D. F. Weeks.Biology and Eugenics.79 
Form for the Written Heredity History. 
Name, Consecutive Number, Date. 
Source of information. 
a—name ; b—relation to patient; c—address. 
The patient and his home. 
a.—Description of the patient. 
b.—Housing conditions : tenement, house, number of rooms, general 
condition. 
C.'—Home treatment : good, bad, fair, neglectful. 
D.—Number in the household : adults, children; number defective, 
number normal. 
E.—Financial condition : good, moderate, poor, very poor. 
F.—Neighbourhood : good, fair, bad. 
G.—Education : time in school, grade attained, reason for leaving. 
A description of the individuals on the chart covering the following points 
—name, sex, date and place of birth, mental and physical condition, if 
married a description of consort and children, if immigrant the date of 
immigration, if dead cause and place of death—is written up under the 
following headings :— 
1.—The patient's fraternity (the patient’s brothers and sisters). 
2.—The 'patient’s father and his fraternity. 
3.—The patient’s father’s father and his fraternity. 
4.—The patient’s father’s mother and her fraternity. 
5.—The patient’s mother and her fraternity. 
6.—The patient’s mother’s father and his fraternity. 
7.—The patient’s mother’s mother and her fraternity.