INSTRUCTIONS 
TO 
Medical Examiners 
OF THE 
f ratal |)nlrrf|)ol(lcn (|; ross, 
ADOPTED MAY, 1880. 
KNOXVILLE, TEN'S,: 
“WHIG AND GHBONICLK” STKA.M PRINT. 
1881. INSTRUCTIONS 
TO 
Medical Examiners 
OF THE 
Ijnitcd |jnleri|(ol(len |,ross. 
•j «T j j 
ADOPTED MAY. 1880. 
K N OXVILL E, T EN N. : 
“WHIG AND CHRONICLE ” STEAM PRINT. 
1881. PREFATORY NOTICE. 
Examiners are reminded that they are the guardians of 
our most vital Interests; and that the Order is entitled to 
the henelit of any doubt affecting an applicant; and further 
that fraternal, as well as professional, obligations require 
that the examination be rigid and impartial, and that exact 
and definite statement be made of everything necessary to 
a just and comprehensive estimate of the eligibility of an 
applicant. 
By strict compliance with these Knles, much time and 
labor will be saved and our mutual relations be satisfactory 
and harmonious. 
R. E. CURRAN, M. D„ 
W. P. CROSS, M. D., 
JOHN D. YOUNG, M. D., 
ED. HARTSHORN, M. D., 
U. WILSON, M. D., 
Committee on Medical Examinations. 
J. H. MORGAN, M. D„ Instructions 
TO 
MEDICAL EXAMINERS. 
Please observe the following 
RULES: 
1. Examine the written application 
in every case. 
It may suggest the weaker points of the 
family and personal history, which demand 
especial notice in the succeeding examination. 
Any Loose or Equivocal statement of the 
applicant should be corrected and explained 
by the Examiner. 
It is especially desirable that the applicant 
ue interrogated by a medical man upon all 
doubtful points, that at least an approxima- 
tion to the truth may be had. Among many statements given in reply to questions as to 
causes of death, we may cite “Fever,” “Child- 
birth,” “Complication of Diseases,” “De- 
cline,” “Asthma,” “Dropsy,” “Change of 
Life,” “Uncertain,” “Don’t Know,” &c., 
where Phthisis has been the real cause. 
In case of death imputed to Child-birth, for 
instance, it should be ascertained if the de- 
ceased was healthy previous to parturition; in 
what form danger appeared, whether in hem- 
orrhage, convulsions, puerperal fever, or oth- 
erwise, and what interval of time elapsed be- 
tween delivery and death. 
Where Change of Life is mentioned, in- 
quire as to the symptoms, and if cough was 
present, determine for how long a time it 
existed, and. with what concomitant signs of 
pulmonary disease. 
The statement of a death from Lung fever 
should always suggest questions as to the 
previous health of the deceased, the duration 
of the ailment and its termination. 
In reported Asthma ascertain if it were 
purely spasmodic, or a dyspnoea dependent 5 
upon organic pulmonary, cardiac, or learn 
disease. 
A few questions, well directed, will facili- 
tate the work of both Examiner and Medical 
Director. 
Having defined the family history as ex- 
actly as may be, the Examiner has it within 
his power to decide how far the applicant 
may be considered predisposed to the diseases 
of which his relatives died. 
If both parents died of Phthisis, or if one 
parent ami several brothers and sisters, or 
other relatives, have so died, the liability to 
Phthisis is great, and the risk should be de- 
clined. 
* Yet in instances where but one parent 
has died of Consumption, the applicant, by 
an affinity to the healthy parent (always bear- 
ing in mind that the mother will more readily 
transmit disease); by the attainment of the 
age of 30 years; by a just proportion of 
height and weight, and a healthy condition 
of all the vital organs and functions; by firm- 
ness of tissue; by folloiving a healthful 
* Dr. Brinton, on Life Insurance. 6 
occupation, and by temperance, in all things, 
may demonstrate the possession of a sound 
organization, and be fairly entitled to admis- 
sion. 
In case of death among relatives from Can- 
cer, the applicant should be carefully ques- 
tioned as to the condition of the stomach and 
digestive organs; and, if a female, special 
inquiry should be directed to the state of the 
uterine and mammary systems. 
11. Give the personal appearance of 
the applicant as accurately as possible. 
The Height and Weight are important 
means of identification and of determining 
family resemblances. 
Temperament ; it lias been observed that 
the temperament of an individual affords, to 
a certain extent, the key to a knowledge of 
the class of diseases to which he would be 
most liable, and consequently it is always 
desirable that the temperament of the appli- 
cant for insurance be carefully noted. 
Four temperaments, the Bilious, Nervous, 
/Sanguine and the Lymphatic, with the com 7 
binations, Bilious Lymphatic, Ner vo-Sanguine, 
etc., constituting the mixed temperaments, are 
all that is essential to observe for insurance 
purposes. 
The tendency to paralysis, epilepsy, insan- 
ity and nervous diseases generally, would of 
course characterise the Nervous Temperament. 
while the Sanguine Temperament wTould pre- 
dispose its possessor to cardiac lesions, haem- 
orrhages, fevers of an inflammatory type, 
acute rheumatism, congestions, etc. The 
Lymphatic or Phlegmatic predisposes to 
chronic maladies, debility, tubercular, scrof- 
ulous and dropsical affections. A fair com- 
plexion, palid skin, languid circulation, soft- 
ness of the muscles, and torpidity of the 
bodily and mental functions, characterizes 
this temperament. 
The Bilious Temperament will be recognized 
in individuals possessing a dark complexion, 
dark hair and eyes, firm flesh, energetic 
thought and action, and inclines the pos- 
sessor to dyspepsia, hypochondriasis, and 
general disordered hepatic action. 
When a. pekson exceeds or falls below the 8 
average weight proportionate to liis height 
by twenty per cent., he transcends a safe 
limit. 
The per centage of variation is obtained 
by dividing the difference between the Nor- 
mal and Actual weight, by the Normal weight. 
Note that excessive obesity, especially 
when occurring rapidly, increases the risk. 
So rapid emaciation, even without apparent 
organic cause, excites suspicion. Any great 
variation in weight at different seasons of the 
year is unfavorable. 
The Examiner will recollect the tendency 
to fatty degeneration in the muscles of the 
heart, and in the coats of the great vessels 
causing aneurisms, and in those of the brain 
tending to apoplexy. The presence of the 
arcus senilis (indicating such degeneration of 
the edge of the cornea), renders some or all 
of these conditions probable. Yet it will be 
remembered that its absence furnishes no aid 
in diagnosis, for it is sometimes not exhibited 
even in extensive and fatal internal fatty 
degeneration. 
The Chest Measurements should be taken 9 
over the nipples and under the vest. and 
should be recorded in their proper places. 
An average extent of respiratory expansion 
is about three inches. Less than two inches 
will reject. 
Many persons are awkward, at first, in re- 
sponding to this test: but if the Examiner 
makes them understand what is wanted, and 
exercises a little patience he will rarely fail in 
getting two inches, even under the conditions 
of our blank. 
The Figure always demands attention, as 
indicating vigor or the reverse. Any decided 
deflection from an erect stature should be 
noted. 
The Age and General Appearance (whether 
the latter be vigorous in proportion to the 
former, or not), are important items. 
Occupation as effecting the risk favorably 
or otherwise should be fully considered. 
Every medical man is conversant with the 
fact that certain occupations are far more 
fovorable to the attainment of a long life 
than others. A large number of occupations 
are extremely pernicious to health, so much 10 
so that persons following them are positively 
unlit for insurance risks. 
Among the class referred to are: Glass 
blowers, quartz-mill operators, workers in 
chemical manufactories, white lead and match 
factories, burr stone and grind stone works, 
marble and stone cutters and carvers, etc. 
The station or social standing of the ap- 
plicant may, or may not, be such as will per- 
mit the exercise of care for the preservation 
of health and life. Due importance should 
be attached to this point. 
111. State definitely what previous 
acqu intance has existed between the 
applicant and yourself. If any, a 
knowledge of it contributes a degree 
of certainty to the opinions expressed 
in the medical certificates. 
IV. The Examiner is expected to 
acquaint himself with the facts in re- 
lation to all infirmities or deformities 
of which the applicant is a subject. 
Among these may be enumerated 11 
Blindness, Deafness, Loss of Limbs, 
Distortions or Inequalities of Limbs, 
Spinal Curvatures, Lameness, Par- 
alysis, Hernia, Cancers, Abscesses, 
Tumors and Fistulse. A specific ac- 
count of such imperfections must be 
given. 
V. Ascertain the condition of the 
Brain and Nervous System, both by 
the pertinent questions of the cer- 
tificate, and careful observation of the 
gait, manner of speech, and control 
over the muscular system, exhibited 
in the absence of tremors and irreg- 
ular movements. 
Witness the applicant’s signature, with this 
in view 
VI. In case of hereditary Insanity, 
investigate each instance as to its 
cause, continuance, and final result, 
and question the applicant about the 12 
influence of his occupation and habits 
upon the nervous system. 
VII. Investigate the condition of 
the Lungs with the utmost care, bear- 
ing in mind that at least one death in 
every seven is caused by pulmonary 
diseases. (See Appendix, for the 
number of deaths from each cause to 
one million deaths in England from 
all causes). 
Note the frequency of inspiration, remem- 
bering that its ratio to the pulse should aver- 
age as one to four and tive-tenths per minute. 
Observe the contour of the chest, whether it 
be regular in surface, or depressed in por- 
tions, especially above and under the clavicles. 
Observe its movements, if it expand in all 
parts evenly and regularly in inspiration, and 
retire equally so in expiration. 
Percuss the entire chest, to determine any 
failure or excess in normal resonance, and feel 
for the normal vocal thrill. 13 
Auscultate to ascertain the existence of a 
normal vesicular murmur everywhere, and the 
proper relation of inspiratory to expiratory 
sounds in duration, quality and musical 
pitch. 
“Where the chest is narrow, especially 
above; the shoulder blades low and near to- 
gether; the chest movements diminished: the 
percussate sounds duller and flatter than 
normal; the vocal thrill lessened and found 
irregularly; the inspiratory murmur jerking 
and brief; the expiratory murmur lengthened 
and heightened in pitch to a consonance with 
the former sound, there is every reason for 
declining the risk, on the ground of a con- 
solidation of pulmonary tissue. 
“Furthermore, if the chest be unnaturally 
deep from before backward, but contracted at 
the hypochondria; the shoulders elevated: 
the sternal movement diminished; the breath- 
ing diaphragmatic; unnaturally tympanitic 
resonance under the clavicles, contrasted with 
a deficient inspiratory murmur in the same 
regions; the usual cardiac sounds lessened 
by over-lapping lung, and in extreme cases 
the liver displaced downwards, we have ample 14 
evidence that the lung is emphysematous and 
the risk unadvisable.” 
Finally, be especially guarded when the 
family history is one showing fatal pulmonary 
diseases, and when the applicant has himself 
suffered attacks of Pneumonia, Pleurisy, 
Asthma, Difficult Breathing, Chronic Cough, 
or Haemoptysis, in which latter case the risk 
will be ahvays declined. (See Appendix). 
VIII. Note the, pulse rate, and its 
force and volume when the applicant 
is quiet and free from disturbing 
agencies, and prolong and repeat the 
interview till such is the case. Only 
thus does the pulse become the con- 
firmatory index of the state of the 
heart, as judged by auscultation and 
percussion. Give the rate of pulse 
sitting, immediately after rising, and 
at the end of two minu'es after rising. 
A pulse more frequent than eighty-jive, or 
slower than sixty, is uncommon, and should 
always be counted while the applicant both 15 
stands and sits. Inquire if this condition is 
habitual; and if so, for how long a time. 
Only where it stands alone and disconnected 
from any history of cardiac, pulmonary, or 
cerebral disease, should it be regarded the 
peculiarity of a healthy individual. 
An intermittent pulse always requires ex- 
planation. In young subjects it is often de- 
pendent upon the use of green tea or tobac 
co, or upon nervous excitement with exhaus- 
tion. In the old, when of recent date, it is 
of grave significance, especially when accom- 
panied by an inelastic and tortuous state of 
the general arterial system, or by a gouty 
history, or by evidences of free living. It 
should be remembered that recent exercise 
or exertion will often obscure the sign. 
IX. Carefully percuss the cardiac 
regions, to determine the heart’s size. 
Feel its impulse, to gain a knowledge of 
its intensity and extent. 
Listen for the dull systollic sound coinci- 
dent with the impulse, and the sharp click of 
the semi-lunar valves in sudden tension. 16 
Notice the rythmic relation of these 
sounds, and ascertain if murmurs attend 
upon or follow them. If so, state the points 
where such murmurs are specially audible, 
and the direction in which they are propa- 
gated. 
Especial care is requisite here, when the 
applicant has had rheumatism of an acute 
character, occurring before the age of thirty. 
X. Be specific in all inquiry con- 
cerning the Stomach, Liver, Spleen, 
Kidneys, Bowels and Urinary organs. 
In Dyspepsia, ascertain its form, severity 
and duration of attack. 
Define what is meant by “Disease of Liv- 
er,” if that be mentioned. 
Explore the Liver and Spleen in all cases 
of reported and protracted ague. 
Test the Urine chemically and micro- 
scopically, in all suspected cases. ( See 
“Scale for Urinomiter," Appendix). 
Do not be satisfied with indefinite state- 
ments concerning the genito-urinary system, 17 
but if necessary, inquire specifically for the 
detection of organic lesions and the syphilitic 
cachexia. Strictures vitiate the risk, and 
syphilis, except after many years of immunity 
from its constitutional manifestation, will 
ensure rejection. 
Fistulje should always he examined, and their 
precise location and condition reported. Their 
frequent association with pulmonary disease 
is here to be remembered. Fistula in Ano 
rejects. 
Hemorrhoids, if severe, will postpone ac- 
ceptance. 
Herni.e should be carefully examined, and 
as carefully described. 
XI. lii case of wounds, or amputa- 
tion of limbs, their precise extent and 
effect upon health are important data. 
Wounds of the head, if severe, require time 
for the proper estimate of their morbid influ- 
ence. , 
Amputations, if above the knee, at the 
shoulder joint, or of both feet or arms, will 
necessitate rejection. XII. In all cases of protracted and 
severe illness, an exact and circumstan- 
tial account must be elicited: and when 
this has occurred within twelve months 
of date of this application, the Exam- 
iner must obtain the opinion of the 
applicant’s medical attendant. Es- 
pecially in cerebral, pulmonary and 
cardiac diseases should this be done. 
18 
In cases of Rheumatism, the number of at- 
tacks, dates, character and severity should be 
stated. Persons subject to and who have 
suffered from inflammatory rheumatism, even 
where the heart is yet in a perfect healthy 
condition, are unfit for insurance. For it is 
a well-established fact that the majority of 
cardiac lesions and some forms of brain dis- 
ease are a result of the rheumatic poison. 
Cases of Hereditary Rheumatism are some- 
times encountered in applicants, and under 
the most favorable circumstances it impairs 
the risk, to say the least. Syphilitic rheuma- 
tism, as well as all other manifestations of 
syphilis, is a sufficient cause for rejection. 19 
XIII. Any latent and morbid pre- 
disposition should be given its due im- 
portance. 
This max have been acquired, and be inde- 
pendent of any hereditary tendency. 
XIV. Especially are the habits of 
the applicant in regard to spirituous 
liquors, and stimulants of all kinds, to 
be inquired into. State explicitly 
whether he uses fermented or distilled 
drinks, or both, and to what extent, 
and how long he has used them. 
Intemperance—The series of morbid phe- 
nomena produced by the excessive use of al- 
coholic drinks {Alcoholisinus), so frequently 
encountered among men in every grade of 
society, should not escape proper attention. 
No one will write himself down an inebriate, yet 
there must be a beginning somewhere, and 
the medical man is asked the question direct. 
Reformed inebriates are not acceptable risks, 
the continued use of alcohol leaving in its 
wake effects which long periods of complete 20 
sobriety fail to remove. Undoubted heredi- 
tary tendencies exist with reference to the 
transmission of the morbid appetite for in- 
toxicating drinks, and “atavism” in intem- 
perate families is as frequently observed as in 
families afflicted with phthisis pulmonalis, or 
insanitv. 
Individuals who indulge in occasional 
“ speees ” come decidedly under the head of 
intemperate, notwithstanding there may be 
intervals of temporary sobriety, and this 
class, as well as the confirmed drinker, must 
be declined. The same holds good with 
persons who indulge in the use of opium, 
chloral or other narcotic, for they will not be 
accepted. 
XV. Require evidence of successful 
vaccination, in the absence of a previ- 
ous attack of Small-Pox or Varioloid. 
XVI. In case of Female applicants 
the Special Blank must be filled by 
the family physician. No false deli- 
cacy should be allowed to prevent a 21 
thorough knowledge of their sexual 
history. (See Appendix.) 
Pregnancy will postpone the risk until 
three months after delivery, with restoration 
to perfect health. 
Women will not be accepted after the age 
of 44? unless they have passed the climacteric, 
or “change of life," and are free from disease. 
Serious deviation from a normal or healthy 
state of the uterine and mammary systems, 
will necessitate rejection. 
Severe or unnatural labors, or a series of 
abortions or miscarriages, will reject. 
In cases where Puerperal Fever, or Mania, 
has recurred, the risk must be declined, unless 
the applicant has safely passed the climac- 
teric. Yesico, vaginal or rectal fistuhe, or 
laceration, phlegmasia alba dolens, leucorrhcea 
(if excessive), emaciation and exhaustion 
from lactation, are each sufficient reason for 
denying admission. 
XVII. Be definite and precise in the expression of a final opinion with re- 
gard to the insurability of every case. 
XV 111, The Medical Certificate 
should always be in the handwriting 
of the Medical Examiner, and all ad- 
ditional remarks should be sinned by 
him. 
Any special information possessed by the 
Examiner, which he thinks it important to 
exclude from the regular blanks, should be 
communicated confidentially to the Medical 
Director, by a letter of the same date as the 
application. Mail all such communications 
to the Medical Director direct. 
Rejections based upon such information 
will not be explained as the advice or opinion 
of the Examiner, 
XIX. The Examiner should not con- 
sider any question of the blanks trivial, 
but should carefully examine these be- 
fore they leave his hands, that no omis- 
sion bo overlooked. 23 
A ditto should never be made to take the 
place of a plainly written “yes" or “no." 
The omission of any answer, the mistake of 
an affirmative in place of a negative, or the 
contrary, however evidently it may be a “cler- 
ical error," will always necessitate the return of 
the papers for a correction in the handwriting of 
the Medical Examiner, and none other will he 
acceptable. APPENDIX. 
The following Rules Govern the Acceptance, Re 
jection, or Postponement of Risks, 
The Medical Director reserves the 
right to reject any or all applications 
presented, and in no instance are the 
local Examiners to construe the rejec- 
tion of risks, recommended by them, 
as in the least reflecting upon their 
judgment, capacity, or honesty, pro- 
fessionally or otherwise. 
FAMILY RECORD. 
1. Apoplexy, Paralysis or Heart Disease 
occurring in both parents, or present in the 
proximate ancestry of both sides, or Insanity 
in two members of the family, especially when occurring on both sides, or in that branch 
which the applicant most resembles, will 
Vitiate the risk. 
2. Consumption; if in one parent, suggests 
the postponement of a risk until the age of 
thirty years. 
3. If it occurred in one patent and one or 
more brothers or sisters, it will probably re- 
ject, and positively will unless the applicant 
has reached the age of thirty-five. 
4. If in both parents., Phthisis absolutely 
rejects. 
5. If Cancer is found to have occurred in 
any member of the applicant’s family, all the 
facts regarding it are to be furnished to the 
Medical Director. 
■PERSONAL RECORD AND PRESENT CONDITION, 
6. Apoplexy, Epilepsy, Insanity, Disease of 
the Spinal Cord (and Paralysis, unless the 
latter were the result of accident, and have 
been entirely absent for seven years), will 
reject. 
7. Haemoptysis invariably rejects. 8. Pneumonia, if there have been several 
attacks; Chronic Bronchitis; Asthma, unless 
purely spasmodic and of mild form; Pleurisy, 
attended with Hydrothorax, or by permanent 
deformity of the Chest: Dyspnoea, from any 
cause, reject. 
1). A pulse intermittent ot very irregular, 
constantly above eighty-eight, or below fifty- 
eight; Cardiac Hypertrophy; Valvular Mur- 
murs; Aneurisms and Arterial Ossification; 
Varicose Veins, if extending as far as the 
groin, or if very large and prone to rupture 
or ulceration, reject. 
10. Gastritis, if frequent; Habitual Vom 
iting; Jaundice, unless functional; Enlarge- 
ment or Contraction of the Liver: Gallstones; 
Chronic Diarrhoea or Dysentery, unless absent 
tor three years; Bilious Colic, if frequent: 
Ascites; irreducible Hernite, and all Hernia* 
when a suitable truss is not and will not be 
worn; Piles, when severe and hemorrhagic, 
will postpone; Fistula in Ano, unless cured 
for two years, rejects. 
11. Albuminuria; Diabetes; Haematuriaf 
Calculus; Urethral Stricture, unless cured for one year; Chronic Prostatitis; Chronic 
Enlargement of the Testes: Syphilis, unless 
all constitutional evidences have been absent 
for seven years; and Chronic Cystitis, will 
reject. 
12. Erysipelas, if frequent; Chronic Ul- 
cers; Psoas or Lumbar Abscess; Tumors: 
Spinal Curvature: serious Deformities of the 
lower extremities: Necrosis or Caries of 
Bones; Blindness or extreme Deafness: 
Chronic Otitis, reject. 
13. Severe injuries to the skull, unless 
several years have elapsed without evidence 
of detriment to the Brain: Gunshot wounds, 
when the ball is retained: Amputations, above 
the knee or at the shoulder, of both legs or 
both arms, are causes for declining the risk. 
14. Inflammatory Rheumatism postpones 
for a year; occurring more than twice, it re- 
jects; Gout, if repeated: Ague, long contin- 
ued and attended by Anaemia, will postpone. 
15. The absence of evidence of successful 
vaccination, where Small-Pox or Varioloid 
have never occurred, requires explanation. 
16. The habitual Use of Opium, Chloral, 29 
or other narcotics; the excessive use of To- 
bacco, where this has produced its character 
istic functional disturbances; the daily or 
regular use of large amounts of Distilled 
Liquors, especially when taken between 
meals, or an occasional but habitual debauch, 
unless reformation has been entire for from 
two to live years, will insure rejection. 
17. Applicants varying materially from the 
normal or proper standard in weight (see ta- 
ble), whether such weight be in excess of, or 
below the proper figures, will as a rule be 
declined. A variation within twenty-live per 
cent, above the standard may not prove objec 
tionable, if all other conditions are favorable. 
TABLE OP MORTALITY OP LABORS. 
The comparative mortality of first and sub 
sequent labors is illustrated by the following 
exhibit: 
Authority. 
o-| 
M 
| No. of 
Deaths. 
Drone 
in 
every 
o § 
c-5 
S 
No. of ‘ 
Deaths. I 
Or one 
in 
every 
Hardy & McClintock 
2.125 
35 
60 
4510 
30 
150 
Mathews Duncan — 
3,722 
50 
74 
12,671 
103 
123 
Johnson & Sinclair.. 
4,535 
83 
54 
0,213 
SO 
115 
Totals 
10,382 
168 
62 
26,394 
213 
124 30 
TABLE OF MORTALITY FROM PUERPERAL 
FEVER. 
Table showing the mortality from Puerpe 
ral Fever in different Pregnancies.—Mathews 
Duncan: 
No. of Pregnancy. 
No. of 
Motners. 
No. of 
Deaths. 
Per cen t. 
of Death. 
Or one 
in 
First 
2.253 
97 
4.30 
23 
Second to Fourth — 
4.031 
85 
2.n 
47 
Fifth to Ninth 
1.503 
47 
3.01 
33 
Tenth to Nineteenth 
189 
9 
4.76 
21 
Observe that the first impressions of the 
Examiner regarding the applicant are often 
valuable guides to his frailties. 
Note the inexpediency of an examination 
by a near relative of the applicant. 
In case the application of a person to be 
examined states that the party has been re- 
jected by any Company, learn if possible the 
cause of rejection, and note if the cause still 
exists. Occasionally persons are declined for 
diseases which existed at the time of making 
application but subsequently disappeared, or 
an error in diagnosis on the part of the 
former Examiner may have been the cause of 
the Company’s declining the risk. An applicant while under medical treat- 
ment will not be accepted. Persons recover 
ing from attacks of acute diseases must be 
fully restored to their usual state of health 
before examination for insurance. 
In all oases where, in the opinion of the 
Examiner, the risk is not a desirable one, or 
in cases whe.re the physician has reason to 
suspect the truthfulness or honesty of the 
applicant, and where he has a well founded 
doubt whether the applicant will reach his 
expectation of life, it is his duty to decline the 
risk. 
Appointments of Medical Examiners are 
only made upon approval of the Medical 
Director, to whom all applications for position 
of Examiner, together with credentials, must 
be referred. 
Deputies are instructed to employ the ac- 
credited and regularly appointed Medical Ex- 
aminers of the order in all cases. When an 
emergency arises rendering it impossible to 
comply with this regulation, the reason for so 
doing must accompany the application, and 
the physician making such examination must 32 
be endorsed by the regular Examiner of the 
vicinity, whose signature will be required to 
the medical certificate, as an evidence of his 
consent and approval. 
Where the Medical Examiner is unknown 
to the Director, or has not been regularly 
appointed and recognized as such, his cre- 
dentials must, in every instance, accompany 
the application, otherwise it will be field in 
suspense until such credentials are received 
and approved by the Medical Director. 
TABLE OE HEIGHT, WEIGHT AND CHEST 
EXPANSION. 
Normal proportion of the height of individ- 
uals to their weight and chest expansion: 
Height. 
Average 
Weight. 
Average Chi 
Not Inflated. 
sst Measure. 
Fuli Inflation 
5 feet 
1 
inch 
120 lbs. 
31.91 
inch. 
33.23 inch. 
5 
2 
“ 
125 
“ 
32.21 
34.85 
“ 
5 
“ 
3 
“ 
130 
a 
33.00 
44 
35.52 
4‘ 
5 
ti 
4 
4* 
135 
44 
33.44 
35.85 
4* 
5 
“ 
6 
U 
139 
“ 
33.94 
30.40 
44 
5 
“ 
0 
“ 
143 
“ 
34.00 
4* 
30.74 
44 
5 
44 
7 
“ 
145 
34.54 
“ 
37.00 
M 
5 
8 
“ 
148 
34.67 
“ 
37.49 
4* 
5 
“ 
9 
“ 
152 
,4 
35.11 
“ 
38.00 
5 
“ 
10 
“ 
150 
44 
35.04 
44 
38.94 
44 
5 
44 
11 
** 
162 
44 
30.00 
*4 
39.00 
4* 
6 
“ 
00 
“ 
IC7 
44 
30.78 
39.87 33 
ACCORDING TO THE AMERICAN TABER OF MORTALITY. 
EXPECTATION OF LIFE TABLE. 
This table is inserted only as a guide for 
the Medical Examiner. 
Years Old. 
i 
IssSSilllsi 
Expectation. 
Years. 
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DEATHS BY DIFFERENT DISEASES. 
The following table, taken from the New 
Yoi’k Underwriter, gives the number of deaths, 
in England, from each cause to 1,000,000 
deaths from all causes: 
Consumption 118,003 Diarrhoea 42,559 
Bronchitis 86.554 Typhus 36,150 
Atrophy and Debility . 69,284 Scarlatina 26,370 
Old Age 61,414 Pertussis 25,454 
Convulsions 56,294 Paralysis 23,175 
Heart Disease 46,499 Apoplexy 22,309 
Pneumonia 45.275 Premature Bir.h 19,272 Cancer 18,320 
Dropsy 15,112 
Hydrocephalus 15.095 
Tabes Mesenterica 14,754 
Fracture & Contusion. 14,141 
Rubeola 14,124 
Brain disease 12,158 
Liver disease 11,859 
Lung disease, not 
Phthisis 10,278 
Croup 9,405 
Cephalitis 9,047 
Asthma 8.0&5 
Sudden death, cause 
unknown 7,510 
Disease of Stomach... 6,320 
Scrofula 6,299 
Kidney disease 6,260 
Enteritis 6,127 
Drowning (accident).. 5.737 
Burns and Scalds (acci- 
dent) 5,574 
Diphtheria 5,574 
Small Pox 5,388 
Child Birth 5,029 
Epilepsy 4,957 
Rheumatism 4,837 
Nephria 4,723 
Syphilis 3,641 
Disease of. Joints 3,584 
Peritonitis 3,368 
Jaundice 3,201 
Erysipelas 3,109 
Suffocation (accident).... 2,899 
Mortification 2,849 
Hepatitis 2,828 
Laryngitis 2,755 
Ileus 2,528 
Aphthae. 2,493 
Accident,not specified. 2,393 
Uterine disease 2,291 
Metria 2,285 
Dysentery 2,002 
Ulceration of Intestines 1.990 
Hernia 1 ,987 
Cholera 1,977 
Pleurisy 1.354 
Gastritis 1.599 
Ascites 1,552 
Diabetes 1-458 
Insanity 1,372 
Influenza 1.301 
Pericarditis 1,209 
Malformations 1,081 
Aneurism 1,078 
Hanging (suicide).. 1,040 
Cyanosis 1,031 
Purpura and Scurvy— 1,010 
Ulcer 950 
Nephritis 948 
Phlegmon 922 
Murder & Manslaughter. 840 
Spina Bifida 832 
Cystitis 817 
Gout 808 
Intemperance 802 
Delirium Tremens 791 
Skin disease (not speci- 
fied) 776 
\ iolent Deaths(not spec- 
ified) 045 
Intussusception 035 
Poison (accident) 602 
Stricture of Intestines... 596 
Cut or Stab (suicide) 575 
Ovarian Dropsy 530 35 
Carbuncle 504 
Drowning (suicide) 489 
Stone 431 
Quinsy 431 
Stricture of Urethra 422 
Noma 373 
Worms..,. 369 
Suicide (not specified) 300 
Poison (suicide) 289 
Gunshot (accident) 266 
Ague, Congestive 259 
Privation 234 
Ischuria 227 
Zymotic(not specified)... 225 
Cut or Stab (accident)... 221 
Fistula? 214 
Spleen, disease of 199 
Remittent Fever 184 
Arthritis 161 
Gunshot (suicide) 122 
Chorea 101 
Pancreas, disease of 39 
Hanging (execution) 24 
Hydrophobia 21 
Glanders 9 
SCALE FOR URINOMETER. 
Specific 
Gravity. 
FLUIDS EXAMINED. 
1000 
Distilled Water. 
1005 I 
1010 V 
1015 ) 
Average in Bright’s Disease 
May go as low as 
. 1013 
. 1004 
1015 1 
1030 j 
Average limits of healthy urine. 
10301 
1035 1 
1040 | 
1045 ]■ 
1050 
1055 1 
1060 J 
Limits of Diabetic urine. 
Average 
. 1040 36 
The Condition of the Urinary Organs de- 
mands very particular attention, and in sus- 
pected cases a searching analysis should be 
made. The specific gravity of the urine can 
readily be obtained by an ordinary manome- 
ter. By comparing the number on the stem 
to which the instrument sinks with the cor- 
responding number in the annexed table, it 
will at once be apparent how much the sped 
men varies from a normal standard.