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Blank No. 11 Series II. Form B. 2.

(continued) 4 - Number of children? 3 Number reaching maturity? All.

Your Paternal Grandmother: home in city or country? Country.
1 - Age when married? 31 yrs.
2 - Occupations? Farmer's daughter, [???], & teacher.
3 - health? Hysterical in early life - Good since.
4 - age and cause of death: 96 yrs. Died of old age.

Your Mother: 1 - Nationality, if American of what descent? American - English.
From New Eng. colonists.
2 - home in city or country before marriage? Small towns & city.
b) home in city or country after marriage? City.
3 - Occupations before her marriage? Teacher.
b) after her marriage? Domestic.
4 - Note any prenatal influences before your birth.
5 - her health previous to your birth?
Good.
6 - After your birth?
Good.
6 - Number of miscarriages? None, as far as she
knows. Possibly one early abortion.
7 - Her age if living and present health? if not, age at time
of death and cause? Living, aged 67 yrs. In-
ordinarily good health. Lungs a little
sensitive, perhaps, not diseased.
8 - how was your mother's health affected by the climacteric
(change of life). Never felt it enough to consult
physician. Grew fleshy[?] [??].
9 - name any diseases in her family.

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