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Blank No. 3 Series II. Form B.

11 - Menstruation:
First menstruation at what age? and when thoroughly established?
17 - at that time.

Present condition as regards menstruation
a) how frequent? Once in five weeks.
b) is it regular or not? Varies within a week.
c) amount? how many napkins? 10.
d) duration? 5 days.
e) pain or not? at what time as to the flow. Some pain,
but great weekness, first two days.
f) is there any leucorrhea (whites)? Character? Yes.
Thick. Viscid.
amount? variable.
constant or occasional?
g) have you pain either frequently or habitually in the
head, small of the back? abdomen or limbs? No.
h) disease or trouble in uterus (womb)or other pelvic organ?
None
i) habit of bowels: how often? always once, frequently
more than once in 24 hours.