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Blank No. 16 B Series II. Form B. 2.

(continued) 4 - Number of children 4 or 5 number reaching maturity?

Your Paternal Grandmother: home in city or country?
1 - age when married? 1st wife
2 - occupations?
3 - health?
4 - age and cause of death?

Your Mother: 1 - Nationality, if American[underlined] of what descent? german descent
2 - home in city or country before marriage? small town
b) home in city or country after marriage? mostly country
3 - occupations before her marriage? married young, housekeeper
b) after her marriage? housekeeper
4 - Note any prenatal influences before your birth. Interest in
newer religious thought, breaking away from old traditions, [???]
worked very hard. gloomy,
[in margin]self
6th child
children born with 2 or
3 years of each other:
born after 15 years of
married life[in margin]
5 - her health previous to your birth? not naturally strong,
frail physique (?)
b - after your birth? very weak
6 - Number of miscarriages? ---
7 - Her age if living and present health? [deleted]if not, age at time
of death and cause?[deleted} 62 poor health.
8 - how was your mother's health affected by the climacteric
(change of life). Sad effect. All troubles emphasized. Head, deafness
in one ear; discharge from ear. Memory [deleted]sugges[deleted] defected.[deleted] Prolapsis[deleted]
Indigestion prolapsus
9 - name any diseases in her family. [deleted]father ??[deleted]

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