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

11 - Menstruation:

First menstruation at what age? and when thoroughly established
Began at thirteen and was regular thereafter, as far as I remem
ber.

Present condition as regards menstruation
a) how frequent? once in 21-26 days. Is improving.

b) is it regular or not? No, but is growing more regular.

c) amount? how many napkins? Amount very small, two
or three napkins would suffice if I chose to be economical.

d) duration? About four or five days.

e) pain or not? at what time as to the flow. There is pain
in the small of the back either before or during
the first part of the flow.

f) is there any leucorrheoa (whites)? Its character? --
amount? --

constant or occasional? --

g) - have you pain either frequently or habitually in the
head, small of the back? abdomen or limbs? There
is chronic head-ache generally all over the head.

h) disease or trouble in uterus (womb) or other pelvic organs? No.

i) habit of bowels; how often? Daily, but most of the
time only with aid of a syringe. -109-