergeant Major and as the principaL assistant to the Chief, Administrative Office. On behalf of the Commanding General and staff, I wel-come you and your family Lo Deseret Test Center and Sal-t Lake City. S incerely, / 1 Incl as 'j ' "'), fdl**^/,-' L/fr*o-,l fr L. WILLIAM Major, BT.ACK Cm1-C Execut.ive Officer PATI EN T'5 oF I rans NAME islration Hospiial , Utah Sali Lake Ci the letter .,X" oses for which treatment was given. Place patient's stay.) before the one diagnosis responsible for the major part of the 84l l3 ICDA CODE 7e.s a f, X 1. Herniated cervical disc at leveI C4 - 5. Major diagnoses noted but not treated OPERATIONS PERFORMED AT THIS HOSPITAI rtinentphysicalfindings,coutseinhospital,treatmentgiven,conditionat discharge, datepatient petency opinion) ";;;;;; fl-ttotpit"r "ttlu]fv, i"lorrtnlations foi iollow-up trealment, medications furnished at discharge, andcom- duty r'rith the U.S. Arnry stationedpatient is a lyJ year old, sgt Major on.activehe noticed- a d.uIL aching sensation aclmission at Ft. Douglas. Thrle months ptior to a shorb time but it comes on on the right side of the necl<' The pain lasts onJ.y the right arm on the fuequentty.Healsonoticeclatinglingsensationgoingd.or'nr are relieved. bY turning antero}ateralsurface.Thepainandthetingl-ingsensation to the left. the head. tor,rard. the rj.ght ana triggered by turning the head' limits except physical exanr-ination and. neurological exanil-atjon lfere lfithin normal and- triceps reflexes' for sliglrtry clecreased- DTR,s on ihe rigilt, that is the biceps rib could' not be demonstrated'' chest x-rays lrere within nornial limits and a cervica-l casts, 5 to g UBCts per h'p'f' Laboratory Data: Urinalysis shor,red- a fen hyaline nornal limits' Blood' urea within llas and occasional RBC's per h.p.f. The herrrograln was 1O5 mg'per cent'' nitrogen rms lf rig. per cent and. b}ood. glucose, fastingt The VDRL t';as nonreactive. patient r.ras primarily admitted for perfor:nan:: puncture *#--'"i the mvelogram was when H:t:::il"*;": AlgiZa.-il; iiuia obtained. at tumbar -::-:,.::1Y:i il: 1 *.i c uiooov. ISitlijil.';":-;i";niv liTil: shapped rirling i-tselr reveared a berl 'J;;;io"v.:TT:":::::.:3'.T:11""1:#31 ilyerograri ::::;ffi;d": ;l;ui"*ril""i"e +L^ !.-i alnrrr onrl --,i and. the ^-i history -^ the reviewing ;; o"-ii," "iett side. After ;$::;";"iui"i-I[;; ,^.. ,l --ah lr'l rr n n n\ye-LogrdJl!2 uL t v . ffi:il,il,'ill-.I]r.iaJr"it"l."t".r'"'p"t: ll: l'::"3:^:i*:.':"*"H:::t* "l tn' ""t i-ncreasgS or.:h:::--t_:,"^:"2Y1"2^tn ffi: benefit rrom s.r"lu"v, rro""lrur, ii--ihi pain 64o-66. or scnaga t'iren u" indicaterl' PatrgSt trras ;;;;;';;;";;;;;il-iliv -$t : i ;iGiI;U;E oC.exysrcraN O; ../ -.t ,) I :: I :: :;:;::;;:; i ;;;;;;;;; 6;;; The 1 .i .,1- 1-- - 1 o ''' ,''/ DMISSION DAYE :: DI SCHA RGE OATE =::= / // 6-28-66 :iJ?si l0-r000 TYPE =::=; OF OISCHARGE FHybglCrAN ' ^^ b-JU-oo supERsEoEs vA FoRM lo-looolrEsr), Ll!-196-a:i-ruo-to:isgs, oec tgez, wHlcH wlLL Nor EE usED. E. E. /t 7 ,/r,/1/11:(,'l 2," KIjNDERT, M.D. HOSPITAL SUMMARY 7-5 ad. FjRST N/it_IE - MiDDLE - !- ., ,ii +\5 - $-1\ ,qo r "t- *5.?'',,'*'f ---'l B E D L-l prr trv TE OF (Abooc spacc for tncchonico!, inzprintinl, il REOU EST .(" I used.) tl* -w{o -. q*-*'\*r:*\ \-) 12 I ( \\- \wY\s\- DATE oF REPoRT nAtlOGRi\PHIC REPOnT , Cgnvg0sas" l'fftrLEdRAFl: After tlw lnJecelsn of eont,rEet eEter1al inco the lunbar eubarachlir{}f.d epace, eE, t,he levetr ot, TJ-L3, cervlcal rnyelography te perfomd. A. curooty tstr:.-ltoy ofehe Lumber aree reveale no otgnificant findinge. Ae tbe cxye i ' 43.3.,*red go ruxr {ato the cervl,cal ap{ne, wich the neck;fl,pxedrr,svl.deace of a e, leee se. ebe rlghe ae the c4-c5 lneirepace is apparent] cross-tebi.e 3.ecera3. v$.esrs iakesr, in*sataee!.y afrer rbe f llor;";;p;:-;;i;;;".-;;-I prJlI.i." def,eee eL thi's 3'eve3' Le apparent. The eord, iteEi.fr-io ttt" area appeare to b€ .&er.\r.@cteo*,-at,,ih{_*."1.evet.,gppears co be lnvolved. ,9f eosenr",tte.ryr1.qry1.;,,,.?hq. op**.tnCg-r,pS- .ehe.,.ce-ry{ce.L,qptr.a:=;,,p .eubeo?.hfte{d s'pa"*,appearg.*;_$3,.fu[n :{!@!sS;-rTl* . I 5 s' e d ,1.'::tii,-r I tri ti i.!fiL:-;i9g ;rl uiIrJ?6r':;i iiiJl: --B*qP.1)r.,]l ;6i':;j I srcl{rrunr,'(SPicifv i*9+e:):::i:f{ii: :gi;;r ';:;13r;il ii loclation ol labota{drJ iii ,ott ol irqucstii! ..'-.._.._" -.;.: .\- ...-- ?*;Tr. . :-,-,, ;{,t?il'.lT_-.,-,--;cj t;Ir",tT. t.' '.,;.O'7 ). rl EFm:" 9 promulgated by Bureau of the ( .\ ) -UVgf:G4. -.- .tf )41.).r I I ilcular A__32 (.RJv.) IlADiCe t,.'P:.i:c REPOit 619.205 '" r.;e; r - r}. a-kpressi.ca: .. ' . 1. Prcable ext,radLlral defect at the c4-c5 lnterspacs on Ebe rlght, Tbe cefect eypical ef a bernleted nucl,euo pulposio; however, thLs eould not def,lnltely :,:-:ls.noe .:,.:; be ru!.ed out.-,;,-Hsr"e 1{ke!.yi::t:,feelr.lEhe-defecu probably repreq€ntp;ala;GKtBdurel ,1 ,;.!PFc,.s, of -whlqh -th. .etiology'-cenngt',be:dererninedi:b+i."i g.,'p: i:r.r....ir\,.iri i:'J il."i: r '' ii.!; :,-: i;Ji; iiii-:' l-i.I,,'.r;L4i)n(:i,- {ij :]Jf,tt i: jj-; ,;,;r_ ".,'..: tr CJ;IJC. ,.,\l a,j ;,,. ;(: -'l"J ,:':::.',,.-.'.". grrl-,:r;i, {.':..:.. ; :ilt!,,..-: :t.,r;{. :t:1$.i;\ i.ia) a:'li::;I: ',....'"1-'a .]{.;';(. ?fi;c.* irtr: ;;.:F: i?:4 r: ri; ;r.j-;'"it c il.,'Icsr i' ;r,: ,-: ,t'; {:.:'j,:l.-'c:illJ .-}I trti.tli,''t:f ' t1 . .,'...:i-l ;r .' l:;-.:r'1-:.i::.',;: ,"- : (:.i:SC: ....1.-; .;-; l{.:rri::ti.l *i:rJ.C:.q#€. il,: ;uq; .'-r.;,_.:,R;E?:i t:i if t:L.f riJH i,r}i';Tr.,:li..l5i:,,. r' ; lrr;ttt':t-:''?J i;; t. . c.) d;- 15',-r"/ -4 0 (Check ona) vA S-r?-ic/ /,4t, lor mechqnicql imprinting, ;I used) PERTINEET cLtNtcAL HI6ToRY, QPERATIoNs' PHY6ICAL FINolNos' f-l Ll -'/ 'r? aY F ro "^tr'*r s ,', EXABINATIqN REQUEATED FEquEoTEo lAi>ove space T_- EEoarDE, wHEELGHAIRI LJ o* stn etcx ea ./- z .t//. r L)an ANo PRQVIEIOiAL plAotQala CEilSl[: FA aad lageral vl.ews of ti]e chesc fall to sh@r evidcnceof acuge lefl'l' eEai:frvc 3.ung d!.scese. The hearE and greeg veseelo are not unusual. There ls scne oncl, pieraral. chi.ckenlng aEd blunt,lng of thc rlght-coetopbrenlc angle. ?llc oeaeous $tcuctutre8 EhG;t no st'Snlflcenc change. Lnprecc{or: Tho pmenee of o1d, healed chaages la the r{gh!-lotter lung f!.e}.d; Ltl:oswi.ee, the chest ls ttlthln tbe llnlts of norpal. / 1) tt:'16 W.!{. TIP?ON,M.D. tot porl ot requesiinq StcDdord Form 519-A (neY. Aug. 1954) Promulqqted by Bureou oI the Budget NAME OF HO9PITAL OR OTHER MEDICAL FACIIITY Cirmlor A-32 (Rev.) RADIOGRAPHIC NEPORT !t 9-20! INSTRUCTIONS Item 30--If you indicate in this item that you-are enplease bring to the- hospital IiFteato hoipital care,-regarding your entitlements. complete inf6rmation Item 35--In territories and possessions of the U. S. ana in ttre Commonweafth of Puerto Rico, applicants not subject to Federal Income Tax will enter the numnef of dependents to which they would be entitled to claim if subject to this tax. Item 36a--If you own your home of :esidence, sho\il community fiiT rrent vdtue, even though-considered If oropertv or owni:d iointly iith spouse. home of only iiiia"ti"ce-is pirt oi a firm or ranch,' indicate it vatue of residence and parcel of land'on which is ioc"La. V-at"e ot balan6e of farm or ranch wlll be listed in item 37a. Items 3?a and 38--Include total value of your propeE ; ofh€r Tfan your home of residence,- or a86ets ive'ritnougit ownediolntly with spoueeor held as community property. Item39--"Average Monthly Net Income" muet include monttrly from all ffi""et'toti[ amounts received sources, Including but not limited to wagee, Ealaries, F€MARKS (Thit tptco aty bo utcd lot tay llrthct fees. comml88ions, bonugesr pensions, earntngg othei than wages, dividends, interest, annuities, retirement benefitb, rents, giftsr, pubiic assistance, and income from i business, profession or farm. Do not report separate income of wite or children. In ieporting wafes or salary, report 'tahe home PlY." vou have rental income, are self-employed or are eniaeed inthe operation of'a business or farm, either soleil or ia par-tnership with others, report the avera"ee nionthlv iiet income you received f rom such sourceg d[ring theiast 6 montlis. Netincome is gr.oss income"less the expenses of operating the rental Pro.pertv or the busine-ss or farm. Gross income ineludes botir receipts in cash and market value of goods or gervices rbceived in tieu of cash. Expenses lnclude cost of goods sold (for businesses), normal repairs, taxes. riaees of employees, insurancer lnteregt on noiGbsJ d"euts (uut nbt fayment of principal), supplies If purchasodr.. and other similar expenseg. for completing this item will be from the examlnlng physlclan. Item 41--Informatlon oEiffi Item 42--Informationfor completlng thls ltem may be offiafr-sd from your insurance- policy, agent, or company representatlve. crpltattlon) Nr*-*-*"\\:-=,\ S----\ c\\ .^.V ":S**-t\.\ NJ r(\ X*<\\) )J$l-*- \s-:>tr*l* G p;.}-*.-t A1:C --^\J$'\J) \ \..S---.--, \--._,*,\ ey- <) U.S. GOVERNMEN'I PRINTING CFFICE : \J** l96r-0-753-t \,la\ 44 0r i\.. d- qj\$.rRa _a\ \ilV-r-'xt ^- {)*-I -J. ^""s PAGE 3 0F va rOnU rO-P-lO. APR 1965 TEDICAL CERTIFIATE (ilnT TO EXAIIII ING PIIYSICIAII - IIistoty, symptons and physical findinBs nrust be tecorded in sufffcient detail to sut: .t cj.arly the diagnosis. If additional space is needed, use reverse side.) a6. sRt, nrsronv, snreroMs AND PHYSICAL, ;9'-' ; LASORATORYT X-RAY, EC6 Al{0 OrHER FINDINGS (lt,.cht.Fott. tl.t.tt.bt.) ;; 5h6/66 Ft. Dougles Utah w:lth tho GrCo of dosr tho rlght amr, that soems t'o bc 1"' sggtlvated by the lostf:-on of the reck. T66 floring ol thc nobk Jn the 'l ln tho Cgi.t direetton seells to givo the patient f,leeting paresthesias g;oing" on for rbeen lrattc forearm of the rieht handand d,r'a.- Thcsa synptons l+? ycar o1d soargent prosents fron a numbness and t]5gUig sensation the past tso months. 0n exeninationr. by rneasurement thore is no atroptry rnanjJested by lrreguLertty the blceps in tho sizo of tht mrscles, and thc refle)@s are slmetrlcal, -hcre no dlffcrcncc is being very week, the triceps boing nrildly brisk. ]Ihen thc erns. fu tle sensatlon of the pLn or brush botseen the two paresthlas, thcre ir neck is 1n the posl-bion that seems to bring on thc thc ln strcngttr no change in'th; radual pu1se.' Thore ls no inequality of the muscles but thc patlent is not really very strongr patient prosented with x-rayE from Ft. Douglass that are of good oua1itv and these are revieroed rrith the chief of radiology he o. thos" iihs, show a bit of porosis, and otherrrlse are rmremarkable. The nural foramina are all open, and without osteophyies, and thero is no apparent dlsk narrorrlng. The shoulder Jolnt is r:nrenarkabLe. The of this patierrbrs problem ls coqpletoly l]-ludfng no. It, r"ould seem from thc history thab the patlent ls hauirng sons dlfficulty as rosul-t of tho eompression of the lrachial pl,e:crs, tnrt the x-rays do not rev6a1 any sulh possibility, though the prtsencc of sofb tlssue aausing compresslon carmot be nrled out. Nevertheless, the neurologic fa{La to and the mass of lhe or scnsation tratc The cause (Scr aotr co .t.tlntla 47. DIAGNOSIS /T6. SURGICAL PROCEDURE REQUIRED Ph/.Ict.A ,bot.) 49. ESTIMATEO NUMBER OF DAYS HOSPITALIZATION fiiEcx CAII APPLICAI{T DO THE FOLLOWI]IO 50. E9. F OPERATE FoLL0WIXG A MENTALLY COMPETENT? IYITHOUT ASSIST slGr.lA 57. IS WHEEL CHAIR WITHOUT AID? 60, NAilE METHOD OF TRAVEL RECOiI T,IEIIIOEO E llt'* cr. TllE REQUIRED DRESS AND 52. 53. EACII 0F UILL BE AMBU. LANCE "l ATTENDANT NEEDED ADORESS OF PROPOSED ATT€I{DAiIT ^}ID I-I PRIVATE L-J corvrYlxcg 63. OF EXAMINING PHYSICIAN ADDRESS OF EXAMININ6 PHYSICIAT.I f,/4:iera.s a'1,'inislraliorr 841 I 3 ur;h !::l'ld Ultro ltot VA Stt' tVSttUCfIOwS . It thlt tppllcctloa t. ao bt tclttttd iloi io iilch orlatntllt"tabtlltod, tlttp nr.. ol tolottlnl VA ttt' alon ln ah. ..rata batot, /s- 7fi fra/o o "f Egsslo /or,t cco-gtt-o stsl _ fllllo 9illxlld lNltrrul^o9 5n { nueclo groups ls the same.by measurernent, and ln addition tbore j.s no dlfferenco Jn the apparont strength. Thore rras sone symetrlcal eeakness, but t'ho conrpialnto arc located 1n the rlght arn reglon or0y. Tho patlent clearly doos not have a cerv-ical rib syndrome, because of the absenco of the cervlcal rlb, and becauso tho radlal pulse remains fulI and bor:ndlng when the patlent places hts neck l.rt the position that yilelds paih; r', for hl:n. ;. Drdocrlne-rnotirubffc. cause's must be consiilered, but the patlentro slmptoms arc Bo locatlzed* as to Suggest that this is not the probJ-en, and he feels ' that he is galning weightr end has.no general nalalse or dtsability. Furthomore, the hlstory is suggestive of a localized process trlggered by I' tbe posltion of the neok. It would seem reasoaable to send thls patlent to the neurosurgical cl1nlc for thelr evaluation of thls problem, end,the paticn! is so referred. ' l,l. J/ //. a K-' //Ctz.-*--z 1 G. -I1ead Henrmetir, /rf J.) ' aall"lua salda.r i(ued acusrnau! .rno[ uo:1 paulelqo -tuoa ro '1ua8e 'fcqod aq feur urail sFn 3u11a1duoa roluolletuJoJttl--Ztttr5]i 'ue;e1sliqd Sutgrursxa aql urorJ paq"1qg aq I11,r ruag slt{l 3u-rlalduoc JoJ uorleur.rolul--1p tu-a11 rpeseqe.rnd 'sasuadr(a JBFurrs Jaqlo pue sallddns '(pdgow.rd ;o parutled pu lnq) slqap ssaqsnq uo'-lsa.ralul taaue.rnsul'saafoldrua 1o sa8e,rl tsaxel 's.r1eda.r Teturou '(sassaulsnq roy) plos spoo8 ;o lsoc apnlcq sasuedxg 'qs?a Jo nall u! peAlacar satlAras .ril dpoira yo anprr la{reu pue IIsEc ut sldlaaar qloq sapnlcq aruocu! ssoJC 'trrJBJ Jo ss_autsnq aql .ro fga aq1 3u11e.rado ;o sasuadrca aql 6sal auro? 'stfluoru I lsrl-aq1 8u1rnp -ul sio.r8 s! auoaurlaN pallaca.r nod auocu.r 1au r{1q1uou a8e q1r,n d1qs.rou1.red w -ro f1a1os -.ra,re aqi l.rodar Jaqlra 'u.re; ro ssaulsnq e Jo uorleJado aqlq pa3eSua a.rtj .ro par{oldura-y1as aJE 'atuocul [elual a.req nof y1 sacJnos ucns [uoJtzdrarip 'd.re1es .ro sa8e \ 8ul1.roda.r q 'ua.rpllqc Jo aJur Jo atuocw ale.rtdas lroda-r 1ou t:torJ aulocul pue oq 'urJBJ Jo uotssa;o.rd 'ssaulsnq tslua.r " ,,'fed awoq arye1, lroda.r erlqnd 's1;13 'a.ue1s1sse tspuaprlrp's1r;auaq luaurarrl tsallrnuue tlsa.ralur -a.r t1 //7-.'+/ ,4J (uo!t.!?Idtz -dilrd Teluar l, 'u.i. fz s8ulu.rea 'suogsuad 'sasnuoq ueql Jaqlo ts uo1 'sa8€r$ I I r uI tu o a tsaa; ).qltnt .tru. tot p.rn, a9 1.. .2]d. .IUI) xxvfr9r tsacJnos tsa8e,rr ol pallwn pu lnq Eqpnpq 'sal.re1es 6e iuoiy [1q1uotu paalaoal 6lunotu? Telol aSeraae aql apnlcq lsnru .,aruoeul laN i(1puor1 a8e.rany,,--68@.ii 'dPado"rd illrunru uaaa flfulofpauto q8noq1 ti(ua -uroc sB plaq Joasnods qryn -atuotl .rnot( ueql .raqlo slasse .ro ?aiuaprsal Jo -io.rd inoX lo dnrea 1ep1 apirpul--gtpue Eif'G-trtall '€L8 ualr u! palql oq II!,TI rltuBJ Jo tuJul Jo aJuBTBq Io anle 'palecol stl! qcTI{ r uo puel yo lac.rud pu" acuaprsal to anfel ,riu (/ .-\ J,,^ - \ .._-/.Jt *T -44n,. f-) ',3.-.^ 1 illn ' -''i ' --J :L,l ttt'-2'J l^_. ') rr' '-. ../V),-;-L, 1,., l/ { )t/- [.10---=- -o-r\ A ,) X.RAY' f ,/ ,/t J \ 'l ,\ \l ) , i ^-.[^-', \o \ vr - \ it ,tf t' , i1c ^- {'-',-. J\t* ! 0.\ V\I to, *,[--t---l]--1 [ --- ..\ \/ ,:*-,1,7'^-,.-*) \\\'/ur, r,J. \ r^-- 1_1 /r:v,.t \)'\-1,'\-9- \ /4jr-n-- ^'l .A.--'t",\-. i t1 ,J Tk(T /l\-"*.-J' -r' li. otleilosts (Srr notc ao or.a!ntnl Phvtlal'n tbova) 48. {,. SURGICAL PROCEDUR€ REOUIRED C"STII\,{ATED NUMBER OF DAY5 HOSPITALIZATION IYILL BE REQUIRED CIIECK EACH OF TIIE FOLLOIIII{O CAI{ APPLICAI{T OO THE FOLLOI{I]tG AND USE LA I. ASCEND 52. FEED 53. OPERATE i9. H IMSELF wl A rHour 56. Is 57. IS Ass l sIANqEl WHEEL CHAIR WITHOUT AID? ME'HOD OF TRAVEL RECOI,I{ENDEO I-1 TRAIN OR I-I AMBU. I-I lJ LJ trrce lJ sus CI. SIGNATURE OF EXAMINING PHYSICIAN . ; )/ 4 // ATTENDANT NEEDED DURING TRAVEL? 60. NAII{E AI.ID ADDRESS OF PROPOSED ATTENDAI{T 62. DATE OF EXAMI NAT I OI{ PRIVATE coNvEYA / lr //1.,,r' 6 3, ADDR .,. E ss oF ExAl' r N r-Ng,if ilYjltt/tr n osPtr v"].::l'_;^ .,i,., v" r $6!t L;i: ur"i 84l13 to bt tolot^tod ftot VA Slt' IllsTtucitIoNs - Il ahlt.PPllc.tlon -r"i-t ci oa,t..t..e nt.t o I t c lot t lnl rA tt t' t tt' i'i.il.' rliin ori eiit tton la aha ..tal^ b.tor. flAME AilD UNIT NO. Dtri slc APPLICANT MENTALLY COMPETENTI ,/c, tt /J /i1 rf ax -z fJf {sr^/F-Y{-{a 3 . PATI9l T'S LAST NAME . DE€Silg, - Louis FIRST NAME .S f'/ n - t"ttODLe NnMe u s'n, Rti{a}t-'l/f (Aboae qtace lor mechanlcal impdnting, il;;r"' I orre or zlL.7ua-z-o