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Blank No.36 Series II Form B. 2.
II (continued) 4- Number of children? 5 Number reaching maturity? 5

III. Your Paternal Grandmother: home in city or country? [Country?]
1- Age when married?
2- Occupations? House keeper
3- Health? Good
4- Age and cause of death? About 40. Cholera

IV. Your mother:1- Nationality, if American of what descent? German
2- Home in city or country before marriage? [country?]
(b) Home in city or country after marriage? [city?]
3- Occupations before her marriage? Teaching school and attending school before 20.
(b)after her marriage? Housekeeper
4- Note any prenatal influences before your birth.
5- Her health previous to your birth? Excellent.
(b)After your birth? Excellent.
6- Number of miscarriages? None
7- Her age if living and present health? If not, age at time of death and cause? 54. Physical health good. Mentally, religious mania since 47 years old. A twelfth child born when her mother was about 43 years old.
8- How was your mother's health affected by the climacteric (change of life)?
Menstruated irregularly since 47 years.
9- Name any diseases in her family. None except Father. Rheumatism when 87 years old. Mother feeblemindedness in 85th year.