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Blank No. 14 Series II. Form B.

11 - Menstruation:
First menstruation at what age? and when thoroughly established?
About Fifteen.
Present condition as regards menstruation
a) how frequent: Once in four weeks
b) is it regular or not? Regular.
c) amount? how many napkins? six
d) duration? five days
e) pain or not? at what time as to the flow,
No pain.
f) is there any leucorrhoea (whites)? character?
None.
amount?
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? Once a day

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