lU MASS. EXPERIMENT STATION BULLETIN 241 



Serial No. HOME RECORD— 3— 



III. Related Health Habits and History 



1. Daily bowel movement 



2. Laxatives, etc. 



habitual, occasional 



3. Digestive upsets 



freq., seldom, never 



4. Bed at p. m. 



5. Up at a. m. 



6. Dentist at least yearly 



7. Eruption 1st tooth, mo. 



