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Blank No. 16 B Series II. Form B. 6.

12 - What knowledge of sexual physiology had you before marriage?
b) how did you obtain it? No knowledge of exact meaning of
marriage relation
13 - Number of times married. 2 If more than once additional blanks
will be furnished you to answer the following questions separately
in regard to each marriage? 2.
14 - Number of years married? 18 mo.
15 - Do you habitualy sleep with your husband? b) what reasons
for so doing or not? yes. Because of companionship &
not wanting to be separated.
16 - Number of conceptions? none
17 - Number of children? State in connection with each a) date
of birth? b) sex? c) whether healthy or not? d) note any
characteristic and the cause. e) note either immediate
or after effect on your health of the birth of each of your
children. f) give time of first menstruation after birth
of each child.

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