[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 Unpublished textual descriptions of cases would be welcome, and will be returned on request.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. Not definitely any of these.
(6) Principal occupation as adult.....................
(7) Lineage (i.e., from what foreign countries did forebears emigrate) ........................................................................
(8) Environment in which life principally passed (Indicate by x’s):
| Rural or village under 2,500 | Municipality 2,500 to 25,000 | Municipality 25,000 to 100,000 | Municipality 100,000 to 500,000 | Municipality over 500,000 | |
|---|---|---|---|---|---|
| Up to 10 years old | ..... | ..... | ..... | ..... | ..... |
| 11 to 20 years old | ..... | ..... | ..... | ..... | ..... |
| 21 to 50 years old | ..... | ..... | ..... | ..... | ..... |
| After 50 years old | ..... | ..... | ..... | ..... | ..... |
(9) Ever legally married..... Children, how many.....
(10) Plays any musical instrument.......................................