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Blank No.33 Series II. Form B. 2.
II (continued) 4- Number of children? 10. Number reaching maturity? 8

III. Your Paternal Grandmother: home in city or country? Country
1- Age when married? Do not know
2- Occupations?
3- Health? Good as far as I know.
4- Age and cause of death? Died at 37. Do not know cause.

IV. Your mother: 1- Nationality, if American of what descent? American, English descent.
2- Home in city or country before marriage? Small town
(b)Home in city or country after marriage? Small towm
3- Occupations before her marriage? Teaching
(b)after her marriage? Housekeeping
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? None that I know of.
7- Her age if living and present health? if not, age at time of death and cause?
She is now 58 yrs old and is fairly well
8- How was your mother's health affected by the climacteric (change of life). She was quite ill during that period. Having always had sympathetic palpitations of the heart, it was much more at the time, but is as much now as before that period.
9- Name any diseases in her family.
One brother had consumption