THE Prudential Insurance Company OF HIWEFICM. NEWARK, N. J. INFORMATION and suggestions FOK MEDICAL KXjPLlXIIISrEK.£5. PREFACE. To render the most effectual aid to a Company its Medical Ex- aminers should be made acquainted with its methods of procedure, at least in so far as these methods relate to the proper discharge of their duties. With this end in view the information and suggestions contained in the following pages have been given. A careful perusal of this manual and an observance of the suggestions contained therein, will, we believe, enable our Examiners to more readily meet the requirements of the Company. Information of a purely professional nature has been purposely omitted. The aim has been to convey, as briefly as was consistent with the importance of the topic, information that might prove serviceable to the Examiner in the daily prosecution of his duties. Nothing has been said about how to make an examination, about the knowledge to be gained by a close scrutiny of the appli- cant, about the influence of certain occupations upon longevity, nor of the significance of certain diseases in his personal history. For information on these points the Examiner is referred to : "TheMedical Adviser in Life Assurance,'' by Sieveking. "Medical Examinations in Life Insurance,'' Allen. " The Insurance Examiner," Stillman, and works of similar character. LESLIE D. WARD, M. D., EDWARD II. HAMILL, M. D., Medical Directors. CONTENTS. THE APPLICANTS. PAGE. Actual and apparent age of ....... 10 Family history of ........ . 16 Habits of ........... 15 Occupation of ......... . 13 Personal history of 15 Postponement of ........ . 17 Rejection of 19 THE EXAMINERS. Accounts-when paid ....... 5 and 6 Assignment of territory to 3 Complaints against 4 Communications from . . . . . . . .21 Disagreements between ........ 3 Duties to Superintendent and others 7 How selected .......... 2 Number of ........... 3 Relation of-to applicant 9 Tenure of office of ......... 3 Fees for-Industrial Branch ....... 4 Fees for-Ordinary Branch ....... 6 Mailed to Home Office ........ 7 Postage on 5 Revivals-Industrial Branch 4 Revivals-Ordinary Branch ....... 6 Salient points in 21 Signatures on ......... 5 and 8 Vouchers for 5 When made 7 The Insurance Decaeogue . . . . . 23 THE MEDICAL REPORTS. TABLES. Combined Experience Mortality 24 Expectation of Life . . .... 26 Height, weight and chest expansion 25 INFORMATION AND SUGGESTIONS FOR THE MEDICAL EXAMINERS OF THE PRUDENTIAL INSURANCE COMPANY OF AMERICA. The duties of a Medical Examiner are often arduous and always responsible. The Company, influenced largely by the advice of its Examiners, annually assumes obligations to the extent of many millions of dollars. Because of the responsibility attached to the position, the appointment of a Medical Examiner is invariably made by the Home Office. The utmost caution is exercised by the Medical Department to select those who are professionally qualified for the duties incumbent upon them. In addition, the appointee must also be in good standing with his professional brethren and of upright life. To assure this selection, in all cities where three or more Examiners reside, the senior Examiner (unless otherwise ordered) Appointments made by Home Office. Qualifications. 2 Chairman. is constituted Chairman or Chief Examiner. Seniority is determined by length of time in the Company's service. Whenever requested by the Home Office, the Chairman will recommend a new Examiner for appointment. The rules to be observed by him are as follows:- ist.-Make nomination of new Medical Exami- ners only when requested by the Home Office. 2d.-Exercise care to select only those whose professional qualifications you can endorse, and whose integrity and sobriety are beyond doubt. 3d.-Send to the person selected a blank Medi- cal Examiner's application (Form 113) to be filled by him and returned to you. These appli- cation blanks will be found at each Superintend- ent's office. 4th.-Correspond with his references and se- cure answers. Printed forms (No. 355) for this purpose will be supplied by the Superintendents. Replies from at least three references are re- quired. 5th.-Endorse application yourself. Secure the signature of the Superintendent in the space provided for that purpose. 6th.-Be expeditious. A fee of $5 is paid for each selection. No allowance is made for incidental expenses. The bill for nominating should always be ac- companied by the order from the Home Office requesting such nomination to be made. Should the Examiner selected fail to do the work for a Rules govern- ing the Chairman in nominating. nomination. Fee for 3 reasonable length of time an additional selection should be made without expense to the Com- pany. The number of Medical Examiners shall be limited to as few as is consistent with a speedy execution of the work assigned them. Each Examiner is given a certain district or territory in which he is expected to make all the necessary examinations. Instances of one Ex- aminer trespassing upon the field assigned to another must in all cases be satisfactorily ex- plained. The examinations of applicants shall be dis- tributed as equally as a due regard for seniority of service, distance to be covered and prompt ex- ecution of business will permit. The territory assigned to Examiners in large cities should be in accordance with this view. Differences of opinion between local Ex- aminers shall be decided by the Chairman, and on appeal by the Medical Director. No report of the examination of an applicant will be received at the Home Office unless made by one of the regular Examiners of the Company, provided such service is available. The Medical Examiner holds his appointment, during good behavior, until he resigns, changes his residence so as to be no longer accessible, or is removed by death. If from any cause he wishes to sever his con- nection with the Company he should send a written resignation to the Medical Department together with any books or papers he may hold. Number of Examiners. Distribution of work. Disagreements. Tenure of Office. 4 He forfeits his position through negligence, unnecessary delay in making examinations, in- temperance, prolonged or frequent absences and untruthful reports. In the friction of an active and aggressive business complaints will naturally arise. The Medical Examiner must expect his share of them. Whenever they arise the attention of the Examiner is called to them. He is fully in- formed of their nature and opportunity given him to reply. Decision is invariaby reserved until all have been heard. The fees for examinations are fixed and paid by the Company.. These vary with the amount and kind of insurance sought and the nature of the medical reports required. For a complete medical report made on the Regular Industrial or white form the fee is 50 cts. When made on Special Adult or blue form the fee is $1.00. No urinalysis is required in the above unless espec- ially requested. In that event an additional fee is allowed. Examinations for revival of policies must be paid for by the persons applying for revival. The Examiner is permitted to make such ar- rangements with the Agent or Superintendent as may be satisfactory to himself. When the reports are complete they should be mailed direct to the Home Office in the envelopes provided by the Company for that purpose. These envelopes are to be obtained of the Super- intendents. No allowance is made for mileage. Forfeiture of position. Complaints made against an Examiner. Fees for Examinations. Ind. Branch. Revival Examinations Ind. Branch. Reports to be mailed direct to H. O. Mileage. 5 The Examiner must pay his own postage. He should use ink in writing his reports. Re- ports written in pencil will be returned. Do not trace or permit an applicant to trace his or her signature over one previously written with pencil or otherwise. Traced signatures are not valid. Accompanying his report and enclosed in the same envelope with them he should place a Voucher, Form 53, filled out, dated and signed. On the reverse side of the Voucher he should write the names of all the persons examined. The Examiner's accounts are made up from these Vouchers. It is important therefore that they should be accurate. If a discrepancy is dis- covered between the Voucher and the names or number of accompanying reports notice of such error will be given at once. If an Examiner receives applications from more than one Superintendent, he will be re- quired to keep separate vouchers for each district. This is rendered necessary because of the work incident to the proper entry and preservation of the vouchers at the Home Office by districts. Upon each voucher state the district or Superin- tendent from whom the applications were re- ceived. Do not allow the names of two Superin- tendents or districts to appear upon one voucher. The accounts of Medical Examiners will (un- less special arrangement is made to the contrary) be adjusted quarterly, as follows:- 1 st.-On the first Monday of each quarter the accounts of all Examiners residing in New York and the New England States will be adjusted. Postage. Traced Signatures. Vouchers for Examinations. Ind. Branch. Separate Vouchers re- quired for each District or Superintendent Ind. Branch. Medical Examiners' Bills. When paid. 6 2d.-On the second Monday of each quarter the accounts of all Examiners residing in the State of New Jersey and the territory covered by the Philadelphia districts. 3d.-On the third Monday of each quarter the accounts of all Examiners residing in Maryland, Delaware and Pennsylvania (except the districts in Philadelphia). 4th.-On the fourth Monday of each quarter the accounts of all Examiners residing in the districts west of Pennsylvania. Blank vouchers (Form 53) and Bills (Form 445) for rendering accounts will be supplied by the Superintendents. When the examination is made for the Ordi- nary Branch and the sum applied for is less than $1000, the fee is $2.00 for each report. When the amount applied for reaches or exceeds $1000, the fee is $3.00 for each report. When the amount applied for reaches or exceeds $5000, the fee is $5.00 for each report. Urinalysis is always required. A microscopical examination of the urine is not necessary, except when ordered by the Medical Department. When this is re- quested an additional fee of $3.00 is allowed. Ordinary Branch revival examinations must be paid for by the persons applying for revival. In the Ordinary, as well as in the Industrial Branch, medical reports must be mailed by the Examiner direct to the Home Office. Examiners' accounts with the Ordinary Branch will be adjusted quarterly during the first week in January, April, July and October. Bills Examiners' Accounts Continued. Fees Ordinary Branch Examinations. Ordinary Branch Revivals. Ordinary Branch Examiners' Accts. When paid. 7 reaching the Home Office later than either of the above dates will be deferred until the next ensu- ing quarter. Blank Bill Heads may be procured of the Super- intendents or General Agents. A cardinal virtue in an Examiner is prompt- ness in conducting examinations and in forward- ing his reports at once to the Home Office. This is especially true in Industrial Insurance. Ap- plications, when handed to the Doctor, should receive immediate attention and his reports should reach us not later than the first mail on the ensuing Monday. In the economy of the Home Office, all reports arriving later than above stated are still further delayed. The work in hand at the Office on Monday morning re- quires and receives attention during that week. It is important therefore that all medical reports shall be received on or before the arrival of the first mail on Monday. The above applies to the Industrial Branch and for the eastern states. From Ohio and states west of this an additional day is allowed and Tuesday morning is named as the latest hour for the reception of reports. Reports for the Ordinary Branch should be forwarded as soon as made. It is taken for granted that the Examiner will accord to the Superintendent the deference due him in his official capacity as the representative of the Company. Also that he will extend to the Assistant Superintendents, Agents and ap- plicants the courtesy due them. Medical Reports : liould reach Home Office not later than first mail Monday morn- ing. Courteous treatment to all. 8 It is desirable for the Examiner to call at the Superintendent's, or a detached Assistant Super- intendent's office, to receive applications requir- ing examination. By doing this obscure ad- dresses and names may be cleared up and other information given that will enable him to save time and effort in accomplishing his work. He may arrange with the Superintendent the days and hours most convenient to all concerned. Prudence will suggest the propriety of reading the application of .each person to be examined. The fact of a previous rejection may be stated, or a past illness. It is well for the Examiner to be placed in possession of such information, should it exist, before proceeding with his exam- ination. Besides, if the signature of the appli- cant is omitted on the application, the case should not be examined, but returned to the Superin- tendent and his attention called to the omission. If an Examiner receives an application to which the signature of the applicant has been affixed on the Medical Examiner's report, he should forward the application, without examina- tion, to the Home Office. In no case should he proceed with the examination. After the examination has been made and the signature of the person examined affixed to the medical report, it may be discovered that the two signatures do not correspond. If the Examiner is satisfied of this, he may secure signatures on both sides of the form, signing his own name as witness, and forward his report. In every in- stance of this kind do not fail to state the fact under ' ' Remarks. ' ' The Examiner to call at Supt's Office. The Examiner should read the application. Medical Reports pre- viously signed must be sent to Home Office without examination. Wrong Signatures corrected. 9 A medical examination should never be made by proxy. The Examiner should sign for him- self alone, and only in cases he has personally examined. When two or more applications on the same life are handed to the Examiner for any current week he should make but one report. A single fee only is allowed by the Company. In proceeding with his examination the Ex- aminer will bear in mind the fact that the rela- tion between the doctor and his patient differs materially from that which exists between the Medical Examiner and the applicant for life in- surance. The one is eager to tell all his ills, and is anxious that the Doctor should know of every symptom and condition ; he speaks freely and without reserve. The other often desires to con- ceal everything that will impair the value of the risk or lessen his chance to effect an insurance upon his life. In other words, self interest prompts the patient to impart information, and the applicant for life insurance to withhold it. It becomes the duty of the Examiner to deter- mine the facts in each case he examines. He is employed by the Company-not by the appli- cant, nor by the Agent. He is, then, in honor bound to subserve the interests of the Company. Since our prosperity depends largely upon the integrity with which he discharges the duties of an Examiner, we offer for guidance the following Examiners must sign only their own Reports. The Doctor and his Patient. The Examiner and the Applicant. 10 SUGGESTIONS. Satisfy yourself as to the identity of the appli- cant. The name, age, occupation, sex and sig- nature will enable you to do this. Note the apparent AGE as compared with the age given by the applicant. The conviction has been forced upon the Company that there is a decided tendency upon the part of applicants to give ages younger than they really are. This is sometimes done, it is true, without the intent to deceive, and simply because the applicant, especially if of foreign birth, is uncertain as to his age. It is very frequently done, however, with the intent of obtaining, for a given weekly premium, as large an amount of insurance as possible. You will understand that as the age appears less the amount of insurance, for a stated premium, is larger. In other words, 25 cents per week will buy more insurance at age 40 than at age 44. Again, we regret to say, that, in some instances, the Agent, knowing this fact, and, in sharp com- petition with Industrial Agents from other com- panies, endeavors to secure the applicant by promising him cheaper rates than he can obtain elsewhere. He can give this in no other way than by misrepresenting the age. In collusion, therefore, with the applicant he writes him up at, say 35 years of age, when the fact is he is 40. Upon the death of the insured the truth is sometimes learned from the attending physician, whose certificate of death is submitted to the Company to establish the claim. Identity. Actual and Apparent age. Age continued. 11 Frequently the holder of a policy applies for additional insurance, giving a different age. This leads to investigation, and the actual age is ascertained. Again. Examiners sometimes detect the at- tempted imposition, and call attention to the difference between the age as given by the appli- cant and the apparent age. Our statistics show that we have more policies in force at 40 than at 41, 42 or 43. The same result is shown at age 45 compared with 46, 47, 48 ; also at age 50, as compared with 51, 52, 53. These figures prove that the tendency is, if an applicant is 41, 42 or 43, for him to give his age at 40, and if 51, 52 or 53 to give his age at 50, and so on. In these and other ways, as we have before stated,* the conviction has been forced upon the Company that they are daily taking risks at ages younger than they really are. Let us for a moment see how important it is for the Company to have the CORRECT AGE at the time the insurance is effected. According to the Company's table of rates the amount insured at age, 40 for a weekly premium of 10 cents is $100.00 ; at age 41 the amount is $96.00. It therefore follows that if 100,000 per- sons state their ages as 40 when they are really 41 years of age the sum insured and subject to loss by death is increased by $400,000. In other words, the Company will pay $400,000 more than would be paid, in the event of death, had the age been correctly stated. Age continued. 12 When it is realized that the Company insures 100,000 persons in a short time, it becomes at once apparent how important it is to be exact upon the question of age. Next in importance to the physical condition, and of more importance than the Family History of the applicant, is the determi- nation of the Age. How shall the Company be protected in this direction ? We must look to our Medical Ex- aminers. We offer the following suggestions for your guidance : If the applicant is in doubt, or seems inclined to deceive, corroborative evidence can be secured, such as: date of emigration to this country, and the age at that time-the age of oldest child, and the age of applicant at its birth-the age of hus- band or wife-ages of brothers or sisters, living or dead, and comparative age of applicant with these. These, taken together with the apparent age of the applicant, will enable a judicious Examiner to closely approximate the actual age. Should the age given be one of the quinquennial periods, as 40, 45, 50, 55, etc., take especial pains, as the probability is that the applicant is older. In all cases of doubt give the Company the benefit of that doubt. The line of inquiry, alluded to above, is briefly epitomized in the following verbatim report from one of our oldest Examiners: Mrs. K ap- plies for a Special Adult policy. She tells the Agent she is 50 years old. She also gives this Ape continued. age to Examiner. She appears older. The report reaches us in this shape : ' ' Actual age, 60. Apparent age, 60. Remarks: Applicant states that she is 50 years old-does not know the year of her birth. Landed in this country at 18-married at 22; first child two years after marriage, who is now 36 years of age." The EXACT OCCUPATION must be stated in both Ordinary Branch and Special Adult Reports. The term laborer should not be used. Ordinary Branch applications upon the lives of persons engaged in the following occupations will not be accepted : Blasting. Mining. Submarine operations. The military or naval service in time of war. The manufacture, handling or transportation of highly explosive substances. The sale or handling of spirituous or malt liquors. Gambling. Aeronauts. Stonecutters. Glassblowers. Sailors. Grain handlers in elevators. Those engaged in the following occupations are received with an addition to the premium rate of one-half per cent, to two per cent, of the amount of insurance : Service in any capacity upon railroad trains. Service upon any steam or other vessel. 13 Occupation, Ord. Branch. 14 Engineers or firemen of stationary or moving engines. Employment in blast furnaces or foundries, etc. All of the above applies to the Ordinary Branch alone. When the occupation is given as merchant, clerk, salesman, foreman, teamster, driver, etc., always state the line of business in which an applicant is engaged. Where technical terms are used to denote the trade or avocation, explain fully the duties of the position. The Special Adult form of application will not be accepted if the applicant is under 18 or over 60 years of age next birthday ; nor if totally blind or deaf; nor if either parent has died of consumption and the applicant is under 26 years of age next birthday ; nor on the lives of persons pursuing the following occupations : Freight Brakemen and Yardmen. Blasting, Mining and submarine operations. Manufacture of Explosives. Circular or Buzz Sawyers. Marble or Stone Cutters Common Laborers. Glassblowers. Sale or Handling of Malt or Spirituous Liquors. Actresses. Sailors. Persons unable to write. Note.-Grain handlers in elevators, Printers and Hatters will be received with caution. Occupation, Ind. Branch. 7 The regular Industrial form of application will be received upon the lives of all persons engaged in any occupation whatsoever. Prostitutes and illegitimate children under three years of age are exceptions to this rule. The importance of determining as accurately as possible the amount and kind of liquors daily consumed should be at once apparent to the Ex- aminer. Excessive or immoderate use invariably shortens life. In answering this question do not write "moderately," "occasionally," etc., but give average quantity each day. The term "moderately," so often written by Examiners, may with one applicant mean from 20 to 30 glasses of beer and one or more drinks of spirits each day. To another it may mean a glass of beer or wine at meals only. To us, in view of the various constructions placed upon the word, it conveys no definite information of the appli- cant's habits. We repeat the request, give the average quantity and kind of spirits drank each day or week. The age, occupation and habits of the applicant having received attention, we now desire to call attention to the PERSONAL HISTORY. For the purpose of eliciting this certain questions are asked, to all of which the Examiner is expected to record positive and definite answers. If a past illness is mentioned, such as pneumonia, pleurisy, sunstroke or any other disease, it is not sufficient to state the bare fact, but he should also state when the illness occurred, the duration and severity of the attack; and if more than one Personal Habits Personal History of the Applicant. I. disease is mentioned, the date, severity and dura- tion of each should be explicitly stated. The Examiner need not confine himself to the ques- tions to be found on the blank provided for his use, but should make such additional queries as in his judgment will clearly reveal all that it is desirable to know. Such expressions as "a cold," "overwork," "nervous exhaustion," "dyspepsia," "headache," etc., etc., are fre- quently given by applicants to account for an illness requiring medical advice. The Examiner will do well to be on his guard in all such cases, and make a rigid enquiry into all the particulars. These conditions are often prognostic of serious incipient diseases. Whenever reports of this character reach us, unaccompanied by evidence that the Examiner has thoroughly investigated the point, they are returned for such investiga- tion. Next in importance is the FAMILY HISTORY. It is universally admitted that certain diseases are transmissible by heredity. Also, that inherited tendencies are most decided at certain ages. To properly appreciate, therefore, the value of a life, it is essential for the Examiner to know the ages at death and the causes of death of near rela- tives. Unless this is clearly given it will be seen that a valuable aid to determining the desirabil- ity of a risk is withheld. If the cause of death of a parent or brother or sister is unknown, en- deavor by questioning to establish the existence or non-existence of hereditary disease, especially Consumption. The mortality statistics of insur- Objectionable Terms. Family History. 17 ance companies prove that 20 per cent, of all death claims arise from Consumption alone. In assigning the causes of death, avoid all in- definite terms, such as "asthenia," "childbirth," "change of life," "debility," "dropsy," "exhaus- tion," "exposure," "failure of heart," &c. If it becomes necessary to use any of these terms, remarks, explanatory of the fact, should alwaysbe made, since these expressions do not establish the cause of death. It is possible for any one or all of them to exist, and yet the death may be due to consumption. Moreover, they are unscien- tific terms which obtain among the laity and should not be used by the careful Examiner. If death is stated to be the result of injury, accid- ent or childbirth, the nature of the injury, the desease complicating childbirth and the length of time elapsing before death, as well as the prev- ious condition of health, should be given. Note.-In Special Adult applications when the applicant is under 26 years of age next birthday, and in Ordinary Branch applications when the applicant is under 30 years of age, if the cause of death of a parent or brother or sister is obscure, be especially careful to enquire into the nature and duration of the last illness. Always give the age at death of near relatives. During your examination you may discover that the applicant is temporarily ill with an acute disease. This would at once disqualify him for insurance in the Ordinary Branch or for a policy in the Industrial Branch until complete recovery What to avoid. Postponements 18 has ensued. It will, therefore, be your duty to advise postponement of the case for such time as you think best. After the postponement has been advised the Examiner need not revisit the applicant unless he is requested by the Superintendent or General Agent. Should the request be made before the postponement period has expired he should delay his report until the proper time. Rejections are made by the Home Office for the following reasons: Postponements Re-examined. IN THE ORDINARY BRANCH. 1. Females under 25 or over 60. 2. All persons under 20 or over 60 years of age Exceptions to the above may be made at the discretion of the Executive. 3. For certain occupations-see page 13. 4. An unfavorable family history. The death of both parents of consumption ; the death of one parent of consumption, unless the applicant has passed the age of thirty years ; the death of two or more members of the immediate family (broth- ers or sisters), unless the applicant has passed the age of the eldest, is usually held to be an un- favorable family history. 5. An unfavorable personal history. Repeat- ed attacks of "cold," bronchitis, rheumatism ; the history of constitutional syphilis; excess in the use of intoxicants, &c., &c., are to be regarded as constituting an unfavorable personal history. 6. The existence of disease. 7. The maximum amount permissible under Rejections. Why made. Ord. Branch 19 the rules of this Company having already been granted. Note.-Each Ordinary Branch Rejection No- tice will contain a statement that the applicant will or will not be received in the Industrial Branch. IN THE INDUSTRIAL BRANCH. In this Branch a lower standard is attained. In- creased numbers and higher rates compensating for a less rigid selection. (A) Special Adult.-Blue Form. i . Applicants under 18 or over 60 years of age next birthday. 2. Certain occupations-see page 14. 3. Unfavorable family history. The death of both parents of consumption ; the death of one parent of consumption if applicant is under 26 years of age next birthday ; the death of two brothers or sisters, unless the applicant has passed the age of the eldest. 4. An unfavorable personal history or present physical condition. 5. Excess in the use of intoxicants. 6. The applicant having already secured the maximum granted on one life. Note.-A risk is sometimes insurable at Reg- ular Industrial rates when declined at Special Adult rates under the above rules. In this event the application is modified and a Regular Indust- rial Policy issued. Rejection'. Why made. Ind. Branch. 20 (B) Regular Industrial.-White Form. i . Applicants (white) under i year or over 70 years next birthday. 2. Applicants (colored) under 1 year or over 65 next birthday. 3. Illegitimate children under 3 years of age next birthday. 4. An unfavorable family history. The death of both parents from consumption ; the death of two or more brothers or sisters older than the ap- plicant. Note.-The death of one parent or one broth- er or sister is not regarded as unfavorable in this Branch. 5. An unfavorable personal condition or in- temperate habits. 6. The amount permissible under the Com- pany's rules having been already granted, further insurance is declined. It is expected of the Examiner, whenever he shall learn of any irregularity upon the part of the Agent or others who may be connected with the Company, that he shall acquaint the Executive Officers with the fact. Failing to do this he be- comes, in a measure, particeps criminis. To re- lieve himself, therefore, of all suspicion, he should not consent to remain silent when he knows that the rules of the Company are being violated. Should it be desired, any communication he sees fit to make will be treated as confidential in char- acter. Securing applications by misrepresenta- tion, false promises to prospective policy-holders, "quiet business,'' rewriting rejections for sums that do not require medical examination, stating Rejections continued. Confidential communi- cations. 21 the wrong occupation, &c., are some of the vio- lations of rules that may come under his obser- vation. Special communications, bearing upon cases that he may have examined, will be very gladly received, inasmuch as they throw greater light upon such cases and enable us to act more intel- ligently. This is especially desirable where re- jection has been made and request to reconsider has been received. The equipment of a medical education by any one of the reputable Medical Colleges of the coun- try presupposes an ability to properly examine an applicant. The points to be determined in a medical re- port on a life are as follows : 1. The age. 2. The habits. 3. The family history. 4. The occupation. 5. The personal history. 6. The health of the applicant. The first five above named have already receiv- ed attention. In determining them the Examin- er has of necessity been compelled to trust to statements made to him, and only partially, per- haps, corroborated by his own observation and enquiry. Upon the last and most important point the Examiner is at an advantage. The sub- ject is before him-under his immediate and per- sonal investigation. He brings to bear the skilled tools of his craft -an observant eye, a quick ear, a skilled touch. Special Com- munication. < Salient points in Medical Report. 22 The existence of disease should not escape his notice. His report on this point should be ac- curate. Here there is the least excuse for error. It is unnecessary to suggest how the examina- tion should be conducted. That is already known if the Examiner is what he professes to be-an educated physician. The Ideal Medical Examiner's report embraces in terse, concise terms a pen picture of the appli- cant. Nothing important is omitted. Nothing unimportant is inserted. It is recognized at once as the production of a thorough physician. It reflects credit upon the writer and begets confi- dence at the Home Office in his examinations. It inspires respect for his opinion and gives increased weight to his judgment. The Ideal Medical Report. Attention is called to the ten rules given on the following page. They briefly epitomize the instructions already given. 23 THE INSURANCE EXAMINERS' DECALOGUE. 1. Examine promptly. 2. Answer each question definitely, and use ink in writing. 3. If consumption is recognized as a cause of death in near relatives, give a full family history, number of family living, number dead, ages at death and causes of death. 4. Avoid indefinite expressions in assigning causes of death or naming a past illness. 5. Explicit information of past illness of ser- ious import-number of attacks-date of last- duration and severity. 6. If suspicious of intemperate habits or (in case of females) immoral life, enquire closely and give your conclusions. 7. Give exact age. 8. State present occupation. If recently changed give previous occupation. 9. Notify the Company of any irregularity. 10. Mail your reports so that they will reach the Home Office not later than the following Mon- day morning. West of Ohio Tuesday Morning. The Examiners' Decalogue. 24 COMBINED EXPERIENCE MORTALITY TABLE. AGE. Number surviving at each Age. Deaths in each Year. Deaths per 1,000. AGE. Number I Deaths surviving . , , in each at each Deaths per 1,000. Age. i ear. 0 143,400 22.184 154.700 50 69,517 1,108 15,938 1 121,216 7,697 63,498 51 68,409 1,156 16,898 113 519 4.030 35,501 52 67.-53 1,207 17,n47 3 109 489 2,617 23,902 53 66,046 1.261 19,093 4 106,872 1,892 17,703 54 64,785 1,316 20,313 104,980 1.428 13,603 55 63,461 1,375 21,664 6 103,552 1,123 10,845 56 62,094 1,436 23,126 102 429 922 9,001 60,658 1,497 24,679 8 101,n07 792 7.802 58 59,161 1,561 26,386 9 100,715 715 7,099 59 57,660 1,627 28,246 10 100.030 676 6,760 60 55,973 1,698 30,336 11 99.3 4 614 61 54,275 1,710 32,612 12 98,650 672 6,812 62 52,505 1,844 35,121 13 97.978 671 6,848 63 50 661 1,917 37,840 14 97.307 671 6,896 64 48.744 1.99 > 40,826 15 96.636 671 6,944 65 46,754 2,061 44,082 16 95,965 672 7,0 3 66 44,693 2,128 47,614 17 95.293 673 7,062 67 42,565 2,191 51,474 18 94.620 675 7,134 68 40,374 2.246 5X630 19 93,945 677 7,205 69 38,128 2,291 60,087 20 93.268 680 7,291 70 35,837 2,327 64,933 21 92.588 683 7,377 71 33,510 2,351 70.158 2*3 91.905 686 7,41'4 72 31,159 2,362 75,805 23 91,219 690 7,564 73 28,797 2.358 81,881 24 90,529 694 7,666 74 26,439 2,339 88,468 25 89.835 698 7,770 75 24,100 2.303 95,560 26 89,137 703 7,887 76 21,197 2,249 103,180 27 88,434 708 8,006 19.548 2,179 111,4(9 28 87,726 714 8.139 78 17,369 2,092 120,444 29 87,012 720 8,275 .9 15,277 1,987 13 ',065 30 86,292 8,4'5 80 13,290 1,866 140,406 31 85,565 734 8,578 81 11.424 1.730 151,436 33 84.831 742 8,747 82 9.694 1.582 163,194 33 84,089 750 8,919 83 8.112 1,427 175,913 34 83,339 758 9,095 84 6,685 1,268 189.678 35 8.>,581 767 9,288 85 5,417 1,111 205,095 36 81,814 776 9.485 86 4.306 958 222,480 37 81,038 785 9,687 87 3,348 811 242,234 38 80.253 795 9,906 88 2,537 673 265,274 39 79,458 805 10,131 89 1,864 545 292,382 40 78,653 815 10,362 90 1,319 427 323,130 41 77,838 826 10,612 91 892 322 360,987 42 77,012 839 10,894 92 510 231 405,263 43 76.173 857 11,251 93 339 155 457,227 44 75,316 881 11,697 94 184 95 516,304 45 74,435 909 12,212 95 89 52 584,270 46 73.526 944 12,839 96 37 24 648,649 47 72.582 981 13,516 97 13 9 692,308 48 71,601 1,021 14,260 98 4 3 750,000 49 70,580 1,063 15,061 ! 99 1 1 100,000 Ages O to 9 Fackler's Extension. 25 TABLE OF HEIGHT AND WEIGHT AND CHEST EXPANSION. NORMAL PROPORTION OF THE HEIGHT OF INDIVIDUALS TO THEIR WEIGH! AND CHEST MEASUREMENT. HEIGHT. WEIGHT. CHEST MEASUREMENT. j Max. Med. Min. Full Inspiration. Full Expiration. 4 feet 10 in. 150 105 83 31.5 in. 29.5 in. 4 " 11 " 160 110 87 32.6 " 31.3 " 5 << >< 167 115 92 33.2 " 31.9 " 5 174 120 96 34.8 " 32 2 " 5 " 2 " 181 125 100 35.5 " 33.0 " 5 " 3 " 188 130 104 35.8 " 33.4 " 5 " 4 " 195 135 108 36.4 " 33.9 " 5 " 5 " 200 140 112 36.7 " 34.0 " 5 " 6 " 205 145 115 37.0 " 34.5 " 5 " 7 " 210 150 120 37.4 " 34.7 ■" 5 " 8 " 215 155 125 38.0 " 35.1 " 5 " 9 " 220 160 130 38.9 " 35.7 " 5 " 10 " 225 165 135 39.0 " 36 0 " 5 " 11 " 230 170 140 ' 39.8 " 36.7 " 6 235 175 145 40.3 " 37.2 " 6 " 1 " 240 180 150 41.0 " 37.6 " 6 " 2 " 245 185 155 41.9 " 38.2 "■ 6 " 3 ' 250 1 190 160 42.6 " 38.9 " 6 " 4 " ! 255 ; 195 165 43.5 " 39 6 " '1'lie above Table is not intended for abosolute guidance, but for reference. 26 Constructed from the Combined Experience Mortality Table. EXPECTATION OF LIFE, Years Old. I xpectation Years. Years Old. Expectation Years. Years Old. Expectation Years. 10 48.3 40 27.2 70 8.5 11 47.6 41 26.5 71 8.1 12 47. 42 25.8 72 7.6 13 46.3 43 25.1 73 7.2 14 45.6 44 24.4 74 6.8 15 44.9 45 23.6 75 6.4 16 44.2 46 22 9 76 6.1 17 43.5 47 22.2 77 5.7 18 42 8 48 21.5 78 5.4 19 42.1 49 20.8 79 5. 20 41.4 50 20.1 80 4.7 21 40.7 51 19 5 81 4.4 22 40. 52 18.8 82 4.1 23 39.3 53 18.1 83 3.9 24 38.6 54 17.5 84 3.6 25 37.9 55 16.8 85 3.3 26 37.2 56 16.2 86 3.1 27 36.5 57 15.5 87 2.8 28 35.8 58 14.9 88 2.5 29 35.1 59 14.3 89 2.3 30 34.4 60 13.7 90 2.1 31 33.7 61 13.1 91 1.8 32 33. 62 12.6 92 1.6 33 32.3 63 12. 93 1.4 34 31.5 64 11.5 94 1.2 35 30.8 65 10 9 95 1.1 36 30.1 66 10 4 96 .9 37 29.4 67 9.9 97 .8 38 28.7 68 9.4 98 .7 39 28. 69 9. 99 .5 Long and careful observation has shown, that notwithstand- ing the life of any given individual is proverbially uncertain, yet, that if a large number of persons in ordinary circumstances at a given age be taken, there is a law, fixed and uniform, determining within very narrow limits, the average number of years remaining to them. For example, if we take 10,000 persons at the age of 32, the sum of their ages at death will amount to about 330,000 years; showing that, on an average, each person 35 years old will live 33 years longer. This mean after lifetime is called the expectation of life at the assured age, that is, the number of years which one at that age may expect probably to live.