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Blank No. Series II Form B. 2.
II (continued) 4. Number of children? Number reaching maturity?
III. Your Paternal Grandmother : home in city or country?
1- Age when married?
2- Occupations?
3- Health?
4- Age and cause of death?

IV. Your mother: 1- Nationality, if American of what descent? American, English and Dutch
2- home in city or country before marriage? City
(b) home in city or country after marriage?
3- Occuaptions before her marriage? Studied Music
(b)after her marriage? No

4- Note any prenatal influences before your birth.
5- Her health previous to your birth? Married 5 yrs before daughters birth
(b) after your birth? Happiest time of her life

6- Number of miscarriages? 1 (1st)
7- Her age if living and present health? if not, age at time of death and cause? 55 - frail
8- How was your mother's health affected by the climacteric (change of life). Miserable. Headaches every 2 weeks.
9- Name and diseases in her family.