II 



Bcgcnptiott of aif)ilti at 23irtlj. 



Name • 



Date of Birth 



Previous health of Mother* .... 

 Birth at full time, or premature . 

 Labour natural, or instrumental. 



Physical peculiarities, if any (including "Mother's marks") 



Weight at birth (naked) 



Length 



Girth round nipples 



Colour of eyesf. 



Colour of hair, it any 



Child healthy, or ailing 



„ quiet, or active 



„ feeble, or vigorous 



„ good-tempered, or fretful . 



* Any strong mental impression, fright, shock, or fancy, occurring to the mother previous to 

 the birth of the child, should be recorded if possible before the birth. 



t The eyes of infants at birth are always dark blue ; but it should be observed at what period 

 after birth their colour begins to change. This generally occurs within a few days. 



