Page:Autobiography of an Androgyne 1918 book scan.djvu/293

 III

QUESTIONNAIRE ON HOMOSEXUALITY

[The governments of all cultured lands take from time to time censuses of the blind, the deaf, and other defective classes. None has ever taken a census of homosexualists, although the latter are fully as numerous as the two definite classes previously named, and their effect on the social body is even more marked. The Medico-Legal Journal, on the basis of the following questionnaire, makes the.first essay, in the history of culture, in lining up the defective class in question so that science may have a broader knowledge of them than that afforded by the comparatively few detached biographical and analytical notes at present extant. The reader is therefore requested to fill out the following questionnaire—or have the intelligent homosexualist do so—and mail it to the Medico-Legal Journal, New York. If unable to answer all queries, kindly give as much information as possible. Additional schedules will be furnished on request. Unpublished textual descriptions of cases would be welcome, and will be returned on request. The results of this questionnaire will be published, and the addresses of respondents will be filed for due notification.]

(1) Physical sex of homosexualist......

(2) Age at date....years (or....years at death)

(3) No. of brothers.... Sisters....

(4) Approximate age of father at subject’s birth.... Of mother....

(5) Underline applicable physical type: Brunette. Blonde. Red-haired.- Net definitely any of these.

(6) Principal occupation as adult....................

(7) Lineage (ie., from what foreign countries did forebears emigrate) ........

(8) Environment in which life principally passed (Indicate by x’s): (9) Ever legally married..... Children, how many.....

10) Plays any musical instrument

(11) Underline interest in sport: Practically none. Slight. Extensive.

(12) Underline interest in music: Practically none. Slight. Extensive.

(13) Underline interest in other art (designate): Practically none. Slight. Extensive.

(14) Underline interest in religion: Practically none. Slight. Extensive.

(15) Underline applicable schooling: Less than 8 years. High school. Liberal-arts college. Postgraduate. Professional school.

(16) If liberal arts course, favorite subjects in order of preference............

(17) Number — if any — of foreign languages ever spoken with considerable ability..... Number studied for translation.....

(18) What—if-any.—mental diseases suffered

(19) A dipsomaniac..... Other drug addiction.....

(20) What rather serious (excluding the practically universal) bodily diseases suffered............. Particularly underline applicable: Venereal warts. Syphilis. Gonorrhea. Locality (initial) of last three..........

(21) IF dead causes of death

(22) What —if any — disease has run in the family of either parent............

(23) What other blood relatives have shown sexual abnormality:

(24) Are seual organs normal .... Describe any abnormalities