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Blank. No. 3 FormB.

Date. April 9, 1892

1. Age when married. 25

2. General health a)before marriage. Excellent. Did not lose a day this
b) since marriage. First and second
illness in college [course??].
Year afterward was in poor health, largely caused by miscarriage
four mos. after marriage.

3. What knowledge of sexual physiology had you before marriage.

Very slight; had read parts of Topology - but
had never discussed or heard discussed functions of repro-
ductive system.

4.Number of times married? If more than once,additional blanks will be furnished
you to answer the following questions separately in regard to each marriage.

5. Number of years married? 3 1/2

6.Do you habitually sleep with your husband? No.

[deleted]7.[deleted]

7. Number of conceptions? Two.

8.Number of children? [inserted]one[inserted] State in connection with each, date of birth, sex, whether
healthy or not; Note any characteristic and the cause if you know it.

Feb. 28, 1891; male: healthy.

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