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Blank No. 18 Series II. Form B. 2.

(continued) 4 - Number of chldren? seven

Your Paternal Grandmother: home in city or country? country
1 - age when married? 18
2 - occupations?
3 - health? Very poor - was nervous & hysterical.
4 - age and cause of death? - Bronchial consumption.

Your Mother: 1 - Nationality, if American of what descent? American
2 - home in city or country before marriage? country
b) home in city or country after marriage? country
3 - Occupations before her marriage? none - lived at home
b) after her marriage? Kept house & did farm work.
4 - Note any prenatal influences before your birth. The millipede
were thick that summer before my birth -- and my mother
disliked them very much. My aversion to them is absolutely
uncontrollable
5 - her health previous to your birth? - good
b - after your birth? Good until the turn[?] of
life - and since then she has been an invalid
6 - Number of miscarriages? None - one baby died
being born.
7 - Her age if living and present health? if not, age at time
of death and cause? 7[?]0 years old - poor health.
8 - how was your mother's health affected by the climacteric
(change of life). Ruined her health -
entirely. Has been a nervous invalid for
twenty two years.
9 - name any diseases in her family. None.

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