54

Blank No. 5 Series II. Form B. 6.

12 - What knowledge of sexual physiology had you before marriage?
b) how did you obtain it?

13 - Number of times married. If more than once additional blanks
will be furnished you to answer the following questions separately
in regard to each marriage?

14 - Number of years married? 3

15 - Do you habitually sleep with your husband? b) what reasons
for so doing or not? No. b) pleasanter, and more comfortable
more [deleted]wholesome[deleted] healthful. Habit of both to sleep alone before
marriage.

16 - Number of conceptions? 2 (1915 - 4

17 - Number of children? State in connection with each a) date
of birth? b) sex? c) whether healthy or not? d) note any
charactersitic and the cause. e) note either immediate
or after effect on your health of the birth of each of your
chldren. f) give time of first menstruation after birth
of each child.

(1) 2. a) 25 June 91. b) girl c) yes. d) - e) - f)
once 6 months after but not established. [??] about 8 months. not established in
next summer.

(2) b) June 14 - '93 b) girl c) healthy d) - e) -

(3) a) Jan. 28. '97 b) girl c) healthy d) develope back? trouble? if any [??]
not tubercular, no symptoms (over)

e) No troubl. f) devl[?]
enlarged legs - 10 days after.

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