LIBRARY 
 
 OF THE 
 
 UNIVERSITY OF CALIFORNIA. 
 
 GIFT OF 
 
 Class 
 
 ; 
 
MEDICAL 
 
 EXAMINATIONS 
 
 LIFE INSURANCE. 
 
 J. ADAMS ALLEN, M.D. LL. D., 
 
 D PRACTICE OF MEDICINE AND CLINICAL MBDICINB IN RUSH M 
 PROF. PHYSIOLOGY AND PATHOLOGY IN THB UNIVERSITY OF Mi 
 
 EIGHTH EDITION: 
 
 REVISED AND ENLARGED, 
 
 With new Introductory Chapter ami an Extensive Appendix, 
 
 NEW YORK AND CHICAGO 
 
 THE SPECTATOR COMPANY, 
 
 PUBLISHERS, 
 
 1886. 
 
Entered according to Act of Congress, in the year iSSo, 
 
 By THE SPECTATOR COMPANY, 
 In the office of the Librarian of Congress, Washington, D. C. 
 
 THE SPECTATOR PRESS, 
 JVo. 16 Dey Street, New York. 
 
PREFACE TO EIGHTH EDITION. 
 
 The exhaustion of six editions of this brief manual within a few 
 months, sufficiently demonstrates the want which has been felt foi 
 some work of the character. The Author tenders his sincere acknowl- 
 edgements for the kindly terms in. which many of the most distin- 
 guished Medical Examiners throughout the country have been pleased 
 to welcome its publication. He is fully sensible of the difficulties 
 necessarily incident to the effort to take an intermediate course be- 
 'ween the voluminous and elaborate treatise and the mere tractate. 
 
 r his little book is published as a chart, and not as an exhaustive 
 Tolume. 
 
 The effort has been to bring fairly before the Medical Exarrine/ 
 the salient points of his business, in as concise a form as perspicuity 
 would possibly permit 
 
 In the present edition there has been but little change, save in the 
 addition of an Appendix containing matter, which, it is believed, 
 will add considerably to the value of the work, and also an Intro- 
 ductory Chapter, calling the especial attention of Examiners to th" 
 importance of the relations they sustain to their respective Companies ; 
 to the parties examined, and to the profession. 
 
 Attention is called to the Index of the Appendix, on page 169, 
 which indicates the general character of the additions made. The 
 contained tables are believed to be valuable. 
 
 219828 
 
!v 
 
 In the preparation of these additions, the Author begs leave to 
 acknowledge the important services of I. N. DANFORTH, M. D., of 
 this city not only a medical examiner of large experience, but an 
 accomplished professional scholar and writer. 
 
 Under the pressure of his own multitudinous affairs, the Author has 
 delayed publication of a new edition until the previous one was long 
 out of print. Advantage has been taken of this delay to seek for the 
 opinions and suggestions of professional Life Insurance men, both lay 
 and professional. These have been regarded in this edition, so far 
 as they have appeared correct and feasible. 
 
 In order not to make the volume too bulky, the Appendix and 
 IntrDductory chapters have been given in smaller type than used in 
 the text. j. A. A. 
 
INTRODUCTION 
 
 It is now about one hundred and fifty years since life insurance first 
 established itself on anything like an enduring basis. Commencing with 
 the "Amicable Society," of London, it has steadily grown in public 
 favor until, at the present day, no form of investment is regarded with 
 greater favor, by even the shrewdest and most sagacious business men, 
 than the stocks of life insurance companies, and policies of insurance on 
 their own lives. At every step of its progress, this noble institution has 
 sought the aid and counsel of the medical profession. It has its very 
 basis and foundatio t n, in fact, in the established laws of mortality, as 
 carefully and patiently worked out by medical men. The first life com- 
 pany was only started after Dr. Halley, of London, had made that 
 series of observations regarding the duration of human life, out of 
 which grew the " Breslau table of mortality." Every important step in 
 life insurance has been preceded by a pioneer corps of physicians, who 
 have carefully marked out the way ; and, in no single instance, has fu- 
 ture experience proved the falsity or unreliability of their conclusions. 
 
 If all this be true, it follows that the relations of the medical profes- 
 sion to the interests of life insurance are vastly important ; and that 
 they are certainly quite as important to the insured party, as to the 
 company insuring. For our present purposes, it will be convenient to 
 consider the relations of Medical Examiners to life insurance, and the 
 insurance interests, under three heads, to-wit : Their relations to life 
 
VI 
 
 companies employing them, or to the companies' agents. Secondly, to 
 applicants, or parties seeking insurance ; and thirdly, to the medical 
 profession. 
 
 First : their relations to companies, or agents of companies. It is 
 scarcely too much to say that the ultimate safety and stability of every 
 l.fe insurance company rests in the hands of those who decide upon the 
 character of its risks : for, however great may be its resources, or with 
 however much of financial skill and sagacity its affairs may be managed, 
 or however many or perfect may be its " tables of mortality," it is abso- 
 lutely certain to come to a disastrous end, unless its risks are selected 
 with care and discrimination. And so many, and so insidious are the 
 diseases whereof the end is only too certainly fatal, that this can only 
 be done by the skilled and experienced Physician. To render the office 
 of Medical Examiner to the greatest degree useful, three things seem 
 to the writer absolutely essential : (ist) That the best talent be secured. 
 (2d) That perfect harmony be maintained between the Examiner and the 
 company's representative or agent. (3d) That the Examiner be ap- 
 pointed from the central office : that he be recognized as an officer de 
 facto of the company, independent, and therefore self-reliant, in his 
 sphere ; and responsible for the proper management of the interests 
 committed to his charge. 
 
 (ist) It is an absolute and palpable wrong for any company to ap- 
 point as its Examiners men deficient in knowledge; in high-toned hon- 
 esty, in devotion to the interests of their profession, or men who are 
 wanting in that practical wisdom which can only be acquired by actual 
 experience. It is wrong, in that it must, to a greater or less extent, 
 militate against, rather than contribute to, the safety of the company ; 
 it is wrong, in that it needlessly places in jeopardy the interests of those 
 who are entirely unable to protect themselves, namely, the policyhold- 
 ers, or those who are dependent upon them ; and lastly, it is wrong, in 
 that it must inevitably bring undeserved odium and disgrace upon the 
 medical profession. Notwithstanding the hordes of quacks and charl- 
 atans which infest every community, competent and faithful Medical 
 Examiners can almost everywhere be found ; but while the former are 
 forever seeking appointments, the latter must generally be sought ; the 
 former are only too apt to foist their services upon the unwary agent ; 
 
Vll 
 
 the latter very properly regard their services as worth seeking, if worth 
 having. Every company ought to be held to a stern and rigid ac- 
 countability for the character and ability of its Examiners ; it is the cus- 
 todian of vastly important interests, which, from the very nature of the 
 case, cannot be looked after by those most interested in its integity. 
 Its policyholders are scattered over every State in the Union, and they, 
 as well as the Examiners upon whose recommendation they are accepted, 
 must of necessity be entire strangers to the Managers and Consulting 
 Physician. But these facts furnish not the least excuse for appointing 
 or at all events, for retaining incompetent Examiners ; rather do they 
 render it more imperatively the duty of those selecting them, to exercise 
 the greatest care in obtaining honest and skilled physicians to fulfill 
 this most important trust ; and, so perfect and complete are the means 
 for acquiring information at the present day, that no company can plead 
 ignorance regarding the qualifications of its Examiners, and at the same 
 time, maintain a creditable reputation for shrewdness and good man- 
 agement. 
 
 (2d.) Unless perfect harmony be maintained between the Exam- 
 iner and the Agent under whom he is acting, the company's interests 
 must necessarily suffer. The former is not unfrequently compelled to 
 reject risks upon which the latter has expended no inconsiderable 
 amount of time and labor, and which, in case of rejection, must go for 
 nothing. Moreover, applicants are often rejected for reasons which are 
 only apparent to the Examiner ; and, to the uneducated ear, or un- 
 skilled touch of the Agent, this seems an unwarranted stretch of power 
 on the part of the former. With the Agent it is a question of commis- 
 missions ; with the Examiner it is a question of safety ; and these two 
 interests sometimes stand diametrically opposed to each other. But it 
 is for precisely this reason that the Medical Examiner is employed at 
 all ; and, unless he resolutely stands, like an alert and faithful senti- 
 nel, between the company on the one hand, and the unsafe and unde- 
 sirable applicant seeking admission thereto on the other, he signally 
 fails of fulfilling his obligations to the former, and renders his office not 
 only useless, but positively harmful. This course, however, although 
 exceedingly desirable and important so far as the company is concerned, 
 must of course sometimes array him in direct opposition to the pecu- 
 
Vlll 
 
 niary interests of the Agent. But with this the Examiner must and 
 can have nothing to do ; it is no concern of his whether the Agent is 
 remunerated by stated commissions or a regular salary : he has only to 
 do with the safety or unsafely of the risk ; and, while he must disregard 
 all else but this, he must, at the same time, maintain harmonious rela- 
 tions with the Agent. We propose to indicate, in the next place, how, 
 in our judgment, this can best be done. 
 
 (3d.) The Medical Examiner, at least in every situation involving any 
 considerable number of examinations, and especially in the large cities 
 and populous towns, where almost every applicant is more than likely 
 to be an absolute stranger to both Agent and Examiner, should be 
 appointed by the authorities at the home office, after they shall have 
 satisfied themselves that he is precisely the man for the place, and 
 unless they are well convinced of this, he should be dismissed and 
 another and more satisfactojy appointment should be made. What- 
 ever may be the actual merit of the Examiner, unless he is fortunate 
 enough to possess the entire confidence of the Managers especially 
 the Consulting Physician at the central office, he cannot resign too 
 soon. For, unless the central authorities implicitly confide in him, it 
 will be impossible for the Local Agent to respect either him or his 
 decisions in regard to applicants especially if they happen, as they 
 sometimes must, to be adverse to the interests of the Agent. For this 
 reason the Examiner should stand in the attitude of an officer, recog- 
 nized as such by the company ; his department should stand by itself, 
 subject only to the control of, and responsiole only to, the home office. 
 He should not be a mere " tenant at will," subject to ejectment at the 
 pleasure or caprice of the Agent ; for such an equivocal position would 
 be derogatory, not to the man only, but to the position he vainly at- 
 tempted to fill. The general adoption of this course on the part of the 
 companies, will most certainly enable them to secure and permanently 
 retain the best medical talent, and also insure harmonious action be- 
 tween the Agent and Examiner both of which conditions are exceed- 
 ingly important and desirable. 
 
 Secondly : The relations of Examiners to parties seeking assurance. 
 The Examiner is of course bound to consider the interests of the com- 
 pany by whom he is employed and paid, as paramount to all others ; 
 
IX 
 
 else would he absolutely endanger, rather than contribute to the com- 
 pany's sifety and stability. But while this is undeniably true, it is ako 
 true that the applicant has claims which he cannot properly disregard. 
 Life insurance has now become something more than &metz privilege ; 
 it has come to be almost a sacred and " inalienable " right to every 
 person who is eligible thereto : and no applicant should be lightly or 
 needlessly rejected. Every applicant coming before the Examiner is 
 entitled to a fair and impartial examination ; if obscure or unusual 
 symptoms present themselves, he is fairly entitled to a second examina- 
 tion, or even more than that if necessary to a proper understanding ot 
 the case. Frequently does it happen that some apparently grave 
 symptoms depends upon a merely temporary cause ; for example, ap- 
 plicants in perfect health sometimes present themselves with an unusu- 
 ally rapid pulse, or with the respiration unaccountably frequent, or with 
 countenance flushed and excited and all this may be the consequence 
 of excitement or perhaps fear ; for, to very many people, a Physician's 
 office is as terrible as the dungeons of the Inquisition ; and the very 
 best insurance risks are those which are least familiar with the sanctums 
 of Doctors, and therefore most likely to give full scope to their imagina- 
 tions. Individual peculiarities or " idiosyncracies " are sometimes met 
 with, which, though generally indicative of some grave and perhaps in- 
 curable disease, are quite normal as regards the persons presenting 
 them ; these exceptional cases demand a fair hearing at the hands of 
 the Examiner ; though it must be admitted, as a general rule, that 
 absolute strangers, presenting symptoms which are ordinarily asso- 
 ciated with organic disease of any important organ, must be rejected, 
 even though they may be in other respects desirable. 
 
 In making examinations preliminary to life insurance as well as in 
 all other investigations of this character, the Physician is likely to be- 
 come acquainted with matters of a strictly confidential nature, which 
 if divulged, might prove seriously detrimental to the party. The same 
 standard of high-toned professional honor should guide the Examiner 
 in his relations to applicants for life insurance, as he feels constan ly 
 bound to observe in his relations to patients under his care ; no excuse 
 can be found for disregarding this matter in the one case, that will not 
 apply with equal force to the other, except, of course, that the Exam- 
 
iner is bound to disclore to the Consulting Physician all facts essential 
 to a correct understanding of the case. Finally, the Examiner should 
 not forget that, however unimportant it may be to him, individually, 
 whether an applicant be accepted or rejected, it may be and often is 
 a matter of vast importance to the latter. Many a man turns to life 
 insurance as the only means by which he can provide for the necessi- 
 ties of those he expects to leave behind him, when he shall have 
 passed away ; many an unfortunate man, whose life may have been 
 one constant struggle with adversity, sees in a policy of insurance the 
 only means by which he can protect his family from actual want, after 
 he has ceased to live. Such cases must not be lightly rejected ; they 
 are always entitled to a careful and candid examination, made under 
 circumstances which are not unfavorable to the applicant ; symptoms 
 which are merely the result of trepidation or of the excitement of the 
 occasion, should be cleared up, and, in all regards, the Examiner should 
 give the applicant a fair and impartial hearing, with the fixed resolution 
 of rendering a decision which shall be just to both parties; and while 
 this rule applies with peculiar force to the class of cases just cited, 
 every applicant, whether high or low, rich or poor, fortunate or unfor- 
 tunate, has the unquestionable right to expect precisely the same kind 
 of treatment ; and, when it is added that a needless rejection is a per- 
 manent and irreparable injury, inasmuch as it must always stand as a 
 grave objection perhaps an insuperable bar to the acceptance of the 
 rejected party by other companies, it will be seen that these observa- 
 tions are based upon principles which cannot be lightly disregarded, 
 without doing violence to the demands of justice and equity. 
 
 Thirdly : the relations of the examiner to the Medical Profession. 
 Every Medical Examiner is, in an important sense, a "representative 
 man," to the company employing him, as well as to parties seek- 
 ing insurance. He is to them the exponent of the present standard 
 of medical excellence ; for, it cannot reasonably be supposed that a 
 powerful corporation would deliberately appoint, or, at all events, 
 long retain, as the custodians of its safety, inferior or incompetent 
 men, when the best talent is quite as easily accessible, and involves 
 no greater outlay of expense. Let no Medical Examiner for a 
 moment suppose that he has a merely personal interest in acquitting 
 
XI 
 
 .himself creditably and honorably ; that his 'individual interests are 
 alone to suffer if he fails to perform his duties satisfactorily ; but let him 
 always remember that he has been selected on acccount of his pre- 
 sumed ability and acquirements; that every blunder he commits, and 
 every unprofessional or undignified act he allows himself to perform re- 
 flects with damaging force not on himself only, but on the Profession 
 as a whole. It is just as imperatively his duty to maintain a high stan- 
 dard of professional honor in the discharge of his duties as Examiner 
 for an insurance company, as it is in any other duty connected with his 
 vocation ; just as much his duty to examine an applicant carefully, as to 
 diagnosticate a case he proposes to treat carefully ; just as much his 
 duty to frown upon and discountenance quackery and charlatanism in 
 this matter as in any other. And this is due to the insurance com- 
 panies, no less than to the medical profession ; ever since its origin, the 
 interests of life insurance have been, to a great extent, committed to the 
 hands of Physicians, and, from the very nature of the case, this state of 
 things must continue ; they alone are capable of deciding as to the 
 safety or unsafety of risks, and they alone are capable of making the 
 observations necessary to a correct understanding of the laws of mor- 
 tality. But in still another and no less important direction do the inves- 
 tigations of medical men subserve the interests of life insurance, namely, 
 in observing the laws and conditions of health, and disseminating in- 
 formation thereupon among the people ; in arresting the progress of 
 contagious diseases, and rendering them comparatively harmless, and 
 in enforcing salutary regulations for the preservation of the public 
 health in cities and towns. The tendency of all this is to enhance the 
 value of human life ; to render the business of life insurance less haz- 
 ardous, and therfore to bring it more directly within reach of those 
 most likely to be benefited thereby ; thus making it not only theoret- 
 ically, but really, a boon and a blessing to those who are unable to 
 make any other provision for the prospective necessities of their fam- 
 lies. To such a work as this, the medical profession ought to yield an 
 active and hearty support, not only in the persons of a few of its mem- 
 bers, but as a compact and united whole. To this end let Medical Ex- 
 aminers so discharge their duties as to increase the confidence of the 
 companies in the profession ; let them remember that, to the companies, 
 
Xll 
 
 they are the acknowledged exponents of the standard of professional 
 acquirement, honor and integrity, and let them remember that they 
 have their part to perform towards making life insurance, in a larger 
 sense, the institution of the people. 
 
NOTE PREFATORY. 
 
 Life Insurance is rapidly growing in public favor, and it is not 
 
 extravagant to say that the time is coming when it will be more gen- 
 eral even than Fire Insurance. All men have lives not all have 
 houses, stores, or barns. The system of endowments, non-forfeiting 
 policies, etc., has gone far toward making what before was consid- 
 ered extra-prudential and exceptional, a matter of ordinary business 
 caution and common usage. That the Insurance Companies and the 
 nolders of their policies should have the highest possible advantage, 
 :t is clearly necessary that none but lives selected with great care 
 should be assured. Hence the MEDICAL EXAMINER becomes their 
 indispensable agent. To aid him in the performance of his 
 important work, is the object of this little Manual. 
 
 It is not its intention to be argumentative, statistical, or rhetorical. 
 Neither originality in substance nor method is sought after but only 
 that more clearness, definiteness, and certainty may be achieved, by 
 attention to the suggestions herein contained. 
 
 A prime object has been to concentrate to the smallest possible 
 bulk. Hence, conclusions only are given reasons and authorities 
 are rarely alluded to. 
 
 Justice to myself compels me to add that, while the urgent press- 
 ure of professional duties has obliged me to write during brief and 
 scanty intervals only nevertheless, the ideas advanced are the re- 
 sult of matured convictions, strengthened by several thousand 
 personal examinations of applicants for life insurance. 
 
 CHICAGO, 186^. J. A. A 
 
THE APPLICATION. 
 
 The Medical Examiner should first read carefully, 
 point by point, the interrogatories proposed by the 
 Company for which he is acting, and the answers of the 
 applicant. This will save time, and indicate those 
 circumstances which require especial investigation. 
 The form generally adopted, proposes twenty -five 
 questions twenty-three of which demand the scru- 
 tiny of the Examiner. For the purpose of brevity, 
 we adopt the order of the form. 
 
 I 
 
 Name, Residence and Occupation. The name 
 identifies. The residence will suggest at once tne na- 
 ture of the causes of the diseases prevalent, and the 
 relative salubrity of the locality. The moist atmos- 
 phere and variable temperature prolific of phthisis ; 
 ochlesis, the products of animal decomposition, and 
 foul air, fertile in typhoid fevers and cachexiae ; ma- 
 larious districts involving endemic diseases which may 
 especially prove noxious to the party, etc., etc. 
 
 THE OCCUPATION healthful or pernicious? Sta- 
 tistics show the relative longevity of the different occu- 
 pations of men, but the Examiner should superadd to 
 
i6 
 
 these the inquiry : What is the probable effect upon 
 the applicant himself? for that which is salutiferous 
 to one, is often prejudicial to another. Statistics 
 establish certain general propositions, to which, it must 
 be recollected, many exceptions can be taken. 
 
 PROFESSIONAL MEN. Teachers exhibit the greatest 
 longevity. Next come Clergymen, who are subject to 
 few diseases save those incident to sedentary habits. 
 Contrary to the vulgar opinion, they are not more 
 liable than others to pulmonary affections. Dyspep- 
 sia, with its incidents, is their principal affection. 
 Lawyers rank next. Then professional Lecturers, 
 and next, Physicians. Of the latter, it may be said, 
 as a class, they have not the ordinary expectation of 
 life, by from one-third to one-fifth subtraction. Nev- 
 ertheless, the variety of exposure and habits is such 
 that each case requires isolated investigation. 
 
 ARTISTS. Painters and Sculptors rank among the 
 best risks, particularly when the former sketch from 
 nature, and the latter merely model. Portrait paint- 
 ers, and sculptors who cut marble themselves, are not 
 as good risks. Photographers and Daguerreotypists 
 rank second class. 
 
 ARTISANS AND MECHANICS. Painters using lead 
 and oil are undesirable risks, yet need not be wholly 
 rejected. Workers in phosphorus and quicksilver 
 stand upon the same level. Stone cutters and millers, 
 and similar occupations, where insoluble or irritant 
 particles find constant access to the pulmonary surface, 
 are les-s desirable, but improved methods of ventila- 
 tion, now in vogue, render them less objectionable than 
 
17 
 
 formerly. Glass blowers are poor risks. Compos- 
 itors in printing offices signally demand caution in 
 acceptance. Blacksmiths, Furnacemen, Carpenters, 
 Coopers, and Cabinet Makers range among the most 
 healthy operatives. Shoemakers and Harness Makers, 
 mainly from their sedentary habits, are second class 
 risks. The same remark may be made of Tailors. 
 Butchers and Market men, aside from the chances of 
 accident, ( to the former particularly, ) are good risks. 
 Machinists, Plumbers, Tinsmiths, Tallow Chandlers 
 and Barbers, and similar occupations, are generally 
 good risks. Engravers, Jewelers, and the like, are 
 liable to the diseases of sedentary life, but are other- 
 wise unobjectionable. Brewers, Confectioners, Dyers, 
 Hatters, Bakers, and others whose business involves 
 constant exposure to warm vapors, often impregnated 
 with medicinal or poisonous substances, are not as 
 desirable. Chemists, Assayers, Gilders, Tobacconists, 
 etc., are liable to the same objection. Day Laborers, 
 unless exposed f.o accident, are equally as good risks 
 as mechanics. Agricultural Laborers, in salubrious 
 localities, are the highest order of desirable applicants. 
 The best lives, other things being equal, are those 
 of persons engaged in out-door and yet protected em- 
 ployments, where the occupation is somewhat seden- 
 tary, and yet combined with a certain amount of mus- 
 cular exercise, with pure air, and variation enough to 
 secure a stimulating impression upon the system. 
 Inertia, indolence, and absolute uniformity of me- 
 teorological influences, are as prejudicial as over- 
 exertion and atmospheric vicissitudes. 
 2 
 
II. 
 
 The Age, Different ages predispose to particulai 
 diseases. So, also, hereditary diseases, according to 
 their kind, may be outgrown, or not yet arrived at. 
 
 During the period of increase, extending to about 
 the twenty-fifth year, (varying, of course, in indi- 
 viduals,) the tendency to disease and death is propor- 
 tionately very great. One-tenth of all children born 
 die the first month. In large towns, nearly one-half 
 die before the fifth year. Respiratory and strumous 
 diseases are especially fatal between puberty and the 
 age of maturity placed at twenty-five. None 
 should be insured before puberty, except at extra 
 rates. Between that period and maturity, the party 
 demands especial investigation of the respiratory and 
 glandular systems. Continued fevers, of the typnoid 
 type, are also liable to be destructive during this pe- 
 riod. The exanthems readily implant the germs of 
 phthisis and other strumous disorders. 
 
 Rheumatism, if it now occurs, in consequence, per- 
 haps, of the excessive activity of the sanguineous 
 system, is exceedingly liable to beget organic disease 
 of the cardiac valves, with its subsequent results. 
 
 From the twenty-fifth year to the thirty-fifth, or 
 fortieth, or age of maturity, the best risks, c<eteris 
 paribus, are chosen. During this period, the applicant 
 stands more, so to speak, on his own individuality. 
 Hereditary predispositions affect him less, and external 
 agencies are easiest resisted when tending to disease 
 The habits and external influences now require mo r 
 careful survey. 
 
'9 
 
 From the fortieth year, at latest, decline commences. 
 Hereditary diseases regain their dangerous tendency, 
 and acute affections are met with less power of resist- 
 ance. Yet, acute diseases of various forms are less to 
 be dreaded than during the mobile years previous to 
 maturity. The progress of changes in the system is 
 slower, and the tendency is to congestions rather than 
 inflammations ; to urinary diseases ; to fatty degenera- 
 tions ; to cardiac and other obstructions from undue 
 deposits ; to dropsies, apoplexies, paralyses, and the 
 like. 
 
 The following table shows the expectations, or 
 average duration of life of each individual, calculated 
 from the Carlisle table of mortality : 
 
 AGE. 
 
 EXPECT- 
 ATION. 
 
 AGE. 
 
 EXPECT- 
 ATION. 
 
 AGE. 
 
 EXPECT- 
 ATION. 
 
 AGE. 
 
 EXPECT- 
 ATION. 
 
 
 
 38.72 
 
 18 
 
 42.87 
 
 35 
 
 3I.OO 
 
 52 
 
 19.68 
 
 I 
 
 44.68 
 
 "9 
 
 42.17 
 
 36 
 
 30.32 
 
 53 
 
 I8. 97 
 
 2 
 
 47-55 
 
 20 
 
 41.46 
 
 37 
 
 29.64 
 
 54 
 
 18.28 
 
 3 
 
 49.82 
 
 21 
 
 40.75 
 
 38 
 
 28.96 
 
 55 
 
 17.58 
 
 4 
 
 50.76 
 
 22 
 
 40.04 
 
 39 
 
 28.28 
 
 56 
 
 16.89 
 
 5 
 
 51.25 
 
 23 
 
 39-3 1 
 
 40 
 
 27.61 
 
 57 
 
 16.21 
 
 6 
 
 51.17 
 
 2 4 
 
 38.59 
 
 4 1 
 
 26.97 
 
 58 
 
 15.55 
 
 7 
 
 50'80 
 
 25 
 
 37.86 
 
 42 
 
 26.34 
 
 59 
 
 14.92 
 
 8 
 
 50.24 
 
 26 
 
 37-H 
 
 43 
 
 25.71 
 
 60 
 
 H-34 
 
 9 
 
 49-57 
 
 27 
 
 36.41 
 
 44 
 
 25.09 
 
 61 
 
 13.82 
 
 10 
 
 48.82 
 
 28 
 
 35.69 
 
 45 
 
 24.46 
 
 62 
 
 13.31 
 
 ii 
 
 48.04 
 
 2 9 
 
 35.00 
 
 46 
 
 23.82 
 
 63 
 
 12.81 
 
 12 
 
 47.27 
 
 30 
 
 34-34 
 
 47 
 
 23.17 
 
 64 
 
 12.30 
 
 13 
 
 46.51 
 
 31 
 
 3368 
 
 48 
 
 22.50 
 
 65 
 
 11.79 
 
 4 
 
 45-75 
 
 32 
 
 33-3 
 
 49 
 
 ( 2I.8l 
 
 66 
 
 11.27 
 
 '5 
 
 45.00 
 
 33 
 
 32.36 
 
 50 
 
 '21.11 
 
 67 
 
 10.75 
 
 16 
 
 44.27 
 
 34 
 
 31.68 
 
 5i 
 
 20.39 
 
 68 
 
 10.23 
 
 17 
 
 43-57 
 
 
 
 
 
 
 
 Other tables vary this expectation from one to two per cent. 
 
20 
 
 But it should be recollected that, in individua. 
 cases, the expectation of life may be increased by pass- 
 ing beyond certain ages a fact wholly ignored by the 
 tables. Thus, for example, where there is clearly an 
 hereditary tendency to phthisis when parents, or 
 brothers or sisters have died of the disease before 
 twenty-five or thirty, and the party has lived, and is 
 now in good health, at the age of forty, half the danger 
 may be said to have passed ; at fifty, three-fourths or 
 four-fifths ; and at sixty, but a mere modicum re- 
 mains certainly not over one-fifteenth or twentieth, if, 
 indeed, it may be said to exist beyond that of other 
 persons without hereditary predisposition of any sort. 
 
 On the contrary, the tendency to gout, urinary dis- 
 eases, insanity, apoplexy, paralysis, etc., increases 
 with the progress of declining years. 
 
 It is safe to say that, when tables indicate a pro- 
 gressive diminution of the life expectation, this idea 
 should be modified and corrected by a full understand- 
 ing of the hereditary, constitutional, or acquired 
 tendency to, or relief from, special forms of disease. 
 
 III. 
 
 The Marriage Relation suggests hygienic influences 
 so obvious that it is unnecessary to delay in its con 
 sideration. Married men are usually the most desira- 
 ble risks. General statistics show that even with 
 females, the dangers incident to maternity do not ma- 
 terially impair the risk. A woman who has once 
 borne a child with no extraordinary difficulty, is a 
 
21 
 
 better risk than the primipara, and married women than 
 those who are unfortunately single. The circum- 
 stances of previous labors, if any have occurred, 
 should be fully understood, and reference had, if 
 possible, to the attending physician. 
 
 In large towns and cities, applications are frequently 
 made by those neither married nor single, for insurance. 
 These applications are not infrequently made by 
 " housekeepers," who, having passed the heyday of 
 their years without physical impairment, save that 
 which years may bring, become solicitous of providing 
 by endowment for later old age, or else for the support 
 of dependants. These cases are not desirable, neither 
 is it necessary utterly to refuse them. But the most 
 rigid investigation is requisite before they are recom- 
 mended. 
 
 IV. & V. 
 
 Sobriety and Temperance Use of Opium, etc 
 
 The habitual drinker of alcoholic spirits, or the ha 
 bitual opium-eater, should, as a rule, be rejected. The 
 inquiry proposed to the applicant will rarely secure a 
 correct answer. Very few will voluntarily admit either 
 intemperance, gluttony, or other generally recognized 
 vice. The Medical Examiner is expected to guard 
 the interests of the Company and co-insurers, by ob- 
 serving carefully the signs of excessive stimulation, 
 as, unfortunately, too often furnished by votaries of 
 Alcohol, Opium, Chloroform, Ether, Cannabis Indica, 
 and the like. The consumption of other stimulants 
 and narcotics besides alcohol, has notably- we might 
 
22 
 
 well say enormously increased within several years 
 past. The alcoholic breath is readily detected, but 
 equally clear to the educated perception is the effect 
 of other narcotics and stimulants. Too often the 
 applicant is induced to apply for assurance, by self- 
 consciousness of his indulgence in some pernicious 
 method of excitement, which he knows tends to short- 
 en life, but which he vaguely believes he can abandon 
 or control before it is too late. 
 
 INTEMPERANCE, by which we mean not merely drunk- 
 enness, but an inordinate, pernicious habit of stimula- 
 tion by something, is, as likely as rheumatism, gout, 
 insanity, or tuberculosis, to be hereditary. 
 
 The family history here becomes noteworthy. A 
 tuberculous tendency may be, to a certain extent, con- 
 trolled by hygienic influences ; among which may be 
 numbered the use of stimulants of various kinds. 
 The rule for the Medical Examiner is this : If the 
 stimulant taken invigorates digestion and assimilation, 
 then it is not cause for rejection : if it merely excites 
 the nervous system, it is an objection to the risk. 
 Observe invigoration of digestion and assimilation 
 (real power) is not to be confounded with mere in- 
 crease of adipose tissue, which is often indicative of 
 depression of nutritive energy. 
 
 Is the party an occasional or an habitual tippler ? 
 There are some men who indulge in only an infrequent 
 debauch, and in the interim are strictly temperate. Such 
 a habit, if ascertained, impairs materially the risk. 
 
 The habitual drunkard is well described by Dr. 
 Brinton : " The chief characteristics one can briefly 
 
express in words, are the fiery, unctuous skin, with its 
 secretions reeking with volatile, fatty acids ; the red 
 and ferrety eyes, with their fitful glare, rather than 
 gleam ; the furred tongue ; the fetid breath, and the 
 trembling limbs, that often announce the impression 
 made by the copious habitual ingestion of alcohol on 
 the stomach and nervous system respectively." 
 
 Other suggestive appearances are afforded by sunk- 
 en eyes surrounded by dark circles ; pallid, or even 
 waxy complexion ; moist, sticky skin ; emaciation ; 
 tremulousness of the muscles, unless rendered tem- 
 porarily tense by a full dose of the stimulant ; a ner- 
 vous restlessness of the whole person ; often abstrac- 
 tion of mind, etc., etc. Many times the party will 
 temporarily conceal the habit, or even persuade him- 
 self it does not exist to an injurious extent; hence the 
 necessity for great caution. The friend's certificate 
 here becomes indispensable, and the attending physi- 
 cian's testimony should not be overlooked. 
 
 Habitual opium-eating does not show such easily 
 described and unmistakable marks, yet can rarely be 
 concealed from an observer of ordinary sagacity, whose 
 attention is directed to the point. 
 
 Notwithstanding the singular character of the testi- 
 mony in the Earl of Mar's case, in England, in 1832, 
 it is safe to say that opium-eating lessens the expecta- 
 tion of life, and is, therefore, a valid reason for de- 
 clining the risk. Undue nervous irritability ; a 
 peculiar, shuffling gait ; flabby muscles ; drooping 
 eyebrows, with dark lower lids, while the eye itself 
 seems to sink and grow dim ; with general marks of 
 
old age ; or else, while the stimulant has full effect, 
 excitement with brilliant eyes, but contracted pupils ; 
 quick, restless movements ; or, sometimes, in differ- 
 ent temperaments, general dullness, lassitude, sleepi- 
 ness, and a relaxed skin, with sticky perspiration, and 
 husky voice. When the applicant says he has a diar- 
 rhcea or dysenteric difficulty which requires occasional, 
 doses of opium, when the eyes are hazy, and the 
 tongue has a whitish coat ; when there is a mucous 
 secretion from the eyes, with frequent hawking of 
 mucus from a flabby mucous membrane of the 
 pharynx, and perhaps of the nose. When he is a 
 married man, and with these symptoms, has no chil- 
 dren, carefully observe and reject him. Much must 
 be left to professional discretion but cave canem. 
 
 Vaccinated? A person who has never been vacci- 
 nated or had the small pox, should not be accepted. 
 If vaccinated, the inquiry should be : Was the vacci- 
 nation successful ? and then, how recently was the 
 operation performed ? A successful vaccination many 
 years previous, is not sufficient, but if it has been lie- 
 quently repeated without infection, the case may be 
 deemed clear. In doubtful cases, examine the cica- 
 trix, or re-vaccinate at once. If small pox or vario- 
 loid has occurred, it requires especial caution as to the 
 condition of the lungs and intestinal mucous mem- 
 brane. The date when it occurred should be given, 
 and the fact of perfect or imperfect recovery noted. 
 
VII. & VIII. 
 
 Residmice in a Foreign Climate, Without ex- 
 act reference to isothermal lines, natives of the zone 
 extending from the thirtieth to the fiftieth parallels of 
 latitude, may be considered as the best risks. An ac- 
 quaintance with the meteorological condition of par- 
 ticular localities, is of great importance. Excessive 
 thermometrical, barometrical and hygrometrical varia- 
 tions, in any particular locality, usually impair risks, 
 by rendering them subject to various diseases. 
 
 Thus, moist, warm situations usually involve the 
 malarious diseases ; cold, or variable, and moist re- 
 gions are prolific of tuberculous cachexiae ; dry (yet 
 variable in temperature) districts, render rheumatic 
 and inflammatory diseases more dangerous. On equal 
 parallels-, the temperature of Europe is higher than 
 that of America, and excepting the influence of the 
 changes produced by cultivation, present the diseases 
 of lower climates in higher latitudes. General tem- 
 peraments are varied by persistent climatic influences. 
 (Fid. p. 6 1, et seq.) 
 
 ACCLIMATION IN THE SOUTH.- Whilst men, almost 
 alone of animals, can range from the Equator to the 
 f< open Polar Sea," with apparent impunity, by observ- 
 ing certain precautions which their reason and knowl- 
 edge suggest, nevertheless, they subject themselves, 
 sooner or slower, to organic changes which are termed 
 briefly "acclimation." These changes render them less 
 iable to the acute diseases of localities, or endemics 
 
26 
 
 but they are fraught with much significance to tne 
 insurance examiner. 
 
 More than two thousand years ago, the naturalist 
 Pliny noticed that " those who are seasoned can live 
 amid, pestilential diseases." The reason of this mav 
 be a matter of speculation, but of its essential truth 
 there can be no doubt. The organic changes thus 
 brought about express themselves in the larger phase 
 of different races of men, begotten through the opera- 
 tion of ages of similar influences acting on parent and 
 progeny. 
 
 Without descending to minutiae, it may be said the 
 Northerner going South may become, to a certain ex- 
 tent, acclimated by physical changes in the skin, liver 
 and spleen, especially involving their heightened ac- 
 tivity of interstitial change, and, usually, increase in 
 bulk. Increased activity of any organ, according to a 
 well known natural law, involves greater tendencv to 
 disease. If, instead of more energetic action of the 
 skin, there is less, from any temporary or permanent 
 cause, then the mucous membrane of the intestine will 
 be called into excessive activity, and the acute or 
 chronic diarrhoea of tropical climates be produced. 
 Else there are the cc bloated belly, distorted features, 
 dark yellow complexion, livid eyes and lips ; in short, 
 all the symptoms of dropsy, jaundice and ague, united 
 in one person/' 
 
 Coming North, the comparatively healthv Soutnron 
 tails an easy victim to tuberculous, nephritic, and in- 
 flammatory diseases. The rule is to observe the rela- 
 tive activity and development of each organ ot 
 apparatu involved whatever the cause of variation. 
 
27 
 
 Acclimation to the so-called malarious fevers, etc., of 
 the South, gives no immunity to YELLOW FEVER, anv 
 more than does typhoid fever from variola at tne 
 North. Yellow fever is a disease of cities and towns 
 epidemic usually, and requires its especial prophylaxis 
 not gained by any mere acclimation. As Dr. Not: 
 emphatically writes : " The citizen of the town is 
 fully acclimated to its atmosphere, but cannot spend a 
 single night in the country without serious risk of 
 life ; nor can the squalid, liver-stricken countryman 
 come into the city during the prevalence of yellow 
 fever, without danger of dying with black vomit." 
 
 The immunity from second attacks of yellow fever 
 is nearly complete, yet the constitution is liable to 
 permanent impairment from its ravages, and in all cases 
 organic diseases are carefully to be looked for. 
 
 The immunity from diseases prevalent in particula- 
 localities often exhibited, in exceptional cases, is due 
 principally to two causes : First, The peculiar organi- 
 zation of the individual himself; and, Second, The 
 care with which he adapts his life, manners and cus- 
 toms to his changed surroundings. As Dr. Ham- 
 mond remarks : " For an Englishman or an Ameri- 
 can to attempt a residence in latitude 80 without 
 changing his food, clothing or habits, by making them 
 conform to the climate to which he has come, would 
 lead to but one termination death. But if he 
 studies the conditions by which he is surrounded, and 
 profits by the experience of those to whom it is nat- 
 ural, he becomes habituated to the new order of 
 and lives in health and comfort." 
 
28 
 
 The same law holds good with reference to a change 
 to hot climates. Hence, he who has shown, by actual 
 experience, that he has maintained good health in 
 either extreme of latitude, may be more safely in- 
 sured, cr, if already insured, be granted permission, 
 more readily, to take up a Northern or Southern 
 residence. 
 
 Nearly the same law holds good with regard to yel- 
 low fever or other epidemic disease the best pro- 
 phylaxis is for the individual so to shape his habits as 
 to keep well and he who will attempt this, is the 
 best risk. 
 
 IX. & X. 
 
 Employed in the Army or Navy? --The careful 
 
 examination to which the recruit is ordinarily subjected 
 before being mustered into the service, is a point in 
 his favor, if he was received. Questions then arise as 
 to the influence of the service upon him. The 
 diseases to which he has generally been exposed are 
 principally " typho- malarial fever," rubeola, camp 
 diarrhoea, dysentery, rheumatism, scorbutus, pneu- 
 monia, catarrh, cardiac changes, Bright' s disease, and 
 not least, venereal affections. 
 
 An individual who has escaped permanent systemic 
 or organic disorder, from these various causes, may 
 generally be put down as a good risk, even though his 
 personal or family history is not every way satisfac- 
 tory. Nevertheless, the obscure results , often capable 
 of discovery on rigid examination, require more than 
 usual care, before accepting the applicant. 
 
2 9 
 
 In my own experience, 1 have often found cardiac 
 and renal diseases, and the secondary or tertiary forms 
 of syphilis in returned soldiers, discoverable only 
 after most careful scrutiny. The exposures and ex- 
 igencies of the service involve the most potent causes 
 of organic disease, even though the elasticity of many 
 systems prevents immediate manifestation of striking 
 symptoms. 
 
 PREVIOUS EMPLOYMENTS, AND THEIR EFFECT ON 
 HEALTH. The present occupation may be ordinarily 
 innoxious, but the previous employments have left 
 lasting traces of injurious influence. So, again, the 
 present business may be such as to endanger the 
 health generated by previous healthful engagements. 
 The peculiarities of the individual here require cau- 
 tious investigation. ( Via. Occupation. ) 
 
 XI. 
 
 Has the Party had any of the following Diseases? 
 
 Fits, 
 
 Fistula, > 
 
 Gout, 
 
 Insanity, 
 
 Liver Complaint, 
 
 Paralysis, 
 
 Palpitation, 
 
 Quinsy, 
 Rheumatism 
 Rupture, 
 Scarlet Fever, 
 Spitting of Blood, 
 Diseases of the Urinaty 
 Organs. 
 
 Apoplexy, 
 
 Asthma, 
 
 Bronchitis, 
 
 Consumption, 
 
 Cholic, 
 
 Diphtheria, 
 
 Disease of the Heart, 
 
 Dropsy, 
 
 Seriatim. A party who has had a decided attack 
 of APOPLEXY should be rejected. Evident tendency 
 Thereto also should disqualify. 
 
 ASTHMA is but a symptom it may or may riot be 
 a cause of absolute rejection. Each case requires 
 specific examination. 
 
30 
 
 Observe Asthma may occur merely from local 
 irritants applied to the respiratory surface, and the 
 causes of such local irritation may depend upon mere 
 idiosyncrasy. Or it may depend upon blood poison- 
 ing of various kinds. Thus particles of hay, soot, 
 excessive moisture, atoms of certain gases, anima. 
 emanations, ipecacuanha and other medicinal substances 
 are capable of producing more or less severe spas- 
 modic asthma. Such cases, irrespective of organic 
 lesion, do not necessarily disqualify from insurance. 
 Some persons always have asthma in certain locali- 
 ties never in others. Thus C. cannot stay a single 
 night in Ann Arbor, Mich., without a severe par- 
 oxysm of asthma ; yet he has lived years in Detroit, 
 only 37 miles distant, without a single attack. A., 
 well known to me, lives in California with perfect 
 health and freedom from the disease, whereas, in the 
 Northern United States, he is a constant sufferer. 
 These individual peculiarities, and the suffering they 
 generate, are the best guarantee that the party will 
 himself protect the interests of the Company. Nearly 
 the same remark may be made with reference to 
 asthma from blood poisoning prominent among the 
 causes of which we may mention malaria, or such 
 other causes as promote portal venous congestion. 
 Alcoholic stimulants, and sometimes even unexpected 
 articles, as sugar, will occasionally produce the same 
 result. Here the persistence of the cause must gov- 
 ern the judgment. None of these cases wholly 
 preclude acceptance of the risk. 
 
 Again, asthma may depend upon reflex causes 
 totally independent of permanent organic disease. It 
 
3' 
 
 may alternate with ague, or other periodical disorders 
 It may depend on uterine, vesical, rectal, or even 
 gastric disorder. It may be dependent solely on an 
 excitable temperament and emotional influences. The 
 gravity and permanence of the excito-motor cause 
 here must be sought out, and only its due importance 
 attached But Asthma, which is the symptom of 
 cardiac obstruction of tuberculosis of emphysema of 
 acute or chronic bronchitis of thoracic tumors or, 
 perhaps, aneurism of hepatic venous obstruction from 
 thoracic disease, or parenchymatous change in the 
 liver itself or from organic cerebral or spinal change^ 
 should utterly preclude insurance. 
 
 BRONCHITIS. A proclivity to attacks of bronchitis 
 should disqualify, not only from the dangers of un- 
 complicated bronchitis, but because it is so often 
 symptomatic of the tuberculous diathesis. Again, as 
 indicative of nephritic, cardiac, gastric, or other dis- 
 eases of remote organs, or those from septic causes, 
 (typhoid, syphilis, etc.) It may be observed, how- 
 ever, that bronchitis may, and often does, leave a 
 condensation of a portion of the pulmonary vesicular 
 structure, simulating tubercular deposit, and again, 
 that it may leave behind dilatations of the tubes, 
 which simulate very closely excavations from tuber- 
 cular softening. Resulting emphysema should be 
 carefully searched for, and its fallacious resonance not 
 confounded with healthy lung-vesicular structure. 
 Popularly, simple pharyngitis, and all slight or severe 
 catarrhal inflammations, are merged in the general 
 term bronchitis ; so that the information conveyed bv 
 
the patient's own statement is of very little practical 
 value. 
 
 CONSUMPTION. The rule is absolute that consump- 
 tive cases should be rejected. Physical investigation 
 is always to be exact, for the healthiest external ap- 
 pearance may but hide the germs of the disease. 
 
 CHOLIC. This term indicates but a symptom, the 
 significance of which depends solely upon its cause. 
 Taken in its widest sense, we may say that at the 
 present time, improved methods of diagnosis and 
 treatment, have robbed the disease of its formerly 
 dangerous character, and unless proceeding from 
 peculiar causes, it need not be considered a cause for 
 rejection. The well known forms are the gastric, 
 intestinal, hepatic, nephritic, and that from lead, or, 
 perhaps, also, copper poisoning. The cholic of flat- 
 ulency, or temporary dyspepsia, does not particularly 
 enhance the risk neither does the so-called bilious 
 cholic, unless the patient is peculiarly subject to it. 
 If, however, the latter evidently depends upon the 
 passage of gall-stones, and frequently recurs, it is a 
 cause foi rejection. Where painter's, or other metallic 
 cholic has occurred, it is not, alone, to be considered 
 cause for rejection, unless it has recurred, and partic- 
 ularly, the same occupation has been continued. The 
 l ead worker who has had this cholic, and continues in 
 the business, should be rejected. A single attack of 
 nephritic cholic need not reject recurrence, even at 
 a distant interval of time, should exclude. Many so 
 called cases of cholic are really enteritis, and may in- 
 dicate marasmus. The local and general evidences of 
 
3J 
 
 tuberculosis of the mesenteric glands, must be inves- 
 tigated. 
 
 CARDIAC DISEASE. Organic disease of the heart 
 positively excludes. Physical diagnosis is indispensa- 
 bie nere, but it should be recollected that, as a' rule, 
 while the healthy heart may, from accidental causes, 
 give an abnormal sound temporarily, the heart dis- 
 eased to such an extent as to reject, can not, for any 
 continuous period, give forth healthy sounds. Ab- 
 normality in rhythm or impulse may depend solely 
 upon temporary causes, and so, also, may abnormality 
 of sound but when these are present, the parts 
 should always be re-examined. Variations in rhythm 
 or impulse may be individual peculiarities, and there 
 are evidences that varied sounds may also depend upon 
 idiosyncrasy, but the safer rule is never to accept the 
 party, unless the natural sounds may be heard. When, 
 from any cause, cardiac disease has frequently occurred, 
 and abnormalities are present, the party should be 
 turned over to invalid companies. 
 
 DROPSY. This is another symptom which may, or 
 may not, be of importance. If present at the time 
 of examination, no chances should be taken, but the 
 party advised to postpone the application. It may 
 nave been a sequence of malarious disease as often 
 from ague if there be not now malarial cachexia, it 
 is no cause of rejection but if hepatic or splenic 
 parenchymatous disease remain, the applicant should 
 be rejected or postponed until that is cured. It may 
 have been left behind by scarlatina, or other zymotic 
 disease if it has not recurred, and the evidence of" 
 3 
 
34 
 
 nephritic, cardiac, or other organic disease do not re- 
 main, it is not cause for rejection. It may have 
 resulted from peritonitis, which has been entirely re- 
 covered from if so, the party may be received. If 
 from chronic peritonitis, it is cause for rejection. If 
 it occurs from renal (Bright's) disease, from perma- 
 nent hepatic, cardiac, or pulmonary organic affection, 
 the party cannot be assured. The dropsy from 
 drunkard's liver, (cirrhosis} vitiates the application. 
 
 Aside from constitutional causes, the effusion into 
 the pericardium is more grave in insurance prognosis, 
 than that into the pleural cavity. The latter than 
 ascites, and ascites than that into the areolar tissue, 
 osdema, anasarca, etc. But local anasarca always ne- 
 cessitates the greatest care, lest albuminuria be present 
 or impending, or lest some permanent organic disease 
 is its origin. Any constitutional cachexia, as syphilis ; 
 in connection with the dropsical effusion, even though 
 organic disease may not be discovered, precludes 
 insurance. 
 
 DIPHTHERIA, aside from its immediate danger, ma) 
 lay the foundation of tuberculosis may be followed 
 by albuminuria or dropsical effusions, or more or less 
 permanent paralysis. It is not usually mentioned in 
 the list of diseases about which the party is ques- 
 tioned, but its grave sequelae entitle it to thorough 
 consideration. 
 
 FISTULA. Fistulas are of importance, as indicative 
 of local or general disease, or both. Locally, they 
 may indicate the presence of a foreign substance at 
 the bottom, as more particularly a bit of dead bone, 
 
35 
 
 or cartilage. In each of these instances the surgical 
 pathology becomes the prime point of inquiry. 
 
 The cause and extent of the necrosis whether of 
 bone or cartilage. The location of the bullet, or 
 splinter, bit of cloth, or whatever it may be. The 
 surgical curability of the salivary, faecal, urinary, etc., 
 false outlet, with the question of its cause. So also 
 of the mechanical action of muscles. The import- 
 ance of the organ reached by the fistulous opening 
 may have much to do with the decision of the case, 
 e. g. bone, gland. Some Life Companies vaguely in- 
 struct their examiners that Fistulas are a positive cause 
 of rejection. In this case FISTULA IN ANO is, evi- 
 dently, the difficulty intended. But whether fistula in 
 ano should reject depends wholly upon its cause and 
 extent. 
 
 First If it is among the signs of tuberculosis, it 
 should certainly reject whatever opinion may be 
 entertained as to its hastening or retarding the 
 tuberculous development. 
 
 Second If it has proved obstinate under correct 
 treatment, it should disqualify. 
 
 Third If it is large, burrowing, and exhausting, 
 it is ample cause for rejection. 
 
 But if it is traceable to ulceration of the part from 
 merely local or temporary causes, as haemorrhoids, 
 acute dysentery, or direct mechanical injury without 
 evidences of the tuberculous diathesis, or remote or- 
 ganic disease if it has proved amenable to appropri- 
 ate treatment, and is no longer a cause of exhaustion, 
 it should not reject the risk. Personally, the opinion 
 
36 
 
 of the writer is that, with the improved surgica 
 methods of the present time, too much significance 
 has been attached to this usually strictly local difficulty. 
 FITS. Under this general and vague designation, 
 the insurance forms prominently intend Epilepsy in its 
 various phases. When Epilepsy is clearly present, 
 whatever its degree or frequency of manifestation, it 
 utterly disqualifies. Not that it necessarily shortens 
 life per se, but because even without this usual result 
 it may impair the mental faculties, or dispose to acci- 
 dents, which essentially impair the risk. The epilepti- 
 form convulsions of primary dentition, and the 
 changes incident to that epoch, if they have not man- 
 ifested a disposition to return, or injured the mental 
 faculties, or involved paralyses, in later life do not 
 disqualify. The irregular muscular contractions of 
 simple Hysteria, unless connected with organic dis- 
 ease, or general cachexia, do not prevent acceptance. 
 Males of nervous temperament sometimes manifest 
 symptoms very like those of Hysteria with its queer 
 symptoms such cases should be carefully investigated, 
 but these symptoms do not necessarily disqualify. 
 Youths of both sexes about and after the age of 
 puberty for several years may exhibit mild or severe 
 epileptiform symptoms, or even decided periodical 
 convulsions, yet if these either spontaneously, 01 
 under treatment subside, it may be laid down as a rule 
 that if after several years they do not recur, the risk 
 is a good one. The age of twenty-five in the male 
 and twenty-three in the female may l>e considerc' 
 critical in this regard. 
 
37 
 
 CHOREA, in all particulars, may be regarded as 
 identical with the "fits" of the formulary, so far 
 as its pathology and influence upon longevity is 
 concerned. 
 
 GOUT, of chronic character, and particularly, if in 
 any degree hereditary, disqualifies. But it does not 
 follow that all sore toes are gouty. Analysis of in- 
 dividual cases is indispensable. The habits of life, 
 and surroundings, will attract the attention of the 
 examiner. The Dyspepsia and general malaise 
 discoverable by examination are of more significance 
 to the cautious medical agent of the Company. 
 
 INSANITY does not always tend to shorten life 
 directly, but if present disqualifies on account, first^ 
 of disease of central nervous organs which it indi- 
 cates : and, second^ because of the greater liability to 
 accidental death which the withdrawal of healthful 
 reason involves. It is to be distinguished from the 
 delirium of temporary disease, and from mere eccen- 
 tricity. Malarious diseases are not infrequently fol- 
 lowed by an interval of insanity, sometimes of the 
 most active character, and yet which recovered from 
 tends not an hour to shorten life. Of this the 
 writer's personal experience has given him abundant 
 evidences. Such cases need not necessarily be 
 rejected. The puerperal state often, also, involves 
 this condition with similar prognosis ; but if puer- 
 peral insanity have occurred, it is better not to insure 
 unless the grand climacteric has been passed. Hered- 
 itary insanity, and a single attack in the individual, 
 or marked proclivity thereto, or where it is as evident 
 
in the family connection as other hereditary diseases 
 adverted to should reject. The well balanced mine 1 
 cannot contemplate suicide without horror, but the 
 evidences are abundant that oftentimes murder and 
 suicide may be the only manifestations of the hered- 
 itary taint of insanity, and, therefore, although preg- 
 nant signs of mania in any of its forms may be 
 absent, and general good health apparent, the risk 
 should nevertheless, in such cases, be declined. Yet 
 justice to applicants requires, when insanity is men- 
 tioned as having occurred in the connection, that the 
 particulars of the case be inquired into. It may occur 
 that the instance was one from some incidental, and 
 not hereditary cause. It may have arisen from local 
 injury, from septic poisoning of the blood, or, per- 
 haps, have been merely senile mental decay, etc., 
 in either instance, not invalidating the risk. Other 
 things being equal, the actual presence of insanity will 
 lessen the chances of longevity to one-fifth or one-sixth 
 the healthy standard. 
 
 LIVER COMPLAINT. Hepatic diseases are to be 
 looked for in those who are, or have been residents of 
 malarious districts ; in spirit drinkers ; and those of 
 the technical bilious temperament, i. Enlargement of 
 the liver, if from portal venous congestion, may not in- 
 validate the risk ; if from hepatic venous congestion,, it is 
 a sign of disease pregnant with danger, and while pres- 
 ent should absolutely reject. The hobnail or drunk- 
 ards* liver (cirrhosis) should reject. As an isolated 
 symptom, the contracted or small liver is more sus- 
 picious than the enlarged one. Persistent hepatic 
 
39 
 
 disorder, points prominently to tuberculosis, fatty 
 degeneration, cirrhosis, or malignant diseases, either 
 of which will disqualify. Adjacent tumors may, more 
 or less, permanently, obstruct the passage of bile, or 
 directly interfere with the action of the organ. Of 
 course, these should reject. Abscesses present reject; 
 but, if formerly existent, and now fully recovered 
 from, are to be judged of from their causes and effect 
 upon the system. The abscess, from local or acci- 
 dental cause, has less significance than that from 
 pyaemia; the latter than that from abnormal deposit,, 
 as of tubercle, cancer, etc. Recurring abscesses dis- 
 qualify, whatever the cause. A tendency to the forma- 
 tion of gall-stones, with ileus or jaundice, if recurrent,, 
 should be an obstacle to approval. 
 
 JAUNDICE, while present, postpones acceptance. If 
 dependent on hepatic venous congestion, it rejects. If 
 it depended simply on portal congestion, as occuring in 
 malarial or other fevers, it is comparatively trivial. 
 Observe, it is only a symptom, and its real meaning 
 necessitates examination and judgment. Thus it may 
 appear as a consequence of a catarrhal condition of the 
 bile ducts ; or as the result of impaction of gall-stone, 
 or the mechanical pressure of tumors ; faecal accumula- 
 tions in the colon ; from lumbricoid worms in the 
 common duct, etc. Or it may be an evidence of ma- 
 lignant degeneration, or of permanent organic disease, 
 as tuberculous, fibroid, fatty or amyloid degeneration, 
 etc. From the largely more frequent causes of this 
 symptom being temporary, and not permanent in ope* 
 ration, the isolated symptom 'may be considered as 
 
4 o 
 
 suggestive of investigation, and not as a reason by 
 itself for rejection. 
 
 PARALYSIS, whether simply local, paraplegic, or 
 hemiplegic, demands the most scrupulous examination. 
 Hemiplegia or paraplegia, if present, totally disqualify. 
 But if formerly present, as clearly the result of some 
 merely temporarily acting cause, and this cause has 
 been entirely removed, e. g. infantile neurosis, acci- 
 dental lesion, hysteria, etc., it may be passed over. 
 When combined with cardiac disease, or the apoplectic 
 diathesis, even though there be apparent health, it 
 should reject. The import of the local cause is the 
 important point of inquiry. Local paralysis may oc- 
 cur from local injury, local tumor, or similar cause, 
 and not disqualify. When present, and not clearly 
 explicable as the result of a removable or innoxious 
 local cause, it should reject. 
 
 PALPITATION of the heart is a symptom of little sig- 
 nificance. Always noted among the list of symptoms 
 about which the patient is questioned, it really is of 
 no importance, save as directing attention toward or- 
 ganic disease of the heart, or toward dyspepsia or dis- 
 orders of innervation. Taken by itself, it is a symptom 
 which attracts attention to its possible cause, but 
 neither accepts nor rejects. 
 
 QUINSY, or Tonsillitis. This local affection is prin- 
 cipally important as one of the evidences of the tuber- 
 culous diathesis. It is capable, it is true, of producing 
 death by mechanical occlusion of the respiratory pas- 
 sages, but this is so rare an accident that, practically, 
 it may be neglected in calculating the chances of the 
 
risk. The same remark may be made as with refer- 
 ence to the danger of lancing the swollen tonsils. B\ 
 this little operation, branches of the carotid artery may 
 be wounded, and death result, just as death may result 
 from choking while eating. But when the party ad- 
 mits being subject to this difficulty, local examination 
 should be made with the tongue spatula, or better still, 
 the laryngoscope. 
 
 RHEUMATISM. Frequent and aggravated attacks 
 of rheumatism, even though important internal organs 
 may not have been previously involved, should dis- 
 qualify. Hereditary rheumatism impairs the risk. 
 It is a disease, so far as danger is concerned, character- 
 ized by its tendency to affect particularly the white 
 fibrous tissues. Thus, the cardiac valves, the pericar- 
 dium, the dura mater, etc., become liable to fatal 
 change. Uric and sulphuric acids are largely abundant 
 in the secretions, and the blood becomes abnormally 
 fibrinous. The real danger of this diathesis is, in the 
 first place, from acute changes which may involve 
 speedy dissolution, or from deposits which necessitate 
 grave organic disease which may, later, cause sudden 
 or gradual death. It is capable also of so exhausting 
 the blood itself, as to render the risk a bad one, 
 irrespective of organic change. 
 
 In judging of the effects of the organic diathesis, 
 the atmospheric vicissitudes, and the habits of life of 
 the party must be noted ; next, the ordinary condition 
 of the skin and kidneys ; then, most assiduously, the 
 irritability, or actual organic cnange of the heart 
 structures ; then, the continuance and frequency of 
 -eturn of the symptoms. 
 
42 
 
 Most patients when questioned with regard to the 
 presence of rheumatism, will refer to occasional pains 
 in the muscles, or stiffness in the joints, of a quasi 
 rheumatic character, as being true rheumatism ; the 
 Examiner must observe that these are not intended 
 by the question, else, no person could be considered 
 as exempt. Acute rheumatism, or a decidedly rheu- 
 matic diathesis, is what is to be looked after. A 
 single attack of even inflammatory rheumatism may 
 not disqualify, although it may have been severe. But 
 if metastatic^ it should militate against the risk. If 
 recurrent, as well as metastatic, it should reject. If the 
 case has been progressive, and without being metastatic, 
 has passed on from point to point, and ultimately 
 involved the heart, the insurance prognosis is more 
 grave than in case of mere temporary metastasis. 
 Mere thickening of fasciae or stiffening of the joints 
 from long previous, but not recurrent rheumatism, 
 need not impair the risk neither lumbago, nor even, 
 so-called, sciatica of a clearly chronic rheumatic origin ; 
 but when local paralyses, or temporary or permanent 
 symptoms of apoplexy have resulted, the risk should be 
 rejected. Coagula may be condensed on the roughened 
 cardiac surfaces, and their detachment from time to 
 time determine local paralysis, apoplexiae or even mor- 
 tification, to the extreme astonishment of the superfi 
 cially informed. 
 
 Chronic Catarrhal Affections sometimes p d roxys- 
 mal in character, are often of rheumatic or gouty 
 origin, so also, sclerotitis and even meningitis and 
 maniacal delirium. The quasi rheumatism of mala- 
 rious districts requires particular examination, and so 
 
43 
 
 also, those varieties resulting from gonorrhoea and 
 syphilis each of which may puzzle the practitioner, 
 but must be isolated to judge of its influence upon 
 longevity. 
 
 Metastatic rheumatism rejects; syphilitic rheuma- 
 tism rejects ; especially does recurrent rheumatism of 
 hereditary character reject; chronic sciatica of intense 
 character rejects so also, does severe lumbago, tic 
 doloureux, etc. Whenever rheumatism is acute or 
 chronic, long continued, recurrent, hereditary or 
 accompanied with cachexia, the insurance company 
 must have the benefit of the doubt which naturally 
 arises, and the party be declined. 
 
 Rheumatism is liable to be confounded in diagnosis 
 with erysipelas, gout, trichinous disease and neuralgia ; 
 especially is it liable to be mistaken for phthisis, 
 pleurisy, etc., when occurring in the intercostal mus- 
 cles. Scorbutic pains are very liable to be mistaken 
 for chronic rheumatism. In prognosis, not more than 
 one or two per cent, prove fatal, directly or remotely, 
 and half of these of the latter result. At the present 
 time, from improved methods of treatment, it may be 
 confidently asserted that the disease has been robbed of 
 half of its individual terror, and in its insurance, 
 direct or remote, prognosis, of three-quarters of its 
 significance. 
 
 RUPTURE. The frequency of Hernia in its differ- 
 ent forms, and its inherently dangerous nature, renders 
 this point one never to be overlooked. According 
 to the most general statistics, hernia is to be found in 
 an average of one to every fifteen of the a ^ alt popula- 
 tion. It is about fourteen times more frequent in 
 
44 
 
 males than females, although in the latter it is more 
 dangerous, as they are more subject to the crural form, 
 and again, because from motives of delicacy, they do 
 not as early apply for relief. Hernia progressively 
 diminishes in frequency from birth till puberty, and 
 then progressingly increases with advancing age. Viz : 
 First year i in 21 ; second year i in 29 ; third 
 year i in 37 ; until at the thirteenth year it falls to 
 i in 77. Shortly after this, its frequency rises again ; 
 thus, at the twenty-first year there is i case in 32 ; at 
 the twenty-eighth year i in 21 ; at the thirty-fifth 
 year i in 17 ; at the fortieth year i in 9 ; at the 
 fiftieth year i in 6; from sixty to seventy years i 
 in 4 ; from seventy to seventy-five years i in 3. 
 In women it occurs most frequently during the child 
 bearing years. Umbilical and direct hernia are less 
 dangerous than the inguinal or crural forms ; the 
 latter more so than the inguinal. The irreducible is 
 more objectionable than the reducible; and always, 
 where a truss, of suitable construction fails to prevent 
 descent of the intestine, the risk should be rejected. 
 Cases of double hernia should always be rejected. 
 Observe Occasionally parties suppose they have 
 hernia, when there is simply an enlarged gland, or a 
 fatty tumor, retained testis, hydrocele, etc. Accuracy 
 of diagnosis is here indispensable to protect the rights 
 both of the company and the applicant. Hernia, 
 whether single or double, which has been operated 
 upon and apparently cured, it should be remembered, 
 is liable to recur on gradual absorption of the new 
 formation. This fact will have weight in properly 
 classifying the risk. 
 
45 
 
 SCARLET FEVER. The larger proportion of cases - 
 of scarlatina occur before the insurable age. When 
 it occurs in the adult, its secondary results demand 
 most cautious examination. These not rarely involve 
 breaking down of the constitution, or serious local 
 organic changes, which imperil the risk, and this, al- 
 though the primary attack may have been apparently 
 mild. Taking all the cases together, the mortality 
 from scarlatina is scarcely exceeded by that of any 
 other single form of disease. Consumption and 
 typhoid fever, (including typhus,) only outrank it in 
 fatality. It is said to be even more fatal in Europe 
 than in this country. Fatal as it is in the onset, the 
 medical examiner has more to do with its subsequent 
 ravages upon the system ; and these, it is found, 
 principally depend on primary obstructions to the 
 functional action of the kidneys. Hence, uraemia, 
 dbuminuria, anasarca, dropsy, etc. Again, its local 
 affection of the eustachian tube, and ear may ultimate 
 in destructive caries of the bones, and eventually 
 prove fatal by lesion of the brain. Thus a chronic 
 ottorrhrea, originating from this cause, militates against 
 the risk, although it may not aione positively reject. 
 Of course albuminuria, etc., reject. If the party has 
 had scarlet fever and fully recovered from it, the risk 
 is improved thereby. Many of the Continental Eu- 
 ropeans reply to the examiner that they have had 
 scarlet fever, or that some of their family have died 
 of it, when on careful questioning, it will be found 
 that "maculated typhus" is the disease intended. 
 
46 
 
 Again, many cases of slight roseolar eruption are con- 
 founded with it. Such cases render it necessary for 
 interrogation to be minute and exact in all doubtful 
 instances. 
 
 SPITTING OF BLOOD. Unexplained Hemoptysis is 
 one of the most pitilessly exclusive of historical 
 symptoms. Primarily, because it is one of the earliest 
 precursors of phthisis, and, again, because it tokens its 
 actual existence. So large is the proportion of those 
 exhibiting this symptom whose lives, sooner or later, 
 terminate by consumption, that it is unnecessary to 
 argue from recorded experience, or to appeal to the 
 abundant statistics which have accumulated. Absence 
 of the tubercular taint in the family history, or of 
 concurrent signs in the individual, will not explain it 
 away. Absence of physical signs is scarcely more to 
 
 oe reafctrded. under such circumstances, than those of 
 
 ^ * 
 
 the rational sort. The proof must be positive that 
 the spitting of blood came from other cause than in- 
 cipient or present tuberculosis of the lungs. Negative 
 evidence* u? e in no case sufficient. It must be proved that 
 the blood came from the gums, the nares, the pharynx, 
 the oesophagus or stomach. Or it must be proved that 
 it came from the accidentally abraded larynx, trachea 
 or bronchi ; or that it depended solely on mechanical 
 or surgical injury of the vesicular lung structure ; or 
 that it depended solely on vicarious causes. Dr. 
 Aitken emphatically observes : " Cases are recorded 
 of its so-called idiopathic occurrence, as from variations 
 (suddenly) of atmospheric pressure, ascending high 
 mountains, or descending in diving bells, violent 
 
47 
 
 straining efforts, or from plethora ; but in such cases, 
 according to the experience of Drs. Fuller, Walshe 
 and others, c there is usually some latent mischief in 
 the chest some local cause of pulmonary conges- 
 tion some mechanical interference with the capillary 
 circulation through the lungs.' ' Finally we observe 
 that it may depend upon disease of the heart, especially 
 with mitral regurgitation; upon aneurism; upon 
 intra-thoracic tumors, either malignant or non-malig- 
 nant ; or upon non-tubercular abscesses. But, in either 
 case, it rejects as decidedly as though dependent on 
 tuberculosis. 
 
 HamatemesiS) a symptom often confounded with 
 haemoptysis, is of vastly less significance, nevertheless 
 requires, from its occasionally dangerous origin, very 
 careful inquiry as to its real cause. The blood may 
 have come from the nares, the throat or the lungs, have 
 been swallowed and vomited. It may have come from 
 aneurism above or below the stomach, from ma- 
 lignant or non-malignant gastric ulcer ; occasionally 
 as the result of severe gastritis ; again as vicarious 
 of menstrual or other discharges. In the vast majority 
 of cases it occurs as the result of the local congestions 
 of malarious diseases, or from scorbutus or purpura. 
 The decomposed blood, or coffee-grounds vomit of 
 yellow fever, etc., need hardly be alluded to. 
 
 DISEASES OF THE URINARY ORGANS. Under this 
 euphemistic designation are intended nephritis, neph- 
 ralgia, cystitis, stone in the bladder, diabetes, haema- 
 turia, albuminuria or Bright's disease, prostatitis, 
 spermatorrhoea, gonorrhoea, stricture, urinary fistula, 
 syphilis, or other organic or constitutional diseases 
 
#8 
 
 involving the urinary organs, primarily or secondarily. 
 The question is last but not least. The obscurities 
 of diagnosis and prognosis are more frequently hidden 
 here than in any other part of the animal frame work, 
 and coincidently, here, the acuteness of the medical ex- 
 aminer will be taxed even more than in the minutely 
 studied and carefully described changes of the thoracic 
 'iscera. For the physical signs are clear to the mode- 
 rately educated perceptive faculties, whilst both physi- 
 cal and rational signs exhaust the skill of diagnosis 
 when the renal and subsidiary organs come under 
 view. Chronic nephritis rejects, and so also, chronic 
 nephralgia, whatever their causes. Cystitis, if present, 
 rejects, whether acute or chronic. Calculus rejects ; 
 but the previous passage of a small concretion may 
 not disqualify, unless the diathesis be strongly marked, 
 and the evidences be strengthened by hereditary pre- 
 disposition. Diabetes necessarily rejects, but doubtful 
 cases should be analyzed, Albuminuria, or Bright' s 
 disease in any of its forms, absolutely rejects. 
 Observe that organic disease of the kidneys may be 
 present without albuminuria, and albuminuria may 
 occur without renal organic change, but either, if 
 present, reject. Prostatitis, or the prostatic enlarge- 
 ment of old age, if sufficient to materially interfere 
 with the extrusion of urine, must reject. Spermator- 
 rhoea, so-called, is usually merdy a catarrh of the 
 urinary mucous membrane, analogous to the leuchor- 
 rhcea of females, and of trivial importance. It is 
 usually an evidence either of mere dyspeptic derange- 
 ment, or of improper medication. Notwithstanding 
 the stress laid upon it by many authorities, it is safe 
 
49 
 
 to say that, in at least nineteen cases out of twenty, it 
 in no wise invalidates the risk. True spermatorrhoea 
 will manifest itself in connection with other symptoms 
 involving the constitution as a whole, which will re- 
 quire no reference to this as necessary to sustain an 
 opinion. Taken as a symptom, isolated, it is of as 
 little importance as a nasal catarrh. The previous 
 occurence of Gonorrhcea is mainly of importance 
 because its old time treatment, by balsamic arid other 
 highly irritant remedies, may have laid the foundation of 
 Bright's disease ; or because it may have been followed 
 by septic poisoning of the blood, involving gonorrhceal 
 rheumatism, etc. This latter is capable of producing 
 organic diseases, of equal importance with those of 
 rheumatism from the usually more noted causes. 
 Stricture, whether the result of gonorrhoea or acciden- 
 tal causes, requires attention. Is it spasmodic or per- 
 manent ? Is it permeable or impermeable ? Is it the 
 result of merely a local or of a remote cause ? It is 
 often times symptomatic of renal or vesical organic 
 disease, and these disqualify. If trivial, although 
 troublesome, it is of less importance. If it require 
 Syme's, or other severe operation for its relief, the 
 insurance should be postponed. A similar remark 
 may be made of urinary fistula. Let it be cured, 
 whatever its cause, before insurance. All malignant 
 diseases of the organs of course reject. In all cases 
 of renal or urinary disease, ONCE MORE, examine the 
 heart. 
 
 SYPHILIS. In all cases where secondary or tertiary 
 syphilis is clearly present the risk should be postponed. 
 This disease is usually capable of perfect cure. In 
 
s 
 
 badly managed or cachectic cases it becomes dangerous 
 to longevity. At the present time it is better man- 
 aged, and the chances of perfect recovery are better 
 than heretofore. But the rule is imperative when 
 present, reject. Observe, historically, the distinction 
 between the merely local sore, (however extensive its 
 ravages) the chancroid, and the true infecting chancre 
 the latter only of insurance import. The best dis- 
 posed party applying for insurance will perhaps deny 
 its previous occurrence, and there may be no signs 
 superficially to be observed. And yet it is easy 
 for the moderately instructed examiner, in the 
 majority of instances, to satisfy himself of the facts. 
 Nevertheless, the present writer admits the loss of one 
 risk for which he was examiner, by giving credit to the 
 party's own statement and innocent countenance. 
 Many cases of reported consumption, for whose de- 
 mise the examiner is held professionally responsible, 
 are in fact, syphilitic decline and ultimate decay. But 
 the examiner must guard himself against such disas- 
 trous result by stern disregard of appearances. This 
 he can do without violating any of the proprieties. 
 Observe whether there are any traces of cutaneous 
 eruption whether there is or has been alopecia 
 whether there is emaciation, or other signs of depraved 
 nutrition, onychia, enlarged post-cervical glands, iritis, 
 catarrh, white patches or tubercles, or cicatrices about 
 the mucous membrane of the mouth, tongue or throat ; 
 whether there are nodes, or have been pains in the 
 bones. If possible, (perhaps under excuse of exam- 
 ining for hernia), examine for the significant indu- 
 ration of the inguinal glands. Indeed when the 
 
 O D 
 
5 1 
 
 attention is directed to the matter, it does not require 
 much tact or sagacity to make up one's mind safely. 
 Fortunately doubtful cases are overrated in importance. 
 It is perhaps necessary to call the attention of the 
 examiner to the general physiognomy of urino-genital 
 diseases, which is almost too unmistakable for the ex- 
 pert ever to be deceived in but for the inexperienced 
 it is proper to say that it is both capable of observa- 
 tion and indescribable. 
 
 XII. 
 
 HAS THE PARTY HAD INFLAMMATORY RHEUMATISM? 
 
 The repetition of this question by several compa- 
 nies in their forms, attests the great importance 
 attached to its satisfactory answer. But sufficient has 
 been written upon this point upon p. 29. et seq. 
 
 XIII. & XIV. 
 
 SUBJECT TO DYSPEPSIA, DYSENTERY OR DIARRHOEA? 
 
 A perfect state of health of the alimentary canal 
 and its subsidiary organs is, of course, necessary in 
 order that there should be perfect nutrition of all 
 parts of the body. Temporary disturbances may 
 arise from temporarily acting causes and yet not inval- 
 idate the risk ; but frequently recurring, or persistent 
 disorder, whatever the cause, throws doubt upon it, 
 and then the case must be carefully diagnosed. 
 
 Dyspepsia is primarily noteworthy because it is one 
 of the initiatory symptoms of the tubercular diathesis. 
 
Or it may evidence organic malignant or non-malig- 
 nant disease of the stomach. It may be sympathetic 
 of cerebral or renal, of uterine or spinal affection of 
 more or less serious character. In the larger propor- 
 tion of instances it indicates merely a catarrhal condi- 
 tion of the gastric mucous membrane, or slight dis- 
 turbance of the hepatic functions. But whatever its 
 cause, duration or severity, whenever present, it should 
 receive ample consideration. 
 
 Dysentery^ when present, rejects, and if the party is 
 subject to its recurrence, enquiry must be made as 
 to its cause and origin. Chronic colitis or entero- 
 colitis reject. But many cases of supposed dysentery 
 depend solely on haemorrhoids, local, curable ulcera- 
 tion, or morbid growths about the rectum. Neverthe- 
 less it is safe to say that tenesmus, discharges of blood 
 and pus, especially with occasional febrile heat and 
 emaciation, should reject. The condition of the liver 
 in such cases, should be carefully observed. 
 
 Diarrhoea is a term relative to the habits of the 
 individual. It does not refer so much to the frequen- 
 cy as to the character of the discharges. Occasional 
 attacks of acute diarrhoea may occur in the very best 
 risks. Such cases point to an examination into the 
 habits of the party, whether of eating, drinking or ex- 
 posure to vicissitudes of temperature, moisture or 
 exercise. Ill regulated diet, imperfect mastication, 
 improper quality of food, irregular hours, and intem- 
 perance of drink, are among the most frequent 
 causes, but some form of enteritis, hepatic derange- 
 ment, or disease of the glandular organs, subsidiary to 
 
53 
 
 the digestive apparatus, Bright's disease, ochlesis, 
 malaria, with other agencies are capable of produc 
 ing the same result. The votary of opium or alcoholic 
 stimulants is scarcely ever free from this symptom. 
 In returned soldiers, or those addicted to vegetarian 
 theories, it is frequently the result of scorbutus. When 
 there is emaciation, a despondent countenance, dark 
 circles around sunken eyes, a sallow, leaden or sodden 
 skin, a sunken abdomen, a red and pointed, or a loose, 
 pale and flabby tongue, an undue indifference, or an 
 augmented irritability of the nervous system, look out 
 for diarrhea and its cause. 
 
 xv. 
 
 HABITUAL COUGH ? The significance of an habit- 
 ual cough in life insurance examinations depends 
 wholly on its cause ; but if admitted, it requires criti- 
 cal examination. It may depend on local causes in the 
 pharynx, larynx, trachea, bronchia, or pulmonary pa- 
 renchyma. It may arise from cardiac, hepatic, gastric, 
 intestinal or spinal disease. It may be a mere morbid 
 habit of the nerves and muscles involved in the act. 
 Primarily, it demands physical diagnosis of the condi- 
 tion of the lung tissue, especially at the apices of the 
 lobes, together with a rational account of the history 
 and diathesis. Taken as a mere symptom, Dr. 
 Hartshorne's statement is as brief and satisfactory as 
 any which c^n be given, viz : 
 
 Cough is dry and hollow, or hacking, when nervous or 
 sympathetic. 
 
 Dry and tight in early bronchitis ; 
 
 Soft, deep and loose, in advanced bronchitis ; 
 
 Hacking, in incipient phthisis pulmonalis ; 
 
54 
 
 Deep and distressing in confirmed consumption ; 
 Short and sharp in pneumonia ; 
 Barking and hoarse in early or spasmodic croup ; 
 Whistling in advanced membranous croup ; 
 Paroxysmal and whooping in pertussis [and asthma.] 
 
 It is needless to advert to the character of the 
 expectoration^ as that will at once command the atten- 
 tion of the practitioner. It may be mucous , purulent ', 
 rusty, bloody and muco-purulent, nummular and heavy, 
 putrid, etc.) etc., each case giving its distinctive infor- 
 mation of value to the examiner. 
 
 XVI. 
 
 MECHANICAL OR SURGICAL INJURY ? Any wound, 
 however trivial, makes its own demand on the powers 
 of life. The amputation of an arm or limb, suggests 
 inquiry as to the reason for the operation. Tuber- 
 culous deposit, malignant disease, caries and necrosis, 
 requiring surgical interference, clearly invalidate the 
 risk ; whereas mere mechanical injuries, as causes, may 
 not materially impair it. Caries, or even necrosis, 
 from acute periostitis or external injury, even though 
 ultimately requiring exsection or amputation, are, by 
 no means, as serious objections to the risk as exostosis, 
 enchondroma, osteo-sarcoma, cachectic deposit and the 
 like. Statistics are wanting upon this point, but the 
 writer's general judgment, from reading and observa- 
 tion, is, that the so-called capital operations, although 
 recovered from, apparently, to a certain extent impair 
 the desirability of the risk. Individual cases, it is 
 true, may lend color to a different opinion, yet the 
 stern proposition remains, that great injuries to the 
 
55 
 
 system, whether accidental or surgical, tend largely to 
 exhaust the original powers of" life and, fro tanto, im- 
 pair the insurance expectation. In the case where a 
 limb has been amputated after a long continued dis- 
 charge, which has become habitual, although exhaust- 
 ing to the system, this remark is especially of impor- 
 tance. Apoplexies, paralyses and various organic 
 affections are not unlikely to supervene. The old 
 ulcer cc cured," may involve new and unexpected dis- 
 ease Any serious mechanical or surgical injury, un- 
 explained with no positive evidences to the contrary 
 lessens the desirability of the risk. Long continued 
 confinement in the recumbent position, of itself, pre- 
 disposes to disease ; and indeed any injury, which, 
 although not severe in itself, has necessitated sedenta- 
 ry habits, with deficient air, exercise, etc., will leave 
 traces of its deleterious influence on special organs or 
 the general system. 
 
 A.VII. 
 
 SEVERE PERSONAL INJURY OR DISEASE WITHIN THE 
 LAST SEVEN YEARS ? This query is based on the 
 general idea that if more than seven years have elapsed 
 the results of previous disease are little liable to be 
 developed The popular opinion founded,' as usual, 
 upon an antique professional idea, is that the whole body 
 is changed in its constitution every seven years. The 
 instructed examiner needs not to be informed that all 
 the moving and acting parts are changed in constitution 
 within a space of time scarcely exceeding, if reaching, 
 the third of a year. The practical rule, however, re- 
 mains, recent diseases require more careful scrutiny 
 
56 
 
 as to their results than those which occurred long pre- 
 vious. Some companies under this head require 
 details as to the character of the disease, and a reference 
 to the attending physician. The latter point will be 
 alluded to further along in this essay. The former 
 will suggest, at once, to the intelligent examiner, the 
 vast differences of degree and danger, of immediate or re- 
 mote disastrous consequences, which may obtain in dis- 
 eases which, for nosological purposes, receive the same 
 name. Whatever the name, the practical fact remains 
 that no disease is the product of a single cause, and vary- 
 ing with the multiplicity of influences acting upon dif- 
 ferent persons will be the result, immediate or remote, 
 of any single cause which may give the present affection 
 its scientific appellation. Some organizations sustain 
 and oppose the specific causes of certain diseases with 
 little derangement even of functional action others 
 manifest the evidences the gravest evidences, of 
 organic and perhaps ultimately fatal change. 
 
 XVIII. 
 
 LONGEVITY OF ANCESTORS ? In the United States, 
 such is the character of the population, this question 
 can, in the majority of instances, be answered onlj 
 with reference to the grandparents. Yet the traditions 
 of families, in the absence of registration statistics are 
 worth something. The descendants of certain families 
 are notably long-lived, and of others short-lived. Co- 
 incident with this fact will be found certain hereditary 
 tendencies to disease. The family record, if tolerably 
 complete and reliable, is of the highest insurance im- 
 portance. It is well known that hereditary diseases 
 
not infrequently pass over one generation to appear 
 in the next, or subsequent generations. The shape, 
 capacity, and mode of action of internal organs are 
 determined by the parentage, with as much constancy 
 as the external likeness. These likenesses determine 
 particular proclivities to intimate textural change, with 
 the results of such change. Nations and tribes, clans 
 and families have their marked peculiarities of external 
 likeness, with almost identical tendencies toward death. 
 This is especially true in the older countries, where 
 rank, caste, and custom keep up the usage of inter- 
 marriage. It is of perhaps less importance in the 
 United States, where these distinctions are only tem- 
 porarily recognized. Nevertheless the observation 
 of three generations, conduces much to correctness 01 
 judgement in any case under examination. If the 
 grandparents on both paternal and maternal sides have 
 reached old age the risk is more desirable. Longevity 
 of grandparents on the maternal side is to be preferred 
 to that on the paternal side. In either instance, if 
 possible, the cause of the death of the grandparents 
 should be noted. If either of them was affected by 
 phthisis, or tuberculosis in any of its forms ; by apo- 
 plexy or paralysis, by rheumatism or gout; by organic 
 disease of the heart, Bright's disease, cancer, insanity 
 or epilepsy ; by syphilis, or other transmissible disease, 
 the risk must be most carefully investigated. Mean- 
 while it should be recollected that change of location, 
 intermarriage and habits, etc., are capable, under the 
 guidance of the present developed principles of hy- 
 giene, of almost entirely controlling or obviating 
 
the hereditary tendency. All causes of disease thor- 
 oughly understood may, not only be robbed of their 
 pernicious tendency but, be rendered subservient to 
 the increased longevity of the race. It is to be recol 
 lected that progressive improvements in hygiene and 
 medical science, as a whole, have largely increased the 
 relative duration of human life, and that the longevity 
 of our grandparents may, cxteris paribus, be well sur- 
 passed by this generation, and this still further increased 
 by the next, by approximation to recognition of the 
 great laws of health as now understood. 
 
 XIX. 
 
 Parents Living or Dead PRESENT HEALTH OR 
 CAUSE OF DEATH, RESPECTIVELY. As previously re- 
 marked, hereditary predispositions require at least 
 three generations for their satisfactory elucidation. 
 But as one of these, and strongly influencing the re- 
 sult of observation, the peculiarities of parents should 
 be studied. " When one only of the parents is the 
 victim of constitutional disease, the tendency to sim- 
 ilar constitutional diseases is most obviously expressed 
 in those children who most resemble that parent in 
 physical conformation and appearance, and it has been 
 observed that, when both parents suffer, the tendency 
 will sometimes be expressed more often in the daugh- 
 ters of the family than in the sons, or more often in 
 the sons than in the daughters." The organic peculiari- 
 ties, derived from the parent, will determine special and 
 peculiar results from any accidental exciting cause, 
 
But it should be recollected that the incidental occur- 
 rence of a family disease is less likely to be marked by 
 acute, prolonged, or obstinate symptoms than when 
 the same disease, nosologically, occurs in an individual 
 without such hereditary predisposition. Nevertheless, 
 its occurrence, whether severe or mild, fully deter- 
 mines the hereditary proclivity, and impairs the risk. 
 Family proclivities to disease are more strikingly man- 
 ifested in brothers and sisters than between parents 
 and children. The intermingling of opposite tenden- 
 cies begets, so to speak, m the children, a neutraliza- 
 tion of the peculiar aptitudes to disease existing in the 
 parents respectively. Physiological likeness of the 
 parents induces imperfect progeny, pro tanto, just as 
 certainly as intermarriage within the forbidden degrees 
 of consanguinity. En passant, we remark, the offspring 
 of cousins, etc., must be most carefully examined, 
 prior to any recommendation of the risk. The ques- 
 tion involving any such relationship of parents should 
 never be omitted. 
 
 Tuberculosis, carcinoma, and other malignant form- 
 ations, rheumatism, gout, insanity, paralysis, apoplexy, 
 syphilitic, renal and cutaneous diseases, are especially 
 noteworthy in this connection. 
 
 In considering the influence of hereditary tendency 
 to disease, the remarks upon p. 6, et seq. y require at- 
 tention. // may have been outgrown, or not yet arrived 
 at. No sufficient exciting cause may have yet been 
 presented. The individual may appear in high physi- 
 cal health, and yet be on the brink of disease of the 
 most fatal kind. 
 
60 
 
 It is fortunately the case that the medical science of 
 the present time looks largely more to individual ten- 
 dencies towards death, and suggests prophylactic 
 hygienic measures, rather than engages in a wild pur- 
 suit of specifics and mysteriously operating agents, 
 to do away with organic morbid changes already grown 
 unmanageable and incurable. 
 
 The exact influence of hereditary tendency to dis 
 ease can, probably, be never precisely estimated, be- 
 cause the vice of organization inherited will always 
 increase the mortality from other forms, of disease 
 The latent predisposition will manifest itself in that 
 increased mortality. Nearly nine out of ten con- 
 sumptive patients will be found, on investigation, to 
 have lost one or two out of the immediate family 
 connexion by phthisis. 
 
 A single instance in a family of a disease, usually 
 hereditary, need not invalidate the risk. The party 
 is thrown on his own personality. Both father and 
 mother being of consumptive tendency, the risk 
 should be declined. But either may have died of 
 some accidental intercurrent disease or injury. Hence 
 the personal peculiarities shonld be ascertained. The 
 mother transmits disease more certainly than the father. 
 But the likeness of organization, if it can be deter- 
 mined, affords the best method of general judgment. 
 When, in addition to one, or both, of the parents, a 
 brother or sister has died of an, usually, hereditary 
 disease, the risk should be declined. 
 
 The author repeats his carefully considered and 
 matured conviction, from the evidences, that brothers 
 
6i 
 
 and sisters are more likely to manifest hereditary pro 
 clivities to disease than are parents and children. They 
 inherit respectively the faults and virtues, as well 
 physical as mental, of each of the parents. How far 
 these may counteract each other, and produce a well 
 balanced mental and physical organization, it Is the 
 duty of the Medical Examiner cautiously to consider. 
 
 In addition to general resemblance of external and 
 internal organization, it should be recollected, mem- 
 bers of the same family are likely to have acquired 
 similarity of habits of living, diet, dress, exercise, 
 exposure, etc., which cannot fail respectively to im- 
 press upon them similar tendencies to health or 
 disease. 
 
 In this relation, also, it is well to bear in mind the 
 physiological fact that half-brothers, or half-sisters, 
 may indicate individual tendencies to organic change 
 which may throw light on the constitutional peculiari- 
 ties of the party under examination. The second 
 husband may not solely be responsible for the organi- 
 zation of his own children. This point, it must be 
 confessed, is one surrounded by obscurity, but the 
 indefatigable medical agent of a life insurance society 
 may derive, from the most unexpected quarters, 
 evidences to guide him in forming an unexceptionable 
 and reliable opinion. 
 
 XX. 
 
 Family Physician, The Examiner should never 
 neglect observance of this query. First, that he may 
 have t^e testimony of the attendant medical man as 
 
62 
 
 to any peculiarities observed in previous diseases. 
 Clear-headed medical men, in cases treated by them, 
 gain cognizance, not only of present severe symptoms, 
 but, what is of more importance, of the tendencies 
 towards a particular form of death. Some physicians, 
 and a great deal of cheap rhetoric has been expended 
 upon this point, complain that insurance companies do 
 not pay them for the information conveyed in their 
 certificate. This is simply absurd. The family physi- 
 cian is the friend of the party applying, and, it is fair 
 to presume, has relations with the party not altogether 
 of the eleemosynary kind. The trouble of filling out 
 the certificate is merely trivial, being altogether his- 
 torical in its nature. Yet it is of value not solely 
 to the company. Doubtful points may be thereby 
 explained, and difficulties cleared up. The professional 
 character of the physician, it is needless to say, lends 
 much of confidence to the examiner in making up 
 his opinion. Aside from his certificate, his attendance 
 upon the party may lessen (or increase) the dangers 
 of accidental disease. One or two companies adver- 
 tise a reduction of rates, even so much as ten per cent.^ 
 provided a particular species of family <c physician" is 
 employed. This would be startling to life companies, 
 and examiners generally, were it not so clearly an 
 advertising device the expense to be defrayed by 
 diminished dividends to the insured. 
 
 XXI. 
 
 Intimate Friend Referred to, There may be cir- 
 cumstances affecting the prospects of longevity which 
 
63 
 
 the applicant is either ignorant of, or wilfully with- 
 holds. Thus, habits of intemperance are most fre- 
 quently of all denied by the party himself, and these 
 may be made known by his acquaintances. The 
 solicitor ought not to neglect inquiry upon this point, 
 and submit to the examiner the friend's certificate. 
 
 Again, the applicant may have had "fits" epileptic 
 or apoplectic seizure, etc., the real significance of which 
 may, for prudential or other reasons, have been with- 
 held from his knowledge. For these and similar 
 reasons, the corroborative evidence thus gained, should 
 be laid before the examiner. 
 
 XXII- 
 
 Previous Rejection or Assurance, The fact of 
 
 previous insurance should never be permitted to lessen 
 the care of inspection. The previous examiner may 
 have been inexpert or careless, or have inadvertently 
 overlooked some important point. Or, again, acute 
 or chronic, or even hereditary diseases, may have since 
 been developed, involving organic changes of imme- 
 diate or remote danger. Previous rejection demands 
 employment of all the physician' s skill in diagnosis. 
 The real cause for such rejection should be discovered, 
 if possible. It may have been in consequence of the 
 applicant's then habits, and some other reason assigned 
 to spare personal feeling. It may have been from 
 some temporary ailment present, or not yet fully re- 
 covered from. It may have been from misapprehen- 
 sion of the applicant's answers on certain points, or 
 from misinterpretation of symptoms observed. Or, 
 
64 
 
 again, because the company to .which application was 
 made, excluded a particular class of cases whicn other 
 companies accept. Or, by the baldest hypothesis, it 
 may have been from the human weakness of attempting 
 to gain credit for remarkable professional skill and 
 acumen, at a cheap rate. 
 
 But when the previous examiner and the attendant 
 circumstances are fully known, nothing but positive 
 demonstration will warrant the medical man in recom- 
 mending the risk. It must be demonstrated that the 
 previous disease is fully recovered from ; that the 
 hereditary taint is absent ; that bad habits do not 
 exist ; that the heart or lungs, or other organ blamed, 
 are respectively free from lesion. Whilst a needless 
 ejection does permanent injustice to both the appli- 
 cant and the company, every medical examiner must 
 avoid the imputation of making the company by whom 
 he is engaged, a hospital for invalid risks. 
 
 XXIII. 
 
 Is the Applicant fully Aware OF THE PURPORT OP 
 
 THE QUESTIONS HE HAS ANSWERED AND SUBSCRIBED? 
 He may be of limited intelligence, or unfamiliar with 
 the language, the names of the diseases alluded to, 
 etc. The solicitor may have been careless in his 
 method, and thus periled the party's subsequent 
 rights, as well as tending to mislead the examiner. 
 
 Wherever there is the slightest cause to apprenend 
 any negligence or mistake in this matter, the exam- 
 iner should himself again propound the necessary 
 questions. 
 
THE EXAMINATION. 
 
 In order that no point may be overlooked, the 
 Medical Examiner should adopt a regular method of 
 personal examination of the applicant the form 
 adopted by the company for which he acts being care- 
 fully adhered to, but, nevertheless, considered merely 
 as suggestive, not exhaustive. All the considerations 
 noticed in the Applicant's personal history, must be 
 given full weight in the proposition of further ques- 
 tions, and still more careful observation. Although 
 not in accordance with the usual mode of systematic 
 general diagnosis, the purposes of this essay will, 
 perhaps, be better subserved by adhering to the more 
 generally adopted formulae furnished by the insurance 
 companies. 
 
 Be sure that the person examined is the one whose 
 application has been read over. Mistakes here occa- 
 sionally occiar, especially when parties have the same 
 names, or several applications are received at once. 
 These blunders might be deemed merely ludicrous, 
 were they not so important in their probable results. 
 5 6$ 
 
66 
 
 I. 
 
 Height and Weight Whilst the general propor- 
 tions are, perhaps, of the most importance, yet the 
 rule is, that the medium height is endowed with the 
 greatest endurance. Five feet and eight inches may 
 be taken as the medium in this country, for adult 
 males. The average of adult females is, of cou?S 
 considerably below this but statistics are wanting 
 upon the subject. Probably five feet and one and a 
 half inches is the approximately correct standard. 
 Emigrants from Continental Europe average a little 
 less than five feet six inches, if we except certain races, 
 as the Hungarians, Poles, and Sclaves, who reach the 
 American standard. Emigrants from the British 
 Islands average about five feet seven inches. 
 
 In this country, the average height of persons bred 
 and living in large towns and cities, is something less 
 than that of those living in rural districts, whilst in 
 Enrope, the reverse is claimed to be the case. This 
 fact is important, as to a certain extent indicating the 
 general hygienic influences which have operated on 
 races, families, and, ultimately, the individual. The 
 better developed having been from a better nourished 
 stock, and physically superior lineage. 
 
 Very tall men are usually of less muscular power, 
 less respiratory activity, with a greater tendency to 
 cardiac and pulmonary diseases. They are more liable 
 to hernia, varicose veins, and ulcers of an obstinate 
 kind upon the extremities. Acute diseases attacking 
 them are more disposed to assume the chronic form, 
 with general breaking down of the constitution. On 
 
67 
 
 the other hand, short persons are apt *o be dispropor- 
 tionately developed ; their muscular power, and ca- 
 pacity for physical endurance are small, and they become 
 the ready victims of acute, and especially epidemic 
 diseases. 
 
 The relation of age to the height ahould never be 
 overlooked, but this will be alluded to a little further 
 
 THE WEIGHT is of moment, relatively to the height. 
 The simplest statement of the due relation is that of 
 Dr. Brinton : " As a rule, it may be laid down that 
 an adult male, in good health, 66 inches in stature, 
 ought to weigh rather more than ten stones, or 140 
 pounds avoirdupois. And for every inch above and 
 below this height, we may respectively add and 
 subtract about five pounds." 
 
 Individuals may present a wide range of variation 
 from this ; "But as a rule, twenty per cent., or one- 
 fifth, is almost the maximum variation within the 
 limits of health." 
 
 The annexed table is introduced for convenience of 
 reference : 
 
 HEIGHT. 
 
 5 feet I inch, 
 5 " 2 " 
 5 
 
 5 " 
 
 6 " 
 
 7 " 
 
 8 ' 
 
 9 " 
 
 10 " 
 
 11 ' 
 
 WEIGHT. 
 
 MEDIUM 
 
 CHEST. 
 
 Should 
 
 weigh 
 
 1 20 
 
 tbs 
 
 34.06 
 
 inch. 
 
 ft 
 
 tt 
 
 125 
 
 ft 
 
 35-'3 
 
 tt 
 
 f 
 
 tt 
 
 130 
 
 tt 
 
 35.70 
 
 " 
 
 ft 
 
 tt 
 
 135 
 
 tt 
 
 36.26 
 
 " 
 
 
 
 tt 
 
 140 
 
 tt 
 
 36.83 
 
 tt 
 
 M 
 
 " 
 
 H3 
 
 tt 
 
 37-50 
 
 tt 
 
 (f 
 
 tt 
 
 HS 
 
 tt 
 
 38.16 
 
 " 
 
 ft 
 
 ft 
 
 148 
 
 tt 
 
 38.53 
 
 tt 
 
 ft 
 
 tt 
 
 155 
 
 tt 
 
 39.10 
 
 tt 
 
 ft 
 
 tt 
 
 1 60 
 
 tt 
 
 39.66 
 
 tt 
 
 " 
 
 ft 
 
 165 
 
 tt 
 
 40.23 
 
 ft 
 
 
 
 tt 
 
 170 
 
 tt 
 
 40.80 
 
 1C 
 
68 
 
 The maximum of height is usually reached at 
 twenty- five the rate of progress being about ten 
 inches from eleven to eighteen, and two inches only 
 from that age to maturity. An increment much 
 surpassing this during the latter epoch is a suspicious 
 circumstance, and unless accompanied by apparent 
 coincident development of the nutrient energy, and 
 correspondent increase of weight, impairs the risk. 
 
 Excessive obesity at any period vitiates the risk, 
 and particularly where it has come on within a com- 
 paratively brief period. After the age of complete 
 maturity, usually, there is a deposit of adipose tissue 
 which largely increases the relative proportion of the 
 weight to the height ; and if this occurs gradually and 
 if clearly traceable to hereditary peculiarity it does 
 not disparage the risk. But the rapid occurrence of 
 corpulence points almost infallibly to deterioration of 
 nutrition, the result of, it may be, newly formed 
 sedentary habits, intemperance, internal organic disease, 
 or that general cachexia which accompanies fatty 
 degenerations. 
 
 On the other hand emaciation slow and progressive 
 after middle life, if clearly a family characteristic does 
 not necessarily disqualify, although it demands close 
 investigation. Rapid emaciation, even without apparent 
 organic cause, rejects/ 
 
 Incidentally it may be remarked, that measurement 
 of the chest will afford an index of the relative pro- 
 portions of the height and weight. The rule suggested 
 by Brent is sufficiently exact. Measured over the 
 nipples : 
 
6g 
 
 Minimum chest: half of the stature, minus one-sixty- 
 first of the stature, is equal to circumference of the 
 chest. 
 
 Medium chest : half of the stature, plus one-fifteenth 
 of the stature, is equal to circumference of the chest. 
 
 Maximum chest: two- thirds of the stature is equal 
 to circumference of the chest. 
 
 Irrespective of the height, the general statement is 
 authorized that <c the circumference of the chest in- 
 creases exactly one inch for every ten pounds increase 
 of weight." 
 
 If these proportions are widely departed from, the 
 case requires research as to the cause of the unusual 
 deposit. 
 
 So, also, local emaciation suggests similar caution. 
 Incipient phthisis generally is denoted by wasting of 
 the tissues of the thorax and of the arms, long before 
 it is to be observed in the face or lower extremities. 
 
 At the present time, when a large proportion of 
 the adult males wishing to be insured have recently 
 returned from the exposures of army life, it is well to 
 bear in mind that diminished weight is one of the 
 most significant evidences of chronic, and possibly, 
 painless diarhcea. 
 
 n. 
 
 General Appearance, The proportionate height 
 and weight with the more or less symmetrical develop- 
 ment of the body, as a whole, make up a part of the 
 general appearance ; but beyond this the attention of 
 the examiner is to be directed to various details which 
 
7 o 
 
 go to make up the tout ensemble. Among these we 
 specify : Aspect of the Countenance, Complexion, Color 
 of the Hair and Eyes, Size of the Bones, Contour of 
 Muscles, Gait, Apparent Age, Temperament, Idiosyncrasy. 
 
 ASPECT OF COUNTENANCE. Experienced observers 
 readily recognize in diseases a physiognomy peculiar 
 to each, always difficult and often impossible satisfac- 
 torily to describe, nevertheless so distinguishable as to 
 be worthy of serious consideration in judging of a risk. 
 By this observation they can ultimately decide, almost 
 as quickly as an expert cashier upon the genuineness 
 of a signature or bank note. But this acquired skill 
 and readiness never, when such large interests are in 
 issue, should be relied upon to the exclusion of those 
 rigid tests by which the opinion may be solidified into 
 an unassailable judgment. We notice here a few only 
 of the more striking facts, as indicating the direction 
 of observation. 
 
 The aspect may inform of tuberculous cachexia by 
 the delicate skin, tumid upper lip, long eyelashes, 
 pearly conjunctiva, etc. Or it may denote the can- 
 cerous diathesis by its sallow anaemic hue intermingled 
 with muscular markings, indicating frequently recur- 
 ring or continuous pain, or of that organic pain of which 
 consciousness as yet takes no note, but which equally 
 calls into action the reflex sympathies of the nervous 
 apparatus. 
 
 Hepatic disease, with its more or less yellow tinge 
 and hypochondriacal look. Or renal affection, with 
 its puffy eyelids, sodden or waxy skin, and features 
 cither downcast or stolid and apathetic. 
 
7' 
 
 Hypertrophy of the heart, with its unnatural fulness 
 and congestion, or the same look from habitual intem- 
 perance. Or the facial muscles may be permanently 
 contracted in forms which indicate the continuous suf- 
 fering of wasting local or general disease. Lesions 
 affecting the nervous centres may find here their 
 earliest exponent. The countenance, which tranquil 
 shows no disorder, when wakened by movement may 
 give warning of coming paralysis. Or the furtive 
 glance from the eyes, notwithstanding immobility of 
 the other features, may warn of impending insanity. 
 Or the rapid transitions in expression, flashing or 
 wandering and unsteady eyes may indicate a different 
 form of the same malady. Or the whole face may be 
 dull and listless, the eye sluggish, and the physiog- 
 nomy of softening of the brain be almost beyond 
 mistake. 
 
 COMPLEXION, This should be noticed as going to 
 make up the temperament hereafter to be considered. 
 But any peculiarities in hue which it may have derived 
 from antecedent or present disease or exposure should 
 be noted, whether rendered sallow by residence in 
 malarious districts, bronzed by exposure or Addison's 
 disease, unnaturally florid by intemperance or cardiac 
 lesion, livid by imperfect aeration of the blood from 
 whatever cause, or " compounded of alabaster and the 
 rose" by incipient phthisis, or pallid and sodden from 
 albuminuria and anaemia. 
 
 COLOR OF THE HAIR AND EYES. This point also 
 refers particularly to the temperament ; but attention 
 is called here to changes in the color of the hair from 
 
72 
 
 advancing or premature age ; to its nutrition, whether 
 drv and husky or soft and silken in texture whether 
 it remains firmly rooted or has fallen. These obser- 
 vations may give a clue to the diathesis or cachexia 
 present. 
 
 The movements of the eye, its expression, the con- 
 dition of the pupil, contracted or dilated, or whether 
 these changes are symmetrical ; whether there be 
 complete or partial amaurosis of either ; the arcus 
 senilis, etc. 
 
 It will be found that the eyes can afford, vastly more 
 information than merely as to their color. 
 
 SIZE OF THE BONES. A strong bony framework is 
 usually connected with strength of the nutrient system, 
 and is indicative of a constitution capable of much en- 
 durance. Prominence of the apophyses is an index, 
 generally, of a fully developed muscular system with 
 its concurrent advantages. But reference to the osse- 
 ous system involves more than simple observation of 
 the size of the bones and their normal projections. It 
 suggests inquiry into the perfection of ossification 
 about the cranium and vertebral column, original or 
 acquired deformity, rachitis, mollifies ossium, curvatures 
 of the spine, gibbosity, &c., fragility, caries, necrosis, 
 morbid growths, etc. 
 
 CONTOUR OF MUSCLES. Closely allied in prognos- 
 tic meaning to the development of the bones, will be 
 found the firmness and abundance of t.ie muscular 
 fibre. The deposit of adipose tissue will often ob- 
 scure the strong lines which mark the boundaries of 
 the muscles, but their compact structure, contractil- 
 ity and tonicity can readilv be observed. The well 
 
73 
 
 rounded and well developed muscular system renders 
 the risk more desirable, as the feeble, ill developed 
 fibre suggests the reverse. 
 
 Attention is here directed to local paralysis, which 
 may be present as the result of lead or other poison- 
 ing, central or excentric affections of the nervous sys- 
 tem, &c. Or again, tonic or clonic spasms, tremors, 
 tremulousness, chorea, &c. 
 
 APPARENT AGE. The applicant having recorded 
 his age, it is proper to compare his apparent with his 
 actual age. Some are really older at forty than others 
 at sixty. Premature old age may be from hereditary 
 or congenital imperfection of structure, or it may be 
 the evidence of previous sickness, long continued ill 
 health, irregular or dissipated habits, overwork, expo- 
 sure and the like. As a general rule, when the appli- 
 cant is really older than he looks to be, his life expec- 
 tation surpasses the average ; but when he has aged 
 beyond his years, the risk is thereby in so far impaired. 
 
 TEMPERAMENT. In noting the temperament it is 
 better to adopt the simplest possible varieties, recol- 
 lecting that the phrase is employed simply to express 
 the preponderance in activity of certain organs or ap- 
 paratuses in the individual. Practically four tempera- 
 ments may be recognized for purposes of description, 
 the Sanguine^ Bilious or Sarcous, Phlegmatic or Lymphat- 
 ic , and the Nervous. 
 
 The Sanguine temperament is characterized by great 
 activity of the blood making .organs, rapid integral 
 changes and free excretion. Activity of mental and 
 muscular movements, delicacy of the skin, etc., are in- 
 cidental to these. Light or sandy hair, blue eyes, florid 
 
74 
 
 complexion and the like are accidental, not necessary 
 concomitants, being frequently conjoined with the 
 other temperaments. 
 
 The Phlegmatic temperament shows, nearly an oppo- 
 site condition of the organism. There is slow and 
 imperfect nutrition the blood tardily developed and 
 assimilation comparatively feeble. Hence languor of 
 both mind and muscle, infrequent and compressible 
 pulse, flabby and soft texture, with abundant adipose 
 deposit. 
 
 The Bilious temperament is characterized by great 
 perfection of assimilation, but not remarkable energy 
 of digestion. The blood making processes are not as 
 active as in the sanguine, because there is less of waste 
 The quantity of excreta is also less. Firmness and 
 strength of muscle characteristically predominate. 
 The less rapidly changing skin assumes a darker hue, 
 and with its appendages, hair, nails, &c., is drier and 
 harsher. Coincidently the liver and subsidiary organs 
 are largely taxed, for the recomposition of blood defi- 
 ciently renewed by food. 
 
 The Nervous temperament, with deficient digestive 
 energy and muscular development, manifests a striking 
 activity of the so called nervous processes. " The 
 countenance is usually pale and the features thin and 
 sharp, the pulse is quick, small and frequent ; the res- 
 piration active ; the chest not largely developed ; the 
 skin dry and rough." These are the incidents of the 
 organic peculiarities before noted. 
 
 Each of these temperaments, it is of course under- 
 stood, may be modified in its manifestations by a com- 
 bination with one of the others a result not unlikelv 
 
75 
 
 to occur when the parents have been of dissimilar 
 temperaments. But almost typical specimens are 
 afforded by families, and even tribes or races, when 
 intermarriage has been restricted within narrow limits. 
 Jn this country where individuals of the most diverse 
 nationality and parentage are cc marrying and giving in 
 marriage/' it is constantly becoming more difficult tp 
 assign the proper status in this regard. The point to 
 be kept in mind is, not the accidents of color, shape, 
 &c., but the preponderant activity of special organs 
 and processes. Thus the child always approximates 
 the sanguine ; the adult, at maturity, the sarcous, and 
 in the decline of life lapses into the nervous or phleg- 
 matic, according to the peculiar organization. 
 
 Relative to life assurance, the matter becomes of im- 
 portance, as evincing proclivities to particular forms 
 of disease. This is noteworthy when there exists any 
 hereditary or acquired predisposition thereto, or when 
 the occupation, habits, residence, &c., renders the party 
 liable to the usual exciting causes. The sanguine tem- 
 perament predisposes to miasmatic diseases, typhoid 
 and remittent fevers, the exanthems, to acute rheuma- 
 tism, organic and functional diseases of the heart and 
 arteries, to haemorhages and under conditions unfavor- 
 able to nutrition to tuberculosis. 
 
 The phlegmatic temperament on the contrary pre- 
 disposes to chronic and often incurable inflammations, 
 dropsies and fluxes of various kinds, especially from 
 mucous membranes, influenza and scrofulosis. 
 
 The bilious temperament favors the occurrence of 
 endemic disease, febrile affections tending to a low 
 
76 
 
 grade, hepatic obstruction with dysentery, haemor- 
 rhoids, fistula in ano. &c. When rheumatism occurs 
 in this organization the heart rarely escapes being in- 
 volved sooner or later. 
 
 The nervous temperament involves liability to in- 
 sanity, epilepsy, paralysis and neuroses generally. If 
 typhoid fever happens to such an one the issue is very 
 dangerous. 
 
 In taking note of the GENERAL APPEARANCE any 
 IDIOSYNCRASY present deserves careful attention and its 
 possible bearing upon the life prospects of the party must 
 be noted, Idiosyncrasies vary so remarkably in their 
 characters that it is unnecessary to do more than sim- 
 ply direct notice to the fact that they are capable cf 
 largely modifying particular indications, and indeed 
 the ultimate judgment. 
 
 ii. 
 
 The Pulse demands attention to its frequency, 
 rhythm and general character. Indications derived 
 from it require analysis to be at all satisfactory. 
 
 The normal pulse described by authors for the 
 adult male ranges in frequency from sixty-eight to sev- 
 enty-two ; more frequent in infancy, childhood and 
 youth again rising in frequency in advanced age, 
 although gradually diminishing from maturity to per- 
 haps sixty or seventy. It is slower in the morning 
 than in the evening. It is more frequent in the erect 
 position than when sitting, and still less rapid when 
 recumbent. It is hastened by nervous excitement or 
 muscular exercise. . Any tension of the contractile 
 
77 
 
 fibre will easily cause it to rise from the usual stand- 
 ard to even double its ordinary rate, In fine it is 
 rather an index of the nervous system than, as formerly 
 supposed, of circulatory energy. 
 
 The pulse of Great Britain and Continental Europe 
 ranges from sixty-eight to seventy-two, but that of 
 the Atlantic States of America from seventy-two to 
 seventy-six, while that of the Northwest will rarely be 
 less than seventy-six to eighty. A pulse uniformly, 
 or even temporarily, below sixty or above ninety must 
 be explained by idiosyncrasy, or else it rejects at the 
 best postpones judgement. 
 
 The irregular pulse must be likewise demonstrated 
 to be an individual characteristic; otherwise it rejects. 
 Unexplained it is totally exclusive. 
 
 The intermittent pulse calls attention to probable 
 cerebral or cardiac disease. Occasionally it is the re- 
 sult of temporary gastric or other local disorder ; but 
 even then it should cause suspension of judgment. 
 The rate of the pulse should be recorded when the 
 applicant is sitting, or, better, the difference in rate 
 between the two positions should be given. 
 
 The hammering pulse emphatically calls attention to 
 the cardiac valves. 
 
 The general character of the pulse is expressed by 
 the terms full, free, hard, soft, weak, etc. 
 
 While considering the pulse the whole arterial sys- 
 tsm should be taken under review. Unnatural or ex- 
 traordinary hardness possibly indicative of senile or 
 calcareous degeneration of the arterial parietes, to u*~ 
 timate in aneurism, senile gangrene or embolism. 
 
 But the pulse is fallacissima rerum 
 
78 
 
 III. 
 
 The Respiratory Organs. A fully developed and 
 
 powerful thorax is one of the best evidences of gene- 
 ral physical capacity and endurance, whilst a narrow, 
 contracted or malformed chest is a strong evidence of 
 a feeble constitution. The methods of investigation 
 differ somewhat in details, but all coincide in essen- 
 tials. 
 
 MENSURATION. Some details have already been 
 given (p. 56 et ^.,)as to the relation of the circumfer- 
 ence of the chest to the height and weight. It is well 
 to bear in mind that due proportion requires that the 
 circumference should equal twice the distance between 
 the angles of the shoulders ; that it should be four 
 times the antero-posterior diameter at the lower por- 
 tion of the sternum, and that this latter diameter 
 should exactly equal the distance between the nipples. 
 
 Practically, measurement is best made with the sim- 
 ple graduated tape line, which adapts itself readily to 
 the surface and can be always carried in the pocket. 
 For physiological investigations other instruments may 
 be of service, but are unnecessary here. The line 
 should be applied under the vest, if practicable, at the 
 level of the nipples, and on the same plane anteriorly 
 and posteriorly. If taken over the vest, or there is 
 much clothing beneath the tape, a suitable allowance 
 must be made therefor. 
 
 Note now the measurement : 
 
 I st. During the largest inspiration. 
 
 ad. During forced expiration. 
 
79 
 
 3d. During tranquil respiration about the middle 
 of inspiration. 
 
 The first and second measurements give a clue to 
 the capacity of the lungs for the " complemental " air 
 or extreme vital capacity, whilst the third suggests the 
 amount of " tidal " or ordinary breathing air, which is 
 perhaps of equal importance, as exhibiting the indi- 
 vidual's present condition. A man five feet eight 
 inches should have a breathing capacity of 230 cubic 
 inches of air, while in point of fact, in tranquil respi- 
 ration there is not usually a change of over 20 or 30 
 cubic inches within the lungs. Nevertheless the phys- 
 ical capacity for large aeration of the blood adds to 
 the desirability of the risk. 
 
 The extreme breathing capacity is increased eight 
 cubic inches for every additional inch of stature be- 
 tween five and six feet, when due proportion is main- 
 tained. If this proportion is not maintained the risk 
 is, in so far, impaired. 
 
 Observations made with the spirometer, although 
 interesting in a physiological point of view, are prac- 
 tically of no avail to the insurance examiner. Inci- 
 dentally it may be observed that the extreme breathing 
 capacity is diminished by obesity ; that it is propor- 
 tionately less in females than in males, and in children 
 than in adults. The volume increases with age to the 
 thirtieth year, and gradually decreases from thence to 
 the decline of life. A deficiency from the normal 
 standard of sixteen per cent, is suspicious, and if very 
 much below this will invalidate the risk. Coincident 
 signs or symptoms under such circumstances, will al- 
 most invariably confirm indications on this point. 
 
8o 
 
 The average expansion in full respiration will be 
 found to be a little over three inches, but in tranquil 
 respiration it is scarcely more than an inch. The right 
 side expands a little more than the left, as it is gener- 
 ally, in right handed persons, a little over half an inch 
 largest. Any variation from the normal amount of 
 expansion at any part of the chest should be noted, 
 and its cause sought out. 
 
 INSPECTION. The general form of the chest will 
 suggest particular observation. Thus, whether there 
 be any flattening, especially in the clavicular regions, 
 or even across the whole anterior surface, with stoop 
 mg shoulders, curved sternum and projecting inferior 
 angles of the scapulae collectively indicative of fee- 
 bleness of constitution, slight power of endurance, 
 and proneness to tubercular deposit. 
 
 Flattening of the lateral or inferior portions, signifi- 
 cant of old pleurisy with remaining adhesion, or of old 
 abscesses, &c. 
 
 Again, deficient transverse diameter with projection 
 of the sternum, or "chicken-breast," suggestive of 
 causes of dyspnoea in early life, or perhaps now pres- 
 ent, or again, of rachitis, &c. The chicken-breast is 
 ordinarily indicative of deficient vital capacity, and al- 
 though not seemingly productive of inconvenience, 
 may, nevertheless, like " hunchback," militate against 
 the risk. 
 
 RESPIRATORY MOVEMENTS. The frequency, rhythm 
 and type of motion in inspiration and expiration are 
 to be noted. 
 
 In the adult male, during tranquil breathing, the 
 average frequency of inspiration may be placed at from 
 
Si 
 
 fifteen to twenty per minute, or about 17, but the 
 slightest mental influences or exercise will vary this 
 widely. Probably the point of most importance is the 
 ratio to the pulse, which should be very closely as one 
 to four or five. The movements should be noted 
 while numbering the pulse, and the ratio then ob- 
 served. Nevertheless, as a rule, if the respiratory acts 
 are less frequent than twelve or more than twenty- 
 four, decision should be suspended. It is to be recol* 
 lected, as Walshe observes, that the rapidity, energy 
 and extent of these movements " increase in the direct 
 ratio of the easy mobility' of the framework of the 
 chest (hence greater in youth than age,) and the height 
 of the individual." In females, generally, and in 
 males of a nervous temperament, the frequency is ex- 
 aggerated easily, and, as a rule, slowness of these 
 movements is a more objectionable feature than its 
 opposite. But coincident evidence will usually ex- 
 plain satisfactorily the cause. 
 
 The fifth expiration (on the average,) is a little deep- 
 er than the others. The ratio of inspiration, expira- 
 tion and quiescence should be about as five, four and 
 one respectively, 
 
 If the motions are irregular, intermittent or jerking, 
 the case requires scrutiny. If the ratio is widely de- 
 parted from, further investigation is demanded, partic- 
 ularly where expiration is prolonged the latter symp- 
 toms awakening great anxiety. The irregular, inter- 
 mittent or jerking respiration is usually indicative of 
 derangement of the nervous system, but prolonged ex- 
 piration minatory of local lesion of the lungs. It 
 6 
 
82 
 
 may become more than twice the length of the inspi- 
 ration. 
 
 The type should be abdominal in the infant, dia- 
 phragmatic and inferior costal in the adult male ; 
 superior costal in the adult female. Any change of 
 these types is suspicious. Notably so pectoral breath- 
 ing of marked character in the man, and even in the 
 woman, when exaggerated and accompanied by a per- 
 perceptible rising of the shoulders with each inspi- 
 ration. 
 
 DISEASES. Acute diseases of the respiratory or- 
 gans postpone and, after apparent cure, demand search 
 for lesions left behind. Catarrh, Pharyngitis, Lar* 
 yngitis, Tracheitis and Bronchitis do not necessarily 
 involve a tendency to Phthisis Pulmonalis, but their 
 frequent recurrence gives grave doubts, which must be 
 cleared up before insurance. If they assume the 
 chronic form, it becomes imperative to demonstrate 
 the absence of the tuberculous taint. Or perhaps they 
 may be the sole exponents of Syphilis or other cachexia, 
 
 Ulceration of the larynx is about infallibly an evi- 
 dence of tuberculosis or syphilis. 
 
 A slight catarrhal condition of the respiratory mu- 
 cous membrane may have become habitual, and in the 
 assured absence of any constitutional cachexia, or he- 
 reditary tendency, need not preclude the risk, although 
 placing it in lower grade. 
 
 But the attention of the Examiner is with greater 
 earnestness called to the more prominent affections 
 which, when decided to be present, must necessarily 
 induce him to decline the risk. 
 
As tnis is not intended as a systematic treatise on 
 nosology or diagnosis, for convenience I shall consider 
 these affections in alphabetical order. 
 
 ADHESIONS of the pleural surfaces often occur with- 
 out noticeable morbific results. It is important to 
 recognize the condition so as not to confound such 
 signs as it may afford with those of a graver character. 
 They impair the mobility of the parietes, and occa- 
 sionally that of the arm of the affected side. Flatten- 
 ing or contraction, more or less discernible, usually 
 of the lower and lateral parts of the chest ; feeble 
 respiration ; very slight diminution of resonance ; no 
 bronchophony or augmented vocal fremitus ; inter- 
 rupted respiration, but not prolonged expiration 
 Diagnosis will be materally assisted by noting his- 
 torical symptoms and absence of tuberculous diathesis. 
 Unless the pleurisy has become chronic, or the adhe- 
 sion is so extensive as to materially impair the breath- 
 ing capacity, this condition need not necessarily reject, 
 but assigns to a lower grade. When the results are 
 seen at the superior portion of the lobes, its almost 
 certain coincidence with tuberculous deposit and result- 
 ing inflammation, necessitates rejection. 
 
 ASTHMA has already been noticed, (p. 17, et j^,)but 
 when the party has wilfully or negligently concealed 
 its previous occurrence, it may often be detected by its 
 peculiar dry wheezing or sibilant whistle, even during 
 the interim. The affections upon which it may de- 
 pend or with wnich it may be confounded will be con- 
 sidered in another place. See, also, p. 18 et seq. 
 
 APHONIA may be due to nervous disorder, as hyste- 
 ria or hypochondria ; or it may evidence organic lesion 
 
8 4 
 
 of the nervous centre ; or local paralysis from loca 
 causes only; a turgid state of the laryngeal surfaces; 
 or ulceration, or, in old age, ossification of the carti- 
 lages. It is an occasional result of rheumatism, and 
 in some instances arises from the pressure of a dilated 
 or aneurismal aorta or other tumor. 
 
 When present it must be demonstrated to depend 
 on the trivial and transitory, and not upon the graver 
 causes. Its intimate relation with tubercular phthisis 
 and syphilis renders it deserving of analysis. 
 
 CONGESTION. It occasionally occurs, on percussion, 
 that there is evident diminution of the normal 
 resonance, with deficient respiratory sound on auscul- 
 tation, at the same time, the pitch is slightly elevated. 
 The ratio of inspiration to expiration may be unchanged 
 the movements slightly augmented in frequency, and 
 a trifle more of muscular effort observable, without 
 marked dyspnoea being present. With the feeble res- 
 piration there may sometimes be noticed a <c dryish, 
 rather fine, but distinctly bubbling rhonchus." 
 
 This condition may be only temporary or be perma- 
 nent in its character, as dependent on its cause. It is 
 important to diagnose it from tuberculous or other 
 deposits. It is the result of congestion, and, possibly, 
 also slight pulmonary oedema. It demands research 
 for the obstruction. 
 
 It is capable of being brought on, temporarily, by 
 the ordinary viscissitudes of temperature and humidity, 
 "functional" diseases of the heart, liver, nervous 
 apparatus, &c. ; or, by special influences malaria, gase- 
 ous or atomic emanations, retained excreta and the like. 
 
But it is also often the result of more or less perma- 
 nent obstruction in the pulmonary blood-vessels, or, 
 again, the heart. When present it should postpone 
 decision unti\ after a subsequent examination. Or 
 else, if the organic origin be determined, cause immedi- 
 ate rejection. But it is due the applicant not to con- 
 found it with the result of tuberculous deposit, or other 
 grave disease. 
 
 DYSPNOEA depends upon such a variety of causes 
 that it is not diagnostic, alone, of any single disease. 
 When considerable and permanent it should reject, 
 whatever the apparent cause. It may, however, be but 
 a peculiarity of a nervous temperament, or originated 
 only occasionally by peculiar influences depending on 
 idiosyncrasy. 
 
 If caused by permanent obstruction to the dia- 
 phragmatic movements, or by disease of the larynx, 
 trachea, lung tissue, pleura or heart it must reject, at 
 least while present. It is well to recollect, that it is 
 rarely a concomitant of tuberculous deposit ; hence, 
 the popular notion that phthisis and "asthma" are 
 incompatible. 
 
 DEPOSITS may be of great variety. Prominently 
 may be noticed: the Inflammatory ^ Tuberculous^ Cancerous , 
 Melanoid, Typhoid, and Syphilitic. The first two only 
 claim particular notice in this place, as any peculiarities 
 about the latter four will be found to depend on the dia- 
 thesis or cachexia by which they are to be determined. 
 
 The results of Inflammatory deposit in the parenchyma 
 are traceable from historical and present symptoms, and 
 the physical signs. 
 
86 
 
 The consolidated exudate of acute pneumonia mav 
 remain unabsorbed a long time, or even permanently 
 after the individual has regained apparent health. 
 Contracting, as does all inflammatory exudate, the 
 side of the chest overlying may flatten as after pleurisy. 
 There is less range of costal motion resulting (p. 71). 
 It is dull on percussion, with bronchial respiration and 
 broncophony over the affected part of the lobe not 
 even feeble respiration being heard as after pleurisy. 
 Occasionally around the part there is uneven, feeble 
 respiration, but this is rather significant of cedema of 
 the parenchyma, as, otherwise, it will be found harsher 
 or puerile. Combined with these signs it will be found, 
 on cautious inquiry, that there are dyspepsia and 
 irregular febrile accessions none of which may be of 
 sufficient seventy to attract attention unless sought for. 
 
 This deposit temporarily postpones but its diag- 
 nosis from tuberculous deposit should be made out, if 
 possible, to give opportunity for subsequent examina- 
 tion as well as in case of cure to protect the Examiner's 
 own reputation. All the evidences of the tuberculous 
 diathesis must be explored ; for, even when the phy- 
 sical signs presented are not about the apices, it is well 
 to bear in mind that there may occur tuberculous degen- 
 eration of the exudate. Where it involves the apices, 
 the diathesis, hereditary, or acquired, affords our only 
 means of judging of the abnormal material present. 
 
 The Life Insurance Examiner is not called upon by 
 Companies to investigate well marked cases of 'Tuber- 
 culous Deposit, accompanied with its well known 
 rational symptoms. He is to watch for its incipiency 
 
with the extremes: anxiety, for it is known to be 
 the greatest possible source of their financial losses. 
 Qbsta principiis is, most emphatically, to be his motto. 
 By his exercise of care, skill and sagacity he will be 
 enabled to reduce those losses to a minimum unexpected 
 before the introduction of Physical Diagnosis. 
 
 It is proper to remark, that when the physical signs 
 give evidence of deposit about the superior lobes of 
 the lungs it must reject, whatever the apparent diathe- 
 sis. It is equally important to remember that the dia- 
 thesis may be strongly marked to such an extent, 
 indeed as to determine rejection, when none of the 
 usual signs of deposit are discoverable. In the vast 
 majority of cases, the two are associated long before 
 manifestation of any of the characteristic symptoms 
 produced by the process of softening. 
 
 Perhaps the most observable early sign is Prolonged 
 Expiration; then Vesicular Murmur lessened at the part 
 Puerile around; Inspiratory Sound less forcible, higher 
 in pitch, and Bronchial Respiration more distinctly 
 tubular; Focal Fremitus exaggerated; Dullness more 
 or less decided on Percussion ; a little later, Flattening 
 with less superior costal motion and more diaphrag- 
 matic the shoulders being more perceptibly elevated 
 at each inspiration, whilst the general frequency of the 
 movements is accelerated to 24 or 28 in the minute, or 
 even beyond thre on the slightest excitement. 
 
 Owing, probably, to their usually more quiescent 
 state, the apices of the lungs are most liable to the 
 deposit, but other causes enforcing similar quiescence 
 
88 
 
 of any part of the parenchyma may determine its loca- 
 tion in that part. The supra scapular, supra, and infra 
 clavicular regions, in the absence of historical symp 
 toms pointing elsewhere, are the parts first to come 
 under investigation. 
 
 In these regions percussion sound elicited may be 
 deficient in clearness and in duration, with lessened 
 elasticity, and even when the deposit is small and in 
 scattered points, there will be less increase in reson- 
 ance over the affected than the sound part, when the 
 lung is inflated by full inspiration the dullness more 
 pronounced at the end of a complete expiration. 
 
 By auscultation the vesicular sounds may be found 
 varied within a limited space suppressed, weak or 
 exaggerated. The displaced tubular sound elevated in 
 pitch, harsher and prolonged. Crepitant dry rales, 
 or, later, of a moist character. More or less distinct 
 broncophony, and the sounds of the heart heard with 
 unusual distinctness through the changed conducting 
 medium. The rhythm, as previously noted, is liable 
 to irregularity. 
 
 The physical signs thus briefly alluded to determine 
 the presence of an abnormal deposit more or less 
 extensive, according to their distinctness of manifesta- 
 tion, and, even in the absence of the so-called c rational 
 symptoms' of incipient Phthisis, preclude insurance 
 unqualifiedly. 
 
 Not all of them may be present, and doubt may 
 arise, to be decided perhaps by reference to the his- 
 tory and diathesis of the applicant. If these are un- 
 satisfactory, the company must have the benefit of the 
 
8 9 
 
 doubt and the party be declined. (Vid. DIATHESIS.) 
 
 The Typhoid Deposit is noticeable for the reason that 
 whereas it will yield the same physical signs as the 
 true tubercular, and is prone to produce similar 
 results by its softening, nevertheless it is capable often 
 of being permanently. removed, and perfect local and 
 constitutional health be restored ; so that the case 
 once properly rejected by an experienced examiner 
 may, ultimately, be accepted by one equally as cautious 
 and expert.- 
 
 The same remark may be made with regard to the 
 Syphilitic Deposit. The "gummata' will yield the same 
 physical signs as tubercle, but eventually, under appro- 
 priate treatment, disappear. But while present they 
 reject as must the cachexia upon which they depend. 
 
 The Cancerous and Melanoid Deposits likewise ex- 
 clude, because of the physical signs afforded, as well 
 as the cachexiae originating them. 
 
 EMPHYSEMA. The pathological and prognostic 
 importance of this lesion depends wholly upon its 
 causation. Unless very extensive it may not be said 
 to shorten life, yet, like a contracted chest and small 
 lungs, it lessens vital capacity for aerating the blood 
 under circumstances demanding an increase of the 
 usual energy of the process, and thus renders its sub- 
 ject an easier prey to intercurrent diseases. A local 
 Emphysematous condition is not infrequently associ- 
 ated with tubercular lesion, but ordinarily its presence 
 over any considerable portion of the parenchyma is 
 said to lessen the liability to tubercle, haemoptysis and 
 pneumonia. Hypertrophous Emphysema is a nearly 
 
90 
 
 incurable affection the Atrophous or Senile form 
 absolutely so. Both varieties tend to produce enlarge- 
 ment of the heart. The hypertrophous form is usu- 
 ally associated with and probably caused by bronchitis, 
 which therefore should be looked for. It may be 
 hereditary, and in its manifestation is confined to no 
 age, sex, or condition. The atrophous form is con- 
 fined mainly to those well advanced in years. In the 
 first form the chest is locally or generally enlarged, so 
 as to give a bulging appearance, very peculiar in char- 
 acter when considerable in extent. The spine curves 
 anteriorly, and the angle of junction with the ribs 
 becomes more obtuse. 
 
 Percussion gives increased resonance, sometimes of 
 drum-like intensity, but with lesssened resistance of 
 the thoracic parietes. Auscultation shows feeble res- 
 piration in the affected parts with, it may be, puerile 
 or harsh vesicular murmur in the healthy structure. 
 Associated with these are usually found the abnormal 
 sounds of bronchitis or asthma. The rhythm of the 
 inspiratory movements is likely to be irregular, and 
 expiration prolonged. 
 
 There is dyspnoea continually, and this, at times, 
 deepens into the asthmatic paroxysm. The superficial 
 veins are turgescent, and the hue of the skin is darkened 
 by the imperfectly aerated blood. The features wear 
 the characteristic marks of habitual laborious breath- 
 ing. With exception of the general expansion and 
 bulging of the chest, the atrophous variety presents a 
 similar array of signs and symptoms. The existence 
 
9 1 
 
 of either form of the lesion being established, the 
 applicant must be rejected. 
 
 EMPY^EMIA is usually made out with sufficient accu- 
 racy by the historic and present symptoms, and the 
 physical signs of pleuritic effusion. It of course rejects. 
 It may be borne in mind that occasionally a fistulous 
 opening occurs, and the contentsof the pleural cavity 
 are discharged a long distance from it. Such cases, 
 mth tolerably fair health, have been mistaken for 
 fistulae or ulcers from other causes. The previous 
 occurrence of pleurisy and the presence of a supposed 
 "fever sore on the back or elsewhere that pus may 
 find its way, demands caution. 
 
 HEMOPTYSIS has been referred to (p. 34). 
 
 HEMATEMESIS. (Vid. p. 35.) 
 
 HYDROTHORAX although the party may appear 
 otherwise in perfect health, while present postpones, 
 whatever the cause. If connected with structural lesion 
 of the heart, liver or kidneys, it positively declines. 
 
 PNEUMOTHORAX rejects as decidedly as Emphysema, 
 and hence its differential diagnosis from the latter is 
 unnecessary. 
 
 PLEURODYNIA, being but a mere symptom, requires 
 analysis. The term is carelessly applied to cases 
 which may prove to be rheumatism of the intercostal 
 muscles; intercostal neuralgia, the chest pains of 
 phthisis, or chronic pleurisy, or from carcinoma 
 within the parietes. It is properly restricted to the 
 first mentioned disorder. The pain on movement is 
 likely to locally diminish the expansion of the parietes, 
 and hence there will be less distinct respiratory mur- 
 
9 2 
 
 mur, and less resonance on percussion. The remark- 
 able aggravation of pain by movement, ibsence of 
 other physical signs of deposit, &c., and reference to 
 the diathesis, will be sufficient to diagnose the case. 
 
 Tntercostal neuralgia is distinguishable by the ab- 
 sence of abnormal physical signs by its tendency to 
 paroxysmal or periodical forms, and by the diathesis 
 present. Its obstinate continuance may point to 
 spinal lesion, or that of remote organs with which the 
 part affected is in relation through reflex nervous 
 action. Movements aggravate it very little if at all. 
 Neither the simple rheumatic or neuralgic affection 
 rejects, unless connected with evidence of constitu- 
 tional or organic disease. 
 
 The chest pains of phthisis, chronic pleurisy, car- 
 cinoma, &c., need only be mentioned to direct the 
 attention of the examiner to their differential diagnosis 
 Of course each rejects. 
 
 TUMORS, within the thoracic cavities, whatever their 
 nature, may attain considerable size before producing 
 noticeable symptoms. Eventually their pressure upon 
 the lungs or heart, the nerves or blood-vessels may 
 give rise to pain, dyspnoea, palpitation, dysphagia, dis- 
 placement of organs, interference with the circulation, 
 haemoptysis, inflammation with its results, bulging of 
 the ribs and sternum, &c. But where these symptoms 
 are present parties rarely present themselves for exam- 
 ination, or if they do, the matter is easily disposed of. 
 
 According to their location they will change the 
 normal auscultatory and percussion sounds. Dimin- 
 ished resonance and feeble vesicular murmur are the 
 
93 
 
 necessary physical signs. Light percussion may show 
 resonance, whilst a stronger blow will elicit deep- 
 seated dullness. The particular character of the 
 tumor can only be surmised from concurrent symp- 
 toms, and the diathesis or cachexia present. The most 
 satisfactory diagnosis is here the result of the exclusive 
 metnod determining the absence of other lesions 
 which might account for the signs and symptoms. 
 
 The intra-thoracic tumor, whether aneurismal, can- 
 cerous, fibrous, fatty, steatomatous, or whatever it 
 may occur, positively forbids assurance. 
 
 In passing from the consideration of the respiratory 
 organs, it is not out of place to remark that, the whole 
 thorax should be comprehended at a coup d y ceil, and 
 yet individual parts be thoroughly scanned. The 
 unassisted ear, applied to the chest, will often gain a 
 more satisfactory acquaintance with its general con- 
 dition and vital capacity, than can be gained by the 
 most expert use of the stethoscope. Whether the 
 ear is applied directly to the chest, or a stethoscope is 
 interposed, is not a matter of so much importance 
 as that the examiner be able to hear with the ear, and 
 correctly interpret the report of the organ. 
 
 IV. 
 
 Heart and Circulatory System, The remark on 
 
 page 21 may be repeated: Ce Organic disease of the heart 
 positively excludes." Its acute affection or chronic 
 lesion with marked rational symptoms will not, mani- 
 festly, be brought to the Insurance Examiner's atten- 
 
94 
 
 tion ; but as its lesions, even when giving rise to no 
 inconvenience of which the party himself may be con- 
 scious, nevertheless are liable suddenly or slowly to 
 cut short the life, it becomes absolutely essential 
 to explore the slightest deviation from its normal 
 condition. 
 
 ^LOCATION. Recognized by its impulse, palpitation 
 and percussion, the heart should occupy in relation to 
 the thoracic wall a space about two inches in diameter 
 vertically between the fourth and sixth ribs, and trans- 
 versely a little to the left of the sternum the impulse 
 of the apex being about two inches below the nipple, 
 and, varying with the size of the chest, an inch towards 
 the mesial line, 
 
 Any change from this location requires inquiry as 
 to its cause. Prominently among causes are to be 
 mentioned ; Pleuritic Effusions, whether of serum, 
 pus, or air ; Emphysema ; Deposits in the Lung, 
 whether tubercular, inflammatory, cancerous or other ; 
 Tumors ; Dilatation of the Stomach, Enlargement 
 of Liver, Ascites, &c. 
 
 BULGING OR DEPRESSION. Protruding of the prae- 
 cordial region indicative of Hydro-pericardium, or 
 Hypertrophy of the organ. Depression, if consider- 
 able, indicative of previous Pericarditis with its 
 contracted exudates and adhesions. 
 
 IMPULSE. This is, as might be expected, normally 
 stronger in persons of a lean habit than in the corpu- 
 lent. Its location is changed by position, whether 
 erect or supine ; by distension of the stomach ; oy 
 respiratory movements, &c. It is augmented ir 
 
95 
 
 extent and intensity by hypertrophy. It is augmented 
 in area of vibration, but diminished in intensity by 
 dilatation or pericardial effusion, or fatty degenera- 
 tion. A feeble impulse, irrespective of local lesion 
 of the heart itself, may indicate cerebral disease, im- 
 poverished or morbid blood, or reflex influences of 
 depression from disease of remote organs. 
 
 A broken or irregular impulse is suggestive of peri- 
 cardial adhesions. When both a systolic and diastolic 
 impulse are felt, hypertrophy with dilated ventricles 
 is to be looked for. In connection with the impulse 
 may be noticed the purring thrill of Laennec, suggest- 
 ing possible presence of valvular stiffening. Vibration 
 as of friction may be felt from roughened pericardial 
 surfaces. 
 
 AREA OF DULLNESS. The diameter indicating the 
 approximation of the heart to the parietes of the 
 chest may be extended by strong percussion, eliciting 
 deep-seated dullness over the entire heart and large 
 blood-vessels superior. But if without change in the 
 strength of stroke, the area is materially increased, 
 there is room for apprehension of fluid effusions in 
 the pericardium or enlargement of the heart itself. Of 
 course, local pleuritic effusion may be confounded with 
 it, but to the examiner this is of little consequence, 
 as either must reject, or, at best, postpone. The same 
 remark may be made as to the differential diagnosis 
 of Hydro-pericardium, and Concentric or Eccentric 
 Enlargement of the Heart. 
 
 An apparent diminution of the area of dullness is 
 noticeable during a deep respiration, but if very 
 
9 6 
 
 considerable, or there is abnormal resonance, there 
 may be pulmonary emphysema, or hydroeria, either of 
 which reject. In doubtful cases the applicant should 
 be examined both in the erect and recumbent position. 
 Abnormal dullness in the aortic region calls attention 
 to the possibility of dilatation, or aneurism of the 
 the great arterial trunk. 
 
 PULSATIONS. In addition to the character of the 
 impulse produced by the cardiac movements, it be- 
 comes necessary to note the rhythm, which may be 
 varied in frequency, order of succession, and multiple 
 character. Coincidently, with the pulse (p. 64 et. seq.} 
 it may be increased or diminished in frequency, or it 
 may become irregular or intermittent. Its normal 
 range for insurance purposes is from sixty to eighty- 
 five, or possibly ninety in the minute. Continuously 
 above or below this standard should reject or post- 
 pone. But the great power of the nervous system 
 over the contractions should be kept in mind. Mental 
 excitement under the examination, in nervous sub- 
 jects, will often throw the beats up to a hundred or 
 more. If without this the applicant stands erect, and 
 brings the muscles of the extremities into a state of 
 contraction, voluntarily or involuntarily, the beats 
 will readily pass the hundred. Hence the necessity 
 of waiting examination until the effects of exercise or 
 mental excitement have passed, and then, while the 
 person is in the sitting or recumbent position, enjoin- 
 ing upon him as complete relaxation of all the muscles 
 as possible. With due precautions, if there be not 
 some fixed cause of a morbid character, apparent 
 
97 
 
 abnormalities in frequency may be made to disappear, 
 Extreme rapidity or palpitation (p. 28,) although 
 generally accompanying some lesion of the heart, 
 cf Hears no positive relation to any special cardiac 
 malady, and is therefore not diagnostic of any." The 
 symptom directs attention to possible cardiac lesion, 
 but in the vast majority of instances to dyspepsia, 
 impaired blood, or nervous disorder. Retardation 
 of the pulsation points to some affection of the 
 nervous centre, or degeneration of the cardiac paren- 
 chyma, or alteration of the aortic orifice. Irregularity 
 of contraction is of rather more significance, as indi- 
 cating valvular or parenchymatous local change, or 
 grave lesion of the nervous centres or remote organs. 
 Yet many cases occur where irregularity is the rule 
 even during most perfect health. Hence, taken alone, 
 it ought not to cause rejection. Palpitation with 
 irregularity and deficient impulse suggests dilatation 
 and weakened walls, although other physical signs 
 may be wanting. In this case the rational symptoms, 
 age, habits, condition of the digestive system, the 
 blood, &c., will afford sufficient concurrent evidences 
 to decide upon the real character of the case. 
 
 The intermittent pulsation may be an individual 
 peculiarity in health, but generally indicates organic 
 cardiac lesion, or some cause either temporarily or 
 permanently impressing the nervous system. It is 
 of graver character, on the whole, than either changes 
 in frequency or regularity. 
 
 The relation of the systolic and diastolic sounds to 
 ^he intervals of rest may be varied; more usually 
 7 
 
9 8 
 
 the longest interval is prolonged, which may depena 
 on auriculo-ventricular stricture ; or, again, the first 
 sound may be prolonged over upon the second, sug- 
 gesting (C hypertrophy with stricture of the arterial 
 orifices." In strongly marked cases of this kind the 
 diastolic sound is sometimes wholly suppressed. 
 
 On the other hand, there may be heard three or 
 four sounds instead of two, ascribable to important 
 organic changes in the structure. The precise nature 
 of these changes it is unnecessary to point out, as this 
 abnormality must peremptorily exclude from assurance, 
 whatever its plausible explanation. 
 
 CHARACTER OF SOUNDS. The "dull, booming ana 
 prolonged" first sound of the heart, and the cc short, 
 abrupt and clear" second sound, in a condition of 
 health are sufficiently distinct to be easily recognized, 
 and when present for any even short period argue a 
 healthy organ, but variation of these sounds may arise 
 from incidental causes not implicating the structure. 
 The healthy sounds when heard demonstrate abnor- 
 mal sounds throw doubt, and their cause must be 
 cleared up. 
 
 Increased intensity of the sounds may depend 
 on hypertrophy with dilatation, induration of the 
 muscular tissue from carditis, or merely upon nervous 
 excitability. They may derive increased loudness 
 from solid or fluid deposits, in which case they are 
 heard with distinctness at distant parts of the chest. 
 
 Feebleness of the sound may indicate fatty degene- 
 ration, or softening, atrophy, general debility, or 
 accumulation of fluid in the pericardium ; or, again, 
 
99 
 
 the interposition of the non-conducting emphysematous 
 lung. 
 
 Increased sharpness may suggest thinness of the 
 walls of the heart, as dullness points to hypertrophy 
 and thickened valves. 
 
 A dry and sharp sound increased tensity of the 
 valves. Hoarse and muffled a tumid condition of the 
 same. 
 
 Metallic sound is usually dependent on gastric 
 flatulency or nervous excitement, but sometimes due 
 to stiffening of the muscular structure from old 
 carditis. 
 
 The addition of a bruit to sounds is a circumstance 
 which demands all the skill of the Examiner to appreci- 
 ate in its bearings. The blowing sound may vary 
 from the lightest murmur to the grating, rasping, and 
 even whistling or musical sound. It is well to recol- 
 lect that the intensity of the abnormal sound is not 
 coincident with the extent of the lesion. The bruit 
 de soufflet is caused by some obstruction to the free 
 flow of blood through the heart and great vessels, or 
 by a wrong composition of the blood, or nervous 
 excitability. In the latter instances the bruit is often 
 temporarily absent, but in case of organic lesion, the 
 bellows-murmur, of greater or less intensity, must 
 always be present. 
 
 The differential diagnosis of the immediate causes 
 of the changed character of the sounds is not so im- 
 portant here, for when traced to actual organic lesion 
 of the heart, the case must be rejected, whatever part 
 
too 
 
 of the structure is involved. But for convenience of 
 reference Dr. Henry's diagnostic table is introduced : 
 BRUIT : If systolic and loudest at 
 
 Base = AORTIC obstruction. 
 Apex = MITRAL insufficiency. 
 BRUIT : If diastolic and loudest at 
 
 Ease = AORTIC insufficiency. 
 Apex = MITRAL obstruction. 
 PULSE : If regular, full, or strong, jerking or 
 
 resilient AORTIC disease. 
 
 PULSE : If irregular, intermittent, unequal, soft, 
 small, weak = MITRAL disease. 
 
 The systolic bruit, synchronous with the pulse and 
 most audible at the apex, indicates mitral disease. 
 The diastolic bruit, most audible over the centre of 
 the sternum and along the course of the aorta, is 
 indicative of aortic disease. Blowing sounds from 
 functional disorder, impaired blood, etc., are usually 
 soft rarely harsh or musical. Although there is 
 evidence that the bruit is occasionally an individual 
 congenital peculiarity, nevertheless the rarity of such 
 cases, and the difficulty of establishing their history, 
 must preclude their acceptance. Recurrence to the 
 historical and other rational symptoms, may convince 
 that the abnormal sound does not depend on or- 
 ganic change, but while present it rejects or at least 
 postpones. 
 
 LOCATION OF SOUNDS. Effusions, tumors, morbid 
 adhesions, etc., may displace the sounds laterally or 
 antero-posteriorly. Descent of the sounds indicates 
 hypertrophy with dilated auricles, or tumors at the 
 base of the heart. Abdominal distension, by raising 
 the diaphragm, may cause ascent of the sounds. 
 
101 
 
 Friction sounds are indicative of changes in the serous 
 lining of the pericardium, analogous to those which 
 have been alluded to on the pleura, tending to adhesions, 
 contraction and impairment of cardiac movements. 
 When present they reject. 
 
 DISEASES. Among those affections of the heart to 
 which the examiner's attention is to be directed may 
 be noted : Aneurism, Angina Pectoris, Adhesions, 
 Atrophy, Cyanosis, Degeneration, Dilatation, Hyper- 
 trophy, Malformations, Myocarditis, Pericarditis, Val- 
 vular changes, and, lastly, disorders not involving ap- 
 parent structural changes, but rendering its movements 
 and sounds abnormal. 
 
 Aneurism may affect the wall of the heart, or the 
 coronary arteries. Its symptoms and signs are alike 
 obscure, but the possibility of a party, pronounced 
 free from cardiac disease, dying suddenly from this 
 lesion renders it desirable for the examiner to bear in 
 mind its occasional occurrence particularly when 
 investigating obscure cases. 
 
 Angina Pectoris that intense pain in the praecor- 
 dial region, with suffocative sensations and fearful 
 anticipations of sudden death is generally indicative 
 of fatty degeneration or obstruction of the coronar) 
 arteries. In all cases it rejects. 
 
 Adhesions, impairing the mobility of the organ, and 
 most usually accompanied by lingering pericarditis, 
 temporarily rejects. In such cases there is possibility 
 of ultimate recovery. 
 
 Atrophy diminished area of dullness, lessened 
 intensity of sounds and impulse. This condition is 
 
IO2 
 
 invariably connected with such a degree of general 
 cachexia, or debility, that the latter alone would 
 preclude the risk. 
 
 Cyanosis, usually congenital, but not always some- 
 times appearing late in life is both incurable and 
 subjects to the chances of sudden death. 
 
 Degeneration, ordinarily fatty and coincident with 
 similar affection of the kidneys, liver, etc., rejects. It 
 is tolerably recognizable by exclusive diagnosis. Feeble 
 impulse, weak sounds, slownesss of pulse, occasionally 
 dyspnoea with evidences of pulmonary congestion, 
 general debility, giddiness, faintness, nervous exhaus- 
 tion, etc. In all cases of obesity, especially where 
 fattening has taken place rapidly, as often during con- 
 valescence from low fevers, the heart must be carefully 
 inspected for signs of this grave change. 
 
 Dilatation may be coincident with hypertrophy, natu- 
 ral thickness of the wall, or with the latter attenuated. 
 In the last mentioned form there are increased area of 
 dullness, less powerful impulse, but increased intensity 
 of sounds. The pulse is weak and irregular. Inac- 
 tive capillary circulation in the extremities. Gastric 
 and cerebro-nervous symptoms, dyspnoea, palpitation, 
 etc. However mild the rational symptoms, the 
 dilatation alone, if made out, rejects. 
 
 Hypertrophy^ whether concentric or eccentric^ declines 
 the risk. It is usually connected with valvular ob- 
 struction, although hypertrophy of the right ventricle 
 may depend on obstruction to the pulmonary circula- 
 tion. Differential diagnosis is scarcely important here. 
 Increased area of dullness, augmented impulse, less 
 
distinctness of systolic sound, and, usually, concurrent _ 
 changes in the valvular sounds. Full and flushed face, 
 headache, vertigo, cardiac uneasiness, pain or palpita- 
 tion increased by exercise, dyspnoea, etc., may be 
 acknowledged as present to a greater or less extent. 
 The hypertrophy is rather the result of disease than a 
 disease itself/ but it is so fraught with danger that the 
 applicant must be turned over to invalid companies. 
 
 Malformations and misplacements of the heart scarcely 
 need more than an allusion in this place. Cyanosis, 
 dyspnoea, palpitation and morbid sounds may be pres- 
 ent. The malformed heart always vitiates the risk, 
 even though signs of its injurious result be not dis- 
 coverable. Congenital misplacement of the heart is 
 so rare a phenomenon that, practically, it may be ig- 
 nored. But if displaced by effusions, tumors, etc., 
 the cause will be warrant for rejection. 
 
 Myocarditis is of importance to the examiner from 
 its results, especially softening and induration. The 
 latter may ultimate in a dense cartilaginous transfor- 
 mation of the tissue, or even osseous deposits. Evi- 
 dences of either of these conditions utterly preclude 
 acceptance of the applicant. (Vid. p. 21.) 
 
 Pericarditis often leaves behind it adhesions impair- 
 ing the cardiac movements, or effusions impeding dila- 
 tation. The methods of diagnosis have been pre- 
 viously given. Entire absence of rational symptoms, 
 and physical signs of lesion, must be insisted upon 
 prior to insurance. Repeated attacks disqualify, 
 whether any symptoms or signs of mischief are present 
 or not. 
 
IO4 
 
 Valvular changes, aside from their interference with 
 the transit of blood through the heart, are significant 
 of chronic Endocarditis, Bright's disease, Rheuma- 
 tism, Gout, and various constitutional derangements 
 of the system with impaired nutrition. So constant 
 is this association that, when there is doubt as to the 
 meaning of abnormal valvular sounds, judgement can 
 usually be largely aided by careful attention to the 
 rational evidences of these, to the superficial observer, 
 apparently disconnected difficulties. 
 
 Aside from the cachexia determining valvular change, 
 all forms are characterized by symptoms denoting in- 
 terference with the capillary circulation. Hence the 
 increased frequency of respiration, and the dysp - 
 or rather the peculiar breathlessness, under all tnose 
 influences which tend to render the pulse more rapid. 
 Even when there are few other noticeable symptoms, 
 it will be found, on questioning, that the party sleeps 
 at night with the head and shoulders unusually ele- 
 vated. There will be evidence of oppressed respiration 
 without actual dyspnoea, with semi-voluntary, deeper 
 inspirations at short intervals. The movements are 
 languid and the extremities, in the evening particu- 
 larly, are apt to be puffy and swollen. A short, dry 
 cough, palpitation, occasional headache, restless and 
 disturbed sleep, and praecordial pains are often present, 
 and usually attributed to dyspepsia by the patient. 
 Hepatic venous changes and disturbed action of the 
 kidneys are the almost natural sequences, and without 
 due consideration there is a liability to refer all the 
 unpleasant feelings of the individual to " functional " 
 
disturbances of these organs. In all doubtful cases, 
 an investigation of the condition of the renal organs 
 will throw much light on the diagnosis. 
 
 With the later symptoms and results of the valvular 
 lesion the Insurance Examiner, as such, has nothing 
 to do, but a few words with regard to the relative fre- 
 quency of the varieties, and their comparative fatality, 
 may not be considered out of place. 
 
 Aortic Obstruction is one of the most frequent re- 
 sults of chronic valvular disease, and is longer in pro- 
 ducing fatal results. It involves slow dilatation of 
 the left ventricle and thus renders the mitral valves 
 insufficient, the consequence of which is mitral regur- 
 gitation, with symptoms of congestion of the lungs. 
 In this obstruction there is, when the heart is beating 
 forcibly, marked parietal vibration over the base of 
 the heart and the aorta. 
 
 Aortic Regurgitation is also quite common, an,. 
 fects similarly the ventricle and mitral valve. The 
 pulse is peculiar "short and jerking/' 
 
 Mitral Obstruction is infrequent. It necessitates dil- 
 atation of the left auricle and pulmonary artery with 
 engorgment of the lungs. The pulse is variable in 
 force, but rapid. Cough, respiratory oppression, and 
 general disorder follow, and death speedily ensues, 
 usually from pulmonary oedema or apoplexy. 
 
 Mitral Regurgitation is the most easily recognized of 
 all the valvular lesions. The mitral valve seems to be 
 the favorite point of attack when. rheumatism impli- 
 cates the heart. The systolic murmur is manifested 
 by the slightest changes, even when symptoms are 
 
io6 
 
 absent. The blood, escaping the imperfectly closed 
 orifice, is driven back upon the lungs, producing con- 
 gestion, with feeble pulse and dusky comp.exion. The 
 left side of the heart is dilated the ventricle also be- 
 ing hypertrophied. There is a chest thrill, but it is 
 not transmitted along the aortic trunk. The pulse is 
 irregular and deficient in fulness and force. 
 
 Obstruction, and regurgitation, through the pulmo- 
 nary orifices are so rare as, practically, scarcely to de- 
 mand notice. Regurgitation through the tricuspid, 
 however, may not infrequently occur as a consequence 
 of dilatation of the right ventricle, which then be- 
 comes hypertrophied, the auricle and vena cava dis- 
 tended, and there is a strong tendency to congestion of 
 the systemic and cerebral circulation. 
 
 So far as term policies are concerned, or invalid 
 risks, simple aortic obstruction is by far the most 
 favorable for assurance. Mitral and tricuspid regurgi- 
 tations are the least so. A system otherwise in perfect 
 order, may gradually adapt itself to the changed cardiac 
 conditions, and life be prolonged indefinitely. 
 
 N ON- ORGANIC DISEASES of the heart are capable 
 alone of producing death, and hence, on determining 
 the absence of organic lesion, they should not be dis- 
 missed unnoticed. Youths and young adults are lia- 
 ble to them to a marked extent. So also women about 
 the climacteric period. They are the product of 
 nervous exhaustion or oppression, of dyspepsia, 
 gout and rheumatism. Sexual excesses, uterine irri- 
 tation, over-use of narcotics and stimulants etc.. 
 readily beget them. 
 
io 7 
 
 Palpitation and intermittent, irregular and feeble 
 pulse may be associated with valvular murmurs, closely 
 simulating those from organic disease. There may be 
 praecordial pains, with occasional attacks of headache, 
 giddiness, or even syncope. Violent pulsations of the 
 larger arteries, and a bruit may be heard along their 
 track. There may even be subcutaneous oedema. 
 
 Dyspnoea is rarely present, and at times the valvu- 
 lar sounds are healthy. All the symptoms are more 
 strongly marked than in real organic diseast. Careful 
 analysis will detect differences not easily described. 
 The concurrence of symptoms will develop a non-in- 
 surable condition, at least temporarily existent, in 
 doubtful cases. Diagnosis from fatty degeneration 
 will give the most difficulty. Frequent functional 
 disorders increase the liability to ultimate organic 
 diseases. 
 
 Generally the blood murmurs of non-organic affection 
 are heard at the base of the heart, but occasionally, 
 probably rarely, the murmur is to be heard over the 
 centre of the heart, -and becomes more distinct at the 
 apex. In the latter case anaemia is usually so distinct 
 as alone to decline the risk. 
 
 In the non-organic affection the signs of hyper- 
 trophy do not accompany the abnormal bruit. The 
 murmur is heard along the blood vessels. It is fol- 
 lowed by a short and sharp second sound. The mur- 
 mur is almost invariably, notwithstanding the exag- 
 geration of other symptoms, of a soft character. 
 
 But it must be confessed that it often requires the 
 grestest tact to decide correctly in these cases. For 
 
108 
 
 the Insurance Examiner the best rule is to examine 
 at different times and with the most rigid precautions 
 against error, recollecting that when the "functional" 
 disorder is so considerable as to give doubt of the 
 presence of organic change, the party is uninsurable 
 on that account alone. 
 
 DISEASES OF BLOODVESSELS. The occasional occur- 
 rence of aneurism, without symptoms noticed by the 
 patient, suggests attention. The aorta may be dilated, 
 or so enlarged by aneurismal tumor, as to cause bulg- 
 ing of the thoracic parietes before its peculiar and 
 ultimately terribly distressing effects are developed. 
 Or it may cause what is supposed to be laryngitis, by 
 pressure on the recurrent laryngeal nerve ; or attacks 
 of dyspnoea, analogous to paroxysmal asthma. When 
 its graver influences are manifest, naturally, the suf- 
 ferer will not present himself for assurance. But 
 earlier examination may detect, along the course of the 
 aorta, slight protusion and dullness over the surface. 
 It is more resistant, and the systolic impulse is com- 
 municated strongly to the finger. There may be vi- 
 bration, but this is not always present. The persis- 
 tent systolic impulse at the point, together with the 
 usually attendant dyspnoea, cough, frequent irregularity 
 of the circulation, swollen veins of the neck, and tho- 
 rax ; sometimes diversity in the pulsations of the two 
 radial arteries from pressure on the sub-clavian; con- 
 traction of a single pupil on the affected side, with 
 more or Jess disturbance of remote organs, will enable 
 a decisive judgment against the applicant. x When evi- 
 dences of intra-thoracic tumor are present, differential 
 
109 
 
 diagnosis is unnecessary, for any kind rejects, but it is 
 well to bear in mind that aneurismal tumors constitute 
 the largest majority. 
 
 The condition of tne arterial system, as a wholt, 
 here comes under review. Is there an aneurismal ten- 
 dency, from disease affecting the arterial wall ? Does 
 the rigid inelastic artery of advanced age suggest the 
 conditions of senile gangrene ? Is the structure such 
 as to endanger rupture and apoplectic extravasation 
 in the brain ? Do the veins show marks of tardy re- 
 turn of the blood ? Has the valvular structure been 
 obliterated and the varicose condition ensued ? Ex- 
 tensive varicosities of the veins impair the risk, not 
 solely from the dangers of rupture and hemorrhage, 
 but because indicative of either a general tendency to 
 disease of the venous system, or some obstruction 
 which may be of permanent character on the proximal 
 side of the enlarged vessel. 
 
 Extraordinary pulsatory movements of the arteries, 
 as noticed particularly along the aorta, carotids and tem- 
 porals, suggest anaemia, structural derangement of the 
 digestive organs as in the gouty diathesis, or great ex- 
 citability of the nervous system. In the female it is 
 liable to be associated with uterine disease. 
 
 In some instances it is one of the concurrent evi- 
 dences of abuse of alcoholic stimulants, tobacco, 
 opium, etc. 
 
 V. 
 
 Abdominal Organs, The historical indications 
 may call attention to the condition of particular viscera, 
 
no 
 
 but in every case the general contour of the abdomen, 
 its proportion, symmetry and movements should be 
 observed. It is proportionately larger in children than 
 in adults, and again with advancing age it becomes 
 more protuberant. Obesity more speedily shows it- 
 self by large deposits on the omentum and in the ab- 
 domina' walls. It may be distended by ascites, by ac- 
 cumulated gases or by tumors. It is more voluminous 
 in females who have borne children. In the region of 
 the epigastrium it is always enlarged after eating, but 
 in many cases of dyspepsia it may become enormously 
 distended by persistent flatulency. 
 The liver or spleen may be so increased in dimen- 
 sions as to occupy, respectively, the greater part of the 
 cavity. Mesenteric disease, ovarian growths, encyst- 
 ed fluid or solid tumors, accumulation of faeces and 
 hernial protrusions, severally, may change its outline 
 and indicate more or less grave results. 
 
 Retraction of the walls may call attention to general 
 emaciation, exhausting chronic diarrhoea or dysentery, 
 metallic poisoning, tuberculosis of the mesenteric 
 glands, or occasionally fibroid or cancerous deposits at 
 the orifices of the stomach. The shrunken abdomen 
 warns of deficient nutrition and cachexia. It is also 
 liable to be present in organic affections of the brain. 
 
 The contour and proportion are best observed in 
 the erect position, but if circumstances require investi- 
 gation of the exact condition of the viscera, the person 
 should be placed in the recumbent position with the 
 limbs flexed on the trunk. With proper precautions 
 to relax the muscular investment, the outline and 
 
Ill 
 
 genera, condition of the contained organs can DC ascer- 
 tained with very great exactness, unless the party is 
 very obese. 
 
 THE STOMACH, if abnormally distended, indicates 
 impaired digestion, or an obstruction to the passage 
 of the chyme from its cavity. Deficient secretion of 
 the gastric juice, or deficient innervation with conse- 
 quent loss of mobility, are suggested the deficient 
 innervation possibly dependent on cerebral lesion. 
 Obstruction involves either temporary spasmodic ac- 
 tion^ or a thickened or carcinomatous pylorus, which 
 latter may be detected by deep palpation. 
 
 The small or shrunken stomach accompanies weak 
 digestive power and scanty nutrition. 
 
 THE LIVER enlarged, points to endemic influences 
 and portal venous congestion, or such other causes as may 
 produce the same result. Even dropsical accumula- 
 tion may ensue, but as the cause is ordinarily tempo- 
 rary and removable, its previous occurrence does not 
 decline, and its presence only postpones the risk. But 
 enlargement from hepatic venous congestion, with or 
 without dropsical effusion, prevents insurance, because 
 dependent on thoracic obstruction to the circulation. 
 Unless that obstruction is proved to have been only 
 temporary, the objection is a fatal one. The diagnosis 
 between these two forms is usually readily made out, 
 and the important character of their diversity must 
 fully impress the Examiner. The enlargement may 
 be due to abnormal deposits in the parenchyma to 
 determine the character of these requires attention to 
 the history, and establishment of the diathesis. If to 
 
112 
 
 be referred to abnormal deposits or growths, the cast 
 must be rejected. 
 
 Atrophy of the organ is generally connected with 
 evidences of impaired digestion and secretion, which 
 taken with the history, will suffice for diagnosis. In 
 vastly the larger proportion of cases the small liver 
 depends upon cirrhosis, and this produced by habitual 
 use of alcoholic stimulants. In all cases this condi- 
 tion established, even without symptoms of its remote 
 results, denies the risk. Its most obvious concurrent 
 symptoms are disturbance of the stomach and obsti- 
 nate diarrhoea. The superficial veins of the abdomen 
 are apt to be enlarged ; the skin is sallow, dry and 
 rough. Dn Budd asserts strongly : " Slight sallow- 
 ness of complexion, a dull pain, or some degree of 
 tenderness in the right hypochondrium, with occasional 
 feverishness, in a person above the age of thirty, who 
 has been long in the habit of drinking spirits to 
 excess, are almost conclusive evidence of the existence 
 of cirrhosis, even before there is any distinct proof 
 that the circulation through the liver is impeded." 
 
 The same condition of the organ may be produced 
 by various cachexiae, particularly malarious and syphi- 
 litic poisoning, caries and necrosis. Whatever the 
 cause, its presence rejects. 
 
 Degeneration of the parenchyma of the organ by 
 fatty or amyloid deposits, begets a similar train of 
 
 symptoms, but is generally associated with enlarge- 
 ment of its bulk. The diagnosis is facilitated by 
 
 reference to the history of the case and concurrent 
 symptoms. Both involve gastric derangement^ 
 
tumidity of the spleen, diarrhoea and anaemia. The 
 fatty degeneration may, however, be connected with 
 more or less general corpulence, often gained rapidly, 
 and in the latter case is always suspicious. From what- 
 ever cause arising, and however moderate the manifest 
 symptoms, both varieties reject. 
 
 Acute Atrophy will not, from the activity of the 
 symptoms, be presented to the Insurance Examiner. 
 
 Chronic Inflammation of the viscus, whether superficial 
 or parenchymatous, is the not infrequent result of resi- 
 dence in tropical climates, or of intemperate habits, 
 or cachexiae. While present, it rejects, whether it has 
 yet produced either hypertrophy, or atrophy, or any 
 of the later symptoms of the disease. It is well to 
 recollect that, under the influence of treatment, the 
 person may suppose a cure to have been effected, and 
 thus present himself for insurance. Nevertheless, the 
 admitted occasional anorexia, diarrhoea, scanty urine 
 loaded with lithates, sallowness, dryness and roughness 
 of the skin, the physiognomy and progressive emaciation 
 and debility, will sufficiently characterize the case. 
 
 Jaundice has been already referred to (p. 27). Since 
 while present, in all cases, it at least postpones, its 
 differential diagnosis is here scarcely necessary. 
 
 THE PANCREAS is rarely diagnosticated as the seat 
 of disease. Its enlargement can usually be determined 
 by palpation, and, from whatever cause, declines the 
 risk. The increase of size is generally accompanied by 
 tenderness, a sense of fulness or hardness, heat and 
 constriction, anorexia, nausea and obstinate vomiting, 
 8 
 
H 4 
 
 or inodorous eructations, emaciation, debility, and 
 mental depression. 
 
 THE SPLEEN is so frequently enlarged permanently, 
 without any evidences of derangement of health, that 
 unless the enlargement is excessive, forming abdominal 
 tumor, or the signs of malarious or other cachexia are 
 present, it may scarcely be considered as impairing the 
 lisk. Nevertheless, the frequent association of en- 
 larged spleen, with degenerations of the liver and other 
 organs, with affections of the lymphatic glands, with 
 leukaemia, phthisis, etc., renders it incumbent upon 
 the Examiner, whenever it is present, to make a mi- 
 nute and exhaustive survey of the organs individually 
 and of the system as a whole. 
 
 THE INTESTINAL TUBE. There may be physical ev- 
 idences of distension of the intestines by tympanites, 
 accumulated faeces, herniae or tumors. But the atten- 
 tion of the Examiner is rather directed to the condi- 
 tion of the canal by historical or concurrent symptoms 
 which indicate its condition. Hernia is noticed upon 
 p. 31, et seq. Heterologous growths of any variety re- 
 ject. Acute affections of the tube postpone. Chronic 
 disorders and lesions may require careful investigation. 
 
 The most frequent cause of question is the presence 
 of chronic diarrhcea, meaning by the phrase abnormal 
 frequency and fluidity of the alvine evacuations, 
 More important than these will be found the charac- 
 ter of the discharge. There may exist a chronic ca- 
 tarrhal affection of the mucous membrane, wherein, 
 with little or no noticeable disturbance of the health, 
 the increased frequency and fluidity of the discharges 
 
is kept up by mere habit of the part, in accordance 
 with a well understood physiological law. Or it may 
 be a normal individual peculiarity. In such a case the 
 risk may not be invalidated. But the fact that such a 
 condition of the canal very generally denotes irregular 
 habits of diet, the abuse of alcoholic stimulants or 
 opium, or local disease of the adjuvant or remote 
 organ, suggests caution, (p. 40.) 
 
 A very large proportion of those engaged in the re- 
 cent war are subject to this form of diarrhoea, which, 
 subsiding for a time, is readily provoked by exciting 
 causes. In the absence of the evidences of ulcerations, 
 organic affection of the liver or kidneys, scorbutus, 
 tuberculosis or other cachexia, such cases need not 
 necessarily be rejected, but very great care should be 
 exercised. The evidences of deficient nutrition afford- 
 ed by emaciation, or its correlative, fatty degeneration, 
 disqualify. Thoracic obstruction to the circulation 
 may ultimate in diarrhoea, and hence inquiry is directed 
 to the heart, lungs, etc. Deficient frequency, or 
 consistence of the evacuations, points to the mere 
 habit of the parts, illustrating rather the distensibility 
 of the large intestine than disease ; or, it may remind 
 of mechanical obstruction by bands of consolidated 
 and contracted lymph from previous enteritis, or her- 
 nia, or the pressure of tumors, or hypertrophied viscera, 
 or of defective secretions from the mucuous membrane, 
 the liver, and pancras, etc. ; or of the benumbing 
 influence of retained excreta, or poisons received ; or, 
 deficient innervation from central disease of the ner- 
 vous apparatus. The varying gravity of these causes 
 
renders their differential diagnosis a matter of great 
 importance, in order that justice may be done both to 
 the applicant and the company. 
 
 Among the lesions of the tube which give rise to 
 the least marked symptoms, and yet pregnant of grave 
 consequences, is to be noticed Atrophy of the mucous 
 membrane a condition frequently found in the tardily 
 convalescent, and in those laboring under a more or 
 less manifest cachexia, tuberculous, syphilitic, amyloid, 
 etc. This may be present without apparent diarrhoea, 
 costiveness or constipation. When present it is likely 
 to invade the entire continuity of the membrane. 
 Often all the symptoms observed are referred vaguely 
 to dyspepsia, but it may have originated in a true cir- 
 rhosis from inflammation extending to the subjacent 
 tissue. From whatever cause arising, it is among the 
 reasons for rejection. The labial, buccal and pharyn- 
 geal membrane will exhibit the imperfect structure to 
 the eye, whilst anaemia and debility are minatory, if 
 not actually present without seeming cause. There 
 will be admitted anorexia, nausea on arising from the 
 recumbent position; a sensation as though "food was 
 never effectually swallowed, but stuck at the diaphrag- 
 matic entrance of the stomach, causing the peculiar 
 feeling of weight which attends indigestion and the 
 abundant generation of gaseous fluids." 
 
 Haemorrhoids are occasionally of such severity and 
 productive of such exhaustion, as alone to preclude 
 insurance, but ordinarily they refer examination to 
 their producing cause, which is usually some obstruc- 
 tion to the return of blood from the rectum. Thus 
 
117 
 
 habitual constipation, enlarged uterus, pelvic or abdo- 
 minal tumors, a cirrhosed or congested liver, etc. 
 Or they may indicate the general relaxation of the 
 va.ve structure of the veins, resulting from residence 
 in tropical climates, or diseases tending to produce 
 congestion of the pelvic vessels. 
 
 Chronic Dysentery is noticed on page 40. "The 
 prognosis is never very favorable*' but the diagnosis 
 should be exact. 
 
 In a general survey of the alimentary canal and sub- 
 sidiary organs, the relative power and perfection of the 
 nutrient system should be comprehensively estimated. 
 Upon it depends the entire superstructure of organiza- 
 tion. Its condition modifies judgment as t;o the 
 probable influence of both hereditary and acquired 
 predispositions. It influences the prognosis as to the 
 results of both acute and chronic disease. Even when 
 organic diseases of grave character are unmistakably 
 present, as developed by the expert diagnostician, its 
 high degree of perfection is capable of masking and 
 concealing the rational symptoms usually observable in 
 less fortunate cases. Lesions, ordinarily confessed 
 beyond the control of so-called medicines, sometimes 
 disappear under the healing influence of healthy blood 
 furnished to them by a powerful digestive apparatus. 
 Thus vigorous digestion may aid the Examiner in 
 conscientiously recommending a risk which has some 
 notably objectionable features. Yet the same condi- 
 tion of the chylopoietic viscera, associated with organic 
 changes, may add weight to the reasons for rejection. 
 Witness the bruit of the heart's valves, while yet 
 
n8 
 
 abdominal health is undisturbed. Witness the tu- 
 berculous deposit in the lung, which remains un- 
 heeded until some accidental cause impairs digestive 
 energy, and then the softening, breaking down, and 
 hectic speedily number the remaining days of existence. 
 The judgment of the Examiner is the combined result 
 of a multitude of perceptions, vivified by the educated 
 reasoning faculty as the body of man is made up 
 from almost innumerable parts, controlled by the 
 single principle of life. 
 
 THE KIDNEYS. As in the instances previously 
 cited, acute affections of the renal organs do not come 
 within the scope of a life insurance examination, but 
 their chronic lesions are so frequently obscure and so 
 frequently misapprehended, both by applicants and phy- 
 sicians, and at the same time they are so dangerous in 
 tendency that the Examiner should be "armed at all 
 points" against mistakes in regard to them. 
 
 Enlargement of one or both kidneys from hyper- 
 trophy, cystic or heterologous growths, etc., may be 
 discoverable as abdominal tumor. Whatever the 
 differential diagnosis, such cases must be declined. 
 
 Chronic Inflammation is one of the forms of Bright/ s 
 Disease to be presently discussed. It is noticed here 
 as frequently confounded with simple nephralgia, spinal 
 irritation, chronic rheumatism (lumbago), gout and 
 scorbutic pains. The chronic nephritis absolutely 
 rejects. 
 
 Nephralgia is often but the evidence of a tempo- 
 rarily, highly acrid and irritating secretion, or a "mis- 
 placed gout ; " or the passage of what may prove but 
 
H9 
 
 a single renal calculus ; or it may be but an alternate 
 of neuralgia, usually occurring in other parts, the effect 
 possibly of malarious disease. It may be the tempo- 
 rary result of medicines or poisons, or, as in small- 
 pox, perhaps from irritation of the specific virus. Or 
 the real anguish may depend on enteritis. The 
 diagnosis is to be exclusive absence of the distinctive 
 concurrent symptoms of the other affections noticed, 
 must be determined. Nephralgia readily passes into 
 nephritis, and unless the fact of its occurrence is an 
 isolated one, and the phenomena definitely traced to a 
 removable and removed cause, it should decline. 
 Recurrent attacks are equally objectionable to the risk. 
 (vid. p. 35 et seq.) 
 
 BRIGHT'S DISEASE, OR ALBUMINURIA. Desquama- 
 tive nephritis in the acute form, from its active symp- 
 toms, does not require notice here but the chronic 
 form may exist for a long time without marked symp- 
 toms, and h^nce a liability for both the applicant and 
 the Examiner to overlook an uninsurable case of 
 disease. Without actual sickness there may be gen- 
 eral feelings of malaise, with imperfection of health 
 and general debility. Anorexia or capricious appetite, 
 with gastric and intestinal disorder, vomiting and 
 diarrhoea, usually attributed to dyspepsia. Progres- 
 sive emaciation, which, however, is sometimes con- 
 cealed by the puffiness of anasarca, most noticeable on 
 the face and eyelids, but gradually becoming general. 
 The urine is passed more frequently than usual the 
 patient being obliged to rise in the night for the pur- 
 pose. The urine may be normal in its appearance 
 
12O 
 
 and chemical reaction, but microscopic examination 
 will detect in the sediment disintegrated epithelial cells, 
 or even fibrinous casts of tubuli uriniferi from the kid- 
 neys. The general aspect of the party will show the 
 almost indescribable, but nevertheless characteristic 
 physiognomy of renal disease. The skin is dry, 
 rough, and sallow in time becoming anaemic, waxy, 
 and sodden. There are evidences of oppression in 
 respiration from slight oedema of the lungs. Frequent 
 local pains most frequently cephalalgia, but invading 
 any part, may be admitted, but are referred vaguely 
 to dyspepsia, rheumatism, or neuralgia. These com- 
 municate a permanent expression to the facial lines. 
 Disorders of vision are not infrequent, and the expert 
 ophthalmoscopist can sometimes detect on the retina 
 evidences that the supposed local affection depends 
 upon organic lesion of the distant kidneys. Deaf- 
 ness and local paralyses elsewhere, may be the sole 
 monitions of the renal affection. Supposed " func- 
 tional," but ultimately clearly organic cardiac disease, 
 may mask the real difficulty. In fine, a marked pro- 
 clivity to local inflammation of whatever organ or 
 surface, even though the party, at the time of the 
 examination, be apparently in excellent health, lends 
 color to suspicion of renal imperfection. 
 
 All the symptoms here recounted may be present in 
 any of the forms of Bright' s Disease, whether resolved 
 into atrophy, cirrhosis, degeneration, or deposit. 
 Save in so far as the accompanying cachexia of each 
 may have its own bearing on the general character of 
 the risk, their differential diagnosis is unnecssary. 
 
121 
 
 Their ultimate result is the same uraemic poisoning 
 and death, which may be hastened by the concurrent 
 affections of the heart, lungs, liver, general or local 
 dropsy, etc. 
 
 The prognosis is always grave, and hence the sub- 
 ject uninsurable, even though temporarily there is an 
 absence of symptoms. In all doubtful cases the urine 
 should be tested in its specific gravity, its chemical 
 reactions, and microscopy of its sediments. The 
 peculiar fuliginous appearance sometimes present, 
 probably from some chemical change in the haematin 
 accompanying the desquamation, will readily attract 
 notice. So also the presence of albumen, but particu- 
 larly the low specific gravity, and the sediment com- 
 posed of the epithelial casts and disintegrated blood 
 cells. The tests are so simple, and so easily applied, 
 that, while interests of such magnitude are in issue, 
 there should be no excuse permitted for neglecting 
 them. It k should be borne in mind that Temporary 
 Albuminuria may have been present, in connection 
 with previous diseases, and yet complete recovery have 
 taken place. Thus, in connection with Scarlatina and 
 other exanthems, Cholera, Pneumonia, Rheumatism. 
 Or again from confinement to an albuminous diet. 
 Occasionally, also, during pregnancy. Probably in 
 these cases there has been no considerable or continu- 
 ous exfoliation of the epitheliun of the tubuli uriniferi. 
 Such cases may not, f~om their history, impair the 
 risk. But it is unsafe to . . :ept a case of present albu- 
 minuria, even though there *.:ay be strong belief that 
 it is the simple, form. 
 
122 
 
 Calculus present rejects. Recurrent attacks also for- 
 bid the risk. But it may be recollected that popularly 
 mere vesical pain and strangury are attributed to grav- 
 el, and hence, when this is spoken of, the case should 
 be further tested. 
 
 Chronic Cystitis and Enlarged Prostate disqualify, and 
 so, also, during its existence, Permanent Stricture. 
 These lesions, on occurrence of slight exciting causes, 
 may eventuate fatally. Spasmodic stricture is not 
 infrequently symptomatic of renal lesion, and the 
 chronic inflammation of the bladder may also be kept 
 up by the deranged kidneys. 
 
 DIABETES may be noticed in this connection, 
 although scarcely to be considered as a disease of the 
 kidneys. From its insidious nature, and long absence 
 of readily cognizable symptoms, it is liable to be over- 
 looked both by the party applying and the too unob- 
 servant Examiner. Aside from the varying influences 
 which, within the limits of health, may increase or 
 diminish the amount of urine excreted, any undue 
 quantity habitually passed should direct attention. 
 Whether saccharine or not, the undue amount post- 
 pones. If repeated tests show the presence of sugar, 
 or abnormal specific gravity, the risk must be declined. 
 Absence of these, and increased amount, suggest 
 Bright's Disease. 
 
 The skilled Examiner may often detect early the 
 rational symptoms of the affection. The skin is dry, 
 rough and shrunken, with a tendency to morbid nutri- 
 tion of its appendages, or boils and carbuncles. Dry- 
 ness, also, of the buccal membrane, with shrinkage of 
 
the gums. Unusual thirst and inordinate appetite, 
 often resulting in distended stomach. Constipation, 
 with dense and friable faeces. The odor of the breath 
 sweetish, or, as has been suggested, chloroformic. 
 Gradual emaciation, with muscular debility, and, occa- 
 sionally, local paralyses. Slight, mental hebetude, 
 with languid movements. Critical questioning may 
 elicit the presence of diminished sexual desire and 
 energy. In very many instances there mav be super- 
 added the signs of hepatic degeneration, and, always, 
 disorder of the nervous system, manifesting itself in 
 all phases, from mere dullness to irascibility, peevish- 
 ness, capriciousness and monomania. By these ner- 
 vous phases of the disease, the emaciation, and rough, 
 dry integument, there is a 'physiognomy impressed upon 
 the person which can scarcely escape the notice of the 
 careful Examiner. In such cases the urine should be 
 chemically tested by the most approved modern 
 methods. 
 
 It is unnecessary to refer to the causation of dia- 
 betes, for its rational symptoms, when strongly .marked, 
 would cause rejection, whatever their cause, and the 
 chemical evidences of its presence are totally exclusive. 
 
 ADDJSON'S DISEASE, or that peculiar anaemic condi- 
 tion, with gradual bronzing in the color of the skin 
 which, within several years past, has attracted the 
 investigation of pathologists, need not here receive 
 more than a passing notice. When it is possible to 
 achieve an exact diagnosis, the concurrent symp- 
 toms will alone be sufficient to establish general 
 disqualification. 
 
I2 4 
 
 VI. 
 
 Cerebro-NerVQUS System Very many of the nota- 
 ble disturbances of the orderly manifestations of the cer- 
 ebro-nervous apparatus, are directly traceable to errors 
 in action of the digestive organs. Hence consid- 
 eration of the former, to be satisfactory in result, 
 demands complete survey of the latter. Again, it 
 often occurs that the apparent disorders of a part, or 
 even the whole, of the nervous system, may depend 
 upon reflex influences local derangement of a single 
 point begetting a train of symptoms which may be 
 mistaken for those dependent on organic lesion of the 
 nervous centres. Evidently, therefore, any judgment 
 formed with reference to the symptoms only, is liable 
 to be erroneous. Aberrations of nervous manifesta- 
 tions, if dependent on organic disease of the nervous 
 centres, while present utterly disqualify whatever 
 their extent. But, if owing their origin solely to 
 blood imperfectly formed, or rendered noxious by re- 
 tained excreta, or poisonous material introduced into 
 it, or, from reflex influences from lesions in other or- 
 gans or tissues, the judgment, obviously, is to be 
 shaped by considerations affecting the importance, ex- 
 tent, character, permanency or removability of the 
 cause. This will thoroughly tax the skill of the 
 Examiner. 
 
 It is well, in analysis of this branch of the subject, 
 so far as it falls within the scope of the present essay, 
 to adopt the simplest possible divisions. Thus we 
 consider: Derangements of Motion, whether of the 
 
I2 5 
 
 voluntary or involuntary muscles ; Derangements of 
 Sensation, whether common or special ; Derangements 
 of Mental Action, whether of the reason, or of the 
 emotions. 
 
 DERANGEMENT OF MOTION. Tremulousness, Tre- 
 mors, Spasms, Convulsions, Error of Co-ordination, 
 Rigidity, Paralyses, severally indicate a greater or less 
 disorder of the nervous apparatus. It is necessary to 
 inquire whether that disorder be dependent on local 
 or general causes ; whether it depend on nutrition, on 
 toxaemia from retained excreta, or poisons taken into 
 the blood from without, or upon organic changes at 
 the nervous centre. 
 
 Tremor, or tremulousness, may be due merely to the 
 changes of advanced age. If this sign of age comes 
 prematurely, the premature age marks a condition of 
 the system, as a whole, which lessens the desirability 
 of the risk. Very frequently it is dependent on the 
 use of tea, coffee, opiates or alcoholic stimulants; being 
 the result of their action, although temporarily re- 
 lieved by them. Concurrent symptoms here must be 
 carefully scanned. The tremors of the opium eater, 
 or spirit drinker, whilst deprived of the accustomed 
 stimulus, should determine rejection. Metallic pois- 
 oning, as from lead, mercury, etc., may give the same 
 result. Concurrent symptoms may determine morbid 
 nutrition, or exclusive diagnosis may refer the feeble 
 muscular agitation to central disease of the brain or 
 spinal cord. But meanwhile it may be a nervous 
 idiosyncrasy, or temporarily the result of reflex 
 influences, from removable disease of remote organs. 
 
126 
 
 Convulsions, or Spasms, sometimes readily occur in 
 persons of a highly mobile nervous temperament. 
 Hysterical females are especially liable to them, but 
 males are not exempt. Like the milder symptom 
 just noted, they majy be of centric or eccentric origin. 
 But ordinarily, when occurring without other evidences 
 of cerebro-spinal lesion, they may be adjudged of ec- 
 centric origin. Among the causes of the latter variety, 
 may be mentioned dental and intestinal irritation, 
 more frequent in children, but not confined to them. 
 Uterine, vesical and rectal irritation in the adult. 
 Contaminated blood, from retained excreta or poisons, 
 and powerful emotional influences. Among the cen- 
 tric causes, we advert to mal-nutrition of the brain, 
 or its inflammation, deposits, morbid growths, sudden 
 interference with the cerebral circulation, as by emboli, 
 the shock of injury, haemorrhage, effusions, etc. 
 
 Epilepsy, one of the forms of convulsive action, is 
 distinguished prominently by its tendency to recur at 
 intervals, which may be more or less distinctly periodic. 
 The period between the paroxysms may show no 
 marked derangement of health, although, unfortu- 
 nately, there is likely to be mental hebetude and tardy 
 development of all normal bodily action. Its pecu- 
 liar suspension of consciousness serves to assist in 
 diagnosing it from hysterical, and, indeed, most forms 
 of convulsions. True epilepsy always excludes, what- 
 ever its supposed cause. Convulsions from other 
 causes, must be measured by them, their permanence 
 or removability, and by concurrent evidences regard- 
 ing their centric or eccentric origin, and the respective 
 
I2-/ 
 
 bearings of these, rather th?.i che accidental symptom, 
 Generally speaking, recurrent convulsions, even from 
 clearly mild and removable causes, should postpone 
 until the tendency to them has entirely subsided. 
 Local convulsive action of greater or less intensity 
 and duration, accompanied with numbness and inability 
 to move the part or cramp, as popularly designated, 
 is sufficiently common to persons in good health, and 
 need not necessarily disqualify. But its occasional 
 occurrence among the initiatory symptoms of central 
 nervous lesions, or of metallic poisoning, or, as reflex 
 from important remote organic disease, suggests in- 
 quiry into the real meaning. 
 
 Defective Co-ordination of the movements as exem- 
 plified in Chorea, but present in other cases without 
 the intensity of contraction observable in that disease, 
 points to a similar train of inquiries as to its causa- 
 tion. It is often one of the most insidious of diseases, 
 occupying months or years in its full development. 
 Thus in Duchenne's "Progressive Locomotor Ataxia" 
 characterized by long antecedent impairment of vision, 
 with inequality of the pupils, with wandering, brief 
 but piercing pains, "like electric flashes" then 
 vertigo and difficulty in maintaining the equilibrium, 
 and in co-ordinating the movements, with local anaes- 
 thesia or paralyses. Functional concurrent disorders 
 of the bladder and rectum. The necessity of a strong 
 effort of the will, in connection with the usually im- 
 paired eyesight, impresses an unmistakable physiog- 
 nomy on the case. Owing its causation, as it probably 
 does, to atrophy or degeneration of the great nervous 
 
128 
 
 centres, and its prognosis always being grave, its 
 incipient signs should be carefully explored. 
 
 Rigidity of the muscles is closely akin to paralysis. 
 It may involve but few muscles, or as many as in half 
 the body. It is so generally associated with organic 
 disease of the brain, especially ramoltissement that, un- 
 less traceable positively to some local cause, it must 
 exclude. 
 
 Paralysis, if involving any considerable portion of 
 the body, as hemiplegia or paraplegia, inexorably must 
 meet with refusal. But many cases of local palsy, 
 from definite local causes only, are not debarred in- 
 surance. Thus where a nerve has been divided by 
 accident or surgical operation ; the pressure of a re- 
 movable tumor or growth ; the presence of some for- 
 eign substance, as a bullet or splinter, etc.; or, wherever 
 clearly referrible to the local lesion alone. Again, 
 paralysis, as well as convulsions, may be reflex, and 
 the lesion at the excitor point be capable of relief. 
 Local vicissitudes may beget a local paralysis of mo- 
 tion, as when, e. g. y the facial muscles of one side are 
 temporarily paralyzed by exposure to a draft of air. 
 In like manner the muscles of articulation may, by 
 paralysis, beget aphonia. Pressure on a nerve from 
 mere position, local shock from a blow, or common 
 inflammation may ensue in palsy of the parts to which 
 that nerve is distributed. Such cases need not neces- 
 sarily be rejected, but the large proportion of cases, 
 wherein this symptom is a concurrent one of diseases 
 of the brain or spinal cord, requires the most minute 
 and exhaustive research. Occasionally it may happen 
 
129 
 
 that the loss of mobile power will be found dependent 
 on the influence of some pervading poison, e. g. lead, 
 toxaemia, etc. 
 
 DERANGED SENSATION may be observed as affecting 
 nerves of common or special sense. Of the former, 
 pain is the prominent exponent ; but sensations of 
 heat or cold, itching, tingling, formication, pressure, 
 etc., may co-exist, or be the sole manifestation. Mu- 
 tatis mutandis, the same considerations enter into exam- 
 ination of the case, as in instances of deranged motion. 
 There is, however, this important diversity, that the 
 intensity of deranged sensation has no such constant 
 relation to the severity of the cause as exists in dis- 
 ordered movements. The commingling of mental 
 emotions may magnify or diminish the real importance 
 of the symptom. It is well remarked: "That acute 
 sensibility is not of necessity inflammatory, is one of 
 the triumphs of modern pathology." 
 
 Diminished sensation is more analogous in its indi- 
 cations to paralysis of motion, than is hyperaesthesia 
 to tremor or convulsion. It is more liable to be con- 
 nected with central organic disease, or some over- 
 powering general poison. Extended anaesthesia, over 
 a considerable surface, is exceedingly apt to be con- 
 necte .. with central ganglionic nervous lesion. But 
 sometimes even the small and circumscribed part, 
 whicn has become thus affected, is among the premon- 
 itory evidences of brain or spinal disease. In such 
 cases the method of exclusive diagnosis will clear up 
 the difficulty. It may depend on local influences, upon 
 poisons in the blood, or other abnormal conditions of 
 
that fluid, (e. g. rheumatism), or be the characteristic 
 symptom of certain cutaneous eruptions. 
 
 The Special Senses may present a similar variety of 
 perversions from merely local causes, reflex influences, 
 impaired or poisoned blood, or central disease of the 
 brain. 
 
 DERANGED INTELLECTION acknowledges the same 
 variety of causation, and while present positively de- 
 clines the risk, whichever may have been the imme- 
 diate source of disturbance. 
 
 DISEASES. Among the forms of disease of the 
 brain, against which the Insurance Examiner must put 
 himself on guard, as liable to be masked by general 
 indications of fair health, are to be noted : Chronic 
 Meningitis, Apoplexy, Deposits or Growths, Ramol- 
 lissement, Insanity, Atrophy, and, not the least in 
 frequency, Chronic Poisoning. As affections of the 
 Spinal Cord : Chronic Inflammation, Softening, De- 
 generation, or other evidences of its deranged nutrition. 
 
 ENCEPHALITIS of the acute form possesses suffi 
 ciently distinctive symptoms. But it may, frorr 
 the beginning, be sub-acute, and readily lapses intc 
 the chronic character. In the latter case, the brair. 
 substance is likely to become implicated, with more 
 or less modification of phenomena presented. There, 
 may be very slight vascular or general disturbance, but 
 careful investigation may detect more or less distinct 
 evidences of lesion. If the pulse is perceptibly affect- 
 ed, it is likely to be slower, or irregular and intermit- 
 tent. A little impairment of the special senses ; i< 
 may be hesitation or stammering in articulation, which 
 
afterward, perhaps, will deepen into complete aphasia, 
 constant, deep-seated headache, nausea and vomiting, 
 general malaise; some stiffening of particular muscles; 
 limited paralysis, either of motion or sensation, or 
 both ; sluggish action of the secretory organs, with 
 constipation and unusual retention of urine. Some 
 peculiarity of mental manifestation, "eccentricity," 
 hypochondria, or preternatural elevation of spirits, or 
 unusual proclivity to entertain false or absurd notions. 
 Restless vigilance may alternate with profound sleep, 
 with, ordinarily, stertorous respiration. The occur- 
 rence of previous traumatic injury of the head, or of 
 some disease tending to affect the brain, will throw 
 light on the diagnosis. Location of the cause of 
 these symptoms in the brain, will frequently require 
 the exclusive method of diagnosis. 
 
 APOPLEXY. Undoubted apoplexy previously occur- 
 ring, although the party be now in apparently perfect 
 health, peremptorily rejects. The Life Insurance 
 Examiner is called upon rather to study premonitions 
 the forerunners of the lesion before it makes its 
 appearance. The apoplectic habit is popularly sup- 
 posed to be one where there is corpulency with a short 
 neck, a florid face, and injected conjunctiva ; the latter 
 appearances more marked in cases of excitement, and 
 accompanied with a sensation of fullness of the head, 
 or vertigo and throbbing of the carotid and temporal 
 arteries. If apoplexy occurs in individuals of this 
 physique, it is rather because of fatty degeneration of 
 the organs, than the condition of rude health supposed 
 present. Or, as in very many cases reported, there 
 
was uraemia or other toxaemic causes of congestion of 
 the brain, mistaken for real apoplexy. The tendency 
 to the so-called congestive or serous apoplexies, is to 
 be elucidated by studying the mal-action of the nutrient, 
 secretory and excretory organs. 
 
 True apoplexy involves haemorrhage into the tissue 
 or cavities of the encephalon, and this presupposes 
 degeneration of the tissue involving the coats of the 
 supplying arteries, or, the originating lesion may be 
 confined to the arterial wall. The symptoms of real 
 apoplexy are closely simulated by the detachment of 
 embolon, and its projection into, and consequent 
 closure of, some important artery of supply. The 
 existence of aneurism, save from simply traumatic 
 causes, always should suggest examination, so far as 
 possible, of all the arterial trunks. Whatever inter- 
 feres with the activity of the circulation, when the 
 arterial parietes are weakened by calcareous or other 
 abnormal deposits, by fatty degeneration or arteritis, 
 etc., may at once involve apoplectic seizure in the 
 midst of apparent high health. Thus muscular efforts, 
 mental influences, especially of the emotional kind, 
 disordered digestion, stimulants or narcotics, febrile 
 accessions, retained excreta, etc. Not only persons of 
 "full habit," but those of spare frame, long necks 
 and scant blood, may die of it from similar exciting 
 causes. There may be none of the commonly sup- 
 posed prodromata present, and yet the party be on the 
 verge of an attack. Something more than head symp- 
 toms are to be looked for. When "shadows are cast 
 before/' they are manifested "by great depression of 
 
spirits, by attacks of loss of memory, by illusions, by 
 vitiated perceptions, by vertigo, by odd sensations in 
 the head ; " but these are rather the indications of the 
 degeneration than of the coming apoplectic seizure. 
 
 DEPOSITS or GROWTHS of an abnormal character 
 will, vary in the symptoms presented, according to the 
 part of the encephalon invaded, and the degree of 
 mischief or size of growth. The symptoms are often 
 obscure, and their character opined from the diathesis 
 or cachexia present. Exclusive diagnosis is the most 
 satisfactory ; the most common symptoms being 
 <c headache, sickness, mental depression with confu- 
 sion, partial paralysis, and epileptiform convulsions." 
 
 ATROPHY of the encephalon is usually the condition 
 of senility ; but it may occur in the child or adult, as 
 the result of those lesions which cut off the supply of 
 blood e. g. pressure of tumors or growths, embolon, 
 ligature of arteries, etc. Advancing insidiously, it may 
 ultimate in utter dementia. 
 
 HYPERTROPHY is very rare, but sometimes is no- 
 ticed in adults between twenty and thirty. It seems 
 more probable that what is denominated hypertrophy 
 of the brain, is rather a disease of its bony case, in- 
 volving replacement of the cartilaginous substance, by 
 abnormal calcareous deposit. Hence, the unchanging 
 cranial wall develops the effects of gradual and pro- 
 longed pressure upon the contents. This increased 
 density and hardness of the bone is gained at the ex- 
 pense of its elasticity, and hence, in such cases, there 
 is unusual fragility of the bones everywhere. Repeated 
 fractures of bones from slight causes, with any of the 
 
'34 
 
 ordinary evidences of cerebral disorder, direct atten- 
 tion to the condition described. It is fatal to the 
 risk. 
 
 SOFTENING (Ramollissemeni) of the encephalon is one 
 of the most covert and insidious and, at the same time, 
 one of the most frequent and dangerous lesions of the 
 brain which the Examiner is called upon to discover. 
 Noticeable enough in the acute form, it may advance 
 from utter obscurity with steps so treacherous and 
 and stealthy, that only the wariest observer can gain a 
 clue to its presence, or avoid sometimes confounding 
 it with trivial affections. Softening may occur as one 
 of the results of acute inflammation, or, as a conse- 
 quence of senility. But without any such history it 
 may come on gradually, at any age, as the result of 
 those causes which beget local or general degeneration. 
 Thus mal-nutrition, diseased arteries, emboli, typhoid 
 or other deposits, fatty degeneration, etc. The func- 
 tional disorder of the brain, taken with the concurrent 
 symptoms, will clear up the diagnosis. The evidences 
 of chronic (white) softening are similar to those of 
 the acute inflammatory (red) form, differing mainly 
 in their intensity and duration. The great difficulty 
 is in assigning due weight to those diseases of other 
 organs, to which the brain symptoms may be only 
 secondary, and here, again, the exclusive method of 
 diagnosis becomes indispensable. Unless clearly at- 
 tributable to remote lesions of a removable character, 
 a case which has presented suspicious brain symptoms 
 should be declined. Among these suspicious symp- 
 toms, we note paroxysmal headache, aggravated by 
 
'35 
 
 noise, light, exercise, etc.; nausea and vomiting with, 
 generally, constipation, which are not traceable to 
 deranged digestion; lessened sensibility of the blad- 
 der ; vertigo, nervousness, hypochondria, diminution 
 of mental powers, with obtuseness of special sensa- 
 tion. Sensations of "prickings and twitchings in the 
 limbs, sometimes pain, and sometimes numbness." 
 Local cramps, and more or less permanent rigidity of 
 particular muscles. General feebleness of the muscu- 
 lar sjystem, and hebetude of all the faculties. A feeble, 
 irregular and intermittent pulse. The party may con- 
 fess difficulty in "collecting his ideas" there is a 
 little hesitancy of speech, a little delay in answering 
 questions a little appearance of abstraction, and the 
 articulation not quite perfect. 
 
 If historically there has been some disease or ca- 
 chexia present, which notably affects the encephalon 
 some local injury from a fall, or blow, or surgical 
 operation, and especially if the age is above fifty 
 the diagnosis is strengthened, that softening, or some 
 equally important lesion of the brain, is present. 
 The -physiognomy of the affection is very impressive ; 
 in fact, scarcely to be mistaken. 
 
 In passing it may be remarked, that a condition 
 very analogous to chronic softening, with its attend- 
 ant symptoms, is very frequently observable after se- 
 vere COUP DE SOLEIL. In cases of the latter the 
 prognosis is not as grave, nevertheless, as it is capable 
 of passing into actual ramollissement, with paralysis, 
 insanity, etc., wherever the party has been so affected, 
 the examination should be cautious in the extreme. 
 
'36 
 
 CHRONIC POISONING of the brain may occur from 
 the habitual use of Alcoholic Stimulants, Opium, 
 Tobacco, "Hasheesh/' even Tea and Coffee, and, in- 
 deed, a great variety of agents taken for the purpose 
 of exhilaration or soothing. During the use of the 
 narcotic, the individual may, so far as external indica- 
 tions are concerned, be on the level of perfect health ; 
 but, let. any accidental physical cause interfere with its 
 usual impression, or let its use be suspended, and the 
 condition of Nervous Asthenia immediately super- 
 venes. A similar condition is often observable in 
 those whese mental faculties have been overwrought, 
 and it engenders an almost uncontrollable desire for 
 stimulants or anodynes which latter then get the 
 discredit of its production. 
 
 "Physicians," says Dr. Flint, "are often consulted 
 by patients who, although far from being well, have 
 no well-defined malady. They complain of languor, 
 lassitude, want of buoyancy, aching of the limbs, and 
 mental depression. They are wakeful during the 
 night, and enter upon their daily pursuits with a sense 
 of fatigue. Under the pressure of mental excitement, 
 they may be able to exert themselves, but, when the 
 excitement subsides, they are jaded and worn out. 
 They become apprehensive that their powers are giv- 
 ing way, and are apt to fancy the existence of some 
 serious malady. An investigation of the different or- 
 gans of the body reveals no evidence of disease ; the 
 lungs, heart, kidneys, etc., are sound. None of the 
 affections embraced in the nosological catalogue may 
 be discovered, yet the morbid condition is real/' 
 
'37 
 
 A person in this condition is, clearly, laboring un 
 der the result of undue changes in the minute structure 
 of the brain, precisely analogous to those which occur 
 from chronic poisoning. The expert Examiner will 
 recognize the symptoms when present, or, if tempo- 
 rarily held in abeyance by the accustomed excitation, 
 will scan closely the history, as given by the applicant 
 and sustained by the friend and physician. Although 
 the prognosis, under correct therapeutic and hygienic 
 treatment, may be pronounced by the physician not 
 grave, the uncertainty of this being carried out, and 
 its dangerous tendency if neglected, precludes, utterly, 
 acceptance of the risk. 
 
 Delirium Tremens, Dipsomania, etc., previously exist- 
 ent, imperil the risk. It is only after the lapse of a 
 long period of time and great weight of collateral 
 moral evidences of reform, that a party who has 
 suffered from them can be accepted. 
 
 INSANITY. Some general observations on this sub- 
 ject have been made on page 25, et seq. In this 
 place, we refer rather to the detection of incipient or 
 of masked insanity. The importance of this topic 
 demands that it shall receive the most careful attention 
 of the Examiner. Distinct cases, or those connected 
 with obvious disease of the nervous centre, of course 
 will not be presented for insurance. But the cunning 
 maniac, with proverbial ingenuity, has been known to 
 outwit examiners, and secure large policies upon his 
 dangerous life. Hence, clear ideas upon its diagnosis 
 become as indispensable to the Insurance Examiner as 
 to the Medical Jurist. 
 
3* 
 
 The Family History first calls attention to the 
 point, as it is well recognized as one of the most com- 
 monly transmissible of affections. It is safe to say 
 that in from one-third to one-half of all cases of obvious 
 insanity, its presence in the family within three genera- 
 tions can be traced. If those slight aberrations of 
 mind or eccentricities, which, from absence of existing 
 causes, do not deepen into such mania as requires 
 treatment, were taken into account, the proportion 
 would certainly be largely increased. 
 
 Atavism is here frequently witnessed. Baillarger's 
 propositions appear to be generally confirmed : 
 
 " The insanity of the mother, as regards transmis- 
 sion, is more serious than that of the father ; not only 
 because the mother's disorder is more frequently he- 
 reditary, but also because she transmits it to a greater 
 number of children. 
 
 " The transmission of the mother's insanity is more 
 to be feared with respect to the girls than the boys ; 
 that of the father, on the other hand, is more dan- 
 gerous as regards the boys than the girls. 
 
 " The transmission of the mother's insanity is 
 scarcely more to be feared, as regards the boys, than 
 that of the father ; the mother's insanity, on the 
 contrary, is twice as dangerous to the daughters." 
 
 To these it may be added that the insanity of 
 brothers and sisters respectively, is a matter of even 
 more import, as establishing the family proclivity, 
 than that of parents. 
 
 The hereditary tendency follows the same law as 
 other inherited tendencies, as to its occurrence at 
 certain ages. (Fid. pp. 8 and 47.) 
 
 A similar rule obtains as to resemblances between 
 parents and particular children, (p. 46.) Owing to 
 
'39 
 
 the absence of exciting causes, the hereditary predis- 
 position may never have been manifested in any strik- 
 ing derangement, and yet the observant Examiner may 
 notice in the temperament, in the habits of life, in 
 the occupation, the peculiar features of intercurrent 
 diseases, domestic or civil troubles, etc., additional 
 reasons for declining the risk. Pursuits which subject 
 to great mental <c wear and tear," and intemperance, 
 are among the most potent of predisposing influences. 
 Many cases are vaguely attributed to religious excite- 
 ment, grief, joy, fear or other emotions, but it is safe 
 to assume that when insanity ensues upon them, it is 
 because the nervous centre is already on the brink of 
 disease. 
 
 There are unusual difficulties attendant upon the 
 decision in suspicious cases. But the Examiner at 
 least escapes the necessity of determining the differ- 
 ence between feigned and real insanity. The trouble 
 *vill be in baffling the great ingenuity with which the 
 party will often conceal the mental disorder. As 
 Bucknill and Tuke remark : 
 
 cc The dread of insanity in many families of this 
 kind is so great as to constitute, in itself, a morbid 
 feeling sufficiently strong to mislead the observation, 
 to warp the judgment, and to occasion sins of con- 
 cealment and untruthfulness towards those who have 
 a right to expect, and to demand the fullest and most 
 explicit confidence." 
 
 Next to the hereditary predisposition, may be men- 
 tioned that arising from the temperament, either orig- 
 inal or acquired. Although examples of insanity may 
 be found in any described temperament, yet in the 
 
140 
 
 Sanguine or Phlegmatic they are about invariably con- 
 nected vith notable organic lesion. In the pure Ner- 
 vous temperament, or particularly in the Bilio-Nervous 
 or Melancholic variety, it is apt to occur with very little 
 or no evidence of internal lesion aside from the mental 
 disorder. The form of insanity which occurs to the 
 melancholiac is that which is most likely to come 
 before the Examiner. There is usually deficient en- 
 ergy of digestion, with costiveness and constipation ; 
 pale and abundant, or scanty urine loaded with lithates; 
 pulse, soft and compressible ; skin, sallow, hard and 
 dry, or sometimes cool and clammy. " The com- 
 plexion of the insane person is never clear and healthy." 
 Fixed dull pain may be complained of in the head, or, 
 at least, a sense of oppression. There are impassive, 
 immobile features, with a moody or saddened expres- 
 sion. " The eyes are motionless, or directed towards 
 the earth or some distant point ; and the look is 
 askance, uneasy and suspicious." In the more dis- 
 tinctly nervous temperament there is, as would be ex- 
 pected, a more changeful countenance, and a greater 
 activity of movement. There is loquacity, and varied 
 emotions lend vivacity to the features; the eye is quick 
 and flashing ; the skin dry, and more florid in parts, 
 with unnatural pallor in others ; the pulse is rapid, but 
 feeble and jerking. There are derangements of the 
 secretions., irregular and capricious appetite, and ten- 
 dency to emaciation. Indeed, defective nutrition is 
 so large an element in the etiology of insanity, that 
 some high authorities attribute to it the whole disease. 
 All diseases which notably impair the constitution of 
 
the blood may awaken, or exaggerate, the hereditary - 
 or acquired predisposition. Unfortunately the con- 
 verse is not always true : insanity once existent, with 
 evident poor bodily health, is not always removed when 
 health seems thoroughly restored. The worst cases,' 
 notoriously, are those which manifest mental derange- 
 ment with ragh health. Briefly: In making up an 
 opinion in a suspected case, in addition to the family 
 history, the habits of eating, drinking, sleeping, and 
 occupation; the diseases previously existent ; the exact 
 present condition of the digestive and cerebral organs; 
 the peculiarities in surroundings, dress, bearing, and 
 expression, as contrasted with the antecedent usage; 
 and, finally, the general physiognomy of the case are 
 each to be fully investigated. In the absence of glar- 
 ing evidences of eccentricities, or peculiarities, as com- 
 pared with those which sane people may exhibit, the 
 individual must be compared, or contrasted with his 
 previous self, and then the change, if any, be traced to 
 its real cause. 
 
 SPINAL DISEASES. Spinal Inflammation of the chronic 
 form, whether of the meninges or substance, is an 
 insuperable obstacle to insurance. The comparatively 
 light local symptoms frequently cause it to be con- 
 founded with rheumatism or neuralgia, but careful 
 examination will ordinarily elicit the presence of a 
 much greater general disorder than would occur in such 
 cases. 
 
 There is generally a fixed pain, usually high up on 
 the vertebra, slight tenderness on percussion or deep 
 pressure ; the pain aggravated by movement, especially 
 
if quick. The passage of a hot sponge ov^r the part 
 is also likely to give increased pain. Tnere is a liabil- 
 ity to spasms or paralysis, particularly of tne muscles 
 of the neck and back, upon the occurrence of exciting 
 causes. 
 
 The occurrence of curvature witn tnese evidences of 
 local lesion, adds to the certainty of diagnosis. 
 
 Spinal Irritation, or that ill-defined assemblage of 
 hyperaesthesia, nervous excitability, with disturb- 
 ances of remote organs, whatever its real pathology, is 
 usually accompanied by such evidences of digestive, 
 thoracic, or cerebral disorder, that tney aione suffice 
 for rejection without differential diagnosis. 
 
 PARALYSIS, of whatever degree, wnether dependent 
 on Morbid Nutrition, Degeneration, Tumors, 
 Apoplexy, Traumatic Lesion, or Softening, always 
 disqualifies. 
 
 The trouble in diagnosis here, is mainly due to the 
 imagination of the patient. Without actual paralysis, 
 either of motion or sensation, there is often Deficient 
 Innervation. There is a sense of weakness of the knees, 
 with slight numbness or prickling sensation ; a loss of 
 perfection of the muscular sense ; disturbance of the 
 function of the organs of the trunk on tne ,evel of 
 the lesion thus disturbed respiration and circulation, 
 disturbed digestion, slow and imperfect extrusion ot 
 the faeces and urine. The genital system is depressed 
 in activity ; the muscular tissue wastes, and nutrition 
 generally is imperfect. The brain sympathizes more 
 or less, and spasmodic contraction may alternate with 
 the paralysis or deficient power of motion. 
 
143 
 
 The history of the case will here throw light upon 
 the symptoms present. A blow, a wrench, a concus- 
 sion ; exposure to cold and moisture ; excessive fa- 
 tigue, long continued cramped positions incident to 
 various occupations, certain morbid habits and indul- 
 gences, mineral poisons, hereditary predispositions, 
 and cachexia, severally, may be identified as originating 
 the difficulty. On the other hand, hypochondria and 
 hysteria may imitate the symptoms very closely. 
 There is a large amount of vulgar literature afloat 
 which serves to torture young adults, especially, with 
 the idea that the dreaded tabes dorsalis has already 
 seized upon them. Half of the symptoms in these 
 cases depend upon dyspepsia, and two-thirds of the 
 balance upon the imagination of the victims. 
 
 VII. 
 
 Miscellaneous Affections, Psoas and lumbar abscesses 
 while present reject; and even when recovery seems 
 perfect, from their great tendency to return, throw 
 doubt on the propriety of accepting the applicant. 
 All abscesses of any considerable extent postpone. Re- 
 current abscesses involve suspicion of some cachexia. 
 Even furunculi should not lightly be passed over, and 
 carbuncle^ reject. 
 
 Open ulcers and obstinate cutaneous affections are so 
 generally connected with constitutional taint, or per- 
 manen* lesion of nutrition, that the case is rendered 
 doubtful by their presence. 
 
 Large or extensive varicose veins, chronic and numer- 
 ous enlargements or induration of the lymphatic glands, 
 
144 
 
 fistula (p. 22, et seq.}, morbus coxarius, or acute or 
 chronic inflammation within, or about any of the larger 
 joints. 
 
 Irreducible hernia, double hernia. 
 
 Excessive loss of structure, as amputations above the 
 middle third of the thigh, or at the shoulder joint. 
 
 Tumors of a non-malignant character, but involving 
 danger by their anatomical position, or as requiring a 
 severe surgical operation. 
 
 All tumors or growths of a malignant or scrofulous 
 nature ; Exostoses, Enchondroma, etc. 
 
 Loss of sight or hearing from accident or causes 
 not involving disease of the cerebral centres, never- 
 theless impair the risk, as subjecting the unfortunate 
 subject unduly to injuries which the deprivation of the 
 special sense does not permit him to avoid, 
 
 Finally, diseases which may have been present, but 
 from which there seems to have been perfect recovery, 
 not infrequently leave discoverable effects and influ- 
 ences to the educated eye, which materially lessen the 
 life expectation. 
 
 VIII. 
 
 Female Applicants. Although some companies 
 decline all female risks, it is safe to say that, taken 
 together, they are equally eligible as those of males. 
 As before remarked, even the child-bearing period 
 does not bring to them a mortality, materially prepon- 
 derant over that of males of similar age. Indeed, if 
 anything, the exposures and vicissitudes to which 
 males are ordinarilv subjected, during the active years 
 
145 
 
 of adult life, more than balance, in fatal results, the 
 incidents of the female life during this period. 
 
 Certain anatomical differences with regard to the 
 height, weight, chest measurement, and capacity, have 
 previously been noted, (p. 54.) 
 
 There is, numerically, a greater proportion of ner- 
 vous temperaments, and the modes of life more fre- 
 quently expose to the evils of deficient ventilation and 
 sedentary habits. But to these their systems become 
 accustomed, by well known physiological law, so that 
 not as deleterious results are produced as would be in 
 the male. 
 
 The regularity and perfection of the menstrual func- 
 tion is to be ascertained ; it being remembered that 
 individual peculiarities in this respect are to be weighed 
 rather in their relation to the general health than with 
 reference to exact rules. If there is good health oth- 
 erwise, irregularities in the menstrual function scarcely 
 impair the risk. But at the climacteric period, the 
 difficulties incident to the cessation of the function 
 must be carefully inquired after. This is an objec- 
 tionable time to insure ; but in the absence of notable 
 disturbance of the general health, or evidences of local 
 disease, the party need not be declined. An anaemic 
 or chlorotic condition, or signs of the cancerous cachexia 
 will exclude. 
 
 Primary gestation impairs the risk, ,but, if this 
 proceed without difficulty or danger to its termination, 
 subsequent pregnancy need not be considered as add- 
 ing to the risk. Statistics are said to show that the 
 mortality from first labors, and ensuing puerperal 
 10 
 
I 4 6 
 
 fever, is about twice that of all ensuing labors up to 
 the ninth ; after the ninth, the danger is increased 
 with each succeeding pregnancy and parturition. 
 Whether this proportion is closely approximated or 
 not, there is no doubt of the general truth of the 
 proposition. 
 
 Labors requiring instrumental assistance, miscar- 
 riages, or repeated mal-presentations, or haemorrhage, 
 impair or exclude the risk. The occurrence of Puerperal 
 Fever, or Mania, also declines. Remarkable varicosity 
 of the veins, phlegmasia dolens^ dropsical effusions, etc., 
 are equally objectionable. Vesico-vaginal, or rectal 
 fistulae, or lacerations, also, while present, exclude. 
 Emaciation and exhaustion, during lactation, also 
 militate against assurance. Chronic Metritis or Sub- 
 involution, deep ulcerations and profuse leucorrhceal 
 or purulent discharges, at least, postpone. 
 
 But it should be recollected that mere dyspeptic 
 derangements, or the habit of the parts, may keep up 
 apparent symptoms when important organic disease 
 has passed away. The real condition of the general 
 health is here the point to be investigated. 
 
 It is unnecessary to remark, to the experienced prac- 
 titioner, that organic uterine disease is vastly less fre- 
 quent and important than is claimed by the specialists. 
 The symptoms paraded as proving its existence, in 
 the large majority of instances, being due to totally 
 different causes. Even if it would be permitted, it is 
 doubtful whether, so far as insurance is concerned, 
 specular or digital examination would give any valua- 
 ble information aside from that which can be gathered 
 
H7 
 
 from the history and the general symptoms presented. 
 Cases which suggest such examination to the family 
 physician, so frequently have concurrent evidences of 
 disease, that differential diagnosis becomes unnecessary, 
 for these alone decline. 
 
 The facts with regard to the transmissibility of 
 hereditary diseases, insanity, etc., in certain instances, 
 rather to the females than to the males of the family, 
 and vice versa, may have weight in deciding upon the 
 risk. (p. 126.) 
 
 IX. 
 
 General Character of the Risk. The systematic 
 
 survey which has been taken of the history of the 
 applicant, and the present condition of the individual 
 organs and functions of the body, is merely prepara- 
 tory to answering the all important question pro- 
 pounded by the Insurance Company : " Do you 
 RECOMMEND THE RISK ?" This question should be 
 answered definitely and distinctly YES, or No. 
 
 But, before answering it, there are certain general 
 considerations which it is necessary to have fully in 
 mind. These are derived from the general physiognomy 
 of the case as indicating the CONSTITUTION. Unde 
 this somewhat indefinite designation we refer to the 
 Temperament, the Diathesis, or the Cachexia of the 
 party. 
 
 The Temperament has already been referred to, (p. 61 
 et seq.) Here the question arises : Is the party so 
 situated that his peculiar temperament modifies the 
 character of the risk ? And in answering this, the 
 
I 4 8 
 
 same principles of prognosis are involved as in weighing 
 its relation to present acute disease. 
 
 The Diathesis bears the same relation to disease that 
 the temperament does to health. Original or acquired 
 abnormalities in the organs determine, on the occur 
 rence of any special disease, a modification in its course 
 or tendencies, which assimilates its changes and symp- 
 toms to those which are especially peculiar to the 
 diathetic infirmity. In the absence of exciting cause 
 the diathesis may be apparently latent. In the absence 
 of direct manifestation it may sometimes be cogently 
 inferred from the family or personal history, or from 
 the obvious results of previous disease. Each im- 
 presses its own physiognomy. Among those diatheses 
 prominently demanding study, may be mentioned the 
 Strumous, ultimating in scrofulosis, or tuberculosis, and 
 characterized by defective nutrition, imperfect assimi- 
 lation with consequent impaired function of the organs, 
 with slow and deficient reparative power. 
 
 The Gouty or Rheumatic diathesis, characterized by 
 " a predisposition to the undue formation of uric acid, 
 and to congestion, irritation or inflammation of the 
 muscular and sero-fibrous tissues, of the vascular sys- 
 tem, of the serous membranes, and of the perito- 
 neum." The development of, on the one hand, gouty 
 affections, and on the other, rheumatic disorders, seems 
 to be due to the relative conditions of the skin, and 
 digestive mucous membrane. 
 
 The Adipose diathesis is marked by its results. 
 Ordinarily there is deficient digestive energy and mus- 
 cular weakness The viscera are large, but notably 
 inactive 
 
The Phlogistic, usually engrafted upon the Sanguine 
 Temperament, where acute inflammation, with active 
 symptoms, readily supervenes upon slight causes. 
 Here there is generally great activity of the blood 
 making processes, with some imperfection of structure 
 of the excreting organs. 
 
 The Typhoid, when with rapidity of textural changes, 
 easily exaggerated by disturbing influences, there is 
 feebleness of nutrition and repair with inactivity of 
 the excretories. 
 
 In fine, the acute physician may recognize a great 
 number of these general proclivities to disease, yet 
 each consistent with present health, which, being 
 known, must enter into his well compacted decision 
 as to the real character of the risk. 
 
 The Cachexia, unlike the Temperament or Diathe- 
 sis, determines the presence of disease, not, perhaps, 
 involving any particular organ, but pervading, in its 
 malign influence, each and all. It may be the diathesis 
 developed into an existent disease. The diathesis, 
 being known, may never find development into ca- 
 chexia or local disease, being prevented by appropriate 
 hygienic influences. But the cachexia may originate 
 without the previous existence of the diathesis, and, 
 in this case, is usually more amenable to therapeutics. 
 When both co-exist, the prognosis is thereby rendered 
 vastly more grave than it would be even with greater 
 severity of local symptoms. 
 
 The noticeable cachexiae are those connected with the 
 developed diathesis, as above suggested, and to these 
 may be added, as requiring attention, the Syphilitic, 
 
150 
 
 Erysipelatous, Anaemic or Chlorotic, Albuminoid, 
 Haemic, Haemorrhagic, Rachitic, Cancerous, etc. 
 
 The sum total, so to speak, of the power of carry- 
 ing on the processes of life, ministering to repair, and 
 resisting morbific influences, derived by the system as 
 a whole, is expressed by the term the CONSTITUTION, 
 This word is significant of the Vital Force, or indi- 
 vidual capacity for living. It measures, for the Exam- 
 iner, the Life-Expectation. Deviations from the 
 typical standard of formation and action, as arbitrarily 
 established for purposes of scientific comparison, may 
 be found present to an indefinite extent, and yet the 
 capacity for living be fully equal to, or even above the 
 Insurance Average. 
 
 Poetical descriptions, or ideas, of the mem sana in 
 corpore sano, may differ as widely as men themselves, 
 and it is idle to set up either Apollo or Vulcan as types 
 of Methuselah. Nay, the educated intellect, by 
 adapting the frail body appropriately to its surround- 
 ings, may cause its years to surpass those of the most 
 symmetrical and well developed athlete. 
 
APPENDIX. 
 
 Note to page 15, (Occupation,) 
 
 Occupation has, of course, a more or less direct bearing on health 
 and longevity : in some vocations there is constant danger of accident 
 or violent death even, while in others the danger on this account is 
 so slight as to be quite unworthy of consideration at all. Again, a 
 particular calling may involve not the least risk on account of phys- 
 ical danger, and yet be extremely prejudicial to health and longevity. 
 The following table indicates approximately the relative influence of 
 the various callings and professions on the duration of life; Class I 
 being considered most dangerous, Class IV least so : 
 
 CLASS I. 
 
 Brakeman on Freight Trains. 
 Buzz Sawyer. 
 Circular Sawyer. 
 
 Powder Maker. 
 Seaman. 
 
 CLASS II. 
 
 Bridge Builder. 
 
 Boatman. 
 
 Barber on Steamboat. 
 
 Brakeman on Mail Traini. 
 
 Cartridge Maker, 
 
 Clerk on River Steamboat. 
 
 Captain of Lake or Sea Vessel 
 
 Car Coupler. 
 
 Conductor on Freight Trains. 
 
 Cooper. 
 
 Dock Laborer. 
 
 Engineer on River Steamer. 
 
 Farrier. 
 
 Fireworks, Maker of. 
 
 Fireman (Locomotive). 
 
 Grinder of Edged Tools. 
 
 Horse Shoer. 
 
 Laborer, (Wharf, Warehouse, Grain Elevator.) 
 
 Lighterman. 
 
 Lumberman. 
 
 Master or Mate of Vessel. 
 
 Match Maker. 
 
 Mail Agent, (Traveling). 
 
 Mate of Riter Steamer. 
 
 Miner (underground). 
 
 Nightman. 
 
 Pilot. 
 
 Quarrier. 
 
 Quarryman. 
 
 Raftsman. 
 
 Railroad Engineer. 
 
 Race Horseman. 
 
 Sailor. 
 
 Steward on Steamboat. 
 
 Switchman. 
 
 Stevedore. 
 
 Slater. 
 
 Steel Polisher. 
 
 Telegraph Builder. 
 
 Timber Cutter. 
 
 Train Starter. 
 
 Wood Carver and Turnr 
 
 Yard Master. 
 
I {2 
 
 CLASS III. 
 
 Agricultural Implement Maker. 
 
 Bar Keeper. 
 
 Blacksmith (working). 
 
 Blast Furnace (working in). 
 
 Block, Oar and Mast Maker 
 
 Boiler Maker. 
 
 Bolt Maker. 
 
 Brass Founder (working). 
 
 Bricklayer. 
 
 Broker in Cattle and Hone*. 
 
 Baggage Master on Trains. 
 
 Baggage Master at Station. 
 
 Canal Boatman. 
 
 Captain on River Steamer. 
 
 Car Driver. 
 
 Carman (Drayman). 
 
 Carpenter and Joiner. 
 
 Caulker (Ship). 
 
 Coachman. 
 
 Cork Cutter. 
 
 Cooper. 
 
 Coal Heaver. 
 
 Carpenter (Railroad). 
 
 Chief Engineer. 
 
 Car Repairer. 
 
 Car Cleaner. 
 
 Conductor on Passenger Train*. 
 
 Distiller. 
 
 Driver of Express Wagon. 
 
 Drover. 
 
 Detective (Railroad). 
 
 Express Agent (not on trains). 
 
 Express Agent on trains. 
 
 Engineer on Stationary Engine. 
 
 Express Messenger on Trains. 
 
 Foundry (employee in). 
 
 Fireman (Engine, Hose, Hook and Ladder). 
 
 Freight Agent (station). 
 
 Freight Laborer. 
 
 Hod Carrier. 
 
 Horse Breaker. 
 
 Hostler. 
 
 Inspector of Wood and Timber. 
 
 Knife and Instrument Maker. 
 
 Lead Pipe and Tube Maker. 
 
 Lighthouse or Lightship Keeper. 
 
 Lightning Rods (one who puts up). 
 
 Livery Stable Keeper. 
 
 Lumberman, manufacturer. 
 
 Laborer, common. 
 
 Locomotive Superintendent. 
 
 Limestone Quarrier or Burner. 
 
 Master Mechanic. 
 
 Mason. 
 
 Machinist. 
 
 Metal Turner. 
 
 Miner (surface). 
 
 Naval Architect. 
 
 Operative in Saw and Planing MilU. 
 
 Painter. 
 
 Prison Office Keeper. 
 
 Puddler. 
 
 Rolling Mills 
 
 Saw Mill (employee). 
 
 Shooting Gallery Keeper. 
 
 Scythe and Sickle Maker. 
 
 Ship Carpenter. 
 
 Shipsmith. 
 
 Slate Quarrier. 
 
 Stable Keeper. 
 
 Stage Driver. 
 
 Sugar Refinery (workman in) 
 
 Station man. 
 
 Signal man. 
 
 Ship Inspector. 
 
 Stone Cutter and Dresser. 
 
 Track Laborer. 
 
 Track Superintendent. 
 
 Track Foreman. 
 
 Track Inspector. 
 
 Teamster. 
 
 Turpentine Manufacturer. 
 
 Watchman. 
 
 Wood Chopper. 
 
 CLASS IV. 
 
 Actor, Actress. 
 
 Ale or Beer Manufacturer. 
 
 Apothecary, Druggist. 
 
 Architect. 
 
 Armorer. 
 
 Artificial Limb Maker. 
 
 Actuary. 
 
 Artist, Painter. 
 
 Attorney, Lawyer. 
 
 Auditor. 
 
 Army or Navy Officer (not in service). 
 
 Author, Writer. 
 
 Bookseller. 
 
 Broker in mdse., stocks, or (old. 
 
 Bank Officer or Clerk. 
 
 Book-keeper, Accountant. 
 
 Baker. 
 
 Barber. 
 
 Basket-maker. 
 
 Bell-hanger. 
 
 Boat Builder. 
 
 Bookbinder. 
 
 Boot and Shoe Maker. 
 
 Box and Trunk Maker. 
 
 Brass Polisher, Finisher. 
 
 Brewer. 
 
 Brickrraker. 
 
 Builder, not Laborer 
 
 Cabinet Maker. 
 
 Cap or Carpet-bag Maker. 
 
 Carpet Weaver. 
 
 Chair Maker. 
 
 Chemist and Druggist. 
 
 Chiropodist. 
 
 CHI Engineer. 
 
 Clock Maker. 
 
 Coach Maker. 
 
 Coffee-Housc Keeper. 
 
 Commercial Agent. 
 
 Clergyman. Minister. 
 
 Clerk, (generally). 
 
 Clothierf 
 
 Commission Merchant. 
 
 Captain of lake or sea gteame 
 
 Chemist, manufacturing. 
 
 Coal Miner (underground). 
 
 Confectioner. 
 
 Cook (professional). 
 
 Coppersmith 
 
 Copperplate Printer. 
 
 Cornice Moulder. 
 
 Cotton Dyer. 
 
 Cotton Packer and Presser. 
 
 Cotton Printer. 
 
 Cow-keeper, Milk Seller. 
 
 Currier 
 
 Cujtoi- house Officer. 
 
 cu*. 
 
1 S3 
 
 CLASS IV Concluded. 
 
 Draughtsman. 
 
 Dressmaker. 
 
 Dentist. 
 
 Die Engraver, Mould Maker. 
 
 Drug Grinder. 
 
 Eating -House Keeper. 
 
 Embosser. 
 
 Embroiderer. 
 
 Engraver. 
 
 Editor, Reporter. 
 
 Engineer, Mining. 
 
 Fisherman. 
 
 Farmer, owner, 
 
 Farm Laborer. 
 
 File Maker. 
 
 Fish Curer. 
 
 Fish and Oyster Dealer. 
 
 Furrier. 
 
 Gardener. 
 
 Gas Fitter. 
 
 Gas Works, service, 
 
 Gauger. 
 
 General Trader, (traveling). 
 
 Glazier. 
 
 Glover. 
 
 Gold Boater. 
 
 Glass Blower. 
 
 Gold or Silver Refiner and Worker. 
 
 Grocer (general). 
 
 Grain Measurer. 
 
 General Trader, storekeeper. 
 
 Grave Digger, Sexton. 
 
 Gunsmith. 
 
 Harness Maker, Saddler. 
 
 Hat and Cap Maker. 
 
 Hollow Ware Maker. 
 
 Hoop Maker. 
 
 Hoop Skirt Maker. 
 
 Hotel or Tavern Keeper (country). 
 
 House Decorator. 
 
 Huckster. 
 
 Hotel Keeper, proprietor. 
 
 Insurance Officer and Clerkf (not traveling). 
 
 Ivory Cutter and Worker. 
 
 India Rubber Manufactory, employee in. 
 
 Ink Maker. 
 
 Instrument Case Maker. 
 
 Japanner. 
 
 Jeweler, worker. 
 
 Lithographer (not working). 
 
 Leather Dyer. 
 
 Locksmith. 
 
 Looking Glass Maker. 
 
 Last Maker. 
 
 Machinist, not in employ of railroad* 
 
 Marble Cutter. 
 
 Marble Mason. 
 
 Market man. 
 
 Medical Student. 
 
 Metal Refiner. 
 
 Miller, grain and flour. 
 
 Morocco Dresser. 
 
 Millwright. 
 
 Manufacturer (not working). 
 
 Milliner. 
 
 Musician. 
 
 Moulder. 
 
 Naval Officer, in service. 
 
 Nail Maker. 
 
 Nurseryman, working. 
 
 Oil Dealer, petroleum. 
 
 Operative in Cotton or Woolen Mill*. 
 
 Organ Builder. 
 
 Ouster Dealer. 
 
 Phonographer. 
 
 Photographer. 
 
 Physician. 
 
 Postmaster. 
 
 P. O. Clerk (not traveling) 
 
 Packer of Hay, Cotton, Pork, Beef. 
 
 Packing Case Maker (not using circular saw). 
 
 Painter, house, ornamental. 
 
 Paper Hanger. 
 
 Paper Box Maker. 
 
 Pastry Cook. 
 
 Pawnbroker. 
 
 Pencil Maker. 
 
 Picture^frame Maker. 
 
 Percussion Cap Maker. 
 
 Plasterer. 
 
 Plater. 
 
 Plumber. 
 
 Porter. 
 
 Potter. 
 
 Pressman. 
 
 Printer, compositor. 
 
 Pump Maker, 
 
 President or Secretary of Corporation 
 
 Publisher. 
 
 Purser, steamship. 
 
 Policeman. 
 
 Railroad Employees. 
 
 Rectifier. 
 
 Rope Maker. 
 
 Surgeon. 
 
 Ship Rigger. 
 
 Soap Boiler. 
 
 Sail Maker. 
 
 Saloon Keeper. 
 
 Sausage Maker. 
 
 Segar Maker, 
 
 Scourer, Dyer. 
 
 Ship Broker, agent. 
 
 Ship Builder, contractor. 
 
 Steward on vessel or steamer. 
 
 Smelter. 
 
 Soda Water Manufacturer. 
 
 Shovel Maker. 
 
 Silversmith. 
 
 Spindle Maker. 
 
 Spring Maker. 
 
 Steel Pen Maker. 
 
 Stereotyper. 
 
 Surgical Instrument Maker. 
 
 Surveyor. 
 
 Tanner. 
 
 Tinman, tinker. 
 
 Traveling Agent. 
 
 Type Founder. 
 
 Tailor. 
 
 Teacher. 
 
 Telegraph Operator. 
 
 Tool Maker. 
 
 Turner, Wood and Ivory 
 
 Umbrella Maker. 
 
 Upholsterer. 
 
 Varnish Maker. 
 
 Vitriol Manufacturer. 
 
 Watchmaker. 
 
 Weighing Machine, Scale Maker. 
 
 Wharfinger. 
 
 Wheelwright. 
 
 Whip Maker. 
 
 Whitesmith. 
 
 Wig Maker. 
 
 Wire Maker. 
 
 Wood Dealer 
 
 Watchman. 
 
 Weaver. 
 
 Weigher. 
 
Note to page 16, 
 
 The popular idea that the affection known as " clergyman's sore 
 throat " predisposes to consumption is, to a great extent, erroneous. 
 On the other hand, it is probably safe to say that consumption finds 
 fewer victims among the clergy, than among any other class of 
 people the exercise of public speaking tending rather to develope 
 and strengthen the lungs than otherwise. As a general rule, public 
 speakers are safe and desirable risks. 
 
 Note to page 16, (Professional men, ) 
 
 It must be admitted, as an exception to the general rule, that 
 under-teachers in city schools are most unfavorably situated as regards 
 health and longevity. Confined for six or eight hours a day in close, 
 ill-ventilated rooms, which are crowded with children in all stages of 
 uncleanliness ; with both body and mind wrought up to the highest 
 pitch of exertion, and all this for many consecutive weeks or even 
 months, it is scarcely to be wondered at that their standard of health 
 is low as compared with that of the great majority of teachers in the 
 colleges and higher schools, or of teachers in common schools in 
 country towns. 
 
 It is probable that statistics would show a marked difference in 
 the average duration of life, between city and country physicians, 
 and that the difference would be in favor of the former. The 
 terribly exhausting life of the country practitioner, together with his 
 unavoidable irregularity of habits and of hours of rest, cannot be 
 otherwise than unfavorable to long life. 
 
 As regards other professions, it does not appear that any marked 
 difference obtains between city and country. But the popular belief, 
 that the opportunities for the enjoyment of vigorous health, are, on 
 the whole, better in the country than in the city, is probably true, 
 though a series of observations on this point are much needed. The 
 actual difference, however, is not so great as has been supposed ; owing 
 perhaps to the increasing popularity of gymnastic and other exercises 
 intended to develop a high state of physical health ; the improved 
 methods of constructing dwelling houses as regards warming and ven- 
 tilation, and the improved notions of society as regards diet and 
 
'55 
 
 dress j fashionable society having now learned to tolerate warm attire, 
 however ridiculous or preposterous its form may be another reason 
 for the improved hygienic condition of cities is, that modern science 
 has at length developed the fact that contagious and zymotic diseases 
 may be, to a great extent, prevented by the enforcement of sanitary 
 regulations ; consequently every city of any considerable size has its 
 " Board of Health," clothed with ample powers, and held rigidly 
 accountable for their employment, both by public opinion, and by an 
 exacting and critical newspaper press. 
 
 Note to page 19. (Table of Mortality,) 
 
 In the first of the annexed tables, is shown the mortality from all 
 diseases usually mentioned in Life Insurance Applications, for the 
 year 1860, together with the rates they severally bear to 10,000 
 deaths, from all known causes of mortality. The second table shows 
 the proportion of deaths to 10,000 from all causes, in the several 
 "census districts" of the United States, from the same diseases, and 
 for the same year. The States arid Territories comprising the several 
 districts will be found in connection with the table on page 16. It 
 will be observed that the deaths from "colic," "palpitation" and 
 "spitting of blood " are not given ; this is simply because they are 
 very properly regarded as being symptoms only ; and therefore entitled 
 to no place in a classified arrangement of diseases for scientific 
 purposes. (Compiled from the Census Report for 1860). 
 
 As Life Insurance Companies have multiplied, and operations on a 
 more extended scale have been made, tables of mortality have also 
 multiplied. 
 
 The Carlisle table is given on page 7, of this work ; below will 
 be found the " American," " Combined Experience " and " English'' 
 tables the latter being that generally known as " Farr's table." 
 
156 
 
 SHOWING THE DEATHS IN THE UNITED STATES, AND THE RATIO 
 TO 10,000 DEATHS, FROM DISEASES USUALLY MENTIONED IN 
 LIFE INSURANCE APPLICATIONS, FOR THE YEAR 1860. 
 
 DISEASE. 
 
 NO. OF DEATHS. 
 
 NO. TO 10,000 
 FROM ALL KNOWN 
 CAUSES. 
 
 DISEASE. 
 
 NO. OF DEATHS. 
 
 NO. TO IO,OOO 
 FROM ALL KNOWN 
 CAUSES. 
 
 
 3,083 
 669 
 1,919 
 3,292 
 49,082 
 
 44 
 1,663 
 6, C 3 
 12,090 
 5 01 
 37 
 4i 
 931 
 
 86 
 
 18 
 53 
 92 
 i,379 
 I 
 46 
 183 
 355 
 J 4 
 i 
 i 
 26 
 
 
 452 
 385 
 2,633 
 
 4<637 
 
 12 
 IO 
 
 73 
 130 
 
 Asthma . 
 
 Influenza ........ 
 
 Bronchitis 
 
 
 
 
 Consumption 
 
 Palpitation ..... 
 
 Colic 
 
 Quinsy 
 
 730 
 1,881 
 360 
 26,402 
 
 20 
 52 
 IO 
 741 
 
 Diphtheria 
 
 Rheumatism - 
 
 Disease of the Heart 
 
 
 Dropsy 
 
 Scarlet Fever 
 
 Fits (Epileptic) 
 
 Spitting of Blood 
 
 Fistula 
 
 Disease of Urinary Organs. 
 Syphilis . . 
 
 2,112 
 233 
 
 1 
 
 Gout . 
 
 Intemperance _ 
 
 
 
 SHOWING THE PROPORTION OF DEATHS TO IO,OOO FROM ALL CAUSES, 
 IN THE "CENSUS DISTRICTS" FOR THE YEAR 1860. 
 
 DISTRICTS. 
 
 PROPORTION TO 10,000 OF ALL DEATHS. 
 
 
 I. 
 
 II. 
 
 III. 
 
 IV. 
 
 V. 
 
 VI. 
 
 VII. 
 
 VIII. 
 
 IX. 
 
 
 109 
 17 
 3i 
 140 
 2,162 
 
 8 4 
 16 
 18 
 81 
 i,535 
 
 141 
 25 
 "5 
 107 
 1,793 
 
 62 
 
 3 
 
 79 
 1,298 
 
 7 f 
 26 
 
 60 
 
 95 
 i,!95 
 
 55 
 
 i 
 
 60 
 1,048 
 
 86 
 2 9 
 62 
 71 
 492 
 
 63 
 
 14 
 
 48 
 
 50 
 
 563 
 
 no 
 37 
 5 1 
 47 
 1,214 
 
 
 Bronchitis 
 
 
 Consumption . 
 
 Colic 
 
 Diphtheria 
 
 47 
 319 
 3M 
 17 
 
 ii 
 
 22 
 
 | 
 
 3 S 
 
 3 
 126 
 
 258 
 i4 
 
 81 
 
 164 
 
 5 l 
 
 35 
 95 
 3H 
 
 12 
 
 20 
 96 
 601 
 
 12 
 
 52 
 83 
 
 329 
 7 
 
 i 
 
 116 
 215 
 241 
 
 i5 
 5 
 
 i 
 
 73 
 ii 
 
 7 
 
 102 
 92 
 
 Disease of the Heart.. 
 
 
 Fits (Kliptic) 
 
 Fistula 
 
 Gout 
 
 
 
 
 
 
 
 
 Intemperance 
 
 2 3 
 18 
 
 Ii 
 
 177 
 
 22 
 9 
 
 7 
 107 
 75 
 
 22 
 
 16 
 
 4 
 74 
 194 
 
 15 
 7 
 6 
 74 
 103 
 
 39 
 
 '1 
 
 73 
 190 
 
 3 
 ii 
 7 
 61 
 88 
 
 29 
 
 8 
 J 7 
 74 
 99 
 
 2 7 
 9 
 14 
 Si 
 44 
 
 Insanity 
 
 Influenza .... 
 
 Liver Complaint ... 
 
 
 
 Quinsy 
 
 J 
 
 68 
 766 
 
 12 
 
 45 
 13 
 i,93 
 
 8 
 
 5* 
 ii 
 1,085 
 
 18 
 45 
 9 
 
 1,112 
 
 19 
 75 
 
 & 
 
 3i 
 59 
 9 
 
 766 
 
 42 
 62 
 8 
 
 198 
 
 48 
 43 
 9 
 374 
 
 II 
 
 59 
 
 * 9 
 965 
 
 Rheumatism .... .. ... 
 
 Rupture 
 
 
 
 Disease of the Urinary Organs 
 Syphilis 
 
 82 
 
 7 
 
 55 
 5 1 
 
 57 
 3 
 
 52 
 
 3 
 
 60 
 
 4 
 
 49 
 5 
 
 54 
 ii 
 
 35 
 7 
 
 59 
 
 5i 
 
 
'57 
 
 RATES OF ENGLISH AND AMERICAN MORTALITY. 
 
 
 to 
 
 u "* 
 
 K 
 
 jy 
 
 - >-. 
 Ill 
 
 Zo J 
 
 1J 
 
 ^ 
 
 
 - 1 
 
 
 3 ^ 
 
 WJJ 
 
 
 
 -A j 
 
 
 
 M| 
 
 H '>* 
 
 
 
 e 
 
 W 8. 
 
 **: ~ **- 
 
 
 c J 
 
 VI 
 
 c 
 
 |iB 
 
 c .2 
 
 "S w 
 
 3 a 
 
 
 <J U 
 
 G 
 
 U 
 
 
 (j rt 
 
 C 
 
 -C ^-^ O 
 
 & 
 
 i i 
 
 < Z- 
 
 IS 
 
 lii 
 
 u a 
 S a 
 
 13 
 
 I Hi 
 
 JJ aj 
 
 <J W 
 
 -^ rt^ 
 
 S g J 
 
 CJ g'o 
 
 .2 ^ *s 
 
 III 
 
 10 
 
 100,000 
 
 100,000 
 
 749 
 
 6 7 6 
 
 48.72 
 
 48.36 
 
 47-05 
 
 II 
 
 99*251 
 
 99,324 
 
 746 
 
 674 
 
 48.08 
 
 47.68 
 
 46.31 
 
 12 
 
 98,505 
 
 98,650 
 
 743 
 
 6 7 2 
 
 47-44 
 
 47.01 
 
 45-54 
 
 3 
 
 97,762 
 
 97,978 
 
 740 
 
 6 7 i 
 
 46.82 
 
 46.33 
 
 44.76 
 
 14 
 
 97,022 
 
 97,37 
 
 737 
 
 671 
 
 46.16 
 
 45.64 
 
 43-97 
 
 15 
 
 96,285 
 
 96,636 
 
 735 
 
 6 7 i 
 
 45-5 
 
 44.96 
 
 43.18 
 
 16 
 
 95,550 
 
 95,965 
 
 732 
 
 6 7 2 
 
 44.85 
 
 44.27 
 
 42.40 
 
 17 
 
 94,818 
 
 95, 2 93 
 
 729 
 
 6 73 
 
 44.19 
 
 4358 
 
 41.64 
 
 18 
 
 94,089 
 
 94,620 
 
 727 
 
 675 
 
 43-53 
 
 42.88 
 
 40.90 
 
 19 
 
 93,362 
 
 93>945 
 
 725 
 
 677 
 
 42.87 
 
 42.19 
 
 40.17 
 
 20 
 
 92,637 
 
 93,268 
 
 723 
 
 680 
 
 42.20 
 
 41.49 
 
 39.48 
 
 21 
 
 91,914 
 
 92,588 
 
 722 
 
 683 
 
 41-53 
 
 40.79 
 
 38.80 
 
 22 
 
 91,192 
 
 91,905 
 
 721 
 
 686 
 
 40.85 
 
 40.09 
 
 38-13 
 
 23 
 
 90,471 
 
 91,219 
 
 720 
 
 690 
 
 40.17 
 
 39-39 
 
 37-46 
 
 24 
 
 89,751 
 
 90,529 
 
 719 
 
 694 
 
 39-49 
 
 38-63 
 
 36-79 
 
 5 
 
 89,032 
 
 89,835 
 
 
 698 
 
 38.81 
 
 37.98 
 
 36.12 
 
 26 
 
 88,314 
 
 89-137 
 
 78 
 
 703 
 
 38.11 
 
 37.27 
 
 35-44 
 
 27 
 
 87,596 
 
 88,434 
 
 718 
 
 708 
 
 37-43 
 
 36.56 
 
 34-77 
 
 28 
 
 86,878 
 
 87,726 
 
 718 
 
 714 
 
 36.73 
 
 35.86 
 
 34.10 
 
 29 
 
 86,160 
 
 87,012 
 
 719 
 
 720 
 
 3603 
 
 35-*5 
 
 33-43 
 
 30 
 
 85,441 
 
 86,292 
 
 720 
 
 727 
 
 35-33 
 
 34-43 
 
 32.76 
 
 
 84,721 
 
 85,565 
 
 721 
 
 734 
 
 34-62 
 
 33.72 
 
 32.09 
 
 32 
 
 84,000 
 
 
 723 
 
 742 
 
 33.92 
 
 33.01 
 
 31.42 
 
 33 
 
 83,277 
 
 84^089 
 
 726 
 
 75 
 
 33.21 
 
 32.30 
 
 30-74 
 
 34 
 
 82,551 
 
 83,339 
 
 729 
 
 758 
 
 32.50 
 
 31-58 
 
 30.07 
 
 35 
 
 81,822 
 
 82,581 
 
 732 
 
 767 
 
 31.78 
 
 30.87 
 
 29.40 
 
 36 
 
 81,090 
 
 81,814 
 
 737 
 
 776 
 
 31.07 
 
 30.15 
 
 28.73 
 
 37 
 
 80,353 
 
 81,033 
 
 742 
 
 785 
 
 30.35 
 
 29.44 
 
 28.06 
 
 38 
 
 
 80,253 
 
 749 
 
 795 
 
 29.62 
 
 28.72 
 
 27.39 
 
 39 ! 78,862 
 
 79,458 
 
 756 
 
 805 
 
 28.90 
 
 28.00 
 
 26.72 
 
 40 
 
 78,106 
 
 78,653 
 
 765 
 
 815 
 
 28.18 
 
 27.28 
 
 26.06 
 
 41 
 
 77,341 
 
 77,838 
 
 774 
 
 826 
 
 27.45 
 
 26.56 
 
 25-39 
 
 42 
 
 76,567 
 
 77,012 
 
 785 
 
 839 
 
 26.72 
 
 25-84 
 
 24.73 
 
 43 
 
 75,78i 
 
 76,173 
 
 797 
 
 857 
 
 25.99 
 
 25.12 
 
 24.07 
 
 44 
 
 74,985 
 
 75,316 
 
 812 
 
 881 ' 25.27 
 
 24.40 
 
 23-41 
 
 45 
 
 74,173 
 
 74,435 
 
 828 
 
 909 24.54 
 
 23.69 
 
 22.76 
 
 46 
 
 73,345 
 
 
 848 
 
 944 
 
 23.80 
 
 22.97 
 
 22.11 
 
 47 
 
 72,497 
 
 72,582 
 
 870 
 
 981 
 
 33-oS 
 
 22.27 
 
 21.46 
 
 48 
 
 71,627 
 
 71,601 
 
 896 
 
 1,021 
 
 22.36 
 
 21.56 
 
 20.82 
 
 49 
 
 7,73* 
 
 70,580 
 
 927 
 
 1,063 
 
 21.63 
 
 20.87 
 
 20.17 
 
 5 
 
 69,804 
 
 69,517 
 
 962 
 
 1,108 
 
 20.91 
 
 20.18 
 
 '9-54 
 
 5 1 
 
 68,842 
 
 68,409 
 
 1,001 
 
 1,156 
 
 20.20 
 
 19.50 
 
 18.90 
 
 
 67,841 
 
 67,253 
 
 1,044 
 
 1,207 
 
 19.49 
 
 18.82 
 
 18 28 
 
I 5 8 
 
 RATES OF ENGLISH AND AMERICAN MORTALITY. 
 
 
 
 
 
 
 
 1 C 
 
 V 1 
 
 
 
 
 
 
 
 n o 
 
 
 
 jj j & 
 
 SL "^ 
 
 JU . 
 
 5.*! 
 
 Lj 
 
 g/a 
 
 rt W jj 
 
 
 8 .S 
 
 3.S ' 
 
 -3 g* 
 
 x fe 
 
 W .0 
 
 .3 
 
 wg 
 
 ^^S 
 
 
 a 
 
 6 
 
 h '>, 
 
 
 C 
 
 a. 
 
 X 
 
 ^ ^ 
 
 
 s s 
 
 |* 
 
 3 S 
 
 . 
 
 c.2 
 . 
 
 
 g c 
 
 *_ 
 
 11 
 
 < 55 
 
 lii 
 
 11 
 
 < fc 
 
 J4J 
 _il 
 
 ll 
 
 < w 
 
 ^G t ."t^ 
 
 u g*S 
 
 W^ S, 
 
 53 
 
 66,797 
 
 66,046 
 
 i,o 9I 
 
 ,261 
 
 18.79 
 
 18 16 
 
 17.67 
 
 
 65,706 
 
 64,785 
 
 1,143 
 
 ,316 
 
 18.09 
 
 17.50 
 
 17.06 
 
 55 
 
 64,563 
 
 63,469 
 
 1,199 
 
 ,375 
 
 17.40 
 
 16.86 
 
 16.45 
 
 56 
 
 63,364 
 
 62,094 
 
 1,260 
 
 ,43 6 
 
 16.72 
 
 16.22 
 
 15.86 
 
 57 
 
 62,104 
 
 60,658 
 
 J >325 
 
 ,497 
 
 16.05 
 
 J 5-59 
 
 15.26 
 
 58 
 
 60,779 
 
 59,161 
 
 ',394 
 
 ,561 
 
 15-39 
 
 14.97 
 
 14.68 
 
 59 
 
 59,385 
 
 57,600 
 
 1,468 
 
 ,627 
 
 14-74 
 
 14-37 
 
 14.10 
 
 60 
 
 57,9'7 
 
 55,973 
 
 1,546 
 
 ,698 
 
 14.09 
 
 13.77 
 
 13-53 
 
 61 
 
 56,371 
 
 54,275 
 
 1,628 
 
 ,77 
 
 13.47 
 
 13.18 
 
 12.96 
 
 62 
 
 54,743 
 
 
 1,713 
 
 ,844 
 
 12.86 
 
 12.61 
 
 12.41 
 
 63 
 
 53.030 
 
 50,661 
 
 i, 800 
 
 
 12.26 
 
 12.05 
 
 11.87 
 
 64 
 
 5 J ,23 
 
 48,744 
 
 1,889 
 
 1,990 
 
 11.68 
 
 11.51 
 
 11.34 
 
 65 
 
 49, 34 1 
 
 46,754 
 
 1,980 
 
 2,061 
 
 II. JO 
 
 10.97 
 
 10.82 
 
 66 
 
 47,361 
 
 44,693 
 
 2,070 
 
 2,128 
 
 10.54 
 
 10.46 
 
 10.32 
 
 67 
 
 45,29! 
 
 42,565 
 
 2,158 
 
 2,191 
 
 10.00 
 
 9.96 
 
 9.83 
 
 68 
 
 43,'33 
 
 4, 3 74 
 
 2,243 
 
 2,246 
 
 9.48 
 
 9-47 
 
 9.36 
 
 69 
 
 40.890 
 
 38,128 
 
 2,321 
 
 2,291 
 
 8.98 
 
 9.00 
 
 8.90 
 
 7 
 
 38,569 
 
 35,837 
 
 2,391 
 
 2,327 
 
 8.48 
 
 8-54 
 
 8-45 
 
 71 
 
 36,178 
 
 33,5 10 
 
 2,448 
 
 2,35' 
 
 8.00 
 
 8.10 
 
 8.03 
 
 72 
 
 33,73 
 
 3 I I 59 
 
 2,487 
 
 2,362 
 
 7-54 
 
 7.67 
 
 7,62 
 
 73 
 
 
 28,797 
 
 2,55 
 
 2,358 
 
 7.10 
 
 7.26 
 
 7.22 
 
 74 
 
 28^738 
 
 26,439 
 
 2,501 
 
 2,339 
 
 6.68 
 
 6.86 
 
 6.85 
 
 75 
 
 26,237 
 
 24,100 
 
 2,476 
 
 2,33 
 
 6.28 
 
 6.48 
 
 649 
 
 76 
 
 23,761 
 
 21,797 
 
 2,43* 
 
 2,249 
 
 5.88 
 
 6. 1 1 
 
 6.15 
 
 77 
 
 2i,33 
 
 19,548 
 
 2,369 
 
 2,179 
 
 5-48 
 
 5.76 
 
 5.82 
 
 78 
 
 18,961 
 
 17,369 
 
 2,291 
 
 ,092 
 
 5.10 
 
 5-42 
 
 5-5 1 
 
 79 
 
 16,670 
 
 
 2,196 
 
 ,987 
 
 4-74 
 
 5.09 
 
 5.21 
 
 80 
 
 '4,474 
 
 13,290 
 
 ,091 
 
 ,866 
 
 4.38 
 
 4-78 
 
 4-93 
 
 81 
 
 12,383 
 
 11,424 
 
 ,9 6 4 
 
 ,73 
 
 4.04 
 
 4-48 
 
 4.66 
 
 82 
 
 10,419 
 
 9,694 
 
 ,816 
 
 ,582 
 
 3-7J 
 
 4-18 
 
 4.41 
 
 83 
 
 8,603 
 
 8,112 
 
 ,648 
 
 ,427 
 
 3-39 
 
 3.90 
 
 4-17 
 
 84 
 
 6,955 
 
 6,685 
 
 ,47 
 
 ,268 
 
 3.08 
 
 3.63 
 
 3-95 
 
 85 
 
 5,485 
 
 5,417 
 
 ,292 
 
 ,111 
 
 2-77 
 
 
 3-73 
 
 86 
 
 4,i93 
 
 4,306 
 
 ,114 
 
 958 
 
 2.47 
 
 3.10 
 
 3-53 
 
 87 
 
 3,79 
 
 3,348 
 
 933 
 
 811 
 
 2.19 
 
 2.84 
 
 3-34 
 
 88 
 
 2.146 
 
 2,537 
 
 744 
 
 673 
 
 1.93 
 
 2.59 
 
 3.16 
 
 89 
 
 1,402 
 
 1,864 
 
 555 
 
 545 
 
 1.69 
 
 2.35 
 
 3.00 
 
 90 
 
 847 
 
 
 385 
 
 427 
 
 1.42 
 
 2.II 
 
 2.84 
 
 91 
 
 462 
 
 '892 
 
 246 
 
 322 
 
 1.19 
 
 1.8 9 
 
 2.69 
 
 92 
 
 216 
 
 57 
 
 J37 
 
 231 
 
 98 
 
 J.6 7 
 
 2-55 
 
 93 
 
 79 
 
 339 
 
 58 
 
 '55 
 
 80 
 
 1.47 
 
 2.41 
 
 94 
 
 21 
 
 184 
 
 18 
 
 95 
 
 64 
 
 1.28 
 
 2.29 
 
 95 
 
 3 
 
 89 
 
 3 
 
 52 
 
 5C 
 
 1. 12 
 
 2.17 
 
159 
 
 to 26 inclusive, deduct the age from 100 : half the balance is the expectation 
 it tt it tt gg tt tt it tt 
 
 tt tt tt tt *6 ,t 
 
 The following simple rules for the calculation of life expectation 
 are taken from the "Agents Manual of Life Insurance." They 
 may be relied upon as approximately correct, and will be found 
 useful in the absence of the standard mortality tables : 
 
 From 14 to 
 
 " 26 to 30 
 
 " 31 to 40 
 
 " 41 to <o " " " " " 92 " " " " 
 
 ' 51 to 60 " " " " " 90 " " " " 
 
 Or deduct the age of the party, whatever it ma/ be, from 80, and two-thirds of the difference Is the 
 average expectation : for example, it the age be 43 ; 80 43=37 j % of 37=24%, the average 
 expectation, very nearly, as given by the table. 
 
 The annexed table, after Quetelet, shows the relative mortality of 
 the sexes, at different ages from birth up to 100 years, as affected by 
 city and country life. The table is constructed to exhibit the pro- 
 portion of male deaths to one female death, in both localities. 
 
 TABLE SHOWING THE RELATIVE MORTALITY OF THE SEXES AT 
 DIFFERENT AGES IN CITY AND COUNTRY. (AFTER &UETELET). 
 
 
 MALE DEATHS TO 
 
 [ FEMALE DEATH. 
 
 Age. 
 
 City. 
 
 Country. 
 
 Still born .. 
 
 ^7 
 
 70 
 
 
 . 11 
 
 17 
 
 
 .77 
 
 2, 
 
 
 ,2,Z 
 
 21 
 
 
 .2,4 
 
 .16 
 
 
 06 
 
 O7 
 
 
 06 
 
 **3 
 
 o 07 
 
 
 
 O 0,4. 
 
 
 O.Q 
 
 O.Q 1 
 
 
 o.8a 
 
 O 7C 
 
 
 0,08 
 
 O.Q2 
 
 
 2A 
 
 III 
 
 26 to 30 years 
 
 OO 
 
 o 86 
 
 10 to 4.0 years 
 
 88 
 
 o 67 
 
 
 , oz 
 
 8l 
 
 
 .07 
 
 i.ii 
 
 
 0.06 
 
 I.OC 
 
 70 to 80 years ..... 
 
 O 77 
 
 I OO 
 
 80 to 100 years............. 
 
 o 68 
 
 o 02 
 
 
 
 
 The comparative mortality of the white and colored races is a 
 subject o/ practical and growing importance in its relations to Life 
 Insurance. Already the blacks are beginning to show an intelligent 
 appreciation of the benefits of Life Insurance, and -,he time is not 
 far distant when it will become quite general among them. Full and 
 
i6o 
 
 reliable statistical infoimation in regard to the average duration of life 
 among them is not yet accessible : but the following tables, whereof 
 the first is compiled from the Census Report of 1860, and the two 
 following from that excellent authority, Dr. W. A. Hammond, are 
 believed to be reliable, so far as they go. 
 
 Table first, shows the comparative mortality of whites and blacks 
 in the United States, from diseases alluded to in the applications of 
 the various companies ; the second, shows the comparative mortality 
 of whites and blacks from consumption, at several of the British mili- 
 tary stations, as it occurs from year to year ; the third, shows the 
 comparative mortality from malarial diseases at the same stations, 
 (Gibraltar excepted) from 1818 to 1836 inclusive. 
 
 SHOWING THE COMPARATIVE MORTALITY OF WHITES AND 
 BLACKS IN THE UNITED STATES, FROM DISEASES MENTIONED 
 IN THE LIFE INSURANCE APPLICATIONS, FOR THE YEAR 1850 
 
 
 NUMBER OF DEATHS. 
 
 RATIO IN 100,000 DEATHS. 
 
 Causes of Death. 
 
 White. 
 
 Colored. 
 
 White. 
 
 Colored. 
 
 Apoplexy 
 
 10.184 
 926 
 6.722 
 3-!79 
 
 70.893 
 
 944 
 258 
 2.094 
 346 
 7.771 
 
 18.691 
 1.699 
 
 i*-337 
 5-834 
 130.117 
 
 10.107 
 
 2.762 
 22.420 
 3.704 
 83.203 
 
 
 
 
 
 Colic . 
 
 
 1.529 
 7.662 
 13.891 
 1.074 
 26 
 
 79 
 1.792 
 
 574 
 , 34i 
 3.211 
 
 09 
 
 849 
 4.766 
 
 202 
 07 
 
 5 
 177 
 
 91 
 144 
 294 
 
 ' 2.806 
 14.062 
 
 2 5-495 
 1.971 
 
 47 
 144 
 3.289 
 1.053 
 625 
 5.893 
 
 96 
 
 9.000 
 51.029 
 2.162 
 74 
 53 
 1.895 
 
 974 
 1.541 
 3.147 
 
 Diseases of the Heart 
 
 Fits (Epileptic) 
 
 Fistula 
 
 Gout 
 
 
 Insanity . . 
 
 Influenza 
 
 Liver Complaint 
 
 Paralysis 
 
 
 
 
 
 
 Quinsy ... 
 
 1.284 
 1.500 
 367 
 23.721 
 
 313 
 363 
 
 149 
 
 1.681 
 
 2.356 
 a -753 
 673 
 43-537 
 
 3-35 1 
 3.886 
 1.695 
 17.998 
 
 
 
 Scarlet Fever 
 
 Spitting of Blood 
 
 Diseases of Urinary Organs 
 
 Syphilis.. 
 
 3.308 
 657 
 
 276 
 149 
 
 6.068 
 
 1.207 
 
 2.972 
 1-595 
 
 
 NOTE. The blank spaces indicate that the diseases opposite them are rega ded as symttami 
 nerely 
 
TABLE SHOWING THE COMPARATIVE MORTALITY OF WHITE 
 AND BLACK. TROOPS FROM CONSUMPTION AT SEVERAL OF 
 THE BRITISH MILITARY STATIONS, AS IT OCCURS FROM YEAR 
 
 TO YEAR. (FROM HAMMOND). 
 
 
 RATIO OF OKA 
 
 I-HS IN 1,000. 
 
 Station. 
 
 White Troops. 
 
 Colored Troops. 
 
 
 7,r 
 
 IO.1 
 
 
 6. 
 
 O 7 
 
 
 
 8.1 
 
 
 6. 
 
 6.1 
 
 
 
 12 Q 
 
 Ceylon 
 
 4. Q 
 
 IO C 
 
 Gibralter 
 
 T*7 
 
 51 
 
 1W.J 
 
 d.1 
 
 
 J 
 
 
 TABLE SHOWING THE COMPARATIVE MORTALITY FROM MA- 
 LARIAL DISEASES, OF WHITE AND BLACK. TROOPS, AT THE 
 SAME STATIONS, FROM 1818 TO 1836. (FROM HAMMOND.) 
 
 Station. 
 
 White Troops. 
 
 Colored Troops. 
 
 
 IOI.Q 
 
 8. a 
 
 
 I C.Q 
 
 5-6 
 
 
 81. 
 
 4*4 
 
 
 410. 
 
 2.4 
 
 
 1.7 
 
 o.o 
 
 Ceylon 
 
 24.6 
 
 
 RATIO OF DEATHS TO I,OOO. 
 
 Note to page 22. (Intemperance.) 
 
 That intemperance, using the term in its largest sense, sometimes 
 seems to be hereditary, is undeniably true. The morbid appetite 
 seems, after long indulgence, to become a fixed constitutional vice, 
 and as such to be handed down from father to son. Yet it is fre- 
 quently the case that the children of an intemperate man, smarting 
 under the disgrace of having a besotted father, become, from very 
 disgust and loathing, the most radical temperance men ; but tkeir 
 children are more than likely to follow the course of their grand- 
 parent Indeed, in intemperate families, " atavism " is a common 
 occurrence, and is explicable on- the grounds above stated. When an 
 II 
 
1 62 
 
 applicant comes of a family known to have been intemperate for two 
 or more generations past, his habits should be most carefully scrutin- 
 ized by the Examiner, before recommending him. 
 
 Note to page 23. (Alcohol,) 
 
 Reformed inebriates, unless after a long interval of sobriety, are 
 undesirable ; the long-continued and excessive use of alcohol leaving 
 behind effects more or less permanent in their nature. " The 
 characteristic changes which have been observed in the brain, medulla 
 oblongata, etc., of confirmed drinkers," writes Mr. Anstie " con- 
 sist essentially of a peculiar atrophic modification, by which the true 
 elements of nervous tissue are partially removed, the total mass of 
 nervous matter wastes, serous fluid is effused into the ventricles and 
 the arachnoid, while simultaneously there is a marked development 
 of fibrous tissue, granular fat and other elements which belong to a 
 lower order of vitalized products." Moreover, intemperance is a 
 recognized cause of insanity, particularly if any hereditary predispo- 
 sition thereto exists : out of 816 cases of insanity, treated in a well- 
 known eastern asylum, 55, or one in about every 15, were directly 
 traceable to excessive use of alcohol. 
 
 Note to page 25, (Acclimation,) 
 
 The progeny of parents of northern extraction, born in the 
 tropics, even though sent to a temperate zone early in life, are often 
 questionable risks. The enervating influences of a tropical climate 
 seems to follow them through all their lives ; seems indeed, in a 
 single generation, ofttimes to so modify and break down the constitu- 
 tion, as to render it incapable of long resisting the depressing influ- 
 ences of a northern climate. This is best exemplified in the 
 children of missionaries, born of parents who have for several or 
 perhaps many years resided in the tropical missionary fields, and 
 who have been sent early in' life to the United States to be educated. 
 Very many such instances occur in New England, from whence most 
 of the missionaries to eastern countries have, until recently, been 
 drawn ; and whither their children are often sent, to be reared and 
 educated among relatives. Experience has fully demonstrated the 
 fact, that these children born in the tropics fall an easy prey to con- 
 sumption, or some one of the more virulent zymotic diseases, before 
 
has 
 
 If, however, the period of maturity 
 
 and desira 
 
 seems 
 
 arriving at mature yea 
 been safely reached and pas 
 ble in other regards, the mere fact of having been born in the 
 tropics need not of necessity reject. But in the general make- 
 up of the risk, it must not be overlooked, or treated as an item of no 
 importance in its relations to longevity. 
 
 Note to pages 29 and 115. 
 
 The ready return of chronic camp diarrhoea, even after a long 
 period of apparent perfect recovery, suggests great caution ; it is, 
 however, true, that the lapse of time diminishes the liability to a 
 return of the disease. 
 
 Within the past year, camp diarrhoea has in a great measure 
 disappeared ; and, in our own experience, cases applying for treat- 
 ment have proved much less obstinate than they were during and 
 immediately after the war a return to home comforts and the habits 
 of civil life proving, in the great majority of instances, sufficient to 
 bring about a perfect recovery. Indeed, we may reasonably expect 
 that, in a few years hence, this fearful scourge will only be known 
 historically. But unless the bowels have been in a healthy condition 
 for a long period certainly not less than a year the risk should 
 be declined. 
 Note to pages 32 and 88, (Consumption,) 
 
 The well-known hereditary character of consumption is always to 
 be borne in mind ; but it does not therefore follow, that every appli- 
 cant, one of whose parents died of consumption, is uninsurable. 
 The opinion seems to be gaining ground, especially in England, 
 that the proportion of non-hereditary cases of this disease, is much 
 larger than has been supposed. " That the tuberculous constitu- 
 tion" says Dr. Aitken "is transmitted from parent to child, 
 has long been a popular belief, and regarded as one of the best 
 established points in the etiology of the disease. Actual proof, how- 
 ever, has never yet been afforded of the justness of the general 
 conviction. Out of 102 phthisical patients admitted into Brompton 
 Hospital, for Consumption, 26 per cent, came of tuberculous parents, 
 "a circumstance which may be predicated of any mass of individuals 
 taken in a hospital : namely, that 26 per cent, of them are of phthis- 
 ical parents ' J On the other hand, while the general statement may 
 
i6 4 
 
 be made, that some cases of phthisis may oe traced to hereditary 
 influence, " it is undoubted that much phthisis is in each generation 
 non-hereditary." Our present limits do not permit a lengthy discus- 
 sion of this topic : but the following conclusions seem to the writer, 
 warranted by past experience. 
 
 First. Where both parents have died of consumption, the risk 
 should invariably be rejected. 
 
 Secondly. If brothers or sisters of the applicant have died of the 
 same disease, the risk is rendered less desirable. 
 
 Thirdly. A risk, otherwise desirable, need not be rejected because 
 the party's mother died of consumption ; but, if the party has not 
 already and safely passed the age at or about which the mother was 
 attacked, extreme caution should be exercised in the acceptance of 
 the risk. 
 
 The annexed table shows the ratio of deaths from consumption 
 
 to 10,000 deaths from all causes, in the several census districts of 
 the United States for the year 1 860 ; and the same as modified by 
 sex. (Compiled from the Census Report.) 
 
 DISTRICTS. 
 
 RATIO TO 
 TOTAL DEATHS. 
 
 RATIO OF SEXES. 
 
 MALE. 
 
 FEMALE. 
 
 MALE. 
 
 FEMALE, 
 
 DISTRICT I. Maine, New Hamp- 
 shire, Vermont, Massachusetts, Rhode 
 Island, Connecticut and New York 
 DISTRICT a. Michigan, Wisconsin, 
 
 1,922 
 
 J 3*3 
 1,700 
 1,182 
 
 1,004 
 871 
 402 
 
 55 
 1,258 
 
 2,419 
 1,780 
 1,901 
 1,4^7 
 
 I 39 I 
 i,*45 
 59i 
 
 583 
 
 1,136 
 
 I ,OOO 
 I.OOO 
 1,000 
 1,000 
 
 I,OOO 
 
 1,000 
 1 ,000 
 1,000 
 
 1,000 
 
 1.258 
 
 *345 
 
 i3 
 
 1,207 
 
 i,378 
 i,4* 
 i,47<- 
 i, 060 
 
 po 
 
 DISTRICT 3. New Jersey and Penn- 
 
 DISTRICT 4. Ohio, Indiana, Illinois, 
 
 DISTRICT 5. Delaware, Maryland, 
 District of Columbia, Virginia and 
 North Carolina 
 
 DISTRICT 6. Kentucky, Tennessee 
 and Missouri 
 
 DISTRICT 7. South Carolina, Geor- 
 gia, Florida and Alabama 
 
 DISTRICT 8. Mississippi, Louisiana, 
 Arkansas and Texas 
 
 DISTRICT 9. Oregon, California, 
 Dakota, New Mexico, Utah and Wash- 
 
 
,6 5 
 
 Note to page 32. 
 
 Mere Nephralgia should be diagnosticated as comparatively unim- 
 portant ; but it is probable that, in the great majority of instances, 
 nephralgia is symptomatic of the passage of a calculus and is there- 
 fore warrant for rejection, or at least a suspension of judgment. 
 Nephralgia is also, occasionally, the expression of malarial irritation 
 in which case it is no obstacle to insurance. 
 
 Note to pages 37 and ]37, (Insanity,) 
 
 Probably in no disease, liable to present itself to the Examiner, is 
 the hereditary tendency more strongly or more uniformly marked, 
 than in insanity. Out of 1,654 cases admitted into the Hartford 
 " Retreat for the Insane," 304, or about one in every five cases, were 
 of hereditary origin. Dr. Aitken gives the ratio as " varying from 
 26 to 69 per cent." It is also important to bear in mind that heredi- 
 tary insanity is prone to assume the most hopeless and incurable form 
 of this disease; namely "Melancholia:" of fifteen cases investigated 
 by the writer, all were clearly hereditary. But there is still another 
 point to which the attention of the Insurance Examiner should be 
 drawn : namely, that the suicidal propensity is more strongly marked 
 in Melancholia than in any other form of the disease. 
 
 The Diagnosis of some forms of "delusional" insanity is some- 
 times exceedingly difficult. The following rules, copied from Ait- 
 ken, as compiled by him from the admirable work of Bucknill & 
 Tuke, are practically valuable : 
 
 (i.) Learn as thoroughly as possible the antecedents and history 
 of the patient. 
 
 (2.) Estimate the value of the hereditary tendency, upon the fol- 
 lowing principles : (A.) The insanity of one parent indicates a less 
 degree of predisposition than that of a parent and an uncle ; and 
 still less than that of a parent and a grand-parent, or of two parents. 
 (B.) The insanity of a parent and a grand-parent, with an uncle or 
 an aunt in the same line, may be held to indicate even stronger pre- 
 disposition than the insanity of both parents. (C.) The insanity of 
 a parent occurring after the birth of a child, without predisposition, 
 is Gf no value in the formation of an hereditary tendency. (E}.) If 
 several brothers or sisters, older and younger than the patient, 
 
1 66 
 
 [or applicant,] have become insane, the fact tells strongly in favor of 
 predisposition, although neither parent nor grand-parent may have 
 been lunatic. (E.) The insanity of cousins cannot yet be deter- 
 mined as worth anything in favor of predisposition, except in 
 corroboration of other and weightier facts. 
 
 (3.) Ascertain if there has been any change of habits or predis- 
 position. 
 
 (4.) Exercise the greatest tact and discretion in the personal exam- 
 ination of probably insane patients. 
 
 (5.) Observe any peculiarities of residence or dress. 
 (6.) Study the appearances, demeanor, and general conduct of the 
 patient. 
 
 (7.) Notice any peculiarities of bodily condition ; [as emaciation, 
 state of the skin, bowels, pulse, tongue, etc.] 
 
 (8.) Observe any peculiarities of gesture, or of countenance. 
 As a general rule, when, upon close examination, insanity appears 
 to be clearly hereditary and especially if the parent whose sex 
 agrees with that of the party under examination became insane before 
 his or her birth, the risk had better be declined, even though it may 
 be in other respects desirable. 
 
 Note to page 40. (Palpitation,) 
 
 The following list includes the chief causes of palpitation of the 
 heart, except when dependent upon organic disease of the organ 
 itself: (i.) Diseases or derangements of remote organs, as the 
 stomach or liver. (2.) The use of narcotics or stimulants, as alcohol, 
 opium, or tobacco. (3.) Gouty, rheumatic or malarial irritation. 
 (4,) Masturbation, or excessive sexual indulgence. (5.) Excessive or 
 prolonged mental labor. (6,) Hysteria, disordered menstruation. 
 (7.) Anaemia or leucocythaemia. 
 
 In the latter case it will probably be associated with cardiac, as 
 well as arterial and venous murmurs ; the former best heard over the 
 base of the heart, and the latter along the course of the carotids. 
 Whenever these are present, the risk must be declined : First, be- 
 cause the anaemia is of itself sufficient cause for rejection ; and, Sec- 
 ondly, because it is impossible to distinguish with absolute certainty 
 between the sounds caused by the watery condition of the blood, and 
 
i6 7 
 
 those caused by actual organic disea? i. Palpitation is also occasionally 
 associated with, and dependent upon spinal irritation, "especially if 
 there is tenderness of the upper half of the spine." When easily 
 excited, or long continued, it is very liable to result in organic 
 disease of the heart and is certainly indicative of some source of 
 trouble, which it should be the business of the Examiner to ferret 
 out and explain, before recommending the risk. 
 
 Note to page 46, (Spitting of Blood,) 
 
 While the expectoration of blood is, with great propriety, gener- 
 ally looked upon as an insuperable obstacle to insurance, it is, of 
 course, possible that a person, who is exceedingly desirable as an 
 insurance risk, may have sometime spat blood from the mouth ; for 
 example, the bloody expectoration of acute bronchitis, or of pneu- 
 monia, by no means precludes the idea of subsequent vigorous health, 
 and therefore of insurability and justice to the applicant demands 
 that the cause be carefully sought out. But whenever a doubt exists, 
 that fact alone should determine the rejection of the risk else would 
 the examiner impair rather than increase the safety of the company 
 employing him. 
 
 In insurance applications, the term " spitting of blood " is of 
 course used arbitrarily, else would almost every applicant who 
 answers this question negatively perjure himself. It is intended to 
 ascertain whether any expectoration of blood from the lungs or 
 bronchial tubes, or from any source indicative of organic disease has 
 ever occurred ; and it is sometimes necessary to explain to the applicant 
 its scope and meaniug. Every man who has had a tooth extracted 
 must have discharged blood from the mouth, and many other causes 
 equally trivial might give rise to the same thing ; but while this would, 
 of course, be literally and undeniably " spitting of blood," it would 
 not come within the limits of the technical meaning of this phrase 
 as employed in insurance applications or medical text works. It 
 would be better if the term, on account of its loose and unmeaning 
 phraseology, and on account of its being so frequently and easily mis- 
 understood, could be dropped entirely, and another of greater 
 accuracy substituted for it 
 
i68 
 
 The following table is intended to show the more common and 
 dangerous sources of bloody expectoration, together with their 
 prominent symptoms and insurance significance : 
 
 OURCJt. 
 
 DIAGNOSIS. 
 
 CAUSE AND SIGNIFICANCE 
 
 NOSE. 
 
 Blood generally issues from 
 the nostrils ; sometimes flows 
 backwards, and is coughed up, 
 but if the patient is made to 
 lean forward, the blood flows 
 from the nostrils, which estab- 
 lishes the diagnosis. The blood 
 can generally be seen trickling 
 down the pharynx 5 and is not 
 usually florid. 
 
 Causes are almost always easi- 
 ly made out, and are of little 
 importance to the Insurance 
 Examiner. 
 
 MOUTH. 
 
 The soft, spongy, swollen 
 state of the gums, with blood 
 slowly oozing from them, and 
 the readiness with which they 
 bJted upon being touched, at 
 once indicates the source. 
 
 Generally indicates an im- 
 poverished condition of the 
 blood, as in Scorbutus ; and 
 calls for great caution. 
 
 BRONCHIAL 
 TUBES. 
 
 Expectoration consists of mu- 
 cus or muco-pus, streaked with 
 blood, not intimately and uni- 
 formly mixed ; quantity of blood 
 generally quite small ; large, 
 course rales are easily heard. 
 
 Acute or chronic bronchitis j 
 foreign bodies, or ulceration are 
 the common causes. Either of 
 these reject or suspend until 
 complete recovery takes place. 
 
 LUNGS. 
 
 Coincident with other signs 
 and symptoms of phthisis ; 
 blood in considerable quantity ; 
 florid ; generally " frothy," or 
 containing small air bubbles, 
 and intimately mixed with mu- 
 co-pus ; not coagulated. 
 
 Almost always indicative of 
 tubercular deposit, and is of 
 course an unqualified warrant 
 for rejection. 
 
 STOMACH. 
 
 Sense of weight and uneasi- 
 ness in the epigastric region ; or 
 perhaps decided nausea ; the 
 matter vomited consists of dark 
 grumous blood, altered by the 
 action of gastric juice, unless 
 caused by the opening of an ar- 
 tery, by ulceration ; discharges 
 of altered blood from the bow- 
 els } tenderness of epigastrium. 
 
 Caused by injuries as a 
 blow or kick ; by inflammation 
 or "active hyperaemia"; by 
 ulceration; by cancer; by irri- 
 tant poisons; by an altered 
 state of the blood itself; or it 
 may be vicarious, as of menstru- 
 ation. All but the last must ot 
 course reject, and that even 
 requires careful investigation. 
 
169 
 
 Note to page 48 and 123, (Urine,) 
 
 In all cases where symptoms of obscure origin and doubtful signifi- 
 cance are present, the urine should be carefully tested by the most 
 approved methods, and, if possible, examined microscopically. Not 
 every Medical Examiner, however, will be so fortunate as to possess a 
 microscope; but no one need be without a supply of test-tubes and 
 reagents, or the skill and knowledge requisite for their use. It is true, 
 however, that, in practice, cases will rarely come before the Exam- 
 iner in which an examination will either be proper or necessary, and 
 it should never be done when it can safely be avoided ; nor should 
 the Examiner ever permit himself to subject the applicant to the 
 trouble and annoyance of furnishing him with a specimen of his 
 urine, merely for the purpose of acquiring experience for himself, or 
 of impressing the company employing him with exalted ideas of his 
 scientific ability. Yet cases may and do sometimes arise, when im- 
 portant interests are at stake, and when it becomes the duty of the 
 Examiner to at least make a chemical examination of the urine ; in 
 all such cases, the matter should be fully explained to the applicant, 
 that he may understand its necessity and reasonableness. The fol- 
 lowing table, compiled chiefly from Da Costa and Golding Bird, 
 shows the morbid elements most likely to present themselves to 
 the Insurance Examiner, together with the best means for their 
 detection 
 
 MORBID ELEMENT 
 
 PHYSICAL CHARACTERS. 
 
 TESTS AND REACTIONS. 
 
 ALBUMEN. 
 
 BLOOD. 
 
 Sp. gr. varies from % l,oio to 
 1.025 5 color light ; a precipi- 
 tate of a light color generally 
 falls after a few hours. 
 
 Color red, smoky or dingy j 
 deposits, on standing, a brown- 
 ish or coffee ground sediment 5 
 if in large quantity, minute 
 coagula may be seen at the 
 bottom of the test glass. 
 
 Heat throws down a more 
 or less abundant whitish pre- 
 cipitate, which is insoluble in 
 acid ; Nitric acid also precipi- 
 tates the albumen, and heat 
 fails to re-dissolve it. 
 
 The microscope at once re- 
 veals the presence of blood 
 globules : Sulph. acid changes 
 the urine to a brown or reddish 
 brown color, showing the pres- 
 ence of haematin. 
 
170 
 
 MORBID ELEMENT 
 
 PHYSICAL CHARACTERS. 
 
 TESTS AND FACTIONS. 
 
 SUGAR. 
 
 Color light ; sp. gr. high ; 
 very peculiar odor j rarely de- 
 posits sediments ; contains large 
 excess of water. 
 
 Fill a test tube about one 
 third full of urine ; add a few 
 drops of solution of sulphate 
 of copper, or just sufficient to 
 color the urine a light tinge of 
 blue j add liquor potassae in 
 large excess; the mixture now 
 assumes a deep blue color if 
 sugar be present, and upon be- 
 ing heated, it changes first to a 
 brownish color, then yellow, 
 and finally a reddish brown 
 precipitate of sub-oxide of cop- 
 per falls to the bottom, which 
 establishes the presence of 
 sugar. 
 
 PUS. 
 
 When the urine contains pus, 
 it deposits an opaque, creamy 
 sediment, or a gelatinous mass, is 
 generally alkaline and always 
 slightly albuminous. 
 
 Upon microscopic examina- 
 tion, pus cells are readily dis- 
 covered ; a drop of acetic acid 
 should be added to the speci- 
 men under examination for the 
 purpose of developing the nu- 
 clei. The chemical test for 
 pus is liquor potassae, which 
 forms therewith a gelatinous 
 precipitate of a light straw 
 color. 
 
 BILE. 
 
 Color very dark j sp. gr. not 
 materially changed ; generally 
 coincident with other symp- 
 toms of hepatic derangement. 
 
 Pour a small quantity of 
 urine on a white plate, or other 
 porcelain surface ; a drop of 
 nitric acid is then added $ 
 play of color shortly takes place 
 commencing with green an 
 blue, passing to violet and red, 
 and often finally to yellow and 
 brown. 
 
 MUCUS. 
 
 Color light ; a more or less 
 abundant flocculent deposit 
 takes place ; putrefactive 
 changes com nence very early, 
 the urine apidly becoming 
 ammo liacal. 
 
 Upon the addition of acetic 
 acid, the fluid part of the 
 mucus coagulates into a thin 
 semi-opaque, corrugated mem- 
 brane, which at once estab- 
 lishes the difference between 
 mucus and pus. 
 
flotetopage 76, (Pulse,) 
 
 The rapidity of the heart's action is considerably modified b) the 
 position of the body ; possibly to a greater extent than is comm >nly 
 supposed. This subject has been carefully studied by Dr. Guy, and 
 with the following results : In 100 healthy males, averaging 27 yearj 
 of age, in a state of rest, and of freedom from excitement, the aver- 
 age frequency of the pulse was, when standing, 79 ; when sitting, 70 ; 
 and when lying, 67 beats per minute; or a difference of 9 beats 
 between sitting and standing. In 50 healthy females, of the same 
 mean age, and under the same circumstances in other regards, the 
 average pulse when standing, was 89 ; when sitting, 81 ; and when 
 lying, 80 beats per minute ; or a difference of 8 beats between stand- 
 ing and sitting. 
 
 In my own examinations, I have generally found a difference of 
 from 4 to 8 beats per minute, between the standing and sitting posi- 
 tions ; and a difference of less than 6 beats is the rare exception. 
 Yet the difference is very frequently stated, in the reports of Exam- 
 iners, as being no more than one or two beats which is, at best, 
 but a very unskillful " guess," and of no value whatever to the com- 
 pany. The pulse should be counted zfull half minute, by the watch, 
 in both positions, and the result should be carefully noted down at 
 the time. 
 
 But to the Insurance Examiner, the pulse is, in general, little more 
 than an indication of the condition of the nervous system at the time 
 of the examination. The mere fact that they arc being examined is 
 sufficient, with many people, to cause a marked acceleration of the 
 heart's action, or even to produce violent palpitation. It is often the 
 case that the applicant has walked rapidly from his place of business 
 to the office of the Examiner, in which case he is almost certain to 
 present an unusually rapid pulse. Many an excellent risk has been 
 needlessly rejected, on account of an unusual rapidity of pulse, which 
 probably subsided before the applicant reached his own home. And 
 this is an act of injustice to both company and applicant. In all cases 
 in which the pulse is merely rapid, without symptoms of cardiac or 
 other organic disease, the party should be allowed to sit until the 
 heart shall have had time to resume its normal action ; or if this fail* 
 
172 
 
 ?f accomplish rg the object he shouk be re-examined on a subse- 
 quent occasion, after having learned by experience, that an examin- 
 ation for life insurance is not the fearful ordeal his imagination may 
 have pictured it. I have frequently found it necessary, in my own 
 experience, to make seveial examinations, and have even found some 
 applicants so exceedingly " nervous " that I have been obliged to 
 resort to the strategy of amusing them for awhile, by cheerful con- 
 versation or otherwise, before getting at the real character of the 
 heart's action, and have thcrcb) received some most desirable risks 
 which must otherwise have been rejected; and this is precisely the 
 experience & many Medical Examiners. In fact, the pulse is very 
 like an unreliable witness : it must be sharply " cross-examined," 
 before full credence is given to its testimony. 
 
 Note to page 127. ( Locomotor Ataxy, ) 
 
 It is by no means impossible that cases of Locomotor Ataxy, in its 
 incipient stage, may present themselves to the Medical Examiner, 
 and its early detection is both very important and very difficult. The 
 symptom first complained of is generally pain, or rather pains. The 
 patient generally supposes himself to be troubled with rheumatism 
 or neuralgia ; and careful inquiry will often develop the fact that he 
 has been repeatedly " doctored " for one or the other or both of these 
 diseases. But the anomalous character of these pains ought always 
 to arouse the suspicions of the alert Examiner; the party describes 
 them as "boring," or "stabbing," or "cutting,*' or "shooting" 
 pains, and ofttimes seems vainly to rack his brain in search of a word 
 of sufficient force and intensity to express his meaning ; they are 
 generally aggravated by sudden changes of temperature especially 
 by cold, damp weather; they seldom last longer than from a lew 
 seconds to a minute, but are liable to recur at very brief intervals 
 sometimes as often as "ten, fifteen or twenty times an hour;" they 
 re limited to no particular part of the body, though rather more 
 likely to affect the lower extremities than otherwise. "Often a first 
 sign is reeling about upon getting out of bed in the dark." At this 
 stage, even, while the party admits no deterioration of his general 
 health, careful observation will often detect defective co-ordination: 
 if he is made to walk with his eyes closed, the gait will become 
 
173 
 
 unsteady and staggering. Nocturnal incontinence ot mine, and noc- 
 turnal emissions of semen are also premonitory symptoms of loco- 
 motor ataxy ; though these are less constant than the peculiar pains 
 and uncertainty of locomotion above alluded to. But when these 
 symptoms are present, the risk should be unhesitatingly declined, 
 and the existence of any one of them suggests great caution, and 
 probably a suspension of judgment. 
 
 Note to page 129, (Vertigo.) 
 
 Some companies inquire as to previous attacks of vertigo (dizzi- 
 ness). This is a mere symptom, and its true character is usually 
 misapprehended. It is safe to say that it is ordinarily but an evidence 
 of dyspeptic derangement. It is not a precursory symptom of apo- 
 plexy, paralysis, or organic diseases of the nervous centre of any sort. 
 (FLINT.) It is not an evidence of disease of the heart even. It is 
 sometimes evidence of " nervous asthenia," but under such circum- 
 stances concurrent symptoms will readily determine the true char- 
 acter of the case. So also it may occur from sexual excesses, or the 
 inordinate use of tobacco cessation from the use of narcotics or 
 stimulants, etc. Taken alone, its previous occurrence can scarcely 
 be considered of sufficient importance to materially impair the risk. 
 
 Note to page 134. ( Softening of the Brain.) 
 
 It is unfortunately the case that we have no symptom or group of 
 symptoms which are pathognomonic of softening of the brain in its 
 early stages -the only time at which it is at all liable to come before 
 the Examiner ; and this fact gives an additional importance to the 
 disease, in its relation to life insurance. 
 
 In the first place, softening of the brain occurs most frequently in 
 those persons whose health has been for some time more or less 
 impaired without any assignable cause being apparent; the symptoms 
 complained of are vague and unmeaning, being indicative of general 
 debility or diminished vital power, rather than of any organic dis- 
 ease ; in another class of cases, some " distinct chronic and exhaust- 
 ing disease may be present" but such cases will rarely or never 
 come before the Insurance Examiner, the evidences of disease being 
 sufficiently marked to attract the attention of the .solicitor. The 
 following remarks are intended to apply only to those cases which 
 
174 
 
 re " developed slowly and insidiously," and which are not preceded 
 by inflammation, hemorrhage, or acute ramollissement ; in fact to cases 
 of "chronic idiopathic ramollissement," and to these, even, only in 
 their earliest stages. In the great majority of instances, the symp- 
 tom first attracting attention, is a "torpor and prostration of intellect." 
 The patient himself is generally aware that his powers of mind are 
 gradually becoming weaker and weaker ; he finds himself unable to 
 attend to his business or at least to do so costs him a constant and 
 painful effort ; tasks which have seemed to him but trifles heretofore, 
 now assume immense proportions ; and he especially laments his 
 inability to undertake and successfully prosecute any task requiring 
 sustained mental effort. Sometimes a sudden inability to prosecute 
 some employment requiring unusual perfection of motor power first 
 excites the patient's alarm ; for example, a flutist of celebrity, fifteen 
 months prior to the manifestation of any marked symptoms of cerebral 
 disease, became suddenly unable to " finger " and blow his instru- 
 ment with his accustomed skill, and this turned out to be a typical 
 case of softening of the brain. "Softening of the cerebral hemis- 
 pheres," says Andral, "induces alteration in motion much more con- 
 stantly than in intelligence ;" but this rule is certainly not without 
 its sxceptions ; for it is by no means unfrequently the case that mem- 
 ory, or the power of retaining mental impressions and recalling them 
 at will, is one of the early indeed the earliest symptoms of cere- 
 bral softening. Occasionally the patient notices a slight impairment 
 of the power of controlling the muscles of the lips and tongue, or 
 perhaps of the cheeks and lips, or of the tongue alone ; he is sur- 
 prised to find that he cannot eject his saliva with certainty and 
 accuracy, or that he cannot fix his lips as in the act of whistling; his 
 tongue becomes slightly tremulous, and when protruded turns slightly 
 to one side. Another very important symptom, sometimes observed, 
 is an unaccountable inability to write as well as usual ; the patient 
 cannot form letters, or guide his pen with accuracy ; he complains 
 that "his hand trembles," and calls the attention of his friends to the 
 fact, and to his inability to account for it ; words are sometimes spelt 
 wrong, or one word substituted for another, or the patient some- 
 times writes and dispatches to distant friends, letters which are but 
 
ihe merest muddle of nonsense and yet, at this very time, he may 
 converse rationally and coherently, and even attend to plain, simple 
 matters of business. Among the prodromic symptoms of softening, 
 may also be mentioned headache, "usually dull in character," numb- 
 ness, obscure pain, weight or indescribable sensation of "something 
 wrong," in the extremities, a stooping gait, and tendency to cramp in 
 the limbs. When an applicant admits the presence of these symp- 
 toms or of any one of them ; and especially when to this is super 
 added a general appearance of debility, let the risk be unqualifiedly 
 rejected. 
 Note to page 144, ( Female applicants, ) 
 
 Extreme longevity is but rarely reached by women ; yet the average 
 duration of life among women is longer than among men, probably 
 because they are less exposed to causes of mortality and this even, 
 with the perils incident to maternity added to other causes. In fact 
 other things being equal, the woman who is happily a wife ana 
 mother is far preferable, as an insurance risk, to the unfortunate 
 spinster, upon whom age and decrepitude are only too certain to 
 creep prematurely. 
 
 The following tables are self-explaining, and therefore require 
 no comment: 
 
 TABLE SHOWING THE COMPARATIVE MORTALITY OF FIRST 
 
 AND SUBSEQUENT LABORS. 
 
 Authority. 
 
 No. of 
 Primi- 
 pircB. 
 
 No. of 
 Deaths. 
 
 Or one in 
 every 
 
 No. of 
 Multi- 
 pirce. 
 
 No. of 
 Deaths. 
 
 Or one 
 in every 
 
 Hardy & McClintock 
 Matthews Duncan. . . 
 Johnson & Sinclair.. 
 
 2,125 
 3-722 
 
 4.535 
 
 35 
 50 
 83 
 
 60 
 74 
 54 
 
 4-510 
 12,671 
 
 9.213 
 
 30 
 103 
 80 
 
 150 
 123 
 5 
 
 Totals 
 
 10 382 
 
 168 
 
 62 
 
 
 
 
 
 
 
 
 ^ U o94 
 
 213 
 
 124 
 
I 7 6 
 
 SHOWING THE MORTALITY FROM PUERPERAL FEVER IN DIP- 
 FERENT PREGNANCIES. (MATTHEWS DUNCAN.) 
 
 No. of Pregnancy. 
 
 No. of 
 Mothers. 
 
 No. of 
 Deaths. 
 
 Percentage 
 of Deaths. 
 
 Or on in 
 
 
 a.aci 
 
 07 
 
 4. -70 
 
 2-1 
 
 
 4- Oil 
 
 8< 
 
 2. 1 1 
 
 47 
 
 Fifth to Ninth 
 
 i,<6* 
 
 47 
 
 7 OI 
 
 ^7 
 
 *_ 
 
 189 
 
 9 
 
 3 i 
 
 4.76 
 
 11 
 
 SHOWING THE RELATIVE LONGEVITY OF MARRIED AND UN- 
 MARRIED FEMALES. 
 
 At the age of 
 
 A married female i 
 live 
 Years. Mo 
 4O. 
 
 as to 
 
 nths. 
 4 
 
 
 
 An unmarried female has 
 to live 
 Tears Months. 
 , 8 
 
 Difference. 
 
 Tears. Mo i 
 9 8 
 
 
 16..., 
 
 
 6 
 
 5 6 
 
 
 
 Is 
 
 
 3 6 
 
 
 28 
 
 II 
 
 7 
 
 2 6 
 
 A 
 
 35 
 
 2 5 
 
 *3 
 
 5 
 
 a a 
 
 From the "Insurance Guide and Hand Book." 
 
 Symptoms referable to Tobacco, 
 
 Medical examiners, especially in the United States, will meet 
 with many cases presenting symptoms of somewhat obscure origin, 
 which may without doubt, be fairly attributed to the excessive use of 
 tobacco. It is peculiarly prone to disturb the heart's action, render- 
 ing its contractions weak and uncertain, and even, in some instances, 
 producing marked irregularity of its rythm. A noticeable feature in 
 such cases, is, that the most trifling causes will sometimes bring on 
 violent attacks of palpitation ; a few minutes of rapid walking ; 
 climbing several pairs of stairs hastily ; the presence in the stomach 
 of indigestible articles of food ; any sudden mental excitement, even 
 though trivial in its nature, and a variety of equally simple and 
 unimportant causes, are often sufficient to provoke severe attacks of 
 palpitation, which may also prove quite obstinate, "According to 
 the experiments of Sir Benj. Brodie, tobacco causes paralysis of the 
 heart, through the medium of the nerves " and this conclusion gives 
 additional importance to the facts above detailed in their relation to 
 insurance. Mr. Lizars gives an account of an excessive smoker who 
 was subject to terribly severe attacks of mgina pectoris ; after an 
 
unusually severe and prolonged attack, which came near proving ratal, 
 he abandoned smoking altogether, and the disease disappeared without 
 any treatment. Severe dyspepsia is a very frequent result of using 
 tobacco, and is in general very obstinate when dependent upon thii 
 cause ; obstinate constipation is another of its evil results ; from these 
 two evils result emaciation and general debility, laying the foundation 
 for various nervous diseases. A disorder very much resembling 
 delirium tremens was several times witnessed by the late Dr. Chap- 
 man, and by him attributed to this potent agent ; the patients recov- 
 ered on abandoning their pipes. In the reports of nearly ever) 
 Insane Asylum in the United States, may be found several cases of 
 insanity charged to the account of tobacco. In the form of snuff 
 it sometimes becomes poisonous, on account of being contaminated 
 with lead during the process of manufacture thus producing lead 
 colic or lead palsy. It would be easy to extend this list of symptoms 
 to very much greater length, but sufficient has already been said to 
 indicate its more general and prominent effects. 
 
 Does the use of tobacco tend, materially, to shorten life ? Candid, 
 unprejudiced observations on this point are very much needed. As 
 yet we have no data upon which to found an opinion much less 
 to base a statement of facts. Several American " Counterblasts " have 
 been launched against this persecuted weed ; each as valueless ana 
 impotent as that of the Royal fop of England ; the clergy, the press 
 and the medical profession, have severally waged war against tobacco, 
 and yet it remains and will remain the delight of millions. 
 
 There can be no doubt that an excessive use of tobacco espec- 
 ially by a person of feeble constitution does tend, materially, to 
 shorten life. Moreover, a person whose blood is already poisoned 
 by nicotine, is thereby rendered less capable of surviving severe 
 attacks of acute diseases, and this is a proper matter for the examiner 
 to consider. Severe and obstinate dyspepsia, angina pectoris, or oft- 
 recurring palpitation especially if they exist in persons excessively 
 addicted to the use of tobacco demand rejection. For, even if it 
 cannot be clearly shown that tobacco is the underlying cause, its use 
 most assuredly adds one more element of danger in the ca<e, and one 
 much more likely to remain permanently, than to be removed by a 
 resolute effort on the part of the applicant. 
 
INDEX. 
 
 Artists ..* 1 6 
 
 Artisans 16 
 
 Age 18, 73 
 
 Acclimation 25 
 
 Army Employment 28 
 
 Asthma 29, 83 
 
 Apoplexy 29, 131 
 
 Ancestors Longevity 56 
 
 Answers of Applicant 64 
 
 Appearance, General 69 
 
 Aspect of Countenance 70 
 
 Age, Apparent 73 
 
 Aphonia 83 
 
 Aneurism of Heart 101 
 
 Aneurisms 1 08 
 
 Angina Pectoris 101 
 
 Adhesions, Heart I o I 
 
 Atrophy, Heart 101 
 
 Aortic Obstruction 105 
 
 Aortic Regurgitation 105 
 
 Abdominal Organs 109 
 
 Atrophy of Liver 112 
 
 Atrophy of Mucous Membrane 116 
 
 Albuminuria ..119 
 
 Addison's Disease 123 
 
 Atrophy of Brain 133 
 
 Asthenia, Nervous 136 
 
 Abscesses... 
 
 143 
 
 Amputations 54, 146 
 
 B 
 
 Bronchitis 31 
 
 Bones, Size of. gi 
 
 Bilious Temperament 74 
 
 Blood Murmurs 107 
 
 Blood Vessels, Disease of. 108 
 
 flright's Disease n<j 
 
 Brain, Disease of. 130 
 
 Brain Chron. Poisoning 136 
 
 Blanks, Filling up of. 150 
 
 Climate ........ t jj 
 
 Consumption 32 
 
 Cholic 32 
 
 Cardiac Diseases 33 
 
 Chorea 37 
 
 Catarrh 42 
 
 Cough, Habitual 53 
 
 Chest Measurement 67 
 
 Complexion 71 
 
 Color of Hair and Eyes 71 
 
 Congestion of Lungs.. 84 
 
 Cyanosis 102 
 
 Congestion, Liver Ill 
 
 Cirrhosis of Liver 1 12 
 
 Calculus 122 
 
 Cystitis, Chronic 122 
 
 Cerebro-Nervous System 124 
 
 Convulsions 126 
 
 Co-ordination, Defective 127 
 
 Coup de Soliel 135 
 
 Cutaneous Affections 143 
 
 Climacteric, Female 145 
 
 Constitution 147 
 
 Cachexia 149 
 
 Certificates, Duplicates 151 
 
 Diseases, Previous 29 
 
 Dropsy 33 
 
 Diptheria 34 
 
 Dyspepsia 51 
 
 Dysentery 52 
 
 Diarrnoea 52, 114 
 
 Disease within Seven Year* 55 
 
 Dyspnoea 85 
 
 Deposits, Pulmonary.. ~ 85 
 
 Deposits, Signs of Pulmonarj 86-88 
 
 Degenerations, Heart....... ...,.loa 
 
 Dilatation, Heart 1O> 
 
 179 
 
i8o 
 
 FNDEX. 
 
 Page. 
 
 Degenerations, Liver 112 
 
 Digestion, Importance of. 116 
 
 Diabetes 122 
 
 Duchenne's Disease 126 
 
 Deposits, Brain 133 
 
 Delirium Tremens 22, 137 
 
 Diathesis 148 
 
 Employment, Previous..... 29 
 
 Eyes 72 
 
 Emphysema 89 
 
 Empyaemia 91 
 
 Epilepsy 36, 126 
 
 Encephalitis 130 
 
 Fistula 34 
 
 Fits 36, 126 
 
 Friend, Reference to 62 
 
 Furunculi 143 
 
 Female Applicants 144 
 
 G 
 
 Gout 37 
 
 Gonorrhoea 49 
 
 Growths, Intracranial 133 
 
 H 
 
 Heart Disease 33, 93, 101 
 
 Hernia..... 43, 144 
 
 Haemoptysis 46 
 
 Haematemesis 47 
 
 Hereditary Disease 18, 59, 138 
 
 Height 66 
 
 Hair 
 
 71 
 
 Hydrothorax 91 
 
 Heart Signs of Disease : 
 
 Location 94 
 
 Bulging or Depression 94 
 
 Impulse 94 
 
 Area of Dullness 95 
 
 Pulsation 96 
 
 Sounds 98 
 
 Location of Sounds 100 
 
 Non-organic Disease of. 106 
 
 Hypertrophy, Heart 102 
 
 Hepatitis, Chronic 113 
 
 Haemorrhoids 116 
 
 Hysteria 36, 126 
 
 Hypertrophy of Brain 133 
 
 Hip Disease 144 
 
 I 
 
 Intemperance 22, 136 
 
 Insanity 37, 130, 137 
 
 Injury, Traumatic 34 
 
 Insurance, Previous 63 
 
 Identity of Applicant 65 
 
 Idiosyncrasy 76 
 
 Inspection ... 80 
 
 Intestinal Tube 114 
 
 Intellection, Derangement 130 
 
 Jaundice. 
 Joints 
 
 J 
 
 39 
 144 
 
 K 
 
 Kidneys, Disease of. 118 
 
 " Enlargement of. 118 
 
 Life Expectation 19 
 
 Liver, Disease of. 38, ill 
 
 Longevity of Ancestors 56 
 
 M 
 
 Mechanics 1 6 
 
 Marriage 20 
 
 Muscles, Contour of, etc 72 
 
 Mensuration 78 
 
 Movements, Respiratory 80 
 
 Malformations, Heart 103 
 
 Myocarditis 103 
 
 Mitral Regurgitation, 105 
 
 " Obstruction 105 
 
 Motion, Derangement of. 125 
 
 Menstrual Functions 145 
 
 Metritis, etc 146 
 
 N 
 
 Name 15 
 
 Nervous Temperament 74 
 
 Neuralgia, Intercostal 92 
 
 Nutrition 117 
 
 Nephritis, Chronic 118 
 
 Nephralgia Il8 
 
 Nervous Asthenia 136 
 
 Occupation 15 
 
 Opium Eating 23 
 
 Professional Men 16 
 
 Paralysis 40, 128, 142 
 
 Palpitation 40 
 
 Parents, Living or Dead, etc 58 
 
 Physician, Family 61 
 
 Phlegmatic Temperament 74 
 
 Pulse J^ 
 
 Pneumothorax 91 
 
 Pleurodynia 9' 
 
INDEX. 
 
 181 
 
 Page. 
 
 Pericarditis 103 
 
 Pancreas "3 
 
 Prostate, Enlarged 122 
 
 Poisoning of Brain 136 
 
 Pregnancy and Parturition 144 
 
 Phlegmasis Dolens 146 
 
 Quinsy. 
 
 40 
 
 Residence 15 
 
 Residence, Foreign 25 
 
 Rheumatism 41, 51 
 
 Rupture 43 
 
 Rejection, Previous 63 
 
 Respiratory Organs 78 
 
 Respiratory Organs, Diseases of. 82 
 
 Rigidity of Muscles 1*8 
 
 Ramollissement, Brain 134 
 
 Ramollissement, Spinal Cord 142 
 
 Risk, General Character 14? 
 
 Sobriety ^l 
 
 Scarlatina 45 
 
 Spitting of Blood 46 
 
 Syphilis.- 49 
 
 Stricture.; 49. * i2 
 
 71 
 
 Pigt 
 
 Sanguine Temperament 73 
 
 Stomach 1 1 1 
 
 Spleen 114 
 
 Sensation, Derang. of. 129 
 
 Spasms 126 
 
 Softening of Brain 134 
 
 Softening of Spinal Cord* 142 
 
 Sunstroke 135 
 
 Spinal Diseases ...141 
 
 Senses Special, Loss 144 
 
 Temperance 21 
 
 Temperament 73, 147 
 
 Tumors, Intrathoracic... 92 
 
 Tremor 125 
 
 Tumors... 1A4 
 
 . **t*f 
 
 u 
 
 Urinary Organs, Disease of. 47 
 
 Ulcers 143 
 
 Vaccination.... 24 
 
 Valvular Changes, Heart- 104 
 
 Varicose Veins... 1 43 
 
 w 
 
 Weight.. 
 
 INDEX TO APPENDIX. 
 
 Page. 
 
 Acclimation 162 
 
 Alcohol, Effects of. 162 
 
 Applicants, Female 175 
 
 orain, Softening of. 173 
 
 Blood, Spitting of. 167 
 
 Consumption ...163 
 
 Clergyman's Sore Throat 154 
 
 Colored Races, Mortality of .....160, 161 
 
 Diarrhoea, Camp 163 
 
 Females, Longevity of 176 
 
 Insanity M 165 
 
 Intemperance 161 
 
 Inebriates, Safety of. 162 
 
 Locomotor Ataxy ......172 
 
 Labor, Mortality from... 175 
 
 Page. 
 
 Mortality, Tables of. 157, 158 
 
 Mortality, from various Diseases.-... 156 
 
 Nephralgia ... 165 
 
 Occupation, Effects of. .151 
 
 Public Speakers, Safety of. 154 
 
 Professional Men 154 
 
 Physicians 154 
 
 Puerperal Fever, Mortality from 176 
 
 Palpitation 166 
 
 Pulse 171 
 
 Sexes, Mortality of. 159 
 
 Teachers 154 
 
 Tobacco, Effects of..i 176 
 
 Urine, Examination of. 169 
 
 Vertigo ... ..173 
 
UNIVERSITY OF CALIFORNIA LIBRARY 
 BERKELEY 
 
 Return to desk from which borrowed. 
 This book is DUE on the last date stamped below. 
 
 LD 21-95m-ll,'50(2877sl6)476 
 
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