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

11 - Menstruation:
First menstruation at what age? and when thoroughly established?
14 yrs., I believe. Cannot answer last question.
Present condition as regards menstruation.
a) how frequent? Once in 4 weeks.
b) is it regular or not?
Regular to a day, unless setback by a cold.
c) amount? how many napkins?
Very profuse flowing for two days, then lessening for
three or four more. Perhaps seven napkins at a time.
e) duration?
f) pain or not? at what time as to the flow, before it is established,
when? After? No pain. Quite languid for one day,
Tire more easily that day.
f) is there any leucorrhoea (whites)? Character?
occasionally - thick white.
amount? Very little, hardly enough for me to
notice ever.
constant or occasional?
Occasional, after unusually hard work.
g) - have you pain either frequently or habitually in the
head, small of the back? abdomen or limbs?
None - slight sick head ache
five or six times a year.
h) disease or trouble in Uterus (womb) or other pelvic organs?
None.
i) habit of bowels, how often?
Orinarily regular, once a day. Occasion-
al trouble with constipation.

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