Hygiene and Physiology of Women Volume X: Sex Survey

Blank No. 3 Series II. Form B.

11 - Menstruation: First menstruation at what age? and when thoroughly established? 17 - at that time.

Present condition as regards menstruation a) how frequent? Once in five weeks. b) is it regular or not? Varies within a week. c) amount? how many napkins? 10. d) duration? 5 days. e) pain or not? at what time as to the flow. Some pain, but great weekness, first two days. f) is there any leucorrhea (whites)? Character? Yes. Thick. Viscid. amount? variable. constant or occasional? g) have you pain either frequently or habitually in the head, small of the back? abdomen or limbs? No. h) disease or trouble in uterus (womb)or other pelvic organ? None i) habit of bowels: how often? always once, frequently more than once in 24 hours.

Blank No. 3 Series II Form B. 6

12 - What knowledge of sexual physiology had you before marriage? b) how did you obtain it? (a) very slight and indefinite. (b) From reading parts of Tokology.

13 - 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?

14 - Number of years married? 4

15 - Do you habitually sleep with your husband? b) What reasons for so doing or not? Yes. (b) Convenience.

16 - Number of conceptions? 3.

17 - Number of children? State in connection with each a) date of birth? b) sex? c) whether healthy or not? d) note any characteristic and the cause. e) note either immediate or after effect on your health of the birth of each of your children. f) give time of first menstruation after birth of each child. (1) Feb. 28, 1892. (b) Male. (c) healthy. (d) a tendency to enlarged tonsils, [???], & suppose inherited scrofulous tendencies.

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Blank No. 3 Series II. Form B. 7

18 - Did conception occur by choice or accident? First time- accident. Second "- Choice with accident. Third " " " ".

19 - Habit of intercourse, average number of times per week? per month? Six or more. per year?

20 - Was intercourse held during pregnancy? If so, how often? b) had you any desire for it during this period? Yes - Two or three times per month. (b) Yes, in one case.

21 - At other times have you any desire for intercourse? a) how often? b) at what time in relation to your menses? (a) Infrequent intervals. (b) Can not see any relation.

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Form No. 3 Series II Form B. 8

22 - Is intercourse agreeable to you or not? Usually indifferent. do you always have a venereal orgasm? - I don't know. 1 - When you do? a) effect immediately afterwards? b) effect next day?

2 - When you do not? a) effect immediately afterwards? b) effect next day?

23 - What do you believe to be the true purpose of intercourse? a - necessity to man? to woman? Necessity to neither. b - Pleasure? Yes, to the man, and to the normal woman. c - Reproduction? d - What other reasons beside reproduction are sufficient to warrant intercourse? It seems to me to be a natural and physical sign of a spiritual union, a renewal of the marriage vows.

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Blank No. 3 Series II Form B 9

24 - Have you ever used any means to prevent conception? a) if so what? Once used a syringe after intercourse.

b) - effect on your health? Nothing perceptible.

25 - What, to you, would be an ideal habit? Once, or possibly twice per month.

Dec. 1894. In sixth month of pregnancy. Has been running down since last summer. Examinatioin by Dr. Keith of San Jose who said she had prolapsis and that the uterus was very low.[insert] as low as at [?] mos.[insert]. Was given book to read "Health by Exercise." Took 1 wk for rest away from home. Dr. recommended the using of hot injections followed by cold injections with [???] astrinjent. [???] very bad, more than usual. [insert] Health [insert] worse after going away, {???] [???] with the use of injections. Also thought the fact that she had time to think about herself might be cause. Thoroughly alarmed about her health.

Is not strong since birth of last child. Illness during the last summer of her oldest child was a serious strain. Has been having intercourse on an average of once a week until the last month. Very painful to her. Now occupies a single bed. Her digestion is bad although appetite is good. Is very constipated & has trouble with flatulence.

Did breathing exercises vigerously (while away [???]) using book as a guide. Finds it necessary to lie down most of the time.

Has gained 1 lb since last summer. Expects confinement in March.

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