| Name | Residence when at home City or town or township | is he (or she) self supportng or partly so (see note B) | Age at which idiocy occurred. (see Note C) | Supposed cause of idiocy, if acquired | Size of head, large, small or natural? | Has this person ever been in a training school for idiots? If yes, name the said traning school. | What has been the total length of time spent in training schools? | Date of this person's discharge. (Give year only) |
Is this person also epileptic?
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Is this person also blind?
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Is this person also deaf?
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