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( 7i6 j 372-4503

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MANUAL

-OF —

Life Idsui^anse Eiaminations

JAMES THORBURN, M.D. Edin.,

Corsulting Surgeon Toronto General Hospital ; Professor of Materia

Medica and Therapeutics, Toronto School of Medicine ; Medical

Dirco'or North American Life Assurance Company,

&c., &c., &c

TORONTO:

Ellis & Moore, Prxters,

J 887

jmmm

■PWH"ilWiWtMWIW«»**

^- » 4M nl Parliament of Canada, in the year 1887, by

B'/g^A

LIFE INSURANCE EXAMINATIONS.

/TM. . 1.1>_.l»><Bn A/invn

;«« fA anPiAtr frnm Tiife Insurance are manifold,

ERRATA.

Pages 7 and 9. — " thoraisc " should be " thoracic ".
Page 13. — " metasticis" should read " metastacis ".

" 14. — " straumous " should read " strumous ".

" 17. — " gonnorhaloeal " should read " gonorrhceal ".

" 17. — ' albumenuria " should read "albuminuria".

•• 19. — Third line, erase " and " and substitute " or ".

" 26.— Under Tests, etc., paragraph (1) If "net " al-
bumen, read " If not, i Ibumen."

" 20.— Sp. gr. should be 1010 to 1025.

one of the most important duties undertaken by a physician.

H^b professional attainments are not sufficient in themselves to
qualify a physician to act as an examiner; he must posse3s sound
j'udgmentand the faculty of weighing each and every departure from
Ihat is termed health, and, above all, he must be a 'nan of sine
Integrity and honor; he must not be influenced by favor, fear, or

*^Many°medical men can diagnose ai.d prognose disease with a degree
of certainty, but when called upon to express an opmion as to the
^Expectation of life " of an applicant for insurance, they are at a loss
to decide, not having made the subject a special study.

The following pages are intended to call the attention of medical
examiners for life insurance to those principles which experience ha.

'•f* ' 'if*'

II iiT'Minmr'tinr—mmi

^..

i i

LIFE INSURANCE EXAMINATIONS.

The blessings accruing to society from Life Insurance are mamfold,
and much is due to the medical profession in removing it from the
realm of mere conjecture to that of exact science.

The success of every Life Insurance Institution depends directly
upon the duration of life amongst its insurants proving, at least
equal to that assumed in the calculation of premiums. Nothing
is more uncertain than the duration of any individual life but
there are few things less subject to fluctuation than the average dura^
tion of human life, when the observations are extended to a large
number of individuals. Without medical selection. ^^^ average
among insured persons would doubtless fall below that of the whole
population, as a large proportion of diseased persons wou d
enter • but with a selection excluding not only those who are actually
diseased, but, as well, those constitutionally or otherwise Pre-disposed
to disease, the ordinary average is usually exceeded. It is obvious
that without reliable medical selection, the most careful oalcu lations
upon the most conservative assumptions must prove disappomting in
practice; hence the examination of applicants for life insurance is
one of the most important duties undertaken by a physician.

High professional attainments are not sufficient m themselves to
qualify a physician to act as an examiner; he must possess sound
j'udgmentand the faculty of weighing each and every departure from
what is termed health, and, above all, he must be a man of str.c
Integrity and honor; he must not be influenced by favor, fear, or

^^ManT'medical men can diagnose and prognose disease with a degree
of certainty, but when called upon to express »^ °P»«^°" ^« ^,'^^;^
.. expectation of life " of an applicant for insurance, hey are at a loss
to decide, not having made the subject a special study.

The following pages are intended to call the attention of medical
examiners for life insurance to those principles which experience hai

Lll'K INSl'KANCK.

1 ?

♦?*.,

}■

showu. lead to correct concluBioni in determining whetlier individual
lives will probably survive their life expectation.

APPOINTMENTS.

It is premised that the appointment of Medical Examiner should
be made from the head office of the company. The importance of this
principle is evident,-the Examiner should be free and mdependent of
local influences, and only responsible to the medical department. This
is emphasized by the importance of the function he performs, and the
confidence in his opinion, which is implied by the company assuming
heavy financial obligations upon his recommendation.

THB APPLICATION.

To define perfect health is impossible. We must take an average
and get as near it as we can. The purpose of the examination is to
determine the condition of the applicant's personal health, and whether
or not he is constitutionally or otherwise pre-disposed to disease. To
this end, when he presents himself for examination, the Medical Ex-
aminer should read over carefully the several answers to the questions
put by the agent, take note of any peculiarities of personal or family
history of any general or indefinite statements regarding deaths
therein contained, such as " general debility," " cold," " ruptured
bloodvessel," "slow fever," " child birth," "change of life," etc.
These terms are found from experience to be very generally associated
with'PhthisiB in some of its various forms ; they are not, however,
necessarUy connected with it ; hence the importance of analyzing the
answers, and thus be.ng able to give not only positive, but negative
evidence as to hereditary pre-disposition. For instance, in the case of
the answer " child birth," ascertain if the woman was in good health
previous to pregnancy, and during that condition, and also up to con-
finement. Did she have a difficult labour ? How long did she live after,
and was there any fever, etc ?

Having become satisfied as to the correctness of the answers, given
m the application, proceed to a consideration of the questions proposed
by the Medical Examiner in the company's form.

THE EXAMINEBS REPORT.

Name.— Satisfy yourself that you are examinmg the person named
in the appUcation which is before you. The importance of this has
been frequently tested— impersonation has been successfully accom-
plished, and Insurance Companies thereby defrauded. A careful
examination will detect this fraud. If you have any doubi, compare

! t

•fnasMM

idividual

Br should
loe of this
lendent of
ent. This
B, and the
assuming

Ein average
lation is to
id whether
isease. To
ledioal Ex*
le questions
il or family
[ing deaths
** ruptured
: life," etc.
y associated
Dt, however,
lalyzing the
)ut negative
n the case of
good health
io up to con-
he live after,

swers, given
ona proposed

erson named
le of this has
isfully accom-
l. A careful
)iibt, compare

hxamiNations. »

the signature of the person whom you are examining with the signa-
ture of the applicant for insurance, which will be found on the mside
of the application form.

RKsiDENCE.-Whether healthy or otherwise. A damp atmosphere
with variable temperature is conducive to consumption, rheumatism,
.U. Residence in malarious districts may give rise to fevers which
may prove injurious to the constitution.

As a rule the inhabitants of the country are better risks than those
residing in towns or cities. A temperate climate is conducive to
longevity. We must not, however, be too dogmatic as to the influence
of cUmate, as man can and does acclimatize himself readily.

Occupation.— That occupation has an important bearing on the
duration of human life there can be no question. Is that of the ap-
plicant healthy or injurious, and what probable effect may it have
upon himself? As a rule, those persons whose business necessitates
their being out of doors (unless attended by special dangers) are better
risks than those who are compelled to reside indoors.

This law is influenced much by circumstances ; those living habit-
ually in an impure atmosphere are much more liable to disease than
those who, although following sedentary occupations, have healthy

surroundings. ,

Applicants have been divided into the following classes, for insur-
ance purposes, after their occupations, viz :

FIRST CLASS.

(a) Professional men, as Teachers in the country. Clergymen, Lawyers
and Physicians. .

(h) Certain classes of Mechanics and Artisans, as House Painters,
Blacksmiths and Carpenters.

(d) Dentists, Druggists and Apothecaries.

{e) House Decorators, Agricultural Labourers and Gardeners.
(/) Clerks, as Bank Clerks and Insurance Clerks, &c.
(g) Pressmen, Printers and Compositors.

SECOND CLASS.

(a) Certain of those employed by Railway Companies, as Baggage
Masters.Conductorson Passenger Trains and Railroad Detectives.

nil- iNsi'RANn

; I

1
I

' 1

,M Certain A.ti,au-a„aMech.«ic,,.. J.oiW Maker., HoU Mat<«.

(d) Men UaadliDR borses, a« Team.terH, Stage I'tivere

(.) Smother., a, Prison OHice Keeper, and Shooting Gallery
Keepers.

TBIRI) ('T.AS8.

1 «i «r, RnatH as CaptainB of Lake and Uiver
(a) Certain men employea on Boats, as oapi-»

,, C" rn^:::t;f SMe^r: -^ cur. Bria.
Builders and Steel Polishers.

FOUBTH CLASS (EXTRA HAZARDOUS).

(„) Those employed in the Liquor Trade. Bartenders. Saloon Keepers
and Brewers and DiBtiUerB ^^.^ ^^^.^^^

(/,) Certain employees on Kailroads, as uraKem

Engineers and Switchmen. Mob.ra

(.) CerLn Artisans, as Sawyers and Powder Makers.
V) Brakemen on Freight Trains and Seamen.

V t ■« n,A first and second classes are insurable on ordinary
^rS th a^^^ th b^^^^^^^^^^ -»i^°' »» an extra rate an..
'C' : te trth are insurable only on tbe abort endowment „la„.

A„, For convenience sake we m.y accept the ol.l division, viz
ago ofl^wthTd -Welopment, age of matority and n.anbood,
and the period of decay or old age.

Each of these divisions is liable to special dieeasos.
(„) Tbe rate of mortality in the first period i. ranch greater than in
tbe subsequent period.
With tbe early part of this period we have hltle to do.
The aee of puberty, which comes on in this country, m the
fem^Kfrm the IStb'to tbe 15th year. -^. ^f" 7'«; '^
helUtothe lOth year, is sometimes ""e-""* «'«' *^; j',
vlpmont of hereditary diseases, consequent upon the. mporten
Ibanges which are taking place in the orgamsm of the body at

olt Maker*

and Stable

ng Gallery

;e and Kiver
bers, Bridge

loon KeeperB
Mail Trains,

e on ordinary
Ktra rate, and
iwment plan.

divisioup, viz ,
tnd manhood,

jreater than in

;e to do.
jountry, in the
the male, from
d with the de-
a the important
of the body at

EXAMINATIONS. '

Between puberty and manhood the various organs rapidly
develop themHolveH, and individuals are liable to iutlammatory
and rheumatic affections, typhoid fever, Ac.
(M In the second stage, or that of manhood, which may be stated
to bp from twenty-live to fortylive years of age, the various or
gans of the body have become fully developed, and durmg this
term man is better able to stand the fatiKues and exposures
of life than at any other time ; and therefore the best risks for
insurance are to be found within these years, as a general rule.
(c) The third stage, or that of decay During this time the physi-
cal powers show deterioration. Phthisis may develop itself, but
it is not BO liable to do so as in the first period. DiseasoB of the
nervouB and sanguineous systems are more common. Cerebral
diseases, such as apoplexy, paralysis, .tc, caucor, especially m
the female, often develop themselves.

RACE.-The mixture of races, in many instances, impairs the vigor
of the body The offspring of the Indian and white, as well as that
of the negro and white, are particularly proue to tubercular disease,
and, as a consequence, their expectation of life is not equal to the
average : hence the importance of reporting the raco to which the
applicant belongs.

Figure -The outlines of the body will often assist us in determin-
ing the expectation of a life. An erect figure, with due proportion-
ate measurements, is generally indicative of health; the oppos. e
condition often indicates some weakness, especially in the thoraisc
viscera.

Eye5 -The color of the eyes is not of so much importance as is
generally supposed, but their appearance often gives us a key to the
knowledge ofthe health of the person examined. A dull. listless eye,
especially in the young, points to a sluggish constitution. A red or
yellow conjunctiva is frequently caused by intemperance. The pres-
Lee of arcus senilis in the second period of life is indicative of, and
is frequently associated with fatty degeneration of the internal organs,
espellly tho heart, kidneys and liver. This condition, if in young
per ns. 3detriment.l to longevity. A puffy condition of the eye-
Uds poiit to disease of the kidney ; a yellow, or stained confunctiva,
to the liver. These conditions, as well as any organic changes
in the eye, should be reported.

I.l

LIFE INSURANCE

I |-

c;«TM In health the skin is Boft and pliable, and free from any

rL which to place in those who hab.taally use mtrate of sU
ver, should excite the interest of the medical eMminer.

Bones -In persons of a tubercular diathesis, the ends of the bones
iiONKs. in ^»""' Pornons with small bones are

ore L-enerally dispropcitionaUy large. 1 ersons W" ™
not as a rule, capable of enduring groat exposures or fatigue. Ascer
tain ii the bones give any evidence of rickets or nodes.

Dcro«MrnEs *k» Phvs.c.. DK.Ec>s.-Defects of the organs of
special sense should bo in.aired into such as deatnoss, » blmtoj •
and the cause of such conditions should be ascertamod. If deafness,
nrr HAnt IS it the result of disease, etc. ?

Tetemiti s, Ih as curvature of the spine (lateral or augular). are
objectionable ; exceptionable cases may be insurable.
Has the person ever had any of the following ailments :

^«»ri«-Aneurism may exist without the Pf '»»'« '^^'^f.fj
it may be of the heart, the aorta, or any part of the arterial sydem

?: aneurism may be so large, especially it of the '■'O'J ™-^' -
io cause bulging of the parietes before its peculiar ^"^ ^ " «
effects are developed ; a careful physical examination would reveal

this condition. . .

Thepresencs of an aneurism invahdates the risK.

Apo,,le.y-A person who has ever had true apoplexy, no matter
how remotely, is ineligible for life insurance.

4,ltow-Asthma embraces a variety of symptoms rather than of
disease and must be valued according to the cause which produces
H Those cases of asthma arising froK. idiosyncrasy such as rose or
hay asthma, or that are dependent upon local atmospheric cond. lom
trinot a sufficient cause to disquaUfy the applicant from some forms
meurance; but the asthma which arises from oigamo les^n
Ihrfrom cardiac obstruction, tuberculosis, emphysema, bronchitis,

le from any
peculiarity of
dition of the
ation, or im-
ince. Any
I, as the pig-
coloration of
Qitrate of sil-

of the bones
tail bones are

Lgue.

Asoer-

the organs of

or blindness,

If deafness,

f ftugalar), are

ts :

t's knowledge ;
.rterial system,
rajic variety, as
md distressing
would reveal

lexy, no matter

B rather than of
which produces

such as rose or
leric conditions,
rom some forms

oiganio lesion,
3ema, bronchitis,

EXAMINATIONS.

thorasic tumours, hepatic disease or disease of the nerve centres, is
sufficient cause for the rejection of the applicant.

ry ^ f .«/ mnd ^c^iM— Thls oonditiou is a symptom rather

Bad, or frequent H^ad- Aches ims oiroumstanoes or

than a disease. It may arise from a variety °J^ ° j ^^.

causes; when from functional ^-turbance or the ^^^^ ^,.

laria,itmay notbea bartoinsu^a^^^^^^

Kftnio lesion, pattionlMly of the nerves, u ib» b j

La neoessitetes » most o«efal '-'^^^\Jll^^lZe»
severity oi the symptom ha. » important bearmg on the examm

'tXeople suffer ^omhead-ach. -- ^»-:— ^r^
do not seem to be in impaired health ; snch P^T^' f J^^'^it „.
heing sa«ao.ory, m^ be «oeptjbU ns.s ; agam, ^-"'>». t.,

BiU^ Co!,«-BmoasooUc when of ^^n-"-^^^-^^-^^^^^^
tended by painfaUymptoms, lessens very ^fj""? ™';;;„ *^th„^t
A single attaek, with an intervening period of ^^J^k^oi the
other unfavorable symptoms, would not dimmish the eligibflity
applicant for insurance.

Bro«KUU -The presence of bronohitU is -'"J^l^fZZ^^^^
especially iCi. a chronio form. '^^^^^^^'^^^ X paren-
are usually complicated '"'^ ^""J. "Jt,,, to^eUtis is associated
ehyma of the lung, or cardiac *'»'»'» 'J^ 7 "i,„„ia unhesitatingly
with any of the three foregoing conditions, you snouia u

further examination.

for his re ection. whether it be ot ttie acqu ^^^

:^:;i:r7er;fmrr;^rs. rroperation. is very

common. i. „;«.u ;« tViA female than in the

Caroinoma is more frequently met with m the lemaie m

Je-rd especiaUy ^^^f ^'^^ ^Ittme persistent
.cfjirr (rt:XtT.l more frequently in the mal.

I I

if;

i:;.

LIFE INSURANCE

Ca<arr».-Thi8 q«eflUon, in inauranoe papers, refers espeowUy to
the oonaition of the nasal passages, and points to disease of a
cteorform, which is usually indicative of constitnfonal vice

A neat deal will depend on the locality and extent of the catarrh ;
if the dtp seated structures be involved, especially the bones, the ap-
plicant must be rejected.

Co«,«./io..-This disease, of all others, is the most common
cause of death among the general as well as -™7» ^XT".
Ind requires the most careful and searching exammation on the part
;?th physician, so as lo enable the Medical Director of the Com-
pany to a«ive at a proper decision as to the value of the nsk.

The Examiner must enquire if there are any predisposing causes
eitl« of a hereditary or acquired nature, which are likely to mfluence
the expectation of the life of the applicant.

In life insurance, the claims result largely from Phlhisis, and it .8
here that medical selection teUs more according to the manner m
which it is conducted, than in any other disease.

The deaths from consumption, compared with the general mor-
tally aretcreasing in the'earlier periods of life. Thi-s P';'';^^^^
due to the fact that more regard is being paid to sanitation, and to
the improvement in the social condition of the people.

lia pel on in the slightest degree predisposed, any debilitating in-
fluence,'either mental or physical, may light up the latent disease.

A morning cough with hoarseness, a sense of weakness without
any ^2.1. assignable cause, loss of weight -tl";^2M
pulse and especially if there has been hamoptysis, even of the shght
Ltd^^ee; are strongly indicative of Phthisis, although the physical

signs of the disease may not be well developed.

The general appearance of an applicant is sometimes deceptvve,
.nd persons in seeming good health are on the verge of 4j"«»- ^ «"1
the rule is, that an experienced Physician, who exercises his observa
«on wiUbe able to detect the phthisical diathesis, even it physical
examination give negative results.

DeliriuM Tremn^U the applicant has ever had »" Jre-^
mens, the risk is much imperUled ; its morbid impress is left on too
system, and the danger of ito recurrence is considerable, Md «y
Ih applicant should not be received until after the lapse of a long
period of time, and other strong evidences of a moral reform.

EXAMINATIONS.

especially to
iisease of a
1 vice.

ihe catarrh ;
)ne3, the ap-

ost ootnmon
) population,
a on the part
of the Com-
5 risk.

osing causes,
J to influence

lisis, and it is
he manner in

general mor-
is is probably
itation, and to

•

aebilitating in-
tent disease,
kkness without
th a frequent
n of the slight-
;h the physical

mes deceptive,
I disease ; still
es his observa-
ven if physical

Delirium Tre-
ss is left on the
irable, and any

lapse of a long
reform.

Dta6e<««.— The pathology of this disease is still undecided, but the
symptoms of it are well known.

A person having symptoms of this disease is ineligible for life in-

Burance. . . i. j *«

The presence of a slight trace of sugar in the urme may be due to
temporary functional causes ; a re-exammation would be necessary m
such cases.

mphtheria.-'Y^hi^ disease is frequently foUowed by impaired nerve
power and nutntion. It may also lay the foundation for tubercular
deposit in the lungs, or may give rise to nephrites, or more or less per-
manent paralysis.

Dmm.«.-DiEziness is not a disease in itself , but is indicative of
cerebral trouble ; it may be functional or organic m its origm.

If persistent or recurrent, it is of grave importance, especially m
those past the middle period of life.

Drop»y.-Drop8y is the result of disease rather than a disease

' 'ihe Examiner should direct his attention to the heart, kidneys and
liver, and ascertain their condition.

If the applicant has had dropsy, it may have only been temporary,
such as the dropsy resulting from malaria, scarlatina, or other
zymotic diseases ; in such cases if complete recovery has been made
the applicant may be received. The same may be said of the
anasarca, which accompanies anaemia.

Dropsy arising from organic lesion precludes the person from the
benefits of life insurance.

Eruption or Skin Disease.-The Physician must distinguish between
those eruptions which arise from specific diseCse or other constitu-
tional cause, and those which are purely local in origm and innocuous
in their nature. The former may vitiate the risk, while the latter
may not.

Erysipelas,-ThiB is oftentimes a grave disease, and in some in-
Mduals will recur from very slight causes, either of a traumatic
or idiopathic character. If from the latter the value of the life is
much impaired.

Fw/uiof.-Fistulse occur in different parts of the body, and from

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LIFE INSURANCB

recovered, the risk may be accepted.

mu JThis is a general term including a ^eat variety of conditions,
Bncb as apoplectic, epileptic and hysterical fits.

When arising from apoplexy, reject.

wnen arisi ^ ^ aV,nrf«n life but in consequence of the

toe riek i. k««»°;"- j^^^ „„^, ,„.„.bie to treatment.

Sometime. «P'1«.P^°^*» "^^' ^^^ ^„entrio irritations, that is
B„oh as those havmg for »»«" •"«'" * jm » reflex manner

nlerine, intestinal or yesioal ■^*;'^°™' ^ j!" snch acondition
and oanseconvnWons of an «P>1«P^°»'.™";, b„ elapsed smce

""Epi'S'paroxysms frequently occur in dmnlcard, and may not
a^ftin recur in case of reformation of habits.

insurable.

G^eralDeWUy.-^^^^ term is applied to a «--^|^--^^^^^^^^^^^
vXv ' if such a condition has been present and is entire y "coverea
body, If sucna c^^^ ;..„,.Wa hnt of oourge much will depend on
irom, tue appiiua."" » ino-.-..-- — ? —

EXAMINATIONS.

when foreign
; in the wound,
tea are usually
if the result of
y be insured,
tally to fistula-
in origin ; the
ersons or those
I be rejected.
as the presence
ent has entirely

ty of conditions,

asequenoe of the
ase, the value of

ale to treatment,
•itations, that is
a reflex manner
' such a condition
has elapsed since
le fits arise from
ressed bone, intra-
s, emboli, etc., we

rds and may not

metimes occur in
e difficulty in dis-
ioal fit } the latter
able to treatment ;
Such cases are

ral weakness of the
i entirely recovered
uoh will depend on

the cause of the debility, and the decision will be in accordance
with it.

Gout.— This disease is often hereditary, and is more common in the
older countries of Europe than in America. ,.^ ^ x •.

Although painful, the danger attending it is chiefly due to its
liability to metasticis and to the degenerative condition of the heart
and blood vessels which is usually found in the bon-vivant.

Applicants who suffer from gout are not first-class risks.

Gravel— Thia term is applied to the passage of calculi along the
nreters accompanied by paroxysms of pain.

A person who has experienced one attack is liable to recurrences
at periods more or less remoto, and although the suffering is usually
extreme, it very rarely, if ever, proves fatal, per se, the danger bemg
from the serious diseases to which it may give rise, viz., destructive
inflammation of the kidney, vesical calculus, etc.

ITabitual Cough.-The history of habitual cough is strongly indicative
of disease of the respiratory tract, and the examiner should exercise
his utmost care in ascertaining the cause.

Such cases are generally uninsurable.

Inflammation of the Lungs or Pnmmonia.-ThiB question is suggested
in consequence of the serious morbid changes which are apt to be
developed by this disease, viz, : Chronic consolidation of lung sub-
stance, the development of tubercle and the formation of adhesions,
etc., which may seriously interfere with the due oxygenation of the
blood, and with the proper performance of respiration.

If any serious consequences arising from this disease are mamfest,
the applicant should not be received.

Insanity —If the person examined has ever been insane, the physi-
sician will ascertain if the disease has been hereditary ; the form and
kind of insanity ; the age of the individual at the time of the attack ;
the duration, and whether the person has had more than one attack ;
the nature of the real or supposed exciting cause, and whether the
person at present exhibits symptoms of the disease.

We must not confound mere eccentricity of manner or character
or imbecility of mind with true insanity.

Chronic insanity of itself does not necessarily shorten hfe. A per-
son who has suffered from the acute form is apt to have a recurrence

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LIFE INSURANCE

of it, and in oonseqnence of his inability to control his actions he is
very liable to injury, accidental or self-inflicted.

Insanity may arise from causes which are quite amenable to
treatment, such as malaria, the delirium which accompanies
acute fever, and the abuse of alcoholic liquors, etc. Some forms of
puerpural mania may also be included in this division.

Liver Complaint, — The liver is the alleged father of many dis-
eases, and is the seat of cirrhosis, amyloid disease, fatty degen-
eration, cancer and tubercular disease, all of which render the
applicant unfit for life insurance.

If, however, the disease has only caused a temporary derangement of
the organ, such as catarrh of the bile ducts or the effect of malarial
influenpe, which have yielded to treatment, the applicant may not be
rejected.

Lumps or SwelUnga, — This question is intended to direct attention
especially to the swellings which result from scrofulous disease of the
lymphatic glands, and to nodes, such as the syphilitic.

Swellings of the lymphatic glands generally point to a strau-
mous diathesis, which is at all events closely allied to tubercle, and
the medical examiner should in these cases look carefully to the con-
dition of the lungs.

The mere presence of a cicatrix in the region usually aflfeoted by
scrofulous inflammation of the lymphatic glands does not necessarily
result from struma, as these glands frequently inflame and suppurate
in diphtheria, scarlatina, etc.

The presence of nodes should induce the examiner to look for a

previous history of syphUis.

Neuralgia.— NevLt&]gia, is the purest type of pain, and is generally
functional in its origin, that is unattended by inflammation or struc-
tural change.

It may occur in any part of the body, but especially in those parts
most abundantly supplied with nerves of sensation.

It may be caused by mechanical pressure on a nerve trunk either
at its origin or in its course, as from the pressure of tumours, etc. ; it
is also a common symptom in malaria and lead poisoning. Neuralgia
in itself iloes not shorten life; the repeated recurrence or peraisteut
presence of it, however, should excite the examiner's suspicion of some

liis actions he is

lite amenable to

ch aocompanies

Some forms of

er of many dis-
use, fatty degen-
hich render the

y derangement of
effect of malarial
Leant may not be

> direct attention
}as disease of the

)int to a strau-

to tubercle, and

efully to the con-

ually affected by
>s not necessarily
ae and suppurate

nerto look for a

and is generally
Qmation or struo-

lly in those parts

lerve trunk either
tumours, etc. ; it
>ning. Neuralgia
nee or persistent
suspicion of some

EXAMINATIONS.

morbid influence affecting the constitution, such as the individual's
surroundings or personal condition.

The observant physician will readily distinguish the pain of neu-
ralgia from that arising from inflammation or other causes.

Unless the neuralgia be obdurate and accompanied by constitu-
tional vice the applicant may not be rejected.

Open Sores. — Open sores point to diseased action, such as cancer,
ulcers of various kinds, sinuses, fissures, fistulae, etc., and the
physician should ascertain their cause and nature, and whether they
are curable or not.

If an open sore be due to cancer or syphilis, reject.

Palpitation of the Heart or any form of Heart Disease. — Palpitation is
a symptom, not a disease, and is of little practical value in itself ex-
cept in calling the attention of the physician to the condition of the
heart.

Perhaps there is no organ of the body which requires a more care-
ful study than the heart ; the skill of the physician is tested to dis-
tinguish between functional disturbance and organic disease.

Dr. Walsh observes that aortic regurgitation is the most common
cause of sudden death. He remarks it may take place during the act
of walking, eating or speaking while the person's emotions are ex-
cited and, per contra, at a moment when he is perfectly calm ; and
a very singular proposition is that the more pure and uncomplicated
the regurgitation, the freer the heart from any other disease, the more
likely is the individual to be cut off without a moment's warning ;
further, that there is no direct connection between the amount of
danger of disease at an orifice of the heart and the intensity of the
existing murmur.

The very weakness of a murmur may indeed be a fatal sign.

According to Dr. Begbie, of Edinburgh, the deaths from heart
disease comprise five per cent, of the deaths in adult life.

The most common cause of heart disease in this country is rheuma-
tism.

Paralysis. — Paralysis of either motion or sensation, or of both, calls
for a most careful enquiry whether it be paraplegic, hemiplegic or
local.

We must always endeavor to ascertain the cause in every instance.

If concurrent with disease of the circulatory system and lesion of

it ; 1

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LIFE INSURANCE

nerve centres, the applioant must be rejected ; also in caso the con-
dition be due to diseased nutrition, degenerative changes, tumours
or traumatic lesion of nerve centres.

Some forms of paralysis are curable, and may be entirely recovered
from, especially those of a local character, as the paralysis resulting
from the division of a nsrve, from pressure of a tumour, the presence
of a foreign substance, as of a buUot or piece of cloth, and that form
of paralysis of one side of the face caused by cold.

If a considerable interval of time has elapsed since the person was
afifected, and if he has now fully recovered, he may bo received.

There may also be a paralysis which is usually temporary, as
sequelae to such zymotic diseases as typhoid fever, diphtheria, &o., or it
may arise from reflex action as in teething children ; the latter case,
however, would not come under the cognizance of the examiner for
life insurance.

Piles. — Piles are often associated with liver disease in consequence
of the communication between the veins of the rectum and the portal
circulation. They are also caused by a debilitated condition of the
system ; they are painful, and sometimes give rise to a hemorrhage
which may endanger life.

In those cases where the piles are associated with disease of the
liver, or if there has been much hemorrhage, we would reject the
applicant.

Piles may arise from constipation, &c., or in females from the
presence of a gravid uterus.

These cases may sometimes be received, but in every case ascertain
if possible the cause, and decide accordingly.

PUurUy. — If followed by extensive adhesions, so as to interfere
with the respiratory act, or if fluid be present in the pleural cavity
as well as adhesions at the apex, which are usually associated with
chronic inflammation and tubercle, reject.

The physician must satisfy himself by a careful physical examina-
tion and by analyzing the statements of persons supposed to have
had this disease, as it is often confounded with intercostal neuralgia
or pleuro-dynia on account of the common symptom of a stitch-like
pain.

Pleurodynia would not invalidate the risk.

Rheumatism. — Bheumatism in its various forms, viz. : Inflam-

EXAMINATIONS.

so in caso the con-
ohanges, tumours

I entirely recovered
paralysis resulting
uuiir, the presence
}th, and that form

ace the person was
ly bo received,
ally temporary, as
liphtheria, &o.,or it
n ; the latter case,
f the examiner for

ase in consequence
tum and the portal
id condition of the
) to a hemorrhage

vith disease of the
e would reject the

1 females from the

)very case ascertain

so as to interfere

the pleural cavity

bUy associated with

l1 physical examina
B supposed to have
itercostal neuralgia
»om of a stitch-like

rms. viz. : Inflam-

matory, hereditary, syphilitic, gonnorhoeal and alcoholic, is a most
serious disease, not only from the danger attending its actual pre-
sence, but from the sequel® which may arise from it.

The rheumatic poison has a strong tendency to aflfeot fibrous
tissues wherever found, as in the valves of the heart, the pericardium,
the dura mater and the fibrous structure of joints, etc.

These structures, although often escaping at the time of the attack,
may be involved in serious lesion as a consequence of the rheumatism,
even after a long period has elapsed since the last attack ; heart
disease sometimes is developed in this way.

The attention of the physician must be especially dureoted to the
condition of the heart in those persons who have ever had rheuma-
tism.

If there is any disease of the heart the applicant must be rejected.
Not only is there danger' from heart failure consequent on
disease of the organ, but also from embolism, a sequence of
diseased valves.

Other objections to applicants who have suffered from rheumatism
are that one attack predisposes to a recurrence, and from the degen-
erative changes which ensue in the blood vessels apoplexy is not an
uncommon sequence of rheumatism.

We must not confound the pain in muscles (myalgia) which occurs
in different parts of the body with the condition above described ;
such pains are very common, and in fact there are few persons who
do not experience them in some form or other now and again.

Scarlatina.— ThiB is a disease of youth rather than adult life and is
of importance to the examiner for life assurance because it is frequent-
ly followed by serious lesion which may terminate fatally after the
lapse of a long period of time.

OtorrhcBa of a chronic nature often results from an attack of soar-
latma and is liable to develop at any time into an acute inflammation,
which, spreading to the structures of the middle ear and mastoid cells,
may cause death from inflammation of the brain and its membranes.

T. idneys are frequently involved in disease after scarlatina and
hence we may have uraemia, albumenuria and dropsy as a result ;
hence the necessity of enquirmg carefully mto the condition of these
organs ia persons who have had scarlet fever ; if any of the foregoing
conditions aire present at the tune of examination they disqualif;^

fViA AnniinAiif. for insurance.

LIFE INSURANCE

If a person has had scarlatina and fully recovered from it, the risk
is improved thereby.

^cro>ia.— Persons of a scrofulous diathesis are less liable to stand
the attack of disease than healthy people, and they are frequently
carried off by tubercle of glandular structures, and hence are not good

risks.

The fact of former scrofulous disease of the glands of the neck does
not render such persons uninsurable as clinical observation shows
that those who have been thus affected in early life are not more
liable than others to be carried off by tuberculous disease of the lungs
in after life.

Shortnets of Breath.— la often indicative of thoracic disease or func-
tional disturbance, and requires the careful attention of the physician
to ascertain its cause ; it is sometimes due to mental emotion or
physical exertion.

The gravity and permanence of the excito-motor cause must bo

sought for and weighed accordingly.

Small-Pox.— The discovery of vaccination by the immortal Jeuner
towards the close of the eighteenth century has divested this disease
of much of the importance which it had in the two previous centuries,
when it ranked first among the acute affections destructive of human
life. Whole communities and tribes have been extinguished by it and
many people are still carried off by this preventible disease. The
ignorant prejudice and obstinacy of man is well illustrated by the
refusal of many to avail themselves of the antidote, vaccination.

The proofs of its efficacy are overwhelming. It appears from the
report of the Begistrar General of Eugland (1871), that of 100,000
persons who have been vaccinated, one hundred may expect in any
year to have the disease, and ten of these to die.

Of persons not vaccinated it is calculated that in 100,000 six hun-
dred will be infected in the same time and 270 die, the probability
being 26 to 1 in favor of those vaccinated. In persons having one or
more clear marks the mortality was but 4 in the 100 of those attacked.
With bad or indifferent marks the mortality was 25 m 100, and in
patients without marks (presumably not vaccinated) the deaths were
48 in 100 of those attacked.

person not vacuiiiuiuw sf^uifiM yc 5v uciujto y^*"© ivvv^^^y^% »» ?^
yiek,

' jm^t :j'.i.' 2iS\<iS^££

-«i_-«i„

from it, the risk

IS liable to stand
y are frequently
nee are not good

of the neck does
)servation shows
fe are not more
lease of the lungs

c disease or func-

of the physician

intal emotion or

ir cause must bo

immortal Jeuner
rested this disease
revious centuries,
bructive of human
aguished by it and
ble disease. The

illustrated by the

vaccination.

appears from the
I, that of 100,000
tnay expect in any

L 100,000 six hun-
ie, the probability
ions having one or
I of those attacked.
25 in 100, and in
) the deaths were

3Pted as f\j

EXAMINATIONS. 19

^"-2S ... ,. . ^ r^

Some Insurance Companies insert a clause m their policies whereby
the policy becomes null and void provided the insured dies from
small-pox not having previously been vaccinated and not having had
the disease.

Spinal Disease.— ^hen there is evidence of organic disease of the
spine the applicant must be rejected, but the examiner must take
great care to distinguish functional disturbance from organic disease ;
the former is common in females and antemic individuals.

The early symptoms of locomotor ataxia should be carefully looked
for as they are sometimes very insidious ; if there is any want of
proper co-ordination accompanying vague so-called rheumatic pains,
the case should be rejected.

Spitting of Blood.— IhiB is an important question and requures care
and time on the part of the medical examiner to diagnose the cause.

In a great majority of cases it comes from the lungs and is a pre-
cursor or associate of tuberculosis, either in its latent or active form ;
or it may arise from mitral regurgitation : in either case reject.

If it comes from diseased bone of the nose or malignant disease of
the stomach, reject.

If it can be thoroughly established that it has come from the nose,
throat or gums, or in females from vicarious cause, or even in some
cases of ulcer of the stomach, the application may be accepted.

Often cicatrized ulcers have been found in the stomach of those who
have died of some other affection and the presence of the ulcer was
only revealed by post mortem. Moreover, persons suffering from
purpura haemorhagica and typhoid fever often lose large quantities of
blood by the mouth, nose, rectum, &c., and make good recoveries;
this should not be a bar to insurance itself.

In a case where there has been hemorrhage from the lungs and seven
to ten years have elapsed without any return, the appHcant being now
perfectly healthy, he may not be disqualified for insurance, especially
for a short term endowment.

Sunstroke.— SxmBtroke is not uncommon in hot climates and in hot
seasons; Sometimes little or no effects follow it and the patient
makes a complete recovery, but such a result is not always to be met
with. The brain power may be diminished and organic disease
occur ; perhaps epilepsy or paralysis may ensue, therefore ascertain
how long a time has elapsed since it occurred and whether or not the

LIFE INSURANCE

I'l

i^-

.ppUcant is offering «»? "> «««>*» '«»» ""> ™"""'"' """ **"*° .
accordingly.

Sypm..-Bir Wm. J»ner .nd Sir J.m.. P.g.t, with many cthor
enJent rargeom, consider that this disease .s a very common cause

of death. , ,, , i

When it iB present in any form the deoiBion bhould be post-
A wLr we must not conclude too hastily. By some
Se^ve y B-^n^ lals is called syphiUs. This is far from
S the case; tiie true chancre is characteristic and it only is fol-
towed by constitutional symptoms. The physician must look carefjUy
fortra^es of eruptions on the skin, whether there is any emaciation
^ reLe of depraved nutrition, enlarged cervical glands, white
^at^^s or cicatrices on the mucus membrane of the moutii or tongue
or throat, nodes, induration of lymphatic glands, onychia. &c.

Such persons should not be received until aU evidences of the dis-
ease have disappeared.

Typhu. or Typhoid F^^.-Typhus fever is a very virulent disease
wila large mortality, and like other acute fevers is apt to leave
ZlL consequences which tend to weaken the constitution. For^
TiSely. however, for us it has not made its appearance m this counbry
forupwards of forty years.

Tvphoid or enteric fever. This f'iBease is common throughout
the world. Persons in the -r « M, je woulu uot come under our
Xervation in our capacity as Examiners for life assurance, but m
oorsr^uence of the probabiUty of its affecting the glandu ar or nervous
gystems of the body our attention must be directed towards their

%he recurrence of diarrhoea in a person who has had typhoid fever
would pomt to some weakness in the glandular structures of the m-

^U^'oi power or paralysis, caused by embolism, frequently follows
this disease, and if present would render the applicant mimsurable.

If tiiere is a tubercular diathesis, however slight, m a person who
has suffered from typhoid, it is not uncommon for the latent tubercle
to be developed as a result of this disease.

Varicose F«r«.-The etiology of this disease is not certain ; it may
. .. 1 i _„3 -•_ i.u^ «^«i, ;« fVinoA who live well and

those who do not, in tiie young and in the old, and although it may

EXAMINATIONS.

I, and decide

many cthor
)mmon cause

lid be poBt-
r. By some
is is far from
it only is fol-
look carefully
ly emaciation
jlands, white
uth or tongue
ia, &o.
ces of the dis-

irnlent disease
I apt to leave
ution. Fortu-
in this country

on throughout
ome under our
urance, but in
ular or nervous
towards their

d typhoid fever
itures of the in-

quently follows
I uninsurable,
a a person who
latent tubercle

certain ; it may
live well and
edthough it may

interfere with the comfort of the person it does not necessarily

shorten life. * u »

Varicose veins may appear in any part of the venous system, but

are most likely to recur in the veins of the legs.
The Examiner must bear in mind that they are liable to become

inflamed, or thrombosis may take place, or they may ulcerate or may

rupture. n u

They are common in pregnant females, but after labor usually sub-
side. Unless the varicose veins are unusually large or extending
above the knee the applicant may be insured.
Is the person subject to dyspepsia, constipation, dysentery or

diarrhoea? - . •».

Dyspepsia is very common, and per se is not of grave import ; it
generally indicates a catarrhal condition of the mucus membrane of
the stomach or a sUght disturbance of the functions of the Hver, or it
may be merely sympathetic of uterine, kidney or nervous a£fections.
Such is not always the case, however, as it is frequently a premom-
tory symptom of tuberculosis or it may indicate a maUgnant or non-
malignant organic disease of the stomach.

Whatever maybe its cause, duration or severity, it ia deserving of
the serious attention of the Examiner.

Conatipation.— The demands of nature allow a wide latitude in
reference to the evacuation of the bowels in mdividuals, and what
would be considered alarmmg in one person may be quite normal m
another: for instance, some persons are never comfortable without
one or more evacuations m the 24 hours ; others do not have them
reUeved more than once a week, and this may be natural in both
cases ; the latter is common in ansemic females or m persons who
have an atonic condition of the muscular fibres of the mtestme.

These and similar cases ere usually insurable, but when it arises
from mechanical obstruction, such as from stricture, morbid growths,
whether maUgnant or non-malignant, or if the condition be due to
certain diseases of the bram or spinal cord, reject.

Diarrhcea or the opposite condition of Constipation.-The character
more than the frequency of the discharge is important here.

Many of the causes of diarrhoea are amenable to treatment such as
that arising from improper dietary ; acute attacks are very common
at aU ages of life, and with every person. The frequent recurrence
of this disease would lead one to enquire mto the con-oiaoa o. .fts

jaEJsarawi

msBssBTsmm

LIFII INSURANCE

liver and into the habits of life of the person ; those addicted to the
use of alcohol or narcotics frequently suffer from a relaxed condition
of the bowelo.
If the disease is persistent, and especially if the person loses flesh,

the diarrhoea being attended with more or l;««^.«f d^^^^V^TlUT
unhealthy hue of the courtenance, occasional chills or slight eleva-
tions of temperature, the rase is serious and is probably due to
ulceration of the glands of the intestine. Such persons would be
ineligible for insurance.

If along with the alvine evacuations aie found blood or pus, the
applicant must be rejected, as serious organic disease is mdicated.

Dysentery in the acute stage is sufficient cause for rejection ; if
chronic, we must ascertain its cause, if possible; we will frequently
find it arising from local disease, such as piles, ulcers, or morbid
growth about the rectum, and may be curable ; such cases should be
reported and the apphce it may or may not be rejected, according to
circumstances.

If the disease is persistent, and if the party has resided in hot
climates or made free use of alcoholic drinks, we would have reason
to suspect some obstruction to the portal circulation.

As in all other cases, ascertain the cause and decide accordingly.
Describe fully the person's practice in regard to the personal use of
stimulants and narcotics.

We need hardly expect an applicant who uses stimulants to excess
to admit the fact on being questioned ; we must look for the signs of
habitual over-indulgence.

Those people who have occasional sprees at long intervals of time
are not so apt to show the injurious impress on the constitution as
those who habitually use an excessive quantity of alcoholic drmk. In
the latter cases the general appearance will be a good guide to the
Examiner, the complexion, the condition of the eye (arcus senUis, &o.,)
any tremor of the muscles of the hands, &c., may assist us in deter-
mining the habits of the applicant. Some authors have fixed a
standard whereby to judge what is an excessive quantity ot alcohol
for an adult. The effects on the constitution is what the Medical
Examiner must investigate. The use of narcotics, which is another
form of intemperance and which in some cases is even more intractable
than the abuse of alcohol is detrimental to longevity.

EXAMINATIONS.

The principal narcotics which are Ukely to be habitually used are
opium, chloral hydrate, cannibis indica, tobacco, ether and chloroform.
What has been the habit in this respect throughout life ?

If a man has reached the age of 40 without forming the habit of
over-indulgence he is unlikely to form such a habit after that age, but
we must take into consideration his occupation, surroundings, &c.

If a man be now a total abstainer, we must remember he may be a
reformed drunkard, and besides the dangers of a relapse to his former
condition we must be careful to find out if any serious morbid impress
has been left on any of the important organs, as liver, kidneys and
heart.

Is there anything disproportionate in the weight, stature or girth
measurements ?

Weight. — In considering this question, the general development of
the body, must be taken into aco:^unt as well as the peculiari-
ties of families. Excessive weight, particularly m early life, not being
hereditary, is indicative of faulty nutrition, and is often caused by in-
temperance or want of exercise.

Siature. — As a rule tall men are capable of less endurance than
those of average height, viz., 5 ft. 8 in., and are more prone to
pulmonary and cardiac diseases, and are more liable to have hernia,
varicose veins, and ulcers of the extremities. Short men are apt to
be disproportionally developed, and their physical endurance is small.

As a limit of under and over-weight the following table will aid the
examiner in forming an opinion of the safety of the risk for the Com-
pany, y wenty-five per cent, xmder-weiyht is the loss of one-fourth of
the man, and calls for the most searching investigation on the part of
the examiner. These light weight cases may be the result of chronic
dyspepsia, diarrhoea or dysentery, marasmus, scrofula, hoomorrhoids
(bleeding), hypertrophy of the heart, with excessive impulse, albumin-
urea, Brights disease, &c., &c. In addition to these, in the case of
females, some chronic uterine disease may be suspected. The excep-
tions are few in which it is safe to disregard these limits, and in every
such case of under-weight tests for Bright's disease and other obscure
organic mischief are imperatively mdicated. In this connection will
be seen the importance of bemg accurate in stating the height and
weight. Mistakes might cause the rejection by the Home Office of ^
good risk, or the acceptance of a bad oiie,

;

life insurance
Table of Hbioht, Weight and Measure.

25 per ot.

20 per ct.

Amer'oan

Standard

Average

Weight.

26 per ot.

40 per ot.

Average
Chest

Height.
\

"Indej*
Weight.

Under
Weight.

Over
Weight.

Measure-
ment.

6 ft.

115

144

161

88 in.

6 ft 1 in.

120

150

168

84 in.

5 ft. 2 in.

100

126

156

175

85i in.

5 ft. S in.

104

130

163

182

86 in.

5 ft. 4 in.

101

108

185

169

189

36iin.

5 ft. 5 in.

105

112

140

175

196

37 in.

5 ft. Gin.

107

114

143

178

200

37i in.

6 ft. 7 in.

109

116

145

181

203

38 in.

5 ft. 8 in.

111

119

148

185

208

38iin.

5 ft. 9 in.

116

124

155

194

217

39 ip.

5 ft. 10 in.

120

128

160

200

224

89i in.

6 ft. 11 in.

124

182

165

208

281

40i in.

6 ft.

127

1S6

170

212

288

41 in.

6 ft. 1 in.

131

140

175

219

245

41iin.

6 ft. 2 in.

135

144

180

225

252

42^ in.

The Respiratory System. — The importance of a thorough examination
of the respiratory organs cannot be too forcibly impressed on the
mind of the Examiner. In England, according to the latest authori-
ties one in six ol the deaths occurring in the adult population is from
diseases of the respiratory tract. Foul air is a great factor in pro-
ducing respiratpry diseases. We must ascertain by inspection, per-
cussion and auscultation, and ascertain whether the respiratory
murmurs and percussion notes are clear and distinct and of normal
character over all parts of both lungs.

In general terms, in health, the act of respiration (including inspir-
ation and expiration), should be quiet, easy and regular in the ratio
of one to four or five of the pulse, and not exceeding 20 per minute.
This may, however, be temporarily influenced by mental causes or
physical exercise.

Drawing a full breath and holding it for a few seconds should oanse
no distress or pain.

An adult should be able to count alou^ rather slowly from 20 to 80
without drawing a &esb \fXQtkth,

EXAMINATIONS.

m.
in.
in.
in.
in.
in.
in.
in.
in.
ip.
in.
in.
in.
in.
in.

In the adult the chest should expand in all directions and the
mnscles of the neck and arms (axilliary muscles) should not take
any very active or visible part in the act.

If the blood be well aerated the lips and ears and the tips of the
fingers should not have any livid or purple tint. The respiratory
murmur should be gentle like a slight breeze among the trees, not
harsh or noisy.

Prolonged expiration frequently points to lung disease.

Irregular, intermittent or jerking respiration points to derangement
of the nerve centres. If the respiratory act varies from the normal
standard in frequency, a subsequent examination should be made be-
fore reporting on the case.

Is the character of the heart's action uniform, free and steady ?

In health, the heart's action should be uniform, free and steady, its
sounds and rhythm regular and normal. On inspection the impulse of
the heart will be visible about one and a half inches within and the
same distance below the left nipple, in the fifth intercostal space ; it
should be plainly perceptible when the person is in the erect position,
but should not appear jerking or widely diffused.

The sounds of the heart should be quite clear and distinct, unat-
tended by any murmur or friction.

The rhythm of the normal heart is regular ; we must not, however,
too hastily conclude when departure does take place that it is neces-
sarily due to disease. Sometimes such a condition is due to idiosyn-
cracy or a temporary disturbance of the nerve centres ; it may also
be due to anemia. In such cases postpone decision until thoroughly
satisfied as to the cause of such departure.

The frequency of the pulse varies during the different periods of
life and also in different climates.

In the adult its rate in temperate climates is from seventy to eighty
per minute, the pulse of females being slightly more frequent.

In the North-west part of this continent the pulse rate is increased
by about 10 beats per minute, while in the West India Islands it is
reduced by about the same number. The pulse should not intermit
or become irregular when the applicant is in a passive condition.

Some people, without any evident cause and perfectly free from
disease, have an intermittent pulse ; others have an abnormally slow
one from idiosyncrasy. Note all such peculiarities. If the pulse
rate is above 88 or below 54, r^-examine on another day,

LIFE INSURANCE

Urine. — Beference to the following tahle will be found useful when
examining this fluid : —

MORBID
ELEMENT.

PHYSICAL CHARACTERS.

TESTS AND RE-ACTIONS.

Albumen.

Sp. gr. varies from
10.10 to 10.25 ; color,
Ught ; a precipitate of
a light color generally
falls after a few hours.

(1) If the urine is clear (and if
not, filter) nearly fill a test tube
and heat the upper portion ; if
it becomes turbid add two or
three drops of nitric acid ; the
precipitate dissolves if it is
phosphates, if net albumen is
present. (2) To another por-
tion of the filtered urine add
ferrocyanide of potassium and
acetic acid ; a white precipitate
in the cold indicates albumen.

Sugar.

•

Color, light ; sp. gr.
high ; very pecuUar
odor; rarely deposits se-
diment; contains large
excess of water.

To a portion of the urine (if
albumen is absent) add an equal
volume of Fehling's solution of
copper and boil; a yellow or
yellowish brown precipitate in-
dicates sugar ; if a slight precip-
itate only is produced, add more
urine, boil again and allow it
to stand for a few hours ; if
sugar is present, the solution
becomes colorless and a red
precipitate falls to the bottom
of the test tube ; if doubtful, use
fermentation test, which is con-
clusive.

Blood.

Color, red, smoky or
dingy ; deposits, on
standing, brownish or
cofifee-ground sediment ;
if in large quantity, min-
ute coagula may be seen
at bottom of test glass.

To a portion of the urine add
an equal volume of tincture of
guaiacum, followed by a few
drops of old turpentine or solu-
tion of peroxide of hydrogen ; a
blue color, if produced, indicates
blood.

EXAMINATIONS.

MORBID
ELEMENT.

Pus.

Bile.

Mucus.

PHYSICAL CHARAOTEBS.

TESTS AND RE-ACTIONS.

When urine oontains
pus it deposits an
opaque, creamy sedi-
ment, or a gelatinous
mass, is generally alka-
line, and always slightly
albuminous.

Upon microsoopio examina
tion, pus cells are readily dis-
covered ; a drop of acetic acid
should be added to the specimen
under examination for the pur-
pose of developing the nuclei.
The chemical test for pus is
liquor potasssB, which forms
Uierewith a gelatinous precipi-
tate of a light straw color.

Color very dark ; sp
gr. not materially
changed ; generally co-
incident with other
symptoms of hepatic
derangement.

Four a small quantity of
urine on a white plate or other
porcelain surface ; a drop of
nitric acid is then added ; a play
of colors shortly takes place,
commencing with green and
blue, passing to violet and red,
and often finally to yellow and
brown.

Color, light; a more
or less abundant floccu-
lent deposit takes place,
putrefactive changes
commence very early,
the urine rapidly be-
coming ammoniacal.

Upon the addition of acetic
acid, the fluid part of the mucus
coagulates into a thin semi-
opaque, corrugated membrane,
which at once establishes the
difference between mucus and
pus.

N.B. — In case of any suspicious color or deposit in the urine, use
microscope.

Nervous System.— This system of all others is most influenced by a
great variety of causes. The question suggests itself, if there is any
departure from the normal condition of the nervous system, is it due
to organic disease or temporary functional derangement ?

Digestive Organs. -The nutrition of the body depends on a healthy

^l!^

■i

LIPE INSURANCE

condition of the digestive organs, and unless digestion is properly
performed wholesome assimilation will not take place.

Genito-Urinary Organs.— Enquury should be made as to any evidence
of present or past disease of these organs.

Locomotory Organs.— The connection between the diseases of nervous
system and the locomotory system is very close, and reference has
already been made to the more promment ones.

Cutaneous System.— ItB abnormal condition often points to constitu-
tional disease, hence the importance of careful observation when
examining this system.

The Organs of Seme.— Disease of the organs of special sense is
sometimes fraught with danger, as in the case of disease of the ear ;
although not urgent at the time of examining, still may at some future
time prove fatal by an extension of the inflammatory process to the
structures of the middle ear and mastoid cells and thus light up an
inflammation of the brain and its membranes. The loss of sight,
although not in itself lessening the " expectation of life," exposes the
aflicted one to greater dangers of accident than he otherwise would
have.

Do you find any tendency past or present to cough, expectoration,
difficulty of breathing, or palpitation ? Or of predisposition, heredi-
tary or acquired, to any particular disease ?

This question is intended to direct the Examiner's attention par-
ticularly to the condition of the thoracic viscera, past or present, and
to ascertain, if possible, whether, when there has been any departure
from the healthy condition, if it has been due to hereditary or acquir-
ed causes.

Do you find that there have been any cases of consumption or other
hereditary disease among the parents, brothers or sisters of the
applicant ?

On the evidence or non-evidence of such, the fate of the applicant
fcr insurance frequently depends.

At the present day the hereditary nature of some diseases is un-
questioned, and of all the diseases wb'ch exercise an hereditary
influence, consumption is the most prominent.

The proportion of hereditary and acquired cases vary at the different
ages of life. According to Dr. Fleming those cases which occur be-

EXAMINATIONS.

fore the age of forty or forty- five are usually hereditary ; after that
period they are usually acquired oases.

The same authority states that there are fewer deaths from con-
sumption in Insurance institutions in the period of life embraced be-
tween 15 and 80 years than is experienced in the general population,
but a considerably higher proportion above this period, that is after

80 years of age.

That consumption is capable of being transmitted from parent to

offspring, we presume is admitted.

The offspring of consumptive parents may or may not be attacked
by the disease, or the seeds may lie dormant in one generation and
become developed in another ; thus we find phthisical parents bearing
apparently healthy children, or the children of such parents who seem
themselves to be healthy having phthisical offsprmg.

In such cases individual modifying circumstances must be carefully
examined and weighed.

The age, personal health, configuration, habits, residence and
occupation of the person examined, and the health and longevity of
relations generally must be considered before deciding on a case; also
ascertain if more than one relative has died of the disease and the
degree of propinquity, the age or ages at which death occurred, the
number of deaths and the ages and state of health of the members of
the family now alive.

Drs. Begbie and Ohristison state :— When two members of a family
have died of consumption the risk must be declined. This rule is
not, however, always acted upon.

The following general rules have the approval of medical experts
in reference to accepting applicants who have the history of consump-
tion in their family : —

In the following cases reject :

1. When three cases have occurred in a family.

2. When the appUcant is under twenty-one years of age and one

case has occurred.

8. When under thirty and a parent has died of the disease.

4. When under thirty-five and two members have shown the

5. V/hen under forty and both parents have died of the disease.

These are the general rules for applicants on the whole life plans
of insurance, but some of the foregoing cases may be taken on en-

iii

I V

LIFE INSURANCE

dowment plans for a suitable term of years, when the personal history
of the applicant is good.

The communicability of consumption is patent to all physicians of
any considerable experience ; how this communication occurs is still
an open question.

Among the other hereditary diseases we may mention insanity,
gout, cancer and epilepsy.

Has the applicant ever had any serious illness or injury ?

The Examiner will here enquire carefully ; bojae illnesses are £re>
qnently followed by organic lesion, such as malarial fever, typhoid or
diphtheria, &o. As to injuries :

Injury to the head or spinal cord may, after the lapse of months or
years, give rise to fatal results, hence the importance of finding out
the fact and history of any such occurrence and its probable effect on
the constitution or on any important organ. As an instance, a man
may receive injury of the brain or spinal cord, and although he
recovers from the immediate effect, it may be followed by ulterior
consequences which may terminate unfavorably.

If the applicant be a woman, state number of children, if now
when last pregnant, whether there have been any miscarriages or
difi&cult labors, are the uterine functions now regular, has she ever
suffered from uterine or menstrual disease or disorder ?

Most Companies do not insure a pregnant woman, nor a married
woman until she has had one child, unless she is over forty years of
age ; nor an unmarried woman, except on short endowments.

With the whole population the duration of life amongst females
exceeds that amongst males ; but in the experience of life insurance
companies the reverse is true. If this curious fact is to be explained
on the assumption that medical examinations of females are not
usually so thorough and disingenuous as that of males, it is a reflec-
tion upon our profession which we hope the future will remove.

There are certain conditions incident to females which render their
lives somewhat hazardous, such as menstrual functions, child-bearing,
miscarriage or dif&culty in labor, &c. A woman who has once borne
a child without any considerable difi&culty, is a much better risk than
a primipara, and married women are belter risks than those who are
single. Previous labors, if any, should be carefully enquired hato.

Is the tierson matured ?

EXAMINATIONS-

Rupture is much more common than is generally suppoaed and is
met with oftener in the male than in the fema' ., the proportion heing

5 to 1.
According to Malgaine one man in every thirteen m France is

ruptured.

The word Hernia in insurance papers refers especially to the various
forms of abdominal hernia ; the dangers attending this condition are
well known, but at the same time it is a remarkable fact that the
mortality due to hernia is only four per cent, of those so affected.
Hence, if a properly adjusted truss be worn, the risk may be received,
and in most policies a clause is inserted to the effect that the insured
must wear a suitable and well fitting truss.

Are the muscles hard and strong ? Is the gait firm and elastic ?
These questions have a bearing on the general condition and
physique of the person examined.
Is the spleen or liver enlarged ?

If the party is residing at present or has resided in a malarious dis-
trict, we may find some enlargement of the spleen or liver as a result
of the influence of malarial poison acting on these organs. If the
enlargement be chronic it is due to organic change in the structure of
the organs themselves, and would be a cause for rejection.

If the person has been a bonvivant, or used alcoholic drinks to
excess, or if he has resided in tropical climates, we may have an en-
larged liver as the result. Such cases must be postponed or rqected,
as the circumstances point out.

Does the state of the teeth, mouth and throat indicate health ?
Persons who have sound teeth masticate their food properly and
are not liable to dyspepsia.

Sound teeth are usually associated with a strong constitution, and
decayed teeth with the reverse.

Inherited syphilis may sometimes be recognized by the conforma-
tion of the teeth, particularly that of the incisors, and also by the
state of the mouth and throat ; look for any evidence of syphilis, see
if chronic pharyngitis be present or if the tonsils are enlarged. If
any evidence of ill health be found from the condition of these parts,
weigh carefully its importance.

Do you find by examination or enquiry any indications that the
applicant's habits of life are or ever have been other than co^^^ a^^
.Zr..r.^.? Make a searching investigation here. The observant

LIFE INSURANCE

Examiner can usually judge of this from the general appearance of
the applicant.

Excess of anylcind, if continued for a period of time, will lessen
the chance of longevity, but there is a great difference between indi-
viduals as to toleration of the system. Inroads upon the constitution
will be recognized if looked for, and should be weighed carefully.

Do you find any unfavorable features whatever in the applicant's
physique, family or personal history, residence {e.g., if malarious),
occupation {e.g., if involving any special exposure or danger), habits
or circumstances of life ?

This question is a summary ot the circumstances affecting the pro-
posed risk, and the answers to it should be well weighed and studied.

Physique refers to conformation or build ; any departure from the
normal standard would be of importance only when it affects the
probable duration of life.

Family and personal history. Special care must be exercised to
ascertain if there have been any cases of hereditary disease in the
immediate family or near blood relations.

Personal history refers not only to his present physical condition,
but also to his present and past habits of life, &c.

Residence, whether healthy or otherwise. If malarious, the person
is exposed to the dangers of the various forms of malarious disease,
both of an acute and chronic nature.

Who is the applicant's medical adviser ? Do you need any inform-
ation from him ?

This question may sometimes be of importance, as applicants for
insurance have denied having had any medical man attending them,
and it became subsequently known that they had undergone a serious
illness, and had been under professional treatment.

A false answer to this question might invalidate the pohcy.

Sometimes much valuable information may be obtained as to the
habits and former health of the applicant from his usual medical
adviser which might not be brought to light by the Company's Medi-
cal Examiner.

Do yon think the appUoant will reach the full expectation of life ?

By "expectation of life" for a given age, is meant simply the
probable average duration to which life, among men who have attain-
ed that a"e. will be further extended^ Thus takin" IjOOO heftltby
men who have attained the age of 85, the aggregate durt^tion of life

<
0)

EXAMINATIONS.

beyond that age for the v/hole number, will be 81.020 years, or an
average of 31.02 years for each man. . , i i

Tables of " life expectation " are a deduction, by a simple calcula-
tion, from the -mortality tables," which are made up from observations
of the rate of mortality at each separate age. Several such tables
are in use, but the one named in the Dominion Insurance Act of 1880
is the Hm Table, and is made up from the experience of 20 leading
English offices. The following is the expectation of life, for each
age! from 20 to 70. on the basis of the Hm. Mortality Table :-

Table of Life Expectation.

>
(a

42.06

41.83

40.60

39.88

89.15

88 41

37.66

36.91

36.16

85.42

84.08

33.95

33.21

o >

.2 --^

CD
O >

O (p

iga

32.48

31.75

31.02

30.29

29.56

28.84

28 12

27 40

26 68

25 96

25.23

24.51

23.70

23.08

22.38

21.68

20.99

20.81

19.63

18.95

18.28

17.62

■^6.96

16.32

15.68

15.05

-TlT^uTco^derations involved in the foregomg questions lead
„„1o this most important one. The skilful examiner having investi-
V.dtherbits the personal and family history, and the present
fhtslcaSt^ n become acquainted wih the

LnTi ions and influences which surround him in his daily he is
/r^pared to give a reliable opinion as to the probable duration of the

"'JnTntafof reasonable doubt he should give the Company the
Inan> cas application, or by recommendmg an

benefit of it by rejecung ui pf ^^^ probable

endowment policy ^fhase term suall .8 w^.i witi-
duration of the applicant's life.