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Blank No. 10 Series II. Form B. 2.

I (continued) 4 - Number of children? 6(?) number reaching maturity? 3(?)

II Your Paternal Grandmother: home in city or country? city.
1 - age when married?
2 - occupations? household
3 - health?
4 - age and cause of death? Don't know. She died when
my father was a child.

[?] - Your Mother: Nationality, if American of what descent? American.
2 - home in city or country before marriage? Small city.
b) home in city or country after marriage? " "
3 - Occupations before her marriage? married at 19.
b) after her marriage? household.
4 - Note any prenatal influences before your birth.
5 - her health previous to your birth? good.
b - after your birth? good.
6 - Number of miscarriages?
7 - Her age if living and present health? if not, age at time
of death and cause?
Age 50 in June health good.
8 - how was your mother's health affected by the climacteric
(change of life). Not yet passed.
More nervous but not seriously
affected.
9 - name any diseases in her family. -151-