PROPOSED LEGISLATION RELATING TO THE 
MEDICAL PORTION OF THE PENSION 
BUREAU. 
BY 
HENRY BIXBY HEMENWAY, M.D., 
OF KALAMAZOO, MICH. 
FROM 
THE MEDICAL NEWS, 
February x, 1890. [Reprinted from The Medicai. News, February i, 1890.] 
PROPOSED LEGISLATION RELATING TO THE 
MEDICAL PORTION OF THf PENSION 
BUREAU. 
By HENRY BIXBY HEMENWAY, M.D., 
OF KALAMAZOO, MICH. 
It is mot a matter of indifference to the general 
profession how any portion thereof is regarded and 
treated. The disgrace of a single man is a disgrace 
upon the fraternity. A physician doing public ser- 
vice is almost without exception ill paid. How 
many health officers receive compensation propor- 
tionate to the work done ? No one would think of 
letting the position of city or county attorney to the 
lowest bidder, and yet in a wealthy and intelligent 
community, at no distant period in the past, the 
position of county physician was given to the lowest 
bidder, after advertising for proposals. While attor- 
neys may regulate admission to the bar, a like 
privilege is not granted to physicians. Because 
many knaves with little education secure large 
patronage, the people depreciate the medical service. 
Two boys set out, the one to study medicine and 
the other law. The lawyer is admitted to the bar at 
the end of two years, after having been able to pay 2 
his expenses by legal writing while studying. The 
doctor must be at constant expense for three full 
years before he is entitled to earn anything by his 
profession. Each is then called upon for a like 
amount of public service. The lawyer’s bill is 
promptly audited, while the authorities hesitate to 
allow one-fourth as much to the doctor. Such con- 
duct toward our profession is belittling and de- 
grading. It is therefore time that the whole pro- 
fession should be aroused to act in harmony. 
The attention of the profession at large has occa- 
sionally been directed to pension lesislation. Dr. 
P. S. Connor, of Cincinnati, read a paper before 
the American Academy of Medicine, at Pittsburg, 
1886, in which he urged the appointment of forty 
boards of examining surgeons, each consisting of 
two members, who should devote their entire time 
to that service. His paper was published in the 
Journal of the American Medical Association (vol. 
vii. p. 570). Dr. L. Brown, of Pottsville, Iowa, in 
the same journal for January 1, 1887, criticised 
this paper at length, but he omitted to say that 
such a special service would not attract men of 
large experience, and lacking that, the examiners 
would be dogmatic and theoretical rather than prac- 
tical. I might give illustrations of this, drawn from 
the work done in the Washington office, had I the 
space. 
On the other hand, it is not desirable that boards 
be too greatly multiplied; first, because from lack 
of available material from which to construct boards, 
the quality of the work done must deteriorate ; and, 3 
secondly, if the work is so decreased as to diminish 
materially the pay of members, the position cannot 
command the best talent. 
In this same journal for Oct. 27, 1888, is an article 
by Dr. John W. Wright, of Columbus, read before 
the Section on Ophthalmology at the meeting of the 
Association in 1888, on “A Plea for the Better 
Recognition of the Oculist in the Service of the 
U. S. Pension Department.” A like plea might be 
made for all specialists treating diseases of men. It 
simply shows hows how preposterous it is to attempt 
to establish a board at every country cross-roads. 
Pension applicants are examined only when 
ordered by the bureau, or by a “special examiner.” 
(The “special examiner’s” work is purely legal, 
and cases are put into his hands in which the evidence 
is conflicting or doubtful.) Examination orders are 
issued in duplicate, one going to the applicant and 
the other to the particular board or single surgeon 
before whom the case is ordered. An order is to be 
obeyed by the applicant and honored by the surgeon 
within three months from date of issue. At the end 
of that time, orders remaining in the hands of the 
surgeon are returned with the endorsement, “failed 
to appear.” The order to the surgeon gives the 
statement of claims. When it is impossible for the 
examination to be made by a “board,” the Com- 
missioner orders a single surgeon to visit the appli- 
cant and make the examination. 
The boards, or single surgeons, do not grant the 
pension, or pass upon the legality of the claim. 
Evidence as to the degree of disability, or to the 4 
cause thereof, have no value for the board. That 
should be sent to the bureau. The work of the ex- 
aming board consists of making a record of the 
present physical condition of the applicant, with an 
estimate of the degree of disability from each cause, 
including senility. Formerly the examination was 
only with reference to the special claims. Under 
the late medical referee, as well as the present, all 
disabilities have been examined, whether originating 
in the service or not. The record made is called 
the “certificate of examination.” 
In the Washington office the force consists of one 
medical referee, one assistant, two surgeons, and 
eighteen medical examiners. These men receive 
each per annum, respectively, $3000, $2500, $2000, 
and $1800. The completed certificate is first ex- 
amined by one of the eighteen medical examiners, 
later by a surgeon and the medical referee or his 
assistant. In passing upon the case, the examiners 
have before them all the papers in the case, often 
including several certificates of examination. Can 
it be expected that a dozen and a half medical ex- 
aminers should carefully judge all the certificates for 
the country ? Is it strange that when the magnificent 
salary of $1800 is paid each examiner, incompetent 
assistance should be secured. Dr. Wright’s remark 
really applies more forcibly to the Washington 
office than elsewhere. 
A certificate of examination must be in the hand- 
writing of a member of the board. It gives the 
eame, rank, service, and post-office of applicant, 
number of his claim, date of examination, and post- 5 
office of board, disabilities for which pension is 
claimed, pulse rate, respiration, temperature, height, 
weight and age of applicant, and applicant’s state- 
ment. These are followed by results of examina- 
tion, and ratings of each disability. If the claim is 
on diarrhoea, for example, the certificate must show 
the condition of tongue, teeth, gums, skin, liver, 
spleen, stomach and intestines, and heart. “ The 
rectum must be explored digitally or with specu- 
lum,” and any fissure, fistula, hsemorrhoid, or pro- 
lapse must be carefully described. As to heart, 
it is required to give location of apex beat, area of 
dulness and position, character of impulse, char- 
acter of sounds, exact location of bruit as to time 
and valve, dilatation or hypertrophy, dyspnoea, 
oedema, or cyanosis. If disease of kidneys is af- 
firmed (which generally means simply lumbago), 
the condition of all vital organs must be stated, with 
chemical and microscopical examination of urine 
and opthalmoscopic examination of the eye. Gun- 
shot and other injuries, neuralgic tracts, etc., must 
be shown by a diagram. Every certificate must be 
signed by each member upon its face and back, and 
it must be copied verbatim into the record book, 
and the copy also signed by each member. 
It will therefore be seen that the work is not 
small—is, in fact, many times greater than that re- 
quired by any life insurance company. It is not 
allowable for one member of a board to make the 
examination. All must participate. Boards vary 
greatly as to capacity for work. One may examine 
thoroughly twenty men, while another is going 5 
through five cases. This capacity for work depends 
upon system and concentration. Since it takes 
more time to write the certificate than to make the 
examination, much depends upon the speed of the 
writer. It is not allowable to have a clerk. Twenty 
examinations is a legal day’s work, and as a rule it 
is a full day’s work. A good certificate must be 
short, concise, clear, and complete. 
Aside from any writing that may be done at the 
meeting of the board, it is expected that the secre- 
tary shall transcribe the certificate into the record 
book, back the certificates (for filing), make out the 
daily and quarterly reports, and attend to the cor- 
respondence of the board. For each day’s work 
there must be made out one daily, and two quarterly 
reports. These reports give, for each applicant, 
date of examination, name of applicant, character 
of claim, number, and services, and the fee of each 
examiner. The names must be arranged in two 
alphabetical series. For a day’s work of twenty ex- 
aminations made by the Kalamazoo board, the word 
“Kalamazoo” must be written sixty times on the 
certificates and fifteen times on reports; total, sev- 
enty-five times. It may occur more times. The 
date must be written 102 times for the same work, 
and each member must sign his name forty-three 
times. No stamping is allowed. 
Surgeons are supplied with the blank forms of the 
office, and envelopes addressed to the Commissioner. 
They must supply other stationery, pay postage on 
all correspondence, except with the Commissioner, 
and furnish an office with the necessary instruments 7 
for making the examinations in accordance with 
modern science. 
Prior to the act of March 3, 1885, surgeons re- 
ceived two dollars for each examination. That act 
reduced the compensation so that now surgeons 
receive two dollars each for each examination up to 
five, and one dollar each on further examinations up 
to twenty, examined on the same day. There is no 
legal compensation for the extra labor devolving 
upon the secretary of the board. Many boards, 
however, agree upon certain concessions. Some 
pay the secretary five or ten dollars per quarter ; 
others ten per cent, of the receipts of the board ; 
others still, ten to twenty-five cents per examination. 
The present small compensation is made still 
smaller by delay in auditing and paying accounts. 
On October 23, 1889, the accounts for the board 
of which the writer is a member had not been 
audited for the quarter ending June 30th. 
A meeting of examining surgeons was held in the 
Pension Building during the International Medical 
Congress, September, 1887. After a general dis- 
cussion, it was resolved unanimously that the present 
compensation is far too small, and Congress was 
asked to restore the former fee. At the request of 
Dr. Campbell, medical referee, I drafted two bills, 
which were introduced before the lower House by 
the Hon. J. C. Burrows. The first of these relates 
to the medical staff in the Washington office, and 
reads as follows: 8 
To increase the efficiency of the Medical Division of the 
Pension Bureau. 
A BILL 
Be it enacted by the Senate and House of Representa- 
tives of the United States of America in Cotigress as- 
sembled, That the medical staff of the Pension Office 
shall consist of one medical referee, one assistant medical 
referee, three surgeons, and twenty-four medical exam- 
iners. 
Sec. 2. That the medical referee shall be a man ot 
preeminent professional ability, and shall receive the 
sum of four thousand dollars annually. He shall be the 
chief of the Medical Division, and as such shall oversee 
and arrange the work of said division. 
Sec. 3. That the assistant medical referee shall also be 
of preeminent professional ability, and shall receive an 
annual salary of three thousand and six hundred dollars, 
Sec. 4. That the three surgeons shall be experts in 
their profession, and shall each receive an annual salary 
of three thousand dollars. 
Sec. 5. That the medical examiners shall be surgeons 
of education, skill and experience, and shall receive each 
an annual salary of two thousand and five hundred 
dollars. 
Sec. 6. That all former acts or portions of acts con- 
flicting with the provisions of this act are hereby re- 
pealed. 
Sec. 7. This act shall take immediate effect. 
It adds one surgeon and six examiners to the 
present force, and increases their salaries as fol- 
lows : 
Medical Referee, from $3000 to $4000. Assistant 
Referee, from $2500 to $3600. Surgeons, from 9 
$2000 to $3000. Medical Examiners, from $1800 
to $2500. 
As originally drafted, at Mr. Burrows’ suggestion 
the salary of medical referee was $5000 and his 
assistant $4000, but Dr. Cambell asked that they 
be cut down as above to assist in the passage of the 
bill. 
The second bill relates to boards of examining 
surgeons, and reads : 
To increase the efficiency of Boards of Surgeo7is for the 
examination of pension applicants. 
Be it enacted by the Senate and House of Representa- 
tives of the Lnited States of America in Congress as- 
sembled, That each member of each board of surgeons 
for the examining of applicants for pensions, shall, as 
now authorized by law, receive the sum of two dollars for 
the examination of each applicant. 
Sec. 2. That the secretary of each board of surgeons 
shall receive a further compensation of fifteen cents for 
each examination. 
Sec. 3. That the secretary of each board of surgeons 
shall be, and hereby is, empowered to employ a clerk, 
and for the official conduct and pay of such clerk the 
said secretary shall be responsible. 
Sec. 4. That all former acts, or portions of acts, in 
conflict with the provisions of this act, are hereby re- 
pealed. 
Sec. 5. This act shall take immediate effect. 
Dr. Campbell thought that section 2 ought to say 
twenty, in the place of fifteen cents. So far as ex- 
amining boards have been heard from, all agree 
A BILL IO 
that it should say twenty-five cents, and when the 
bill is again introduced, this change will be made. 
It must be noticed that section 3 does not add any 
expense, but makes legal the employment of a clerk 
by the secretary. 
Mr. Burrows has introduced these bills before the 
present session of Congress, and Mr. Stockbridge 
will present them in the Senate. It is therefore 
hoped that every physician, whether in the govern- 
ment service or not, will, without delay, write to his 
Representative and Senator in support of these 
bills. It is not claimed that the pay here proposed 
is such as it should be, but it is better than at present. 
If all will give their aid, the changes may be accom- 
plished. If the present low rate of compensation is 
continued, the service must deteriorate. Imperfect 
work necessitates more frequent re-examinations, and 
justice to the pensioner is impossible. THE MEDICAL NEWS. 
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