ANNUAL REPORT 
. . . OF . . . 
Medical examiner-in-Chief, 
. . . OF . . . 
Royal Arcanum. 
1892. 
JOEL SF.AVERNS, M. D. ANNUAL REPORT 
. . . OF . . . 
Medical Examiner-in-Chief, 
. . . OF . . . 
Royal Arcanum. 
1892. 
JOEL SF.AVERNS, M. D. Report of Medical Examiner-in-Chief. 
To the Officers and Members of the Supreme Council of the lloyal 
Arcanum: 
Brethren: During the year that expired December 31, 1892, 
3,079 applications passed through my hands and were acted upon 
as follows: 2,146 were approved, 861 were rejected, and 49 were 
not acted on. Ten others were forwarded to me by mistake, and 
13 were sent for my opinion. 
This total of 3,079 applications was made up of 868 which were 
sent to me from the councils under the jurisdiction of the Supreme 
Council, and 2,211 which were referred to me by the State Medical 
Examiners of the states where there is a Grand Council jurisdiction. 
Of the 868 coming from councils under the jurisdiction of the 
Supreme Council, 739 were approved, 111 were rejected, and 18 
have not been fully acted on. 
Of the 2,211 sent me by the State Medical Examiners, 1,407 were 
approved, 750 were rejected, and 31 were not acted on. Ten others 
were, as above stated, sent to me by mistake, and were forwarded 
from my office to that of the State Medical Examiner for whom they 
were intended, and 13 were sent me as test cases by the State Medi- 
cal Examiners for me to express to them my opinion as to the 
advisability of accepting such risks. 
The cases referred to me for action by the State Medical Exam- 
iners came from the following states, viz.: 
From New York . ... 540 
“ New Jersey . 339 
“ Pennsylvania . . . 289 
“ Massachusetts . 183 
“ Illinois 139 
“ Virginia 91 
“ Georgia 81 
“ Maryland . ... 34 
“ Indiana 26 
“ Rhode Island . 21 
“ Connecticut . 19 
From Missouri 77 
“ Michigan 72 
“ Minnesota 56 
“ Tennessee 58 
“ Ohio 52 
“ North Carolina ... 45 
“ Wisconsin . ... 40 
“ Ontario .... 18 
“ Iowa 16 
“ Nebraska 9 
“ New Brunswick . . 6 
CORRESPONDENCE. 
The amount of correspondence performed at the office has been 
largely in excess of previous years. In addition to the duties of 4 
SUPREME COUNCIL, R. A. 
returning applications in which were unanswered questions, and of 
asking for additional information where the history of the applicant 
or his family history seemed to be stated too briefly or imperfectly, 
all cases where the occupation has not been made clear have been 
inquired into, and this not only in cases of extra-hazardous risks, 
but in every instance it has been required that the application state 
fully the kind of business of all mercantile employees, such as clerks, 
book-keepers, and salesmen, the kind of work done by all mechanics, 
machinists, laborers, and similar classes of men, the nature of the 
duties of all railroad men and electricians, and the various climates 
and ports visited by travellers and mariners. 
These particulars have been sought out and ascertained not only 
for the purpose of determining their influence upon the character 
of the risk and the propriety of its acceptance, which they often 
materially affect, but also to assist in completing the history of 
those who die after admission, the better to enable us to judge 
whether the character of their duties proved unfavorable to their 
health and longevity. In addition to these points it should also 
be stated that in the applications showing a marked discrepancy 
between height and weight none have been decided upon unfavor- 
ably, until careful inquiries have determined whether the figures 
denoting the height and weight in the application were correct, 
and whether the candidate was weighed and measured by the 
examiner. 
It has naturally resulted from these precautions that out of the 
whole number of 3,079 applications, 272 have been returned for 
further revision to the subordinate examiners, and 869 letters of 
inquiry have been addressed to those officials. This work com- 
prises, of course, only a part of the correspondence of the office, 
for in addition to this are the letters in response to rejected appli- 
cants, letters to persons who desire to become applicants, but are 
afraid of rejection, answers to inquiries of all kinds from council 
officers as to the probability of the eligibility of certain persons, 
and the still larger branch of inquiry ordered by the Supreme 
Regent in the investigation of the history of deaths. Altogether/ 
no less than 3,127 pages of my letter books have been filled during 
the year. 
ENUMERATION OF DEATHS. 
The Supreme Secretary reports that 1,170 deaths have been 
officially reported during the year, and with an average member- 
ship of 132,134 men it results that the ratio of deaths to the thou- 
sand has been 8.86, which is a little less than the rate of last year, 
9.02, but larger than some of the previous years; undoubtedly the 
grippe still swells our mortality list, though not so greatly as in some 
of the other fraternal associations. REPORT OF MEDICAL EXAMINER-IN-CHIEF. 
5 
These deaths were distributed in the various states as follows 
Arkansas 10 
California 3 
Colorado 1 
Connecticut 21 
District of Columbia ... 8 
Georgia 43 
Illinois 89 
Indiana 20 
Iowa 4 
Kansas 1 
Kentucky 1 
Maine 3 
Maryland 52 
Massachusetts 129 
Michigan 44 
Minnesota 2 
Missouri 28 
Montana 1 
N ebraska 3 
New Brunswick 5 
New Hampshire 5 
New Jersey 55 
New York 257 
North Carolina .... 19 
Nova Scotia 2 
Ohio .... 90 
Ontario 30 
Pennsylvania 133 
Quebec .... ... 1 
Khode Island 10 
Tennessee . . 22 
Utah 1 
Vermont 2 
Virginia 47 
West Virginia 2 
Wisconsin 26 
The mortality of the different states as shown by the proportion 
which the number of deaths in each bears to the number of members 
appears as follows: (As in former years the table includes only 
those states wherein the membership exceeds five hundred.) 
State. 
Number of 
Deaths. 
Average 
Membership. 
Rate per 1,000. 
Arkansas . . 
10 
590 
16.9 
Virginia ... 
47 
3,768 
12.5 
North Carolina 
19 
1,535 
12.4 
Georgia 
43 
3,482 
12.3 
Maryland . . 
52 
4,563 
11.4 
Ohio 
. 90 
9,004 
9.9 
District of Columbia 
8 
817 
9.8 
Ontario . . . . 
30 
3,107 
9.6 
New York . . . 
. 257 
27,679 
9.3 
Massachusetts . . 
. 129 
13,901 
9.3 
Tennessee .... 
22 
2,404 
9.2 
Illinois .... 
. 89 
10,267 
8.6 
Pennsylvania 
133 
15,623 
8.5 
Connecticut . . . 
. 21 
2,551 
8.2 
Rhode Island . 
10 
1,232 
8.1 
New Brunswick 
5 
631 
7.9 
Wisconsin . . . 
20 
3,315 
7.8 
Michigan ... 
44 
5,859 
7.7 
Indiana . . 
. 20 
2,893 
0.9 
Missouri ... 
28 
4,054 
6.9 
New Jersey . . 
. 55 
8,369 
6.6 
Maine 
3 
503 
5.9 6 
SUl’KEME COUNCIL, K. A. 
State. 
Number of 
Deaths. 
Average 
Membership. 
Rate per 1,000. 
Nebraska . . 
. . . 3 
519 
5.8 
Iowa . . . 
. . . 4 
1,024 
3.9 
Kentucky 
. . 1 
530 
1.9 
Minnesota . . 
. . . 2 
1,398 
1.4 
Of the six largest jurisdictions,— New Jersey, Pennsylvania, Illi- 
nois, Massachusetts, New York, and Ohio, — the first mentioned occu- 
pies the place of honor, as she did two years ago ; the others follow 
in the order given, though the difference between Massachusetts and 
New York is so small as to require two decimal figures to indicate 
it. Arkansas is first in the list of mortality, and four other Southern 
states follow" it directly, whilst Tennessee, Missouri, and Kentucky 
hold an excellent position, the latter having lost but one of its five 
hundred and thirty members during the year, and being surpassed as 
regards its small proportion of deaths only by Minnesota. Still, 
howrever, in the states where the membership is so small as in Ken- 
tucky, Maine, and Nebraska, the occurrence of a single death in one 
or the other may make a great difference in their relative standing, 
which seems, therefore, largely a matter of accident. 
CLASSIFICATION. 
The arrangement of these deaths by classes shows the following 
results: 
Classes. 
Whole Number. 
Percentage. 
Zymotic . 
... 93 
7.9 
Tubercular 
.... 170 
14.5 
Brain and spine 
... 193 
16.5 
Heart and arteries .... 
.... 137 
11.7 
Lungs (not phthisis) . . . 
141 
12.1 
Digestive organs 
121 
10.4 
Kidneys, etc 
... 118 
10.1 
Casualities 
.... 100 
8.6 
Suicides 
... 29 
2.4 
Cancers 
. . 42 
3.6 
Unclassified 
... 26 
2.2 
1,170 
100.0 
The proportions of these classes differ hut little from the usual 
average, as will be seen from the following table; but the number 
of deaths from the zymoses, phthisis, and suicides, is materially less 
than in many years. Deaths from diseases of the urinary organs, 
as in the previous year’s report, were somewhat more than usual, as 
were also the deaths by misadventure. REPORT OF MEDICAL EXAMINER-IN-CHIEF. 
7 
1880. 
1881. 
1882. 
1883. 
1884. 
1883. 
1886. 
1887. 
1888. 
1889. 
1890. 
1891. 
1892. 
Aver- 
age. 
Zymotic 
14 
19 
11.6 
8.8 
11.6 
10.7 
12.2 
9.9 
10.6 
9.3 
10.2 
9.1 
7.9 
11.2 
Tubercular 
13 
12 
17.8 
19.5 
20.3 
16.9 
15.9 
15.9 
14.7 
14.5 
14.3 
15.4 
14.5 
15.7 
Brain 
16 
10 
13.7 
15.7 
15.6 
14.4 
15.5 
17.6 
17.6 
17.0 
16.2 
14.8 
16.5 
15.4 
Heart 
9 
9 
8.7 
7.9 
9.1 
10.7 
12.0 
11.8 
8.2 
9.0 
11.4 
10.6 
11.7 
9.9 
Lungs 
13 
12 
14.1 
9.5 
12.4 
9.9 
11.6 
10.7 
13.7 
10.8 
14.6 
15.0 
12.1 
12.3 
Digestive 
9 
13 
11.2 
9.7 
7.7 
12.8 
9.0 
11.5 
10.9 
11.0 
9.3 
9.0 
10.4 
10.3 
Kidneys 
9 
8 
5.0 
9.7 
6.4 
7.3 
7.0 
7.4 
8.9 
9.6 
7.7 
10.3 
10.1 
8.2 
Casualties 
10 
9 
8.7 
7.7 
7.7 
5.9 
8.7 
7.1 
6.5 
8.5 
7.0 
6.8 
8.6 
7.9 
Suicides 
5 
1 
3.3 
5.3 
3.0 
3.7 
3.1 
2.3 
4.3 
3.5 
3.9 
3.4 
2.4 
3.4 
Cancer 
2 
6 
3.7 
3.8 
3.0 
4.5 
3.0 
2.9 
3.9 
4.5 
3.3 
3.6 
3.6 
3.7 
Unclassified 
0 
1 
2.0 
2.4 
3.1 
3.4 
2.0 
2.9 
0.2 
2.3 
2.1 
2.0 
2.2 
2.0 
COMPARISON WITH PREVIOUS YEARS. 8 
SUPREME COUNCIL, R. A. 
ZYMOSES. 
The deaths from zymotic diseases numbered 93, and as usual were 
made up principally (67 in all) of malarial diseases and of typhoid 
fever, though the latter had much the greater number, namely, 52. 
Quite a large portion of the typhoidal deaths were the result of per- 
foration of the bowels or intestinal hemorrhage. In one case the 
temperature ran very high, being never less than 104, and in the 
course of the three weeks of the fever running up to 107 degrees. 
The malarial victims were largely from the Southern states, though 
not by any means exclusively so. 
Of the whole number of zymotic deaths, 21 were from the South- 
ern states, and 70 from the North. 
Four were cases of malignant diphtheria, and one was of yellow 
fever, occurring in a sea-captain during a voyage. 
Seventy-three of them died before they were fifty years old and 
13 died in their first year of membership. ’ The shortest term of 
membership were those of a member from Georgia whose death was 
numbered 6911, and who lived but three and one-half months after 
joining us, dying of typhoid fever; and one from Pennsylvania, also 
living but three and one-half months, and a victim of typhoid. 
Death No. 6962 was that of a Virginian, who also died of typhoid 
seven months after joining. Another typhoid death was No. 7051, 
from Pennsylvania, the member living a little more than six months ; 
and still another was a typhoid case from Virginia (7257), who died 
in six months. There are, however, no special features of interest 
in these cases except their brief terms of membership. 
The rate of death by zymotic diseases was, however, much lower 
than usual this year. 
PHTHISIS. 
The proportion of deaths under this heading has not been unduly 
large, though I have included in it not only those from phthisis pul- 
monalis, but all others which were said to have been due to tuber- 
culous deposits, whether in the lungs, brain, or abdomen, and have 
added all which were caused by chronic pulmonary illnesses, even 
when they have been designated by the attending physicians as 
chronic bronchitis, chronic pneumonia, or even asthma. Two or 
three cases wdiere a sudden attack of hemorrhage of the lungs proved 
fatal have also been included in the phthisical column, although there 
was no previous history of continued pulmonary disease, or even 
ill health. 
The whole number of this class of deaths is 170, and they occurred 
in the various states, as follows : REPORT OF MEDICAL EXAMINER—IN—CHIEF. 
9 
Arkansas 1 
California . . 0 
Colorado 0 
Connecticut 4 
Delaware 0 
District of Columbia ... 0 
Georgia 7 
Idaho 0 
Illinois .15 
Indiana 2 
Iowa 1 
Kansas 0 
Kentucky 0 
Maine 0 
Maryland 8 
Massachusetts 18 
Michigan 5 
Minnesota 0 
Missouri 5 
Montana 0 
Nebraska 0 
New Brunswick . ... 0 
New Hampshire ... ,1 
New Jersey 10 
New York 42 
North Carolina .... 2 
Nova Scotia 0 
Ohio 10 
Ontario 6 
Oregon 0 
Pennsylvania 20 
Quebec 0 
Rhode Island 1 
South Dakota 0 
Tennessee 1 
Utah 0 
Vermont 1 
Virginia 6 
Washington 0 
West Virginia 0 
Wisconsin 4 
In the States which have over 1,000 members the relative propor- 
tion of deaths by consumption to the 1,000 members was as follow's 
State. 
Deaths. 
Membership. 
Rate per 1,000. 
Georgia . . . 
... 7 
3,482 
2.0 
Ontario . . . 
... 6 
3,107 
1.9 
Maryland 
... 8 
4,563 
1.8 
Virginia . . . 
... 6 
3,768 
1.6 
Connecticut 
... 4 
2,551 
1.6 
New York . . 
... 42 
27,679 
1.5 
Illinois . . . 
. . 15 
10,267 
1.5 
North Carolina 
... 2 
1,535 
1.3 
Massachusetts 
. . 18 
13,901 
1.3 
Missouri . 
. . 5 
4,054 
1.3 
Pennsylvania 
... 20 
15,623 
1.2 
Wisconsin . . 
... 4 
3,315 
1.2 
New Jersey 
. . . 10 
8,369 
1.2 
Ohio .... 
... 10 
9,004 
1.1 
Michigan . . . 
... 5 
5,859 
0.9 
Rhode Island . 
• • 1 
1,232 
0.8 
Indiana . . . 
o 
2,893 
0.7 
Tennessee . . 
. . 1 
2,404 
0.4 
California, Minnesota, and 17 others of the smaller jurisdictions 
lost none by phthisis. 
As in previous years of course a very large majority of thsse 
fatalities occurred in youthful men of light weight; 22 were under 10 
SUPREME COUNCIL, K. A. 
30 years of age at death, and 52 were under 30 when they joined; 
140 were under the normal weight, and 30 were above it. 
Fourteen of them were over 50 years of age at entrance, thus 
affording fresh evidence that we can never exclude all danger of 
consumption, even in persons well advanced in life. 
Nine of our members died of phthisis in less than a year, one in 
about two months of “ galloping consumption,” and an investigation 
of the case led to the belief that the disease existed when he was 
examined. The commission of the medical examiner was therefore 
revoked. 
Death No. 6295, in a young man of 22, occurred in about four 
months from an abdominal disease, with emaciation, and was believed 
by the attending physician to have been of a tubercular character, 
but no autopsy was held to decide the precise nature of the disease. 
Still another of abdominal origin was death No. 6316, where the 
patient died after an illness commencing, as is stated, shortly after 
his admission to the order. He had diarrhoea, want of appetite, 
emaciation, cough and chronic bronchitis, with ulceration of the 
bowels; there was no post-mortem examination. Death No. 7090 
was also considered to be a case of tubercular disease of the mesen- 
tery, which proved fatal in about ten months. 
Another (No. 7214) died in eleven months after becoming a 
member, and the duration of his illness is said to have been six 
months and to have been the result of the grippe; his symptoms 
were constant cough, profuse sweating, high temperature, and speedy 
exhaustion. He was a machinist by occupation, and this is believed 
to have been one of the causes of his disease. 
Death No. 7230, also occurring in a few weeks less than a year, is 
said to have been the result of an attack of pneumonia, from which 
he never rallied. He had, however, lost a sister by phthisis, so that 
there was probably a tubercular taint in the family. 
The useful restrictions of our laws protect us from the admission 
of those whose family history shows any marked tendency to this 
disease, and therefore there have been but few members who have 
thus died in whom there has been any clearly shown hereditary 
predisposition. In twenty-four instances only there is direct record 
of the occurrence of death by consumption in the family of the 
deceased when he joined. Eleven had lost a parent by consumption, 
and each of the eleven was more than thirty years of age on admis- 
sion. One had lost a mother and sister by consumption, but he 
himself was over fifty years old and was undoubtedly believed to be 
beyond the age when he was liable to take consumption. Still 
another had lost three brothers and sisters by consumption, and this 
applicant was thirty-six years old on joining, and lived eleven years 
afterwards. He died, however, of phthisis. REPORT OF MEDICAL EXAMINER-IN-CHIEF. 
11 
DISEASES OF THE BRAIN. 
The deaths from diseases of the brain and spinal cord were 193 
in number, and were mostly from apoplexy and paralysis; the 
former, including those designated cerebral hemorrhage, amounting 
to 84, and the latter, including all called paralysis and paresis, num- 
bering 43; 18 were attributed to meningitis, 13 to brain softening, 
11 to congestion of the brain, and 11 were simply designated as 
brain disease. There were 3 cases of locomotor ataxia, 2 of epilep- 
tic or epileptiform convulsions, 2 of nervous prostration, and 1 each 
of progressive muscular atrophy, acute mania, and multiple sclerosis. 
They were, of course, mostly in men of middle age or more, and 
10 had reached the age of 70 ; 149 were over 45 years old, but there 
were 5 who died before their thirtieth birthday. Of the last men- 
tioned 1 died at 25 of acute meningitis, 1 at 25 of cerebral hemor- 
rhage, 1 at 26 of congestion of the brain, 1 at 23 of what was called 
“ disease of the brain,” and 1 at 28 of apoplexy. The first man 
(No. 6606) died a few weeks after becoming a member. He had 
had no previous illness, and was an undertaker by trade. The dur- 
ation of his last illness was four days, with symptoms of catarrh, 
oedema of the lungs, delirium, and collapse. Ilis occupation may 
have predisposed him to this disease. 
The second (No. 6635) died in less than a year after joining the 
Order ; he was taken suddenly ill, was unconscious for eight hours 
and a half, regained consciousness, but died an hour later. His 
family history was good, and he was a printer by trade, but had 
been using stimulants too freely for the last month before his death. 
The third (No. 6861) also died in less than four months. He was 
a cabinet-maker, and had had typhoid fever and slight piles before 
joining. The duration of his last illness was but ten days, with 
inflammation of the brain, terminating in acute congestion. No 
autopsy was held. 
The fourth (No. 6931) died two and one-fourth months after his 
admission to the Order. He had had no previous sickness, and was 
by trade a coppersmith. lie was ill three weeks with brain symp- 
toms, delirium, coma, etc., and died from meningitis, probably tuber- 
cular. In this case, also, no post-mortem examination was held. 
The fifth (No. 7043) was a merchant, and had had no previous 
illness, hie remained in a wild frenzied condition for about an hour, 
then became comatose, with symptoms of compression of the brain, 
and died in twenty-four hours. 
One of the five who died young, the last, had lost a father by the 
rupture of a blood-vessel, and another had lost a brother at seventeen 
by meningitis, said to have been the result of an injury. 
An evident hereditary tendency to cerebral diseases existed in 17, 
who had each lost a parent, or a brother or sister, from some kindred 
form of disease; in one, the father and sister each had cerebral or 12 
SUPREME COUNCIL, R. A. 
spinal disease; one, who died of softening of the brain, had reported 
that his father died of alcoholism. 
It may be said in conclusion that a large majority of the men 
included in this class were above the normal weight. 
DISEASES OF THE HEART AND BLOOD-VESSELS. 
Various forms of cardiac lesions caused the death of 137 of our 
members, of which 34 are said merely to have had heart disease or 
heart failure, 45 are reported to have had valvular disease, ‘23 angina, 
14 endocarditis, pericarditis, or myocarditis, 6 hypertrophy or dila- 
tation, 8 fatty degeneration, 2 rupture of the heart, 1 had embolus 
of the femoral artery, and 1 had varicosis. The last is said to have 
had varicosis not only of the veins of the limbs and abdomen, but of 
the brain as well, and the attending physician believed death to have 
been owing to one of the latter vessels. The whole vascular circu- 
lation is said to have been involved, and he was under medical 
treatment and observation for several months; he was forty-nine 
years old at death. 
Most of the men in this class were above the ordinary weight and 
were no longer young; 81 were above and 54 below the standard of 
weight to height in our tables. Only one was under 30 years of age 
at death, 4 were over 70, and 105 were over 45. 
In 21 only was there a direct history of rheumatic disease. 
No less than 41 died suddenly, or with an illness of not over 24 
hours. Some of these were known previously to have had some 
form of heart disease, but many of them at the time of the fatal 
attack were apparently in robust health. 
No. 6678 had had no illness prior to joining the Order, and was 
ill but half an hour. lie had some organic disease of the heart, and 
died sitting in his arm-chair, of heart failure. 
No. 6785 had suffered at times from pain in his stomach during 
the past two weeks, and fell from his chair and instantly expired, 
probably from paralysis of the heart. 
No. 7003 was a bank president, and had had no illness before 
joining. He too died instantly, but had had cardiac depression for 
some time with a pulse rate of thirty. lie had been about during 
the forenoon, but when he arose from the dinner-table dropped dead. 
No. 7189 was a merchant. In 1863, during the war, he had had 
his arm amputated at the shoulder. He was at his store talking and 
smoking, and suddenly fell dead. He had a habit of excessive 
chewing and smoking tobacco. 
No. 7248 was a United States gauger: previously had jaundice in 
the army, and dysentery. He was found dead in his room at a 
hotel; from the evidence and a post-mortem examination the verdict 
at the coroner’s inquest was that he died of fatty degeneration of 
the heart. 13 
REPORT OE MEDICAL EXAMINER-IN-CHIEF. 
No. 7298 was a journalist. The duration of his last illness was 
six or seven hours. He had “breast pang” while getting off a street 
car, recurring at intervals till death. He had had previous attacks, 
and was addicted to alcohol. 
No. 7425 was ill but twelve hours. lie woke at 5 A.M. with pain 
in the region of the heart and left shoulder, extending down his arm 
and hand, and continuing till death, at 5 P. M. 
Only one of the 187 died in less than a year alter his admission to 
the Order, and the history of his illness is reported simply as that of 
a case of hypertrophy and dilatation of the heart with mitral regurgi- 
tation and general anasarca. He was 39 years old at death. 
Of the 7 sudden deaths just described none had been members 
less than three and a half years, and all but 2 had been members 
more than 10 years. All but 1 were over 50 years of age. 
ACUTE RESPIRATORY DISEASES. 
The number of those who died of acute diseases of the lungs was 
141, although a few cases, which were called pneumonia, pleurisy, or 
chronic bronchitis by the attending physician, have been placed by 
me in the phthisical column, because the history of the attacks and 
the symptoms seemed to show that the disease was probably tuber- 
cular. 
A very large proportion of this class of deaths (110) was attrib- 
uted to pneumonia, some being called simply pneumonia, others 
typhoid, broncho- or pleuro-pneumonia, according to the prominent 
features of their attacks. 
Others died of bronchitis, asthma, congestion of the lungs, quinsy, 
laryngitis, and grippe, though in all some lung«affection was eventu- 
ally the principal cause of death. 
No. G584 was ill but three days, but had suffered from la grippe 
for two weeks, without consulting any physician. He was then 
taken with severe pain in the right side, followed by fever, with a 
temperature of 103£ and a pulse of 144, was unable to lie down, 
had large effusion into the pleura, and a weak pulse, followed by 
heart failure. lie was a glass-blower by trade. 
No. 6608 had a duration of illness of one month, and was a manu- 
facturer. He had suffered from gout and had a gouty arthritis of 
the knee-joint; was threatened with suppuration of the joint, with 
considerable fever which undermined his health ; he also had en- 
largement of the liver and congestion of the brain. Death was 
finally caused by oedema of the lungs. 
No. 6676 had suffered from bronchitis, and had had quinsy five 
times in thirty years, leaving a difficulty in swallowing. His last ill- 
ness lasted one week. He had an invasion of quinsy almost every 
spring, and was an inveterate smoker, which probably weakened his 
heart. His fatal illness was caused by an ordinary attack of quinsy; 
“ the inflammation suddenly extended toward the larynx, a sudden 14 
SUPREME COUNCIL, It. A. 
spasm of the glottis supervened, and the heart failed at the same 
time under the strain ; death resulting with extraordinary rapidity. 
The malignant character might be laid to prevalent grippe.” He 
was a judge. 
No. 6772 had had pneumonia five years before joining the order. 
He wras a lieutenant, and while en route to join his station, con- 
tracted his fatal illness, and died at Sitka, Alaska, after an illness of 
two weeks. He had dry pleurisy of the left lung in the axilla, con- 
solidation of the left lower lobe, temperature 104, pulse and respira- 
tion nearly normal. Resolution occurred in the left lobe, but the 
next day the right lung became involved, the lower lobe of this 
became consolidated, the temperature rose, the respiration became 
more rapid and labored, the pulse grew rapid, weak, and irregular, 
low muttering delirium supervened, and though for six hours there 
was a slight improvement, he then failed rapidly till death. 
DISEASES OF THE DIGESTIVE ORGANS. 
Among the diseases of the digestive organs from which 121 of our 
members died during the past year, of course hepatic affections 
occupied the first place, and numbered 30. 
There were 16 cases of peritonitis, and 10 of gastritis, not includ- 
ing 5 cases of hematemesis and 3 of ulcer of the stomach. Gastro- 
enteric complaints were 15 in number, in addition to 10 cases which 
were called diarrhoea or dysentery. 
Eight were cases of intestinal obstruction, including 1 of impacted 
gallstone and 3 of strangulated hernia. 
Twelve cases of typhlitis (appendicitis), a very large number, 
occurred, and in 5 of them laparotomy (a surgical incision into the 
bowels) was performed without saving the patient. In one other 
case also this operation was performed with fatal result. This was 
in No. 7001, the case of a merchant who had had no illness previous 
to becoming a member. His fatal illness lasted two weeks, being 
appendicitis gangrenosa, followed by perityphlitic abscess; an 
operation was performed successfully, and the case progressed well 
until hepatitis produced chohemia and death. This diagnosis was 
proved bv a post-mortem examination. 
Death No. 6629 was that of a manager. His last illness was of 
seven days’ duration, with rupture of the appendix vermiformis, 
abscess, and inflammatory products. The appendix became gan- 
grenous with well-defined abscess, which was opened, and the man 
died on the following day of septic peritonitis. 
The duration of the last illness in death No. 7161 was six days, 
lie was taken sick while in New York, came home to Pine Bluff, 
Ark., suffering violent pain in abdomen with excessive vomiting. 
He grew rapidly worse with suppurative peritonitis complicating his 
disease. Laparotomy was performed and a large quantity of pus REPORT OF MEDICAL EXAMINER-IN-CHIEF. 
15 
was removed, but he was not relieved, and died a few hours later. 
He was a cotton buyer. 
No. 7250 was that of a merchant who was ill but five days, with 
intestinal obstruction followed by appendicitis and general septic 
peritonitis. An operation was performed, but did not save the 
man’s life. 
No. 7352 was that of a contractor who had had typhoid fever 
fifteen months before joining the Order. The duration of his last 
illness was three days. He also had acute appendicitis and peritoni- 
tis. An operation was performed, and the appendix was found 
gangrenous and perforated. Death followed rapidly. 
No. 7475 had a duration of illness of ten days. He was exposed 
to cold at a funeral and had a chill, followed by appendicitis and 
perityphlitis. An operation was performed and the vermiform ap- 
pendix was removed, but he died subsequently. He was a salesman, 
and was a strictly temperate man. 
In one case also (No. 7111) of internal strangulated hernia, an 
abdominal incision was made, and the case is thus described: He 
was taken suddenly ill with symptoms of bowel obstruction. Sixty 
hours later abdominal section revealed strangulation of the small 
intestine through an aperture in the mesentery. He died of uncon- 
trollable vomiting forty-eight hours later. Internal strangulated 
hernia was shown by the post-mortem examination. He was ill but 
four days, and was a ticket agent by occupation. 
KIDNEY DISEASES. 
There is hut little evidence of hereditary tendency in 118 mem- 
bers who died from diseases of this class; only 2 having lost a 
relative by Bright’s disease, 8 one each of diabetes, 1 a sister, of 
nephritis, 1 a brother, of kidney disease, and 4 different members 
of the family, of so-called dropsy. 
The list was made up of 83 cases of Bright’s disease, or chronic 
nephritis, 14 of diabetes, 9 of cystitis, 2 of abscess of the kidney, 
2 of stone, and 1 each of prostatic disease, lithaemia, septicaemia 
(probably prostatic), nephritic colic, pyuria, and gouty kidneys. 
Only one (No. 6827) had been a member less than a year, though 
8 died in less than 2 years; but the great majority had belonged 
to the Order many years and were old men, 67 of them being more 
than 50 years old, 3 over 70, and only 4 under 30 years of age at 
death. The one who died in about six months (No. 6827) seems to 
have been taken with a sudden acute affection of the kidneys, and 
the tale is briefly told as follows: he suffered from intense conges- 
tion, pain, and nausea of stomach, congestion of liver, suppression 
of the urine and uraemia,; death followed at the end of an illness of 
eighteen days. He was a druggist, and had had dyspepsia before 
becoming a member. 16 
SUPREME COUNCIL, R. A. 
No. 6839 was the case of a merchant who had previously had 
occasional neuralgia. His fatal illness lasted one year, and he 
had litlnemia for some time prior to that, causing insomnia, 
anorexia, high specific gravity of the urine (1,030) writh alter- 
nately albumen and sugar, numbness of the limbs, staggering gait, 
pain in the back, and general malaria, becoming more intensified as 
the end grew near. After eating a hearty supper he dropped dead 
from heart failure caused by weakness. 
Death No. 6682 occurred in one of our members who was a 
caterer. The duration of his last illness was two years, and was 
caused by general overwork, producing sub-acute articular rheuma- 
tism of left shoulder, hip, knee, ankles, and the joints of the fingers 
and toes, with great pain, swelling, tenderness, redness, fever, and 
symptoms of general nervous prostration, lie had no appetite, and 
w7as unable to retain food, suffering from diarrhoea, cough, pain in 
the back and all over the body. The urine contained albumen with 
casts. Then followed symptoms of uraemia, labored heart’s action 
which became irregular and wreak, and he grew gradually worse till 
death came from heart failure. 
The duration of illness in No. 6651 was but five days, though he 
had previously had symptoms of diabetes lasting eight months. lie 
had passed large quantities of urine since September, 1891, and 
though at the last he had slight pneumonia, it probably would not 
have been fatal had it not been for the diabetes. He finally died 
from exhaustion. He worked at his trade as master mechanic 
till five days before his death. His mother died in the preceding 
October of diabetes. 
No. 6999 was that of a man wdio had no occupation and whose 
final illness lasted several months, writh pain and tenesmus in the 
bladder, and frequent desire to urinate; lithotomy (primal), and 
supra-pubic cystotomy for encysted stone were performed with con- 
sequent exhaustion and death from nerve shock. There was no 
post-mortem examination. 
ACCIDENTS. 
No less than 100 of our members have died from the effects of 
casualties which were of exceedingly various kinds. 
Twenty-three died by falling or by being injured by falling objects, 
18 were killed by railroad accidents, 11 were drowned, 8 died from 
the effects of heat (sunstroke, etc.), 7 received gunshot wounds, 
and G were poisoned by overdoses of medicine, 8 were caught in 
machinery, and 3 were murdered. There were several who met with 
unusual accidents, 1 of whom died in the deserts of Arizona from the 
effects of exposure whilst out prospecting, 1 w as suffocated by the 
inhalation of gas, 1 wras kicked by a horse, 1 was crushed by an 
elevator. REPORT OF MEDICAL EXAMINER-IN-CHIEF. 
17 
Seven of the railroad accidents happened to railroad men, of whom 
2 were freight conductors, 2 brakemen, 1 a conductor, 1 an engineer, 
and 1 a postal clerk. The brakemen were both killed in the dis- 
charge of their usual duties; the 2 freight conductors and the other 
conductor were likewise killed whilst performing their daily work; 
1 had both legs cut off; 1 had been a member but four months, and 
was admitted to the Order by an oversight of the State Medical 
Examiner. Three engineers were among the dead, 1 being run over 
whilst standing on the track, 1 drowned by accident in Lake Erie, 
and 1 murdered, receiving a fracture of the skull and multiple 
wounds of the head. 
The other murdered men were a physician (No. 6346) and a sea- 
captain (No. 7635). The physician was summoned to the door and 
shot in the head and limbs and instantly killed. The sea-captain 
was murdered on board his bark, the “William Hales,” of New 
York, at sea, by the Chinese cook, who killed him and his wife 
while asleep in the cabin, with the ship’s broadaxe. The murderer 
then jumped into the sea and Avas drowned. According to the 
report of the case, the deed seems to have been instigated by the 
mate. The depositions of the crew Avere all made and sworn to 
before the U. S. Counsel at Cape Town, South Africa, the first port 
made by the ship afterwards. 
SUICIDES. 
Out of our total of 1,170 deaths only 29 committed suicide, to the 
best of my information and inquiry. 
This favorable showing is doubtless largely owing to the care 
which has been exercised in keeping out all candidates in whom 
there seemed to be an hereditary tendency to insanity or suicide; 
the result apparently vindicates us from the charge so often made 
of being too strict with applicants who have a family history of 
insanity. 
Eleven shot themselves, 8 ended their lives by hanging, 6 took 
poison (Paris green, opium, etc.), 2 cut their own throats, 1 suffo- 
cated himself by gas, and 1 drowned himself. 
Four were less than 30 years old at death, and the youngest was 
25; 9 were over 50, and 3 of them were over 60. 
They were fairly enough distributed in the different states, for 
New York had 7, Pennsylvania 4, Massachusetts and Michigan each 
3, Ohio, New Jersey, Georgia, Tennessee, and Missouri each 2, 
whilst Illinois had but 1, and West Virginia 1. 
They were still more divided in their occupations, as there was of 
course a fair complement of merchants, salesmen, and book-keepers, 
2 of each, but there was also a minister, a physician, and a dentist, 
as well as an engineer, a coal dealer, a grocer, and a provision 
dealer, also a manager, a real-estate agent, a restaurant-keeper, a 18 
SUPREME COUNCIL, li. A. 
chief of police, a livery-stable keeper, a farmer, a piano-tuner, a 
glass-cutter, etc. No trade or profession seemed to have the advan- 
tage of any other in the matter of numbers, and the only point 
which occurs to me in connection with their occupations is that 
none of them wrere plumbers, painters, or printers, or dealers in 
leaden materials. 
CANCER. 
Forty-two deaths were the result of cancer or other malignant 
growths. These occurred mostly in men beyond the middle age, 33 
being over 45, none under 30, and 1 being over 70. 
The disease occurred 14 times in the stomach, 10 times in the 
liver, 6 times in the bowels* mesentery, or rectum, and was also 
found in the lungs, chest, mouth, and tongue, etc. 
In 7 instances a surgical operation wras performed for the removal 
of the diseased parts, but afforded only temporary relief. 
Two cases only furnished a history of a family tendency to the 
disease ; in one, the mother having died of uterine cancer, and in the 
other, the father having died of cancer of the stomach. Both these 
members had belonged more than nine years. 
Only one (No. 6302) had been a member less than a year, and 
the membership of the majority was over 8 years in length. 
UNCLASSIFIED. 
I have entered in this section 26 cases which cannot be for various 
reasons included under previous heads. Five of these deaths were 
due to anaemia, called in two instances pernicious anaemia. No. 
6f>29 was thus described: he had dysentery and jaundice some 
years before entering the Order. His last illness continued four or 
five years, and was marked by gradually progressing rhythmical 
tremor, muscular rigidity, digestive disturbances, impaired nutrition, 
intercurrent gastric and bronchial catarrh, anaemia, mal-nutrition, 
and exhaustion. In another invalid the anaemia was accompanied 
or caused by hemorrhage from the bowels and vomiting of blood. 
Seven were cases of chronic alcoholism, 1 being a liquor dealer. 
Three died from carbuncle, with the debilitating and exhausting 
symptoms usually attendant. 
One had lymphangitis, or inflammation of the lymphatic vessels, 
quite probably due to septic causes. He was a liquor salesman, and 
his symptoms were red lines in the right leg, inflamed glands, an 
erysipelatous condition, and lastly, heart failure, as these changes 
subsided. It is said that his social habits and occupation were potent 
factors in precipitating his illness. 
In 2 undertakers blood poisoning was attributed to the effects 
of their occupation, and was indicated bv fever, pain in the muscles UKPORT OF MEDICAL EXAMI^ER-IX-CHIEF. 
19 
and joints, with impoverishment of the blood, and abscesses, as well 
as general breaking down of the tissues. One had an abscess of the 
eye. 
One with rheumatism and dropsy is reported to have had great 
pain from rheumatism, “ so that one eye burst.” This was succeeded 
by dropsy of the bowels and limbs, and eventually partial paralysis. 
Another is said to have died from convulsions, with a history 
of spasms resembling those which are the results of strychnia poi- 
soning, but the cause was not discovered. 
A case of purpura hemorrhagica is also included, in which the 
patient had fever for two days, purple spots on the surface of the 
body, vomiting, and great distress and pain, with sub-normal tem- 
perature, and general prostration. A post-mortem showed extrava- 
sated blood in the intestines and other viscera. 
A patient with gangrene (No. 7086) had the disease in the leg ; 
it was supposed to be caused by a blood clot or embolism. lie was 
a farmer, and had been dissipated. . 
No. 7361 was one of necrosis of the leg, requiring amputation 
below the knee, followed by gradual sinking, pneumonia, and death. 
The last of the 26 deaths occurred in a tailor who had been very 
intemperate. This resulted in diarrhoea, vomiting, and nervousness 
and insomnia. There was some reason to think that an overdose of 
chloral was the final cause of death. 
LA GRIPPK. 
In 97 instances in the past year has la grippe been a prominent 
agent in causing the death of our members. It is not probable that 
our total number of deaths has been directly increased to that extent 
by this disease; but in 97 deaths la grippe is spoken of as either 
causing the mortality, accelerating it, or sowing the seeds of it. 
Arranging the cases as in other reports into three classes, first, 
those in which the epidemic constituted the chief source of the fatal 
illness (even when the illness terminated, as it might, in acute dis- 
eases of the lungs, the bowels, the brain, the kidneys, or some other 
organ); second, those in which the epidemic attacked persons already 
invalids, so adding to their burdens that they died in consequence; 
and third, those who having had the disease and imperfectly recov- 
ered from it were left so feeble by its ravages that they soon sank 
from some chronic disease, as, for instance, consumption. 
In the first class there were 23, in the second 18, and in the third 
50. 
These cases have been distributed among the various classes of 
diseases in which the symptoms shown by each seemed to place them; 
thus, 16 are in the zymotic diseases, 22 in the phthisical, 9 in the 
cerebral, 17 in the cardiac, 7 in the diseases of the urinary organs, 
and 7 in the diseases of the liver and other abdominal viscera; 2 also 20 
SUPREME COUNCIL, R. A. 
died from cancer of the stomach, though one can hardly agree with 
the belief entertained that la grippe was the originator of the malig- 
nant disease. 
Sixteen of the deaths occurred in New York, 14 in Ohio, 10 in 
Massachusetts, and the remainder were divided about from Maine 
to Georgia in a way that showed no preferences of latitude or longi- 
tude. 
Eleven of the victims were under 30 years of age, 82 were between 
30 and 60, and 4 were beyond the latter age. 
As a whole, however, it is very plain that our proportion of losses 
from this cause was less than for the two previous years. 
GENERAL PARALYSIS OF THE INSANE. 
General paralysis of the insane, or general paresis, as it is now 
more frequently designated, is a chronic affection of the brain, 
coming on in the prime of life in men who have lived a life of ex- 
cesses either in their habits or their duties. It is characterized by 
a gradually failing body and mind, fits resembling epilepsy or apo- 
plexy, and a general impairment of the cerebral functions which 
eventually (in from 1 to 5 years for the most part) proves fatal. 
Its most striking symptom, which serves as a point by which it is dis- 
tinguished from other cerebral disorders, is the presence of what is 
called by the French the “ delire des grandeurs,” a condition which 
gives the patient an exaggerated sense of his own power, influence, 
wealth, and greatness, which buoys him up through all reverses, so 
that no matter how poor he is he believes himself lich, and no 
matter how feeble he is he believes himself to be immensely strong. 
The whole subject is from time to time prominently an object of 
study in our medical work, partly from the consideration of the his- 
tories of those of our members who have died with it, and on the 
other hand in the consideration of the eligibility of applicants who 
have lost a parent or a brother by it. Medical authors, many of 
whose works I have consulted, but have not room to quote, believe it 
less often the result of hereditary tendencies than are other brain 
diseases, and it is more often ascribed to the effects of over-work, 
over-play, intemperance, or syphilis, the latter especially being of 
late years considered its most frequent cause. I)r.' II. O. Williams, 
in the “North American Review” for December, 1892, says, “Pare- 
sis does not come unbidden. Ruthless as it is when once it has seized 
a victim, it need have no terrors for any one who does not invite it 
by his actions.” Professor Sachs also says, “ There can be no doubt 
about this, that the disease will never occur in a person from heredi- 
tary influences and causes alone: there is always an exciting cause.” 
So much for the opinions of authors on this topic. In the Royal 
Arcanum there have been, out of about 7,200 deaths, 58 undoubted 
cases of mortality from this disease. There have probably been REPORT OF MEDICAL EXAMINER—IN—CHIEF. 
21 
others, but in some the symptoms and history are imperfectly given, 
so that it is impossible to say but that the attack may have been 'the 
result of cerebral hemorrhage. In the cases herein counted, however, 
there is a history of symptoms and of the course of the disease, 
which is easily recognizable as belonging only to this affection. 
The history of these cases gives but little support to the theory of 
frequent hereditary cause; in fact, out of all the 58 there are none 
which give a direct history of any other instance of general paresis 
in the family history. In one it is said that the member’s mother 
had died of paralysis at the age of 75, in another that the father had 
died of paralysis at 65, in a third a brother had died of paralysis at 
23, and in a fourth a brother aged 45 had been the victim of apoplexy; 
and these four instances are the only ones where there is a positive 
history of paralysis in the immediate family. Still another had lost 
a father at 35 of delirium tremens, and two brothers at 29 and 33 of 
intemperance. One more had lost a father at 59 of nervous pros- 
tration ; the mother of one had died at 56 of general debility, the 
father of one at 70 of general debility likewise, and one father had 
died at 60 of “general breaking down four parents had died from 
some unknown cause; and one member who had been intemperate is 
said to have been neurotic by inheritance, but no details are given. 
With these exceptions the family history of these 58 men was 
good and in many of them unusually good. It appears to me that 
their family history taken as a whole was quite as good as that of 
any 58 men among our deceased has been, even of those who died 
of typhoid fever or pneumonia. 
Still further, it might be supposed that their occupations would be 
found to have been of some character tending to produce brain 
disease. Even this is apparently not true. Eleven of them were 
merchants (including dealers in grain, coal, woolen goods, etc.), 7 
were manufacturers, 5 physicians, 4 book-keepers, 3 salesmen, 3 
clerks, and 1 was an attorney. Two worked in leaden materials, 
another was a liquor dealer, and there was a mason, a tailor, a saw- 
yer, a magician, a broker, etc., among them. 
Of the stated causes of the disease, only one attending physician 
alluded directly to the intemperance of his patient as being its cause. 
In no single case was it attributed to syphilis. This might be ex- 
plained by the theory that some delicacy on the part of the attending 
physician may have kept him from making such a disgraceful feature 
in the man’s history prominent in a certihcate which would pass not 
only under the notice of the family, but of the officers of the Royal 
Arcanum. This may have led to the suppression of this part of the 
record in some instances, as, for example, when the patient has died 
at home under the care of his family physician; but I cannot think 
that this would have occurred in all, especially when the patient died, 
as many of them did, in an asylum or hospital, and in which the 
certihcate has been filled out by the superintendent or an attending 
physician, whose relations with the family of the deceased could not 22 
SUI’BEME COUNCIL, It. A. 
have been so intimate as to lead to a concealment of this important 
element in the case. I am therefore forced to the conclusion that in 
a large majority of our men syphilis was not an important factor. 
As regards ages, 41 of the 58 were over 40 at death, and 3 Avere 
over 60, but 42 were under 50. 
The results of the analysis of the 58 cases would be disappointing 
if one had expected to obtain from them positive proofs of the 
direct effects of heredity, of intemperance, or to syphilis. Nothing 
in these cases shows the disease to have been plainly the result of 
either of these causes. The very fact, however, that so many show 
negative results is, I think, very important, as tending to prove that 
the prevalent assumption on these points is not confirmed by our 
records, and that, at least so far as is shown by our own experience, 
heredity does not play an important part in the etiology of general 
paralysis of the insane. 
Besides the main question of hereditary influence, it appears, too, 
that no large proportion of these 58 were intemperate, or immoral, 
or followed occupations requiring an excessive expenditure of brain 
power, or compelling them to live in unhealthy localities, or within 
depressing influences. 
The chief significance of these results for our purposes lies in the 
demonstration that it is not of special importance to refuse insurance 
to men whose family history, habits, or occupation may be thought 
to have a tendency to induce this disease, and that in point of fact 
the disease is so rare as not to be an element of essential weight in 
the consideration of risks for life insurance. 
And conversely that on the whole the diseases of these 58 men 
did not proceed from anything in their family history, their habits, 
or their vocations in life, which could have led to any unfavorable 
discrimination against them when they applied for admission. 
IMMUNITY. 
During the past year a great deal of attention has been paid in 
bacterial researches by many distinguished observers, notably Pro- 
fessor Metschnikoff, of Berlin, to the consideration of the processes 
of inflammation and the further question of “immunity,” and it 
appears to be one of these instances in which investigation in what 
is called pure science seems likely to result in having a marked prac- 
tical value in excess of what was expected by the observers 
themselves. 
It has long been understood that the human frame enjoys a power 
of protecting itself against the exciting causes of specific diseases, 
and that it is in this way that a robust person wards off the attacks 
of disease to which he is exposed. It is also observed that some 
persons are not in danger of taking certain diseases, and are pro- 
tected from them or unsusceptible to the poison of the germs which REPORT OF MEDICAL EXAMINER—IN—CHIEF. 
23 
convey them. Familiar instances of this are seen in those persons 
who have once had scarlet fever, or small-pox, or heen vaccinated, 
and who have thus received protection or “immunity” from other 
attacks of those diseases. 
Naturally, by a parity of reasoning, medical men have been con- 
sidering the question whether there ma3r not he methods or processes 
by which the human organism may be protected against various 
other diseases, such as pneumonia, diphtheria, cholera, and many 
more ; and whether we may not learn of means whereby the poison- 
ous action of the bacilli of these diseases may be antagonized or 
destroyed, so as to render men unsusceptible to or impregnable 
against these bacilli, or, as it is called, “ immune ” to their influences. 
That this has been done with small-pox by vaccination is a well- 
known fact, and that Professor Pasteur has done a similar work for 
hydrophobia, by inoculating the system repeatedly with a mild form 
of the poison of the mad dog, is also known. This repeated intro- 
duction into the organism of what is called “attenuated virus ” (virus 
weakened or diluted) therefore seems to render the animal or the 
person unsusceptible to further poisoning by the same material, or in 
other words “immune;” and it has naturally been thought that a 
similar use of attenuated or weakened or diluted virus of other 
bacterial products, which in their ordinary strength will produce 
diseases (fatal perhaps), may by a graduated application produce 
such changes in the person inoculated as to protect him against the 
diseases caused by these bacteria. Experiments in this direction 
with the organisms of pneumonia (called pneumo-cocci) have been 
made with apparent success. Experiments are also being made in a 
similar line with the germs of cholera, and possibly another season 
may show beneficial results from these. 
It was long ago observed that there are in animal organisms cer- 
tain simple movable or migratory cells called leucocytes which have 
as their special function the taking into themselves all those particles 
of the organism that have become effete and useless, digesting them 
and getting rid of them from the system; this they can do not only 
as individuals, but, when they fail in doing it singly, they can com- 
bine and conduct a concerted attack with greater success and 
certainty. These cells are found to have an instinctive aversion for 
some materials or germs, a liking for others, and a decided indiffer- 
ence to substances from which they can gain or lose nothing. 
In 1881 Carl Koser called attention to the fact that these leuco- 
cytes had the power of attacting the various microbes or bacilli, 
which make their entrance into the body, there to multiply and pro- 
duce disease, and could take them within their own walls, digest, and 
assimilate them, and thus prevent their further inroads. 
An extension of these observations showed that as the bacilli 
entered the system the leucocytes might retreat from them, or might 
meet together, attack and destroy them ; and that when this invasion 
of bacilli took place in an “immune” animal, these cells at once 24 
SUPREME COUNCIL, R. A. 
became the aggressors and destroyed the microscopical enemy. 
These leucocytes, when they performed this work, were called 
phagocytes, and the process of devouring the bacteria was called 
phagocytosis. It has also been found that when doses of the virus 
or poison produced by a particular bacillus paralyze at first the 
leucocytic cells, these same cells may by careful preparation and by 
the administration of repeated (at first small but gradually increas- 
ing) doses of the same poison become habituated to them, and 
eventually take them up as they would other injurious germs, and in 
time destroy them. 
Thus phagocytosis, or the consumption of the bacteria by the 
phagocytic cells, may be observed when the bacteria are not strong 
enough to force their way into the body, either because the body is 
immune to its poison, or when for any reason the body is able to 
recover from an inoculation of bacterial germs. 
When in animals that are not immune, the bacilli are introduced 
into the system, little or no local change follows immediately, but 
the poisonous germs grow unhindered and produce general disease; 
when, however, the animal is immune and the same poison is intro- 
duced, inflammation and leucocytosis, or a gathering of the leucocytes, 
is observed at the point of danger, the bacilli are destroyed, and the 
infection of the system is prevented. 
Thus these leucocytes (or phagocytes) are found to have the 
power of seizing upon everything possessing a less power of resist- 
ance than they themselves, and this power is exercised in a marked 
degree in defending the organism against bacteria. But if the 
animal into whose tissues the bacteria gain entrance is not protected, 
and is therefore susceptible to their virus, then the phagocytes seem 
to be repelled and the bacteria become victorious. Or still again, if 
the virus which is introduced has been attenuated diluted by any 
means, the phagocytes meet them more courageously, as if by some 
attraction, and vanquish them. 
I have thus, as simply as possible, and avoiding the use of long 
technical scientific words, explained the views of Metschnikoff and 
his followers on this subject; but there is still another school of 
observers under the lead of Professor Buchner, who maintain the 
“ humoral ” theory, as it is called, and who disbelieve in the active 
agency of the phagocytes, and maintain that the duty of these cells 
is only that of scavengers, to gather up and remove the bacterial 
elements which have been destroyed by other germ-destroying 
agencies. They claim that as the virus, or the bacterial poison, 
advances into the system, there are certain portions of the blood, 
especially the serum, which are so dangerous to these microbes as to 
kill them and thus stop the progress of infection. They claim that 
there are certain bactericidal or microbe-destroying qualities in the 
serum of the blood, and that as the bacteria die from the effects of 
the blood they set up a certain chemical action which attracts the 
leucocytes, who thereupon gather in force to remove their dead 25 
REPORT OF MEDICAL EXAMINER-IN-CHIEF. 
bodies. Some observers of this school do not deny wholly the 
phagocytic action of the cells, but claim that this is but one of the 
means by which the destruction of these organisms is accomplished, 
and that the action of the blood is quite as important. 
It will be expected that investigations made into microscopical 
objects and with objects so infinitely small that they cannot be dis- 
tinguished until they have been stained by various aniline dyes, 
different observers may see the same objects and the same phenom- 
ena very differently, and honestly entertain antagonistic and varying 
views. Hence, before the Pathological Society of London the 
subject has led to repeated arguments on either side by able micro- 
scopists whose views are very conflicting. 
For the sake of the layman who would be glad to know of some 
means by which he himself can obtain protection or immunity against 
cholera for the coming year, it is to be hoped that these conflicting 
doctrines may be so far harmonized as to lead to some agreement 
on methods and processes, and that some means may be agreed upon 
to give immunity from cholera. On this point it need only be added 
that already Mr. Haffkine has been experimenting with attenuated 
cholera virus by inoculation for the production of immunity against 
cholera in rabbits and guinea-pigs, and has finally made inoculations 
of himself and other medical gentlemen. Among these were Dr. 
Ilawkes and other physicians of England, who, in the “ British 
Medical Journal,” have given an account of their own experience in 
undergoing these operations, and state their belief that these inocu- 
lations can be practiced with safety on human beings, and that 
inasmuch as these processes have given immunity to guinea-pigs, 
rabbits, and pigeons, there is reason to hope that they may also 
produce an equally good degree of immunity in mankind. 
Decent French and German journals state that certain men, ill 
with typhoid fever, have been put under treatment by the inoculating 
into their systems of the serum of the blood of rabbits which have 
previously been made immune to typhoid; but the disease has not 
been thus far checked in these men, and went on in its usual course. 
Certain other patients with tetanus and diphtheria have been sub- 
jected to inoculations of the serum of sheep, which had been similarly 
protected against those diseases; but this experiment was also 
unsuccessful, the progress of the disease not having been modified 
by the treatment, though the patients were not injured thereby. 
The whole subject is therefore still in the stage of experiment and 
investigation, but gives great promise of auspicious results in the 
future. 
The preceding pages had been suggested and made important at 
this time by the fact that last summer at our very gates pressed the 
advance guards of a pestilence, Asiatic cholera, whose advent among 
us cannot but be viewed with justifiable apprehension; whilst the 
country as a whole did not suffer from its ravages, yet it must be 
ASIATIC CHOLERA. 26 
SUl'REME COUXOIL, K. A. 
remembered that it was present in New York harbor, where there 
were many victims, and that a few cases of the disease occurred in 
New York City. 
It is fresh in the minds of us all that by a special proclamation of 
the President a vigorous interdict was established by the national 
and state authorities against the landing of immigrants w ho had had 
the disease, and also of those who had been exposed to it or came 
from ports infected by it. Of the latter, among foreign ports the 
name of Hamburg was most prominent as a city in which many 
persons were affected by this disease, and a large number of deaths 
occurred. The steamers, therefore, which sailed from that city were 
kept outside our ports on arrival, their passengers quarantined and 
disinfected, their freight and baggage made antiseptic by disinfec- 
tants and steam, and the bodies of the dead cremated. 
It was deemed necessary that no sick person, and no one who had 
been exposed to the influences of the disease, should be allowed to 
go ashore until every precaution of the most rigorous kind had been 
enforced to prevent his carrying the disease ashore. Thus not only 
were the sick detained in hospitals or the ships, but even well people 
who had had no sickness were kept in the same ships with the sick 
and thus cruelly imprisoned, away from their friends, their business, 
or their duties, exposed in the fullest degree to all the dangers of 
cholera. 
It cannot be denied that the results of this rigorous quarantine 
were completely satisfactory, in that none of the parties infected or 
likely to be infected escaped from the restraint; and it is believed 
with good reason that not a case of cholera on land was due to the 
cases on board ship. The result was salutary, but the question 
whether the rigor of the quarantine was necessary is doubted even 
by physicians. 
It is agreed by the majority of medical men that cholera is not 
contagious in the sense in which scarlet fever, diphtheria, or small- 
pox are contagious. 
Ernest II art, M.D., the famous editor of the “ British Medical 
Journal,” says that you “can eat cholera or you can drink cholera, 
but that you cannot catch it.” This by no means signifies that you 
can eat or drink it with impunity, but that if you eat food containing 
the germs of cholera, the comma bacilli, you will be likely to take the 
disease, and the liability is greater from this source than it would be 
by handling or contact with cholera patients. It is well understood 
now that with proper appliances and due precautions cholera 
patients can be nursed without fear of the nurse catching the 
disease. “Cholera,” says Dr. Hart, “is a filth disease, carried 
along the lines of human intercourse by dirty people, and only 
flourishing in dirty places; it comes not now by pedestrians and 
horsemen, but by locomotive and fast steam-boat.” 
Hamburg, where most of the disease existed and flourished in 1892, 
owed its prominence in this regard to the polluted condition of its drinking-water. Its water-supply was taken from the river Elbe, and 
into this river was also turned largely the sewage of the city, and 
microscopical investigation of the water showed it to he filled with 
the cholera bacteria. 
It is now confessed that the comma bacillus, as discovered and 
investigated by Professor Koch, is really the essential feature of the 
disease; and it is acknowledged that cholera does not exist without 
the bacillus, hut men differ as to how much the presence of this 
bacillus necessitates the presence of the disease. As with all other 
germs and microbes, it will not grow and multiply and produce its 
specific effect unless it finds a suitable home or nidus for its growth. 
Professor von Pettenkofer thinks it is still open to doubt whether the 
bacillus alone is the cause of the disease. He declares that for the 
propagation of the disease these three factors are necessary, x, y, and 
z; x being a specific germ disseminated by human intercourse; y a 
factor dependent on place and time, which he called “ local disposi- 
tion ; ” and z the individual predisposition. He is so far satisfied of 
the truth of his statements that he has not hesitated to eat cholera by 
taking into his stomach a large amount of the comma bacilli. He 
says, with German phlegm, that he himself was an old man of 74, 
toothless, diabetic, and with other infirmities of age, and therefore a 
person who could well be spared. Two days after swallowing the 
virus he had severe colicy pain and moderate diarrhoea, which con- 
tinued eight days. He had, however, no dangerous symptoms of 
cholera, though his stools wrere found on examination to be swrarming 
with the bacilli. He asks howT many millions of these bacilli he must 
have had in his intestines and yet no symptoms of Asiatic cholera. 
His coadjutor, Professor Emmerich, made a precisely similar ex- 
periment, and suffered much more severely from the colic and diar- 
rhoea, but without any other illness. Neither of these gentlemen 
are therefore willing to acknowdedge that they had genuine cholera, 
and do not believe that the bacillus is the x alluded to above as the 
specific cause. Pettenkofer says, however, recently, that the only 
question now appears to he how the comma bacillus is to be de- 
stroyed or at least prevented from multiplying. 
Different countries, as may be supposed, under the advice of 
different sanitarians, have adopted very different regulations of 
quarantine, some, like England, only requiring inspection of immi- 
grants and isolation of the sick; others, as in our own case, 
endeavoring to absolutely exclude every person w ho may, can, or 
might have received the infection. 
In the coming summer the disease will undoubtedly be brought to 
the seaports of this country, and it is to he hoped that proper pre- 
cautions will he taken to prevent the dissemination of the disease by 
the sick, but that the well wTill be treated with proper consideration 
and kindness and care, even if they seem to have been exposed to 
the dangers of the disease. 
REPORT OP MEDICAL EX AMINE R—IN’—CHIEF. 
27 28 
SUPREME COUNCIL, R. A. 
Should, however, the disease gain a footing in our cities, the pre- 
cautions for individuals are well understood and agreed upon by 
almost all authorities. This is what Dr. Hart says: “ Keep your 
houses, your cisterns, your stables, your cow-sheds, pigsties, and 
slaughter-houses, your drains, your dust-bins, yourselves, and your 
clothing clean ; and help your neighbor to do so. Boil your water, 
or drink a pure natural table water. Boil your milk. Inspect your 
fruit, fish, and meat markets. Avoid unsound food and excesses of 
diet. Feed wholesomely the needy and destitute; help the poor to 
be as careful in their homes and habits as you will be in yours; 
and have no fear of contagion. If you take the cholera, it will be be- 
cause you or those about you have made you liable to it by neglect.” 
Another authority says concerning food, that “its preparation is 
a matter of extreme importance; water and milk should be boiled, 
and the boiling should be very recent. Coffee and tea should be 
recently made and served hot. All food should be thoroughly and 
recently cooked. No raw food of any description except possibly 
a moderate quantity of perfectly fresh, ripe, and absolutely clean 
fruit should be taken. Salads and other such articles should be 
interdicted. Bread as well as butter should be carefully protected 
against the possibility of contagion. The culinary utensils and 
table-ware should be scrupulously cleaned with boiling water.” 
The subject of obtaining “immunity” from this disease by inocu- 
lation as explained in previous pages, is largely experimental. 
Haffkine, in Berlin, and Ferran, in Spain, have investigated the 
subject, and over and over again tested their theories by actual in- 
oculations of physicians and others, and their results are reported to 
have been thus far successful. 
The objectors to this plan, however, make one strong point in 
saying that in Hamburg, where the epidemic of 1892 was more 
severe than in any other city, three per cent, only of the inhabitants 
took the disease, and only one and three-tenths per cent, died with 
it. Why, therefore, should the remaining ninety-seven per cent, of 
the population be inoculated against a disease which they did not 
take when exposed to the directly dangerous influences of the drink- 
ing-water filled with the germs as has been mentioned. 
CAUSES OF DEATH OF OUR MEMBERS. 
In July last 7,000 of our initiates had died, and I have carefully 
investigated the causes of their deaths to determine how far it is 
possible for us to foresee in the future the diseases which will prove 
most frequent and from which deaths must be anticipated. 
It is easy, of course, for the medical expert to predict that, as cer- 
tain forms of disease are especially prevalent in youth, certain others 
in middle age, or still others in old age, these diseases will, one 
after another, become more fatal and succeed one another as men 
grow older. The experience of all ages would have been amply 
sufficient to teach us, for instance, that phthisis is generally a disease REPORT OF MEDICAL EXAMINER-IN-CHIEF. 
29 
of men under 40 years old, and that disease of the blood vessels, 
carrying with it injury to the heart and brain, is a disease of .those 
who have become older; but to see this demonstrated clearly and 
tabulated before our eyes is very striking. This becomes very in- 
teresting in the following figures, which show the number of the 
7,000 dead who joined between 20 and 30 years of age, and those 
who joined in the three successive decades, though we do not now 
accept men over 55 years of age. 
There were 1,376 of these deaths of men who were between 20 
and 30 on joining, 2,261 deaths of men between 30 and 40, 1,942 of 
men between 40 and 50, and 1,421 of men over 50 years of age. 
Now by collating the causes of death in these four classes, it has 
been found that in the first class more than one-fourth died of 
phthisis, another fourth of acute lung disease and diseases of a 
zymotic type (the latter being neai’ly double the foi-mer), and that 
the next largest source of mortality is casualties, nearly one-tenth 
dying of these, probably from the dangers incurred by the hot 
impulses of youth. 
If we go to the other end of the scale, those who were more than 
50 when they joined, it will be seen that the tubercular or zymotic 
classes are no longer conspicuous, but that diseases of the brain and 
the heart come first in the assigned causes, that acute diseases of the 
lungs come next, and diseases of the urinary organs are fourth in 
order. It would undoubtedly have been hard to say in advance that 
the brain diseases would have outnumbered heart diseases, or that 
each of them would have been more numerous than diseases of the 
kidneys, etc. The table is as follows: 
AGES AT JOINING THE ORDER. 
Causes of Death. 
Between 
20 an d 30. 
Between 
30 and 40. 
Between 
40 and 50. 
Between 
50 and 60. 
Zymotic 
256 
230 
130 
70 
T ubercular 
395 
450 
189 
68 
Brain disease .... 
124 
318 
380 
289 
Heart disease .... 
Respiratory diseases 
75 
176 
229 
270 
(acute) ... 
136 
305 
264 
197 
Digestive diseases 
113 
218 
229 
133 
Kidney and bladder 
diseases 
72 
151 
195 
158 
Accidents 
135 
199 
133 
79 
Cancer 
12 
79 
74 
84 
Suicides 
39 
88 
70 
27 
Unclassified ... 
19 
47 
49 
46 
1,376 
2,261 
1,942 
1,421 
[N. B. — It will be seen that in the first vertical column the 
classes of diseases are arranged in a more simple system than that 30 
SUPREME COUNCIL, R. A. 
adopted usually in registration reports, for the purpose of showing 
clearly the various features which are important as bearing on the 
examinations for life insurance, such as accident, suicide, and 
phthisis.] 
But this display of figures is of comparatively little interest as 
compared with the following percentages, which show how the dif- 
ferent classes of disease vary in frequency with the increasing ages 
of the applicants, and are as follows: 
PERCENTAGES OF EACH CLASS. 
Ages at joining the Order. 
A 
Classes of Diseases. 
r 
Between 
20 and 30. 
Between 
30 and 40. 
Between 
40 and 50. 
Between 
50 and 60. 
Zymotic 
18.61 
10.17 
6.69 
4.93 
Tubercular 
28.71 
19.90 
9.73 
4.79 
Brain disease . . 
9.01 
14.07 
19.57 
20.34 
Heart disease .... 
5.45 
7.78 
11.79 
19.01 
Respiratory diseases 
(acute) 
9.88 
13.49 
13.59 
13.86 
Digestive disease . . 
8.21 
9.64 
11.79 
9.36 
Kidney and Bladder 
diseases 
5.28 
6.68 
10.04 
11.12 
Accidents 
9.81 
8.80 
6.84 
5.56 
Cancer 
0.87 
3.49 
3.81 
5.91 
Suicides 
2.83 
3.89 
3.60 
1.90 
Unclassified .... 
1.38 
2.08 
2.52 
3.24 
From the above we cannot but observe that the classes 
are most severe and dangerous in the men represented in the first 
decade, and grow less so in each class; that the same is markedly 
true of tubercular diseases; that brain affections, proving fatal in 
only nine per cent, of deaths of men between 20 and 30, become 
rapidly more prominent and fatal with each advancing period of 
years, until they are the most dangerous of all diseases in men over 
50, and that the same is true to almost the same extent with heart 
lesions; acute disease of the lungs, always a prominent death agent, 
performs this function more and more often as men grow older, 
though the increase is but slow; illness caused by affections of the 
digestive organs seems not markedly influenced by years, being 
probably more influenced by personal habits and places of residence, 
and hence remains a pretty constant factor; diseases of the kidneys 
and urinary organs show, as would be expected, a steady increase; 
accidents, on the other hand, a steady diminution, with the loss of 
the fire and hurry of youth; cancer is progressively more fatal, 
whilst the mortality from suicide seems to reach its highest point 
with men between 30 and 40. Those placed in the last category 
(unclassified) comprise many forms of disability, such as alcoholism, 
carbuncle, general debility, exhaustion, and the like. REPORT OF .MEDICAL EXAMINER-IN-CHIEF. 
31 
Scarcely had these tables been completed when I discovered that 
by a strange coincidence my friend Dr. Withered, of Union, N. Y., 
Chief Medical Examiner of the Knights of Honor, had during the 
year made similar examinations into the history of 19,387 deaths in 
that society, and tabulated them under the classification of the Regis- 
trar-General of England. This classification is not so convenient 
for showing the points to which I wish to call attention, and T have 
therefore rearranged his statistics under the more condensed head- 
ings used in the tables above, which seem to show more clearly the 
large classes here grouped together. In addition, I have computed 
the percentage of these classes as in the previous calculations, and 
thus present the following results of Dr. Witlierell’s tables : 
19,387 DEATHS IN' KNIGHTS OF HONOR CLASSIFIED. 
Ages when admitted. 
Causes of Death. 
r 
Between 
Between 
Between 
" \ 
Between 
20 and .30. 
30 and 40. 
40 and 50. 
50 and 60. 
Zymotic* 
560 
907 
997 
191 
Tubercular . 
784 
1,256 
938 
125 
Brain disease . . 
279 
873 
1,301 
314 
Heart disease .... 
122 
434 
874 
233 
Respiratory diseases(acute) 317 
889 
1,251 
255 
Digestive diseases . . 
Kidney and bladder 
187 
655 
939 
161 
diseases 
129 
367 
637 
161 
Accidents 
307 
649 
594 
88 
Cancer 
26 
166 
337 
97 
Suicides 
77 
212 
294 
40 
Unclassified .... 
36 
109 
165 
54 
2,824 
6,517 
8,327 
1,719 
Age when admitted. 
Causes of Death. 
/ 
Between 
Between 
Between 
Between 
20 and 30. 
30 and 40. 
40 and 50. 
50 and 60. 
Zymotic 
19.83 
13.92 
11.97 
11.11 
Tubercular 
27.76 
19.27 
11.26 
7.27 
Brain disease .... 
9.88 
13.39 
15.62 
18.26 
Heart disease . . 
4.32 
6.67 
10.49 
13.55 
1 Respiratory diseases (acute) 11.18 
13.65 
15.02 
14.84 
Digestive diseases . . 
6.62 
10.05 
11.27 
9.37 
Kidney and bladder 
diseases 
4.57 
5.63 
7.66 
9.37 
Accidents ... 
10.87 
9.96 
7.13 
5.11 
Cancer 
0.92 
2.55 
4.04 
5.63 
Suicides 
2.72 
3.25 
3.53 
2.33 
Unclassified ... 
1.27 
1.67 
1.98 
3.14 
PERCENTAGES OF ABOVE. 32 
SUPREME COUNCIL, It. A. 
(In explanation it may need to be said that the above percentages 
show, in reading the lines vertically, the relative ratio of those in 
each decade who died of the several classes of diseases, and, in read- 
ing them across the lines, show the increase or diminution of the per- 
centage of deaths from the various diseases as the men grow older.) 
The general points of difference in the results of the Knights of 
Honor and those of the Royal Arcanum do not need to be pointed 
out, but the points of similarity are very wonderful, and the same 
comments which I made on the first set of tables are just as true and 
as significant in the other. The proportion of zymotic deaths is a 
little larger in each decade of the Knights of Honor than in the cor- 
responding one of the Royal Arcanum, and undoubtedly points to 
the fact that the former have extended their lines farther into the 
Southern States. The same reason also may have made their per- 
centage of deaths from acute diseases of the lungs a little larger. It 
is, however, the gradual increase and the gradual decline, as the 
years pass along, which will be seen to be similar and so interesting 
in the tables of each society. The increase by advancing age in the 
deaths from brain, heart and kidney diseases, and the decrease in 
zymotic, tubercular, and accidental deaths, will be seen to follow 
identical paths in both societies. The number of losses from cancer 
and from suicide are much alike in both organizations. 
It seems to me then, in closing these observations, that it is seldom 
that in the study of vital statistics the result of tables of figures is 
so effective and conveys such accurate information as do the above 
tables. From them one can have no hesitation in saying that with 
a large number of persons insured and who are between 20 and 30 
years of age that about one-fifth of those who die (18 to 19 per 
cent.) will die of zymotic diseases, that more than one-fourth (27 to 
28 per cent.) will die of consumption, that nearly one-tenth (9 to 10 
per cent.) will die of brain diseases, that about one-twentieth (4 to 
5 per cent.) will die of heart disease, and that one-tenth (10 to 11 per 
cent.) will die of accident. 
Still further, it may safely be asserted that as the age of those who 
join increases, the number of deaths by fevers, phthisis, and casual- 
ties will grow steadily less, whilst those by heart and brain diseases 
will go on in an ever increasing ratio, as will also deaths from can- 
cer and from kidney diseases, until in those who were 60 or more at 
their entrance diseases of the heart and the brain carry off, each of 
them, a fifth of the deceased (18, 19, and 20 per cent.), and cancer- 
ous deaths creep up to about six per cent. The law of increase and 
ot' diminution is undoubtedly as fixed as the tides of the ocean, and 
may be counted on with all the security and confidence that we can 
place in astronomical computations. 
AT WHAT AGES CAN MEN BE INSURED MOST PROFITABLY? 
A careful consideration of this questisn will show that there are 
two branches of the inquiry on which the answer largely depends: REPORT OF MEDICAL EXAMINER—IN—CHIEF. 
33 
first, at what age do the largest number die? and, secondly, at what 
ages do they live longest after admission? A hasty thought would 
lead to the supposition that these two are but different forms of the 
same question ; but this is not true. On investigation it appears 
that of those who get insured in each of the four decades,—namely, 
those between 20 and 30, between 30 and 40, between 40 and 50, 
and between 50 and 60,—the smallest proportion dies in the first 
class, and that the number of deaths increases materially with each 
of the other classes. 
Now it might, a priori, have been believed that similar advantages 
would be found to exist with the first class as regards their length 
of life; but the reverse is the fact, and it appears that of those who 
die, the members who were youngest at joining live the shortest 
time, and those who were oldest at joining live the longest time; in 
other words, that those who died having joined between 50 and 60 
have lived longer on the average than those who had joined between 
20 and 30, or at either of the other decades. 
Hence the question of the pecuniary returns to be derived from 
the insuring of these various classes does not depend solely on the 
question in which the greatest number of deaths will occur, but on 
this question as modified by the additional one of how much longer 
they will live and pay their premiums. 
Taking this topic into consideration, I find that between June 23, 
1877, and January 1, 1892, 149,176 men had joined the Royal 
Arcanum; of these 55,135 were between 20 and 30, 57,482 were 
between 30 and 40, 28,574 were between 40 and 50, and 7,985 were 
over 50. 
Still further, it appears that of this whole number of initiates 6,332 
had died, being a percentage of per cent., or at the rate of 42£ per 
thousand in this period of 14£ years. Of these 6,332 deaths, 1,268 
were from the class that were between 20 and 30 on joining, a per- 
centage of 2£ or 23 per thousand; 2,635 were between 30 and 40 
on joining, a percentage of 3£ or 35£ per thousand; 1,750 were be- 
tween 40 and 50 on joining, a percentage of 6£ or 61 per thousand; 
and 1,279 were over 50 on entrance, being at the rate of 16 per cent, 
or 160 per thousand, which in tabular form may be thus represented : 
Became Members. 
Died. 
Percentage. 
Rate per 1000. 
55,135, 
between 20 and 30 . 
. . 1,268 
H 
23 
57,482, 
44 
30 “ 40 . 
. 2,035 
H 
35 
28,574, 
44 
40 “ 50 . 
. 1,750 
H 
61 
7,985, 
44 
50 « 60 
. 1,279 
16 
160 
149,176 
6,332 
Hence it appears that the frequency of deaths with those between 
50 and 60 has been nearly 8 times as great as in those between 20 
and 30, a result which will no doubt surprise those who do not 
reflect that the expectancy of life is much greater in the first than in 34 
SUPREME COUNCIL, R. A. 
the following classes, hut a result that should not lead to hasty 
generalization, for there are additional features to be considered. 
As a basis on which to calculate what are the best lives to accept 
in our Order or any life insurance company, it will be evident that 
if all these persons pay, as they do in some organizations, the same 
rates, then the younger men are evidently the better risks; but if, as 
in the Royal Arcanum, the assessments are graded according to the 
age of admission, the question contains different elements. 
Even with the level graded assessments the question is not wholly 
settled by the above figures, as it will at once occur to the investiga- 
tor that not only the absolute number of deaths is to be figured, but 
the length of time during which members live and continue to pay 
assessments must also be a factor in the computation. If, therefore, 
we can ascertain how long each of these men or these classes lived 
and continued to pay assessments, it will give us something nearer 
to a solution of the question as to the relative profit and loss in in- 
suring men at different times of life. 
To do this for 6,300 men and figure up the number of months of 
membership singly and together would involve a greater amount of 
time and labor than is at my disposal; but I have taken 1,000 of the 
deaths, those between 5,000 and 6,000, and carefully and laboriously 
figured out the following results : 
The 213 in this thousand who joined at ages between 20 and 30 
lived 15,456 months. The 318 who joined between 30 and 40 lived 
26,282 months. The 281 who were between 40 and 50 lived 25,977 
months; and those who were over 50, 188 in number, lived 19,223 
months, making the average length of life a follows : 
The 20’s lived 72.6 months each. 
“ 30’s “ 84.4 “ “ 
“ 40’s “ 82.4 “ “ 
“ 50’s “ 102.2 “ “ 
This fact, that the average duration of membership is greater in 
those who died of the men who joined between 50 and 60 than that 
of those who joined younger is also confirmed by the figures of Dr. 
Withered, who has put in tabular form the average duration of 
membership of 18,000 Knights of Honor of every age between 18 
and 55, from which it appears that the average of those who entered 
between 21 and 30 lived 57.8 months, those between 30 and 40 
lived 66.6 months, those who entered between 40 and 50 lived 73.5 
months, and those who entered between 50 and 55, comprising 
rather a small proportion of them all, lived the longest, 75.7 months. 
Of the first there were 3,204, of the second 6,252, of the third class 
7,369, and of the fourth only 1,156. The total number who entered 
during these years is not given, so that we cannot determine if the 
ratio of deaths to members joining is like our own. 
The full significance and pertinency of these figures may be seen 
when it appears that they thus demonstrate that, even if those over 
50 die in greater numbers, yet individually they live longer. This REPORT OF MEDICAL EXAMINER—IN—CHIEF. 
35 
showing probably results from the fact that deaths from zymotic 
diseases, accidents, and even from phthisis, occur more rapidly .than 
deaths following from change in the blood vessels, the results of 
diseases of old age which produce conditions of the heart, biain, or 
kidneys that eventually but slowly terminate life. 
The tables, as above stated, would therefore seem to show that of 
the class above 50 nearly seven times as many die in a given time as 
of those below 30, but that the individuals live longer, in a ratio of 
102 to 73. So that the increased rate of payment to be called from 
the older class should be T7032 of J^0-, or or 4.9 times as much. 
In my opinion, then, the question whether we shall continue to ex- 
tend the benefits of our membership to men over 50 years of age is 
therefore simply a financial or actuarial one, and that if these parties 
will accept membership and pay rates five times as great as that of 
men at 21 we can just as well afford to insure them. 
It has been urged, as may be well known, that men of these ad- 
vanced ages have already paid into our treasury more than their 
share; and this is seen to be true in a certain sense on examination. 
Dr. Styer, in an interesting article published in the “Guide and 
Candidate” for December, 1892, showed the comparative amounts 
paid by men of different ages, from which lie found that in a thou- 
sand deaths the average amount paid by 187 members who were 
above the age of 50 was $426.64, whilst those who were above 55 
paid $559.00, but that the average members whose average age was 
found to be 34 years had each paid only $114.09. 
He quotes two individual cases, one aged 27 on admission, and 
who lived nearly 15 years and paid $209.56; and the other aged 
59 on admission, and lived about 14 years, and had paid $1,059.50. 
By similar computation I have found that of five hundred other 
men who died in the Arcanum between Nov. 20, 1891, and March 
25, 1892, 99 were under 30 at initiation and 104 were over 50 years 
old, the average age of the former being 25 and of the latter 53. 
The former paid into our treasury $8,299.02, or about $83 each, 
whilst the latter paid into the treasury $44,970.67, or about $432 
each; and this increased amount of payment made by the old men 
should be acknowledged as a set-off against the greater mortality 
in that class. 
Taking still another 500 men, in order to see if these results are 
uniform, of those between 6,034 and 6,500 it will be found that 94 
were over 50 and 99 were under 30. But the former, the old men, 
paid into our hands $40,207.33, or about $430 each, whilst the 
young men paid for our benefit $8,949.15, or only about $90 each. 
Thus with each of these two sets of five hundred men it appears as 
an actual fact that the older men who died paid us about five times 
as much as the younger ones, so that if they died nearly eight times 
as often our loss by them was not so excessive as is claimed by those 
who desire to have our limit of age brought down to 40 or 50. 
o O 36 
SUPREME COUNCIL, R. A. 
As I have before said, the question is wholly one of dollars and 
cents, for it is quite as easy to reckon the law of mortality in the 
older as in the younger classes, and it is quite as simple to arrange a 
scale of payment for the one class as the other. If, therefore, these 
elderly men are willing to take membership with us, and to pay as- 
sessments which will equalize the cost of their membership to that 
of the younger men (as will undoubtedly be found to be the case), 
there is no reason why we should not continue to confer membership 
on them and to accept their payments. 
MEDICAL EXAMINER-IN-CHIEF. 
The Supreme Council at its last session voted to make the Medi- 
cal Examiner-in-Chief an ex-otHcio member of that body, but with- 
out a vote. This makes it his privilege and duty to attend the 
meetings of the Supreme Council, and to learn the views of its 
members and committees. It is to be hoped that this action will 
conduce to the welfare of the Order. 
At the suggestion of the Supreme Regent, a code of rules for the 
direction of the State Medical Examiners has been prepared by the 
Medical Examiner-in-Chief with the view of making their action 
uniform in deciding upon the admission of candidates from the vari- 
ous states, especially as regards the question of family history and 
occupation. 
13y further direction of the Supreme Regent, the Medical Exam- 
iner-in-Chief has for several months visited daily the office of the 
Supreme Secretary and examined the death papers which have been 
received there, for the purpose of making the cause of death to be 
announced in the assessment notices agree with the certificate of the 
attending physician, and be at the same time intelligible to the mem- 
bers and medical examiners of the Order. Heretofore the printed 
cause of death has not always been definite or correct, and has given 
rise to much surmise and many inquiries by members, both laymen 
and physicians. It is hoped that in the future the cause of death 
will be given as briefly, clearly, and correctly as the certificate of 
the attending physician will permit. 
To one matter of detail I would call attention in passing, which is 
that of the rejected applications of unsuccessful candidates. These 
papers are now on file in the offices of the various State Medical Exam- 
iners, a hundred in one state perhaps, and some thousands in another, 
and most of them kept with little or no care. These should be 
collected and placed securely in the vaults of the Arcanum building, 
and so numbered and arranged as to be ready to be seen at any 
moment when it is desirable to know when or why the applicant 
was rejected, so that the full cause of his rejection and his history 
may be readily ascertained without delay. 
For this purpose no method of referring to them would be so accu- 
rate and expeditious as a card catalogue, the cards to be kept in one REPORT OF MEDICAL EXAMINER-IN-CHIEF. 
37 
of the cabinets of the Library Bureau of Boston, a concern who 
make it a part of their business to provide the suitable drawers, cards, 
labels, etc., at a moderate expense. These card catalogues are in 
use in the various Insurance Companies, and in several of the Fra- 
ternal organizations, and the Arcanum ought to be similarly supplied. 
I trust, therefore, that the Committee on Supplies will be authorized 
to purchase these very necessary accommodations. 
STATE MEDICAL EXAMINERS. 
The entire courtesy and harmony which have for many years 
marked the relations between the State Medical Examiners and the 
Medical Examiner-in-Chief have continued undiminished this year, 
and the co-operation in the work of the Order by these various 
officers has been for the most part perfect. 
To obviate complaints which from time to time have been made, 
that applicants of certain classes, in respect of occupation, family, or 
personal history, were kept out of the Order in some states by the 
Supervising Examiners and were admitted in other states, a code of 
instructions was carefully prepared under the directions of the Su- 
preme Regent, giving more definite directions than had previously 
been issued, declaring just what applications should be referred to 
the Medical Examiner-in-Chief by the State Examiners, and these 
rules have been for the most part closely adhered to by the latter 
gentlemen. Two notable exceptions occurred, in each of which a rail- 
road man’s application was approved by the State Examiner, 
under some misapprehension of the rules probably, when it should 
have been referred to the higher authority. In both cases the Order 
had to pay for the mistake, as both the railroad men figure in 
our list of fatal accidents. One was a brakeman and one a freight 
conductor. 
There is apparently a tendency on the part of some of the State 
Examiners to refer as few applications as possible, for the reason 
that they do not wish to trouble the Medical Examiner-in-Chief un- 
necessarily, though the latter has never complained that too many 
were sent to him. 
SUBORDINATE EXAMINERS. 
In the latter part of last year the Supreme Regent also set on foot 
an inquiry into the honesty, capability, and efficiency of each indi- 
vidual subordinate examiner, and this inquiry has resulted in some 
changes of these men. 
There have been, nevertheless, some cases among our deaths 
where the final result gives rise to the belief that the duty of the 
examination was not fully or carefully performed. For the most 
part, however, the work of the examiners has been, in my opinion, 
honestly and faithfully done. 38 
SUPREME COUNCIL, R. A. 
SUPREME SECRETARY. 
The Supreme Secretary has offered me all the assistance which I 
could require in the preparation of material for my report, and has 
ever shown a willingness to assist me in any other parts of my work. 
The clerks, too, in his office have been steadily accommodating and 
helpful in the many instances where I have required information 
concerning councils, secretaries, and all the numberless details on 
points that arise from time to time and lie more appropriately within 
their province. 
Nothing could exceed the courtesy and consideration which have 
been uniformly extended to me by the present Supreme Regent, nor 
the zealous and intelligent interest he has shown in all the details of 
the work of examining applicants and investigating the history of 
those who have died. I am greatly indebted to him for his unvary- 
ing support in the discharge of my duties. 
Yours in V. M. C., 
JOEL SEAVERNS, M. D., 
Medical Examiner-in- Chief. 
2 Dudley Place, Roxbury, Mass., May 8, 1898. 
SUPREME REGENT. REPORT OF MEDICAL EXAMINER-IN-CHIEF. 
39 
SUPPLEMENTARY REPORT. 
EXTENSION OF THE ORDER INTO SOUTHERN STATES. 
By vote of the Supreme Council of the Royal Arcanum at its last 
session, the Medical Examiner-in-Chief was directed to make inquir- 
ies into the sanitary conditions of Alabama and South Carolina, 
proscribed territory in the Southern States, and include the results 
of his investigation in his next annual report. 
This matter in all its branches has been before the Medical Ex- 
aminer-in-Chief in several other years, and reports have been drawn 
up by him, first in 1884 on South Carolina, in 1886 on West Tennes- 
see, in 1891 on Arkansas, and in 1892 again on West Tennessee. 
It is difficult to find new material or fresh sources of information 
on which to base a new report. It has been my expectation that 
by this time the results of the Eleventh Census would have been 
completed and made public, so that some definite points as to the 
mortality and healthfulness of these Southern states might be laid 
before you. With this object in view I have corresponded with the 
Hon. Mr. Lodge, the United States Senator from Massachusetts, 
who has kindly sent me Part I. of the Compendium of the Eleventh 
Census, and has promised to send Part II. as soon as it is issued. 
I regret to find that the details in this first volume are not such as 
to give me an}r assistance in the question as it is here presented, the 
tables being simply tables of population. 
My investigations are therefore largely limited to the same lines 
as in previous reports, and the sources therein indicated. To this 
has, in the present instance, been added a large amount of manu- 
script testimony from physicians and other gentlemen residing in 
the parts of South Carolina and Alabama referred to, and obtained 
and forwarded to the Supreme Council by Messrs. Stephenson, of 
Hartwell, W. IT. Davis, of Toccoa, and S. P. Weisiger, of Augusta, 
all of Georgia. This testimony, although general in character and 
not fortified by statistics, speaks in the highest terms of the salubrity 
and freedom from contagious diseases in the northwestern part of 
South Carolina and the northern part of Alabama. With regard to 
the deficiency of statistics as above mentioned, I need only quote 
from these papers the letter of Mr. Jos. M. Elford, the clerk and 
treasurer of the city of Spartansburg, S. C., who writes to Mr. Weisi- 
ger that “ we have a board of health, but no real health commission, 
and I know of no statistics of health in the city or county that I 
could refer to.” Among these papers sent to the Supreme Council 
was also the Report to the Grand Council of Georgia on the subject, 40 
SUPREME COUNCIL, R. A. 
dated May 18, 1892, and which also alludes to the fact that no 
boards of health with propor organizations exist, and that therefore 
reliable statistics cannot be obtained. This report gives data of the 
relative mortality of South Carolina and Alabama as compared with 
other states, all tending to show that in the Knights of Honor the 
results have been more favorable in those two states than in New 
York, New Jersey, and Illinois. This report therefore recommends 
that the Supreme Council be petitioned to extend the Order into all 
the counties of South Carolina except the coast counties, including 
even a large part of the State southeast of the line from Augusta to 
Fayetteville, a line which is said to be the line of separation of the 
alluvial part of the State from the upland. The report recommends 
that of Alabama all the counties be made eligible except those south 
of the thirty-second degree of latitude, a proposition which excludes 
only the lower fourth part of the state. 
Both these suggestions are greatly in excess of the requests of 
Representatives Cray, of Tennessee, and Adams, of North Carolina, 
as the fonmer asked only permission to extend our lines into Alabama 
as far south as the Tennessee River, and the latter only to permit the 
institution of councils in the Piedmont section of South Carolina. 
This so-called Piedmont section cannot be said to extend farther 
south than the line of the sand-hills which traverse the state from the 
northeast to the southwest in the directions above stated. 
My study of the question leads me to the belief that'the claims of 
these witnesses from South Carolina and Alabama regarding these 
restricted sections are very just, and that the Piedmont section of 
South Carolina and that part of Alabama north of the Tennessee 
river cannot be compared unfavorably with the neighboring sections 
of North Carolina or Tennessee. The country is rolling or hilly or 
mountainous, with few malarial regions, and for the sick, those 
especially with chronic pulmonary diseases, is a health resort where 
many invalids from the South and North gain strength. It would be 
impossible for me to draw a line between the Carolinas, or between 
Tennessee and Alabama, where it could be said that the climate in 
one place is favorable to longevity, and in the other unfavorable ; and 
until we reach the sand-hills in South Carolina I know of no section 
of the state that is not as healthy as is North Carolina. 
If the decision of the question before us rests upon a comparison 
with other Southern states, there can be no doubt that the reply would 
be favorable. When, however, it comes to the general question of 
the advisability of extending the field of the Royal Arcanum farther 
south, it must be remembered that our experience in the Southern 
states has been uniformly less favorable than in the Northern, and 
that the states of Arkansas, Tennessee, Georgia, etc., for instance, 
have not been so profitable to our organization as the states of 
Minnesota, Iowa, or Illinois. 
To quote the experience of the Knights of Honor, as prepared by 
our late brother, John A. Cummings, in the “Reporter” of March, REPORT OF MEDICAL EX A MINER-IN-CHIEF. 
41 
1884, he found that the record of South Carolina was better than that 
of Georgia, Florida, Alabama, Arkansas, or Texas, but less good 
than that of Michigan, Minnesota, Connecticut, Nebraska, or Illi- 
nois. In the last Annual Report to the Supreme Council of the 
Knights of Honor, May, 1892, Virginia and Georgia had the highest 
death-rate for the year, about 20 per cent., Louisiana the next, 18 
per cent., and South Carolina and Missouri were next, with a rate of 
17.8 per cent. Alabama occupied a much more favorable position, 
as her death-rate was but 11.9, and she had paid into the treasury 
more money than she received, the reverse being true of the states 
previously mentioned. The death-rate of the whole Order was 15.7. 
Still one other point deserves mention, in view of the claim made 
by many medical men in the South that consumption is almost un- 
known in that region. In the last year, according to the Knights of 
Honor death-list, in Alabama about 10 per cent, of the deaths were 
from this cause, in Arkansas about 11, in Florida over 14, in Geor- 
gia nearly 14, in Louisiana nearly 13, in Mississippi about 10, in 
North Carolina 14, in South Carolina 13, and in Texas 13 per cent. 
It should be stated very plainly that in the whole of New England 
the death-rate by consumption in this same Order, the Knights of 
Honor, was but 16.1 per cent, of all the deaths, from which it will be 
apparent that the disparity of the mortality by consumption in the 
two sections, though marked, is not so excessive as is usually asserted. 
In the session of 1887 of the Supreme Council of the Knights of 
Honor a report was presented by Dr. I. I). Withered, showing the 
number of deaths in each State each year, and the membership and 
annual death-rate per 1,000 members from 1875 to 1886 inclusive. 
From this table it appears that the average death-rate per thousand 
in the States concerning which this inquiry is being made was in Ala- 
bama, 10.7, Arkansas, 17.5, Florida, 13.3, Georgia, 9.2, Louisiana, 
13.3, Mississippi, 15.6, North Carolina, 10.8, South Carolina, 9.9, 
and Texas, 13.5. This makes a good comparative showing for 
Georgia and South Carolina. I have quoted these figures because in 
the report quoted above for 1892 Alabama held a better rank than 
South Carolina, which I believe she is not entitled to. I have availed 
myself so largely of the statistics of the Knights of Honor because 
no others so recent, so pertinent, and so carefully prepared have 
fallen under my observation. 
In the Royal Arcanum it has been the uniform result for one year 
after another that the farther south we go for members the greater 
is our death-rate, Arkansas, Georgia, North Carolina, and Virginia 
being pretty uniformly among the states that have had a high mor- 
tality. In the year just past the same fact holds true, and Arkansas, 
Virginia, North Carolina, and Georgia head the list in the order 
given. 
In the list of deaths by consumption also of this past year Georgia 
appears first with the highest death-rate of this disease, and North 
Carolina and Virginia do not rank very far below. 42 
SUPREME COUNCIL, R. A. 
If we compare the relative advantages of these two sections of 
country, one being the part of South Carolina lying northwest of a 
straight line extending from Augusta, Ga., through Columbia, S. C., 
to Fayetteville, N. C., and the other being that part of Alabama 
lying north of the Tennessee river, we shall find that the former is 
made up entirely of hilly or mountainous regions, through which 
small rapidly flowing mountain streams run ; on the other hand, in 
the part of Alabama described the lower boundary is a navigable 
river, which is two hundred miles in length in the State, and has a 
valley twenty miles wide, of a rich, fertile, and agricultural value. 
The river itself is navigable for the largest steamers as far as Flor- 
ence, and, by means of a canal around the Muscles Shoals, for the 
rest of its way through the State. This alluvial strip, ten miles wide 
along the northern bank, extending to Huntsville, must not be for- 
gotten, for it iff the presence of this river and its valley, together 
with the similar valley of the Mississippi river, that have determined 
the unfavorable character for health of Western Tennessee. The 
additional fact that the river is navigable for the largest steamboats 
as far as Florence makes it quite as possible for the diseases of the 
Gulf of Mexico (yellow fever, for instance) to be brought there as 
to Memphis. The only part of this section of Alabama that is moun- 
tainous is the extreme northeast, where the Alleghanies enter the 
state. 
M y carefully formed opinion on the extension of our Order to the 
states of South Carolina and Alabama, or to any other states south 
of our present limits, is that it is unwise, and that our growth in 
other directions should be favored in preference. There is no doubt 
that all the Southern states have portions of territory quite free from 
deleterious climatic or terrestrial influences, yet that in all of them 
there are at least large portions, like the river bottoms and sea coasts, 
where disease is very prevalent, and where pneumonia or fevers 
carry off many victims, much more than does consumption in the 
North, as is shown by the increased total death-rates in said states; 
and it seems that Avhilst in temperate zones a few more die of 
phthisis than in the torrid zone, yet that more than this difference is 
made up by the increase in the acute respiratory diseases and the 
malarial and congestive fevers of the latter. 
JOEL SEAVERNS, M.D., 
Medical Examiner-in- Chief, It. A. 
Roxbury, Mass., May 5, 1893.