Hygiene and Physiology of Women Volume X: Sex Survey

Blank No. / 3

14 What do you believe to be the purpose of intercourse? a) Necessity? to the man? Yes. to the woman? No.

b) Pleasure?

c) Reproduction? Yes. Primarily.

15 Have you ever used any means to prevent conception? If so, a) What? b) what was the effect on your health?

(a) Thin rubber covering for man. Depended on so called "safety week", at first. b) I have not perceived any effect on my health.

Condoms 1.50 - 2.00 per doz

16. What to you would be an ideal habit?

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2 Series II Form B. 1.

January, 1892

Your Father: 1 - Nationality, if American, of what descent? Welsh descent

2 - Home in city of country before marriage? country - farm

3 - Home in city or country after marriage? country "

4 - Age when married? 24

5 - Occupations before your birth? Carpentering and school teaching

b) after your birth? Schoolteaching and farming; after the age of 34, College Professor.

6 - Health previous to your birth? excellent

b) after your birth? excellent

7 - Number of children living, a) boys? 2 b) girls 1

8 - Number of children deaths; give age at time of death and cause.

a)boys. b) girls. none

9 - If your father is living, give his age and present health, [deleted]if dead, age at death and cause?[deleted] 58; health not very good, largely result of continuous overwork for 30 years; trouble chiefly nervous.

10 - Name any diseases in his family. Melancholia, his Mother and two brothers subject to this; one brother died insane and one committed suicide. General inability to stand up against misfortunes, resulting in melancholia, a tendency in family.

Your Paternal Grandfather: home in city or country? country

1 - Age when married? Probably quite young.

2 - occupations? farming

3 - Health: good

No. 2 Series II FormB. 2.

(continued) 4 - Numbeer of children? Eleven number reaching maturity? eight

Your Paternal Grandmother: home in city or country? country

1 - age when married?

2 - occupations? housekeeping

3 - health? Excellent, great vigor and endurance

4 - age and cause of death? 79, cause = either Rheumatism or dropsy?

Your Mother: 1 - Nationality, if American of what descent? 1/2 Scotch 1/2 Penn. Dutch descent

2 - home in city or country before marriage? country - farm

b) home in city or country after marriage? country "

3 - Occupations before her marriage? housekeeping

b) after her marriage? housekeeping

4 - Note any prenatal influences before your birth

5 - her health previous to your birth? Rather delicate, without any definite disease.

b - after your birth? Same though gradually growing better in following years.

6 - Number of miscarriages? None

7 - Her age if living and present health? [deleted]if not, age at time of death and cause?[deleted] 53: health not very good; Rheumatism, various disorders, result of too easy a life, too little exercise, and unhygenic conditions of her own making in the last ten years; at 40, she was an unusually well woman, though not strong or robust.

8 - how was your mother's health affected by the climacteric (change of life). She had a tumor of a cancerous nature on her neck at that time, but otherwise was reasonably well, though irritable.

9 - name any diseases in her family.

lank No. 2 Series II. Form B 3.

— Your maternal Grandfather: home in city or country? country 1- age when married? 2- occupations? Farming 3 - health? 4 - number of children? 10 or 11 b.) number reaching maturity? 7

Your maternal grandmother: home in city or country? country 1- age when married? 2- occupations? Housekeeping 3- health? excellent 4- age and cause of death? 70 — took cold and died of old age.

II - Your husband: nationality, if American, of what descent? 1. date of birth? Aug. 30th 1856 2- early life in city or country? country village 3- height? 6 ft. 4- weight? 5- muscular or weak? muscular 6- where educated? degrees if any? Cornell, '78 M.M.E. 7- if a college man, has he been athletic? yes: boating 8- complexion? very fair 9- temperament? 10- does he use tobacco? no 11- occupations? Practical Machinist 78-'85; College Professor '86 — 12. health? Good, but not vigorous make; lacks physical [reciliance?] 13. diseases in his family: Nervous Disorders? Rheumatism? Consumption? Dyspepsia? Varicose veins? Heart Disease? Hernia? Habitual Constipation? Catarrh? Tendency + Derangement of the heart.

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No. 2 Series II. Form B. 4.

I. Yourself: 1 - date of birth? Oct. 28th, 1860

2 - Early life in city or country? country

3 - height? 5ft 3 3/4in

4 - weight? 110 lbs.

5 - complexion? Gray eyes, dark hair and brown complexion.

6 - temperament? nervous, sensitive, impulsive.

7 - where educated, give degrees if any? Cornell, '80 & '82, Ph.B. M.D.

8 - Occupations before marriage? a) in city or country? b) time spent in each? Newspaper office '81 - '82, N. York City. Washington, D.C. teaching HIgh School, '82 - '84 Cincinnati, Ohio, " Private School, '84 - '86 Wellesley College, Wellesley, Mass 86 - 90 - teaching & Clinical work

9 - diseases in your family? from father or mother's side? Nervous Disorders/ [deleted]Rheumatism? Consumption? Dyspepsia? Varicose Veins? Heart Disease? Hernia? Habitual Constipation? Catarrh?[deleted] Mypoia and Astigmatism (Father), defective hearing probably result of catarrh, & small-pox in childhood, or may have been inherited from Mother who is now at age of 53 growing deaf.

10 - General health before marriage? b) Since Marriage? a) [Peu??]- Paralysis? Brain Fever? Chronic Headache? Nervous Prostation? a)Catarrh? Hernia? Dispepsia? Habitual Constipation? Inflammate b) of Bowels? Pleurisy? Bronchitis? Shortness of Breath? Spitting Blood? Consumption? Laryngitis? [insert]a+b[insert] Tonsilitis? Insomnia? Rheumatism? [insert]a)[insert] Pneumonia? Jaundice? Varicose veins? Contagious diseases before marriage: measles, small-pox Whooping-cough, Dipththeria (Malignant) with resulting paralysis b) Grippe severely resulting in bronchial cough which lasted four months.

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