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lank No. 2 Series II. Form B 3.

— Your maternal Grandfather: home in city or country? country
1- age when married?
2- occupations? Farming
3 - health?
4 - number of children? 10 or 11 b.) number reaching maturity? 7

Your maternal grandmother: home in city or country? country
1- age when married?
2- occupations? Housekeeping
3- health? excellent
4- age and cause of death? 70 — took cold and died
of old age.

II - Your husband: nationality, if American, of what descent?
1. date of birth? Aug. 30th 1856
2- early life in city or country? country village
3- height? 6 ft.
4- weight?
5- muscular or weak? muscular
6- where educated? degrees if any? Cornell, '78 M.M.E.
7- if a college man, has he been athletic? yes: boating
8- complexion? very fair
9- temperament?
10- does he use tobacco? no
11- occupations? Practical Machinist 78-'85; College Professor
'86 —
12. health? Good, but not vigorous make; lacks
physical [reciliance?]
13. diseases in his family: Nervous Disorders? Rheumatism?
Consumption? Dyspepsia? Varicose veins? Heart Disease?
Hernia? Habitual Constipation? Catarrh?
Tendency + Derangement of the heart.

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