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Blank No.34 Series II Form B. 6.
12- What knowledge of sexual physiology had you before marriage?
(b)how did you obtain it?
What could be known from a good course in zoology and Dr.Wood's course on that subject.

13- Number of times married. 1. Of more than once additional blanks will be furnished you to answer the following questions separately in regard to each marriage?
14- Number of years married? 2.5
15- Do you habitually sleep with your husband? Yes. (b)What reasons for doing or not? I like to be near him and for economic reasons.
16- Number of conceptions? One

17-Number of children? One. State in connection with each (a)date of birth? (b)sex? (c)whether health 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.
a. June 22, 1896, b. male, c.healthy
e. stronger than for two years.
f. Third month after birth