English Translation

Appendix 1 Reporting of a case of (name as referred to in paragraphs 1 to 5 of the footnote) with the child: Surname First name.. née dead 3. At present the child is in twin — yes2) No — Same. — Other sex — marital — illegitimate —; the child of the parents of all children; of which dead born ., still alive Surname and first name resident in born in religion (g. F. (a) the father's mother's profession of the father of the mother. Any questions must be answered in detail in leferlich Schrist. 1. a) Detailed description of the current condition: (In case of cranial anomalies circumference (head of head) in em.) b) Is the condition constant or progressive: 2. Pregnancy undisturbed: yes no What disorders? 3. Information on the birth of the child (Was the child viable?): a) How much weighed the child immediately after the birth? b) Was the birth timely, premature or late? (pregnancy month c) Was it true, shortened ('birth of birth') or prolonged? (hours) d) Was artificial help (sang, twist) necessary? e) Existence after the child's birth Asphyxia (damage)? (f) What resuscitation measures have been taken? According to NdErl. d. NMdJ. v. 18. 8. 1939 — IV b 3088/391079 Mi — children with the following severe diseases bw. disease states: 1. Idiocy as well as Mongolianism (facial cases associated with blindness and deafness), 2. microcephaly (abnormal smallness of the head, especially of the brain skull), 3. hydrocephalus (water head) severe or progressive grade, 4. Deformities of a serious nature, especially the absence of whole limbs, crevices of the head and vertebral rot, etc. 5. Paralysis including Little's disease. 2) The non-perfect should be crossed out B 141 (9.41) Neichsdruederei, Bertin Din 476 A 4