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Blank No.30 Series II.Form B. 4.
VIII. Yourself: 1- Date of birth? Dec. 20, 1874
2- Early life in city or country? [Small town?]\
3- Height? 5ft 5.5
4- Weight? 150 lbs
5- Complexion? [blush?]
6- Temperament? Sanguine - "Intellectually a pessimist; emotionally an optimist"
7- Where educated, give degrees if any? AB Stanford 1895 [enrolled?] for J.D.
8- Occupations before marriage? (a) in city or country? (b) time spent in each? Married Sept 1896
9- Diseases in your family? From father or mother's side? Nervous Disorder? Rheumatism? Consumption? Dyspepsia? Varicose Veins? Heart Disease? Hernia? Habitual Constipation? Catarrh?
Consumption, Heart Disease
10- General health before marriage? Good (b)Since marriage? Good. Paralysis? Brain Fever? Chronic Headache? Nervous Prostation? Catarrh? Hernia? Dispepsia? Habitual Constipation? Inflamation of Bowels? Pleurisy? Bronchitis? Shortness of Breath? Spitting Blood? Consumption? Laryngitis? Tonsilitis? Insomnia? Rheumatism? Pneumonia? Jaundice? Varicose?
Rheumatism, after [tonsilitis?] 1908