SUGGESTIONS 
TO 
THE MEDICAL EXAMINERS 
OF 
z 
THE DELAWARE 
nr. r p r 
Jyitud j ift foiqmj |;om|jnng, 
By D. W. MAULL, M. D., 
Chief Medical Examiner. . 
WILMINGTON, DEL. 
II. & E. F. JAMES, PRINTERS. 
1869. INTRODUCTION. 
The plea for the production of these "suggestions" 
is the frequent embarassment the Home Office is sub- 
jected to from inability to base a just and correct final 
decision upon incomplete medical reports. A risk can- 
not be thoroughly comprehended or properly graded, if 
the record of the examination is imperfect or deficient 
in essential statements. The result is, time is lost and 
labor expended in a correspondence to elicit additional, 
and the requisite, information. 
To obviate in part, the embarassments from this 
source, by offering some hints or general directions 
which an experience has shown are required on certain 
points, is the object of the present paper. 
This essay does not assume to be full and compre- 
hensive in instructions, indicating all the diseases and 
disabilities that disqualify; neither does it claim to make 
any marked addition to Life Insurance Medical Litera- 
ture, nor to usurp the place of any of the manuals that 
have been published for the guidance of the Examiner; 
its province is simply to suggest to the Examiners of 
the "Delaware Mutual" for whom it was exclusively 
designed, in what manner they may so develop and re- 
cord the main facts in an examination, that the Officials 
at the Home Office, may, with greater facility and pre- 
cision, determine the exact character of the risk. APPLICATION 
TO 
Ike 8 el inrar < |nsuranre 
Questions to be answered by the person whose life is 
proposed to be insured, and which form a 
a part of the contract. 
1. What is your name in full? Residence, Occupation, 
Address. 
2. A. Is your life now insured? B. If so, in what office 
or offices, and in what year ? C. Has any Life Insurance Com- 
pany declined granting- a Policy on your life? D. If so, when, by 
what company or companies,and for what reasons? 
3. Sum to be assured ? What kind of a Policy is now 
applied for? 
4. Is the premium to be paid yearly, half yearly or quarterly ? 
5. State the place and date of your birth, year, month, day. 
6. A. What is your age at your nearest birth-day ? B. Are 
you married or single ? 
7. A. Have you resided out of the United States? B. If 
so. where and for what purpose ? 
8. Have you been vaccinated ? Are you at this time in your 
ordinary state of health ? 
9. Have you ever had any of the following diseases ? If so. 
state particulars of their character and duration : 6 
Aneurism, apoplexy, asthma, bronchitis, colic, Consumption, dis 
ease of the heart or any vital part, disease of urinary organs, 
disease of digestive organs, dropsy, epilepsy, fistula, fits, gout, 
inflammation of the lungs, hoemorrhoids, habitual cough, liver 
complaint, neuralgia, palpitation, paralysis, rheumatism, rupture, 
scrofula, small pox, spitting of blood, syphilis, vertigo, yellow fever. 
10. Have you had any serious illness, local disease, or per- 
sonal injury? And, if so, of what nature? And how long since ? 
11. Have you now to the best of your knowledge or belief, 
any disorder, or any infirmity or weakness tending to impair your 
constitution ? 
12. Are your habits of life correct and temperate? Have 
they always been so ? 
13. Are you in any military or navai service ? or employed 
on a rail road or steamboat? If so. in what capacity? 
14. Are your parents living or deceased? Father, age if 
living ? State of health ? Age at death ? Cause of death ? 
Mother, age if living ? State of health ? Age at death ? Cause 
of death ? How many Frothers have you had ? Number living? 
Ages? State of their health? number dead? Ages? Cause of 
death? How many Sisters have you had? Number living? 
State of their health ? number dead ? Ages ? Cause of death ? 
15. A. Have either of your parents, brothers or sisters ever 
had pulmonary, scrofulous, cancerous, or any constitutional or 
hereditary disease ? B. Have your grand parents (paternal and 
maternal) reached old age ? 
16. State the name and residence of your usual medical 
attendant. 
17. State the name and residence of an intimate friend to be 
referred to, for information as to your present and general state of 
health. 
18. Has any material fact, bearing upon your physical con- 
dition and family history, been omitted in the foregoing questions ? 7 
19. What is the name in full of the person for whose benefit 
the insurance is applied ? Residence ? What is his or her rela- 
tionship to you? 
20. Has the above named person an interest in your life to 
the full amount now applied for ? 
It is hereby declared that the above are fair and true answers 
to the foregoing questions, and it is acknowledged and agreed by 
the undersigned, that this application shall form a part of the 
contract for insurance, and that any untrue or fraudulent answers, 
any suppression of facts, shall and will render the Policy null and 
void. 
Questions by the Medical Examiner for the Company. 
1. Name and residence of the person examined. 
2. State the approximate weight, height, figure, general ap- 
pearance and measurement of chest on forced expiration and 
forced inspiration. 
3. A. Is the respiratory murmur clear and distinct over both 
lungs ? 
B. Is the character of the respiration full, easy and regular ? 
C. Are there any indications of disease of the organs of 
respiration ? 
D. If so, state explicitly the result of percussion and auscul- 
tation. locating the seat and extent of the disease. 
4. J. Is the character of the heart's action uniform, free 
and steady ? 
B. Are its sounds and rhythm regular and normal ? 
C. Are there any indications of disease of this organ or of 
the blood vessels ? 
D. If so, state the full extent and location of the disease. 
5. A. State the rate and other qualities of the person's 
pulse. 8 
B. Does it intermit, become irregular, or unsteady at this 
examination? 
6. Is the person subject to cough, expectoration, difficulty of 
breathing or palpitation ? 
7. A. Has the person ever had any disease of.the brain, the 
muscular or nervous system ? 
B. If so, state full particulars. 
8. A. Has. the person ever had any disease of the abdominal 
or urinary organs ? 
B. If so, give the specific gravity of the urine and other 
particulars. 
9. Have the person's ancestors, parents, brothers or sisters, 
been afflicted with pulmonary or other hereditary diseases ? 
10; A. To what extent does the person use alcoholic 
stimulants ? 
B. To what extent does the person use tobacco ? 
C. To what extent does the person use opium ? 
/). Are there any indications that would lead you to suppose 
that the person has led or leads, other than a sober and temperate 
life? 
11. A. Has the person now, or has he ever had any serious 
disease, personal injury, the loss of any limb or rupture? 
B. If so, has it permanently affected his constitution ? 
12. If the person is a female, the following questions are to 
be answered: 
J. Has she passed her climacteric period ? B. How many 
children has she borne ? C. How many miscarriages has she had ? 
/). Has she any organic disease of the uterus ? E. Has she any 
scirrhous disease of the breast, or were her mother or sisters ever 
thus affected ? F Is she now pregnant? 
13. A. Is the applicant in all respects a first-class, healthy 
risk ? 9 
B. Do you recommend that a Policy be granted for the full 
amount applied for ? 
I hereby declare that I have given true answers to all the 
. questions put to me by the Medical Examiner, and that I am the 
same person described in the accompanying application. 
Person Examined. 
I hereby declare that I have attentively considered the appli- 
cation annexed, and carefully examined Mr. 
I have also witnessed the same person's signature as above. 
Medical Examiner. I. 
THE MEDICAL EXAMINER. 
It is evident upon the least reflection, that in order 
to give success to a Life Insurance Company, to secure 
to policy-holders the prospective advantages of their 
relations to that company, and to inspire and deserve 
the confidence of the community, none but lives selected 
with the greatest care and deliberation, should be assured. 
No company having a due regard for its interests and 
reputation as a business organization, desires question- 
able risks; and no Medical Examiner is doing the 
Company a service in accepting risks which are at all 
doubtful; he may be adding by such means to the 
number of policy holders, but he is, at the same time, 
weakening the force of the Institution for good, and 
periling the savings of the co-insurers-those who have 
honestly assured their lives, with the hope and expecta- 
tion that theirheirs shall reap the fruits of their prudence. 
Upon the judgment and discrimination of the 
Medical Examiner, in selecting cases to be insured, much 
depends. The Directors, Trustees and Officers may be 
men well versed in the subject of Life Insurance,-ex- 
cellent business men and devoted to the administration 
of the affairs of the office, and the Actuary may be 
thoroughly accomplished in the Science of Life-Tables 
and Rates, but if the Medical Examiner to whom is 
confided the judicious selection of risks, is careless in 12 
his examinations, and but slightly impressed with the 
grave importance of his duties in guarding the Compa- 
ny against the acceptance of worthless risks,-all the 
efforts of the other officers are rendered nugatory. 
It is true that all applications are carefully scruti- 
nized at the Home Office by the President, Vice Presi- 
dent and Chief Medical Examiner, who, in the light of 
the facts brought out, are competent to approve or 
disapprove, but it is equally true that the Local Medical 
Examiner who has personally examined the case, has 
the better basis for founding a correct and decided opin- 
ion of the merits of that case; hence the medical man to 
whom the company has delegated the office of examining 
men who desire to become insured, should be able not 
only to determine as to the advisability of the risk, in 
his own mind, but should be able also to satisfy the 
Company, from its stand-point, as to the true charac- 
ter of such risk. His "Yes " or "No" is not always 
sufficient; he must, if possible, make the case as clear to 
the apprehension of the Company as it has been to his. 
Without a minute and careful investigation as to 
the physical condition of the applicant, with his heredi- 
tary tendencies, and without the developments of that 
inquiry having been clearly recorded in the report, the 
Home Office may be perplexed in its decision and un- 
certain as to the propriety of the endorsement of the 
Examiner's action. 
Furnished with clear, plain and comprehensive 
statements of a given case, the officers are relieved from 
the embarassment of making decisions on insufficient 
evidence, and from the sacrifice of time and labor con- 13 
sequent upon the return of applications for additional 
data which might and ought to have been obtained and 
noted at first. Care in investigations and the same care 
in recording the results of those investigations are rules 
of primary moment. 
The Medical Examiner has the same occasion for 
the exercise of a rare caution and penetration as had the 
army surgeon in the late war, and like him, is to be 
always on his guard, lest be be made a victim of the 
misrepresentations of others; the latter was often de- 
ceived by simulated ailments; the former is liable to 
be imposed upon by a pretended exemption from disease; 
as many persons very anxious to be insured, will make 
out as favorable a case as possible, giving little signifi- 
cance to symptoms, that, if fairly stated, might, in the 
critical and professional eyes of the Examiner, be re- 
garded as a sufficient cause for rejection. 
In his capacity as an inspector of all of the material 
out of which the Life Insurance fabric is being raised, 
the Medical Examiner can readily leave the impress 
either of his conscientious care or his carelessness upon 
the structure; each first-class risk he accepts building up 
and strengthening it, while each hazardous one weakens 
and tends to destroy. II. 
THE HEALTH STANDARD DESIRED. 
A Life Assurance Institution laboring for the high- 
est financial success and permanence, would naturally 
desire the highest life condition among its insurers; 
indeed the degree of prosperity is commensurate to a 
great extent, with the sum of the health standard se- 
cured among its policy holders. No argument is re- 
quired to demonstrate that the greater the longevity of 
these policy holders, the greater is the profit accruing 
to the Company; such life extension defers the time for 
the payment of the policies. 
Applicants whose life-chances are best are the 
desirable ones; those who approximate to that state de- 
scribed as "a sound mind in a sound body;" to a con- 
dition where there is harmony of function, and no undue 
exaltation of one organ at the expense of another. 
And though we can reasonably expect to find but in a 
comparatively few applicants for insurance, such phy- 
sical perfection as would mark the man whose portrai- 
ture Ilufeland paints as the one who is destined to a 
long life, yet the nearer the applicant approaches to this 
condition, the more readily does he commend himself 
to the favor of the Company. 
The following is his sketch of the man whose 
chances for lengthened days are most favorable, and who 15 
would be considered " a first class risk" in any life 
company. 
"He has a proper and well proportioned stature, 
without however, being too tall. He is rather of the 
middle size and somewhat thick set. His complexion 
is not too florid ; at any rate too much ruddiness in 
youth is seldom a sign of longevity. His hair approach- 
es rather to the fair than the black; his skin is strong, 
but not rough. His head is not too big; he has large 
veins at the extremities, and his shoulders are rather 
round than flat. His neck is not too long ; his abdomen 
does not project; and his hands are large, but not too 
deeply cleft. His foot is rather thick than long; and 
his legs are firm and round. He has also a broad, arch- 
ed chest, a strong voice, and the faculty of retaining 
his breath a long time without difficulty. In general 
there is a complete harmony in all his parts. His 
senses are good, but not too delicate; his pulse is slow 
and regular. His stomach is excellent, his appetite 
good and his digestion easy. The joys of the table are 
to him of importance ; they tune his mind to serenity, 
and his soul partakes in the pleasures which they com- 
municate. He does not eat merely for the sake of 
eating, but each meal is an hour of daily festivity ; a 
kind of delight, attended with this advantage, with re- 
gard to others, that it does not make him poorer but 
richer. He eats slowly and has not too much thirst. 
Too great thirst is always a sign of rapid self-consump- 
tion. In general he is serene, loquacious, active, 
susceptible of joy, love and hope, but insensible to the 
impressions of hatred, anger and avarice. His passions 16 
never become too violent or destructive. If he ever 
gives way to anger, he experiences rather an useful 
glow of warmth, an artificial and gentle fever, without 
an overflowing of the bile. He is fond also of employ- 
ment, particularly of calm meditation and agreeable 
speculation; is an optimist; a friend to nature and do- 
mestic felicity; has no thirst after honors or riches, and 
banishes all thoughts of to-morrow." 
Dr John II. Griscom of New York, in a late essay 
on the "Physical and Physiological Indications of Lon- 
gevity," besides accepting many of these features as 
indicative of the long-lived man, added some others to 
the sketch ; viz: 
" A fully developed osseous frame, and muscular 
organization. 
Stature rather middle size ; a capacious chest. 
Pulse strong and regular; veins full at extremities. 
Skin strong, smooth and clear. 
Teeth sound; eats slowly; excretions all regular 
and free. 
No violent passions. Temperament sanguine with 
a little of the phlegmatic." 
Though this standard may be the ideal of the per- 
fect man, and be difficult or impossible of attainment 
on the part of the average number of those seeking as- 
surance of their lives, it is well to keep this delineation 
before the mind, as an object of comparison with the 
physical structure and appearance of the persons from 
time to time presenting themselves for examination. 
The desideratum, as the concluding question of the 
examination would denote, is " a first-class healthy risk" 17 
one who will, in all probability-barring the results of 
casualties and other non-natural causes-survive the or- 
dinary period of expectation. Such a risk is made up 
of certain elements-a physical frame free from deform- 
ity of all kinds, and conforming nearly in height, weight, 
measurement and expansive power of lungs, to the ac- 
cepted standards; a former exemption from ailments 
which injuriously and permanently affect the system, a 
freedom from any present disease and drift towards 
grave complaints; an inherent force, or permanent 
principle of reaction, as it is styled by Bichat, with 
capacity to oppose disorganizing agencies; an evident 
promptness to co-operate with nature in her efforts at 
the re-establishment of health ; a steady power of en- 
durance, with muscularity and other qualities which go 
to the making up of a robust constitution: good habits 
and an unexceptionable family record. If the subject 
is thus endowed and favored, he has the advantage of 
being such a risk. He may be a good, fair risk of the 
average kind, however, without having all of these 
qualifications: one or more maybe wanting, and the life 
force still be unimpaired and entitling him to insurance. III. 
THE APPLICATION. 
The numerous questions in the application address- 
ed to the applicant are designed to bring out all the 
essential points and facts in the case, so far as he is 
cognizant of them; to determine what organ has been 
or is now most obnoxious to disease; what function, 
according to his confession, has been most frequently 
disordered, and what is the direction of the physique; 
and to develop for the observation of Agent and Ex- 
aminer, the circumstances of family history, present 
surroundings and personality. 
The answers to these questions are the Medical 
Examiners starting point in his investigations, and he 
should always attentively consider the application, care- 
fully studying the answers to gain all possible guides to 
a knowledge of the physical status of the applicant. 
It is not the design to convey very specific instruc- 
tions in this manual, applicable to all the cases to be 
rejected or accepted, and it is impracticable to enumer- 
ate in this connection all the various diseases or special 
forms of disease which should insure rejection. The 
physicians own judgment, with his knowledge of those 
physical infirmities whose tendency is to a fatal termina- 
tion sooner or later, is to be his guide; but it is deemed 
fitting that certain general directions should be given, 19 
by the aid of which Medical Examiners may understand 
what the "Delaware Mutual" desires in the way of 
risks. 
The blank form for application used by this Com- 
pany, embraces the following questions to the applicant 
which have a bearing upon the case, and the list of 
diseases which are most common, and from which In- 
surance Companies are most liable to suffer. 
Residence ? Asa question of Medical Topography, 
this would naturally incite the Examiner to revolve in 
his own mind, the circumstances of temperature, cli- 
mate, situation with regard to the sources of malaria, 
as large ponds, marshes, and swamps, and the probable 
bearing of these meteorological agencies upon each 
individual case offering. 
Occupation ? This has a sensible influence over 
life, and it becomes an interesting subject of study to 
determine its true relation to longevity. The statistics 
on this important point are copious, and from many 
authors, and harmonize well in all essentials. Farmers, 
gardeners, agricultural laborers, and those generally 
who lead a simple, active, out door life, are more likely 
to attain advanced age than any other class. The clergy 
are more favored in length of life than lawyers, and the 
latter than physicians. Painters, workers in lead, com- 
positors, bakers, millers, stone cutters, brewers, dyers, 
confectioners, have generally a lowered life force, be- 
cause of the irritant impression of the fumes and min- 
ute particles upon the membranes of the air passages. 
Bar and restaurant keepers are considered to be very 
indifferent risks, because of the nature of their calling 20 
which subjects them to late hours and temptation to 
drink. Blacksmiths, carpenters, cabinet makers and 
coopers, commonly are good risks: merchants and mu- 
sicians also. Persons of fixed sedentary habits are not 
of the best class of risks, since the exercise needed for 
the maintenance of digestion is wanting, whilst it is 
asserted that no instance can be found of an idler hav- 
ing attained to a remarkably great age. 
Has any Life Insurance Company declined grant- 
ing a Policy on your Life ? 
If answered in the affirmative, the Examiner has 
an added responsibility in his decision, as he may be 
sure that the previous Examiner or the Company which 
he represented, had or thought they had sufficient rea- 
sons for the declension : hence the greater necessity for 
a rigid examination as to the causes for the former re- 
jection, and the need of the greater deliberation in 
forming the judgment. If he accepts, he should ex- 
plicity state his reasons for the acceptance, and demon- 
strate satisfactorily to the Company that the previous 
condition which necessitated the rejection, no longer 
exists. 
Age ? In the language of Hufeland " every created 
being passes through three periods: that of its growth, 
that of its being stationary, and that of its decline;" he 
adds that " the duration of life in that being will be 
proportioned to the innate quantity of vital power, the 
greater or less firmness of its organs, the speedier or 
slower consumption, and perfect or imperfect restora- 
tion." Buffon states that " the total duration of life 
may be estimated to a certain degree by that of the 21 
duration of an animal's growth," and that "a man who 
takes thirty years to grow, lives ninety or a hundred 
years." Other authors have the multiple for the du- 
ration of life, five times the period of growth. 
This consideration of the age has an intimate re- 
lation with the question of the risk, more especially 
under circumstances of hereditary vice or tendencies. 
With the progression of age beyond thirty-five or forty 
years, the exemption from these hereditary inflictions 
increases: hence a Medical Examiner would feel safer 
in accepting a man beyond this age, whose father, 
mother, brother or sister had died of phthisis in their 
earlier years, than one who had not reached the age at 
which some one of them had died. 
A table of Life Expectation based upon the Carlisle 
table of mortality is subjoined. 
AGE. 
EXPECTA- 
TION. 
AGE. 
EXPECTA- 
EXPECTA- 
TION. 
AGE. 
EXPECTA- 
TION. 
T1ON. 
AGE. 
0 
38.72 
18 
42 87 
35 
31.00 
52 
19.68 
1 
44.68 
19 
42.17 
36 
30.32 
53 
18.97 
2 
47.55 
20 
41.46 
37 
29.64 
54 
18.28 
3 
49.82 
21 
40.75 
38 
28.96 
55 
17.58 
4 
50.76 
22 
40.04 i 
39 
28.28 
56 
10.89 
5 
51.25 
23 
39.31 
40 
27.61 
57 
16.21 
6 
51 17 
24 
38.59 
41 
26.97 
58 
15.55 
7 
50.80 
25 
37.86 
42 
26.34 
59 
14.92 
8 
50-24 
26 
37.14 
43 
25.71 
60 
14.34 
9 
49 57 
27 
36.41 
44 
25.09 
61 
13.82 
10 
48.82 
28 
36.69 
45 
24.46 
62 
13.31 
11 
48.04 
29 
35.<>0 
46 
23.82 
63 
12.81 
12 
47.27 
30 
34.34 
47 
23.17 
64 
12.30 
13 
46.51 
31 
33.68 
48 
22.50 
65 
11.79 
11 
45.75 
32 
33.03 
49 
21.81 
66 
11.27 
15 
45.00 
33 
32.36 
50 
21.11 
67 
10.75 
16 
44.27 
34 
31.68 
51 
20.39 
68 
10.23 
17 
43.57 
Married or Single? This question has its sig- 
nificance. Single men, everything else being equal, are 
not so desirable as married ones, as there is a conviction 22 
with many authorities that marriage is essential to 
longevity, one having ventured the declaration that there 
is not "one instance of a bachelor having attained to a 
great age." The same favorable hygienic condition 
which marks the married male, appears to attach to the 
married female, making the risks of maternity but little 
greater than the ordinary risks of single female life. 
Vaccinated? The frequent prevalence of Small 
Pox, with the well-known mortality from this source, 
makes it important that there should have been a suc- 
cessful vaccination. If the applicant has never been 
vaccinated, the Examiner should either perform the 
operation, or influence the applicant to have it done: 
but should not accept him during the progress of the 
vaccination. 
Present State of Health? Postponements may 
be and ought to be made in some instances; for instance 
when the applicant has a severe cold or catarrh, with 
some roughness of respiration, or laryngeal or bronchial 
irritation; as these symptoms might merge into fixed 
disease, a few days delay would be judicious as giving 
time for developments. It is safe to await the subsid- 
ence of all present symptoms. Again the existence of 
a boil of any magnitude, carbuncle or abscess of any 
kind would be sufficient to delay the acceptance, since 
these local affections might, by the supervention of ery- 
sipelas, become constitutional as to results. 
Have you had any serious illness, local disease, 
OR PERSONAL INJURY? AND IF SO, OF WHAT NATURE, AND 
how long since ? This question should be pressed, as 
it might bring to light the former existence of some di- 23 
sease which has left its mark upon the system : it would 
embrace the occurrence of accidents, fractured bones 
and surgical injuries generally. 
Are your habits of life correct and temperate? 
and have they always been so? This is one of the 
most important questions in the entire list, and in view 
of the prevalent indulgence in alcoholic stimulants at 
the present day, and the well-known pernicious results 
of this indulgence, too much emphasis cannot be laid 
upon the need, on the part of the Examiner, of the great- 
est care and circumspection both in his examination and 
his decision. 
Habitual drinkers,-men who are so unfortunate as 
to be afflicted with Dipsomania, and those who are oc- 
casionally addicted to a debauch, are undesirable risks: 
indeed they are hazardous risks in the extreme; as much 
soin the judgement of some, as cardiac disease or in- 
cipient phthisis. Aside from the injury inflicted upon 
the stomach, brain and nervous system generally of him 
who indulges in what is usually designated as a " spree ", 
no little risk is run from his inability to protect himself, 
during his debauch, against accidents or injuries so con- 
sequent upon his rashness and fool-hardiness in heedless 
exposure. 
The Medical Examiner should never lose sight of 
the fact that the habit of using stimulants, surely, though 
it may be but slowly, grows upon the subject, is diffi- 
cult to break up, requiring for its discontinuance a 
greater effort of the will than many persons are capable 
of: that sooner or later its results are abundantly mani- 
fest in an impaired system : that it may be a disease 24 
which shall terminate only with life, and that it may be 
hereditary, transmitting itself from father to son. Up- 
on an examination of a drinking man through whose 
family history this trait runs, common prudence would 
lead the Examiner to reject. 
Some writers recommend that Insurance Compan- 
ies should grade their risks on the habits of the man, 
in the classification marking the perfectly abstemious 
man a first class, the extent of the indulgence graduat- 
ing the degree of the risks in cases not abstemious. 
Another recent writer remarks " that if it be an es- 
tablished fact that the use of intoxicating beverages shor- 
tens human life, why should Life Insurance Companies 
fail to take emphatic notice of such an important element 
of calculation as regards the chances of life ? Do they 
doubt that they could afford to insure the lives of one 
thousand total abstinent men at a much lower rate than 
should be charged for the lives of one thousand wine, 
brandy and whiskey drinkers ? If they can, why not 
give the former the benefit of their good habits by in- 
suring them at a less premium than the others ? There 
is no justice in compelling temperance men to pay for 
the health destroying indulgences of those who despise 
and oppose the reform. Every man who tastes liquors 
as a beverage, should be marked extra hazardous, and 
charged a corresponding premium. Thus only can equal 
and exact justice be rendered to all." In connection with 
this, it may be mentioned that one Company has reduc- 
ed total abstinence rates. 
It thus becomes a matter of moment to ascertain 
if this habit of drinking exists, or has existed, and to 25 
what extent. But it is not always easy to elicit the 
truth from the applicant himself, as the confession would 
possibly be regarded by him as somewhat humiliating, 
as a charge against his moral force. Unaided by any 
voluntary evidence on the part of the applicant to whom 
such a suspicion attaches, the marks of immoderate 
stimulation are to be carefully sought and noted, the 
state of the nervous system inquired into, and reference 
made to the certificate of the family physician or friend. 
The great central thought of the Examiner, in all 
cases of moderate drinkers even, should be, " will this 
case probably live long enough to pay into the funds of 
the Company money enough to reimburse it for its loss 
by his death?" It would be a very difficult thing for 
an Examiner to say that an intemperate man insured, 
would survive the ordinary period of expectation. 
Parents living or deceased? and number of broth- 
ers and sisters? Many applications are received at 
the Home Office, in which the person asking for in- 
surance, states that a father, mother, brother or sister 
has died from consumption: sometimes that a father 
and one or two brothers have died from this disease. 
This acknowledgement should at once place the Exam- 
iner on his guard, and stimulate him to make a thorough 
inquiry into the case, not only as to the present state of 
the pulmonary organs and his present habits and con- 
dition in life, with the impression he makes upon the 
Examiner, but as to whether there were any agencies 
that possibly operated injuriously upon the consumptive 
members of the family that he is free from: both his 
own personality and family record should be closely 26 
scrutinized. Great caution is enjoined in these cases, 
and it is advised that when such risks are accepted, a 
full statement under the head of "Remarks" may be 
made to the Company, as to the reasons prompting the 
approval. 
Sometimes Phthisis removes several brothers and 
sisters, and leaves one perfectly sound, and with no 
tendency whatever to lung disease; nature has favored 
him, and the destroyer has passed him by. If one who 
has had such an unfavorable family record, should have 
attained to the age, say, of forty or forty-five without 
ever having shown any disposition to glide into the 
hereditary groove, the chances are that he will escape 
altogether the phthisical inflictions. 
The family record assists to grade the risk. If fa- 
ther and mother are still living at a ripe old age, and 
are in fair health, and if the brothers and sisters or the 
majority of them are living and healthy, it shows that 
the stock is good, and greater confidence is felt in ac- 
cepting. But on the other hand, if father and mother 
died at an early age, and death has borne off several of 
the offspring, doubt as to the physical soundness of the 
ancestral line suggests itself. 
Further, the question as to the Cause of death has 
no little significance, but is often not satisfactorily an- 
swered. Many applications are received at the Home 
Office where this question relating to the cause of death 
of father or mother is answered thus-" Unknown." 
Now such an answer as this, is not, generally speaking, 
at all acceptable to the Company. There are doubtless 
some instances where the person being insured, is un- 27 
acquainted with the cause of death of parents, but such 
instances, it is believed are not as frequent as the ap- 
plications would denote. The Examiner should not at 
once be satisfied with such an answer, as it is possible 
that it might disguise the fact that one or both parents 
have died of consumption, apoplexy, scrofula or can- 
cer, but should press the question home and tax the 
memory of the applicant. 
Name of your usual Medical Attendant ?- 
The name is given for reference if any is required, 
as the family physician is assumed to be well ac- 
quainted with his patient's idiosyncracies and health. 
Frequently the applicant's answer to this question is 
" never had occasion for a Doctor." This declaration 
may be true with the additional one that he has never 
been sick a day: yet he may not be a safe risk: every 
organ may be apparently in good working order, and 
most of the functions duly administered, still there may 
be wanting the elements of strength and permanence 
in the machinery. This may be the case with men of 
little muscular fibre, who do not look very strong, but 
yet can endure no little labor without great fatigue; 
their weight is small, their stature moderate, and their 
limbs all but attenuated: still no fixed disease can be 
discerned. 
In these cases let the reflection ever be present to 
the mind, could this man successfully resist an acute 
attack ? Would he not promptly succumb to a Typhoid 
or Pneumonia? Could sufficient forces be collected 
from such an organization to oppose successfully such 
attacks from these or other diseases ? So long as he was 28 
unexposed to any agency of disorganization other than 
those inherent in the system, he might escape well, but 
let him contract a severe cold from exposure, and the 
results might be serious: he has not enough reserve 
forces of vitality in such a constitution to bear the waste 
which inflammatory processes would produce. 
Have you ever had any of the following diseases ? 
If so, state particulars of their character and dur- 
ation : 
Aneurism, 
Apoplexy, 
Asthma, , 
Bronchitis, 
Colic, 
Consumption, 
Disease of the Heart, or any 
vital part, 
Disease of Urinary organs, 
Disease of Digestive organs, 
Dropsy, 
Epilepsy, 
Fistula, 
Fits, 
Gout, 
Inflammation of the Lungs, 
Hoemorrhoids, 
Habitual Cough, 
Liver Complaint, 
Neuralgia, 
Palpitation, 
Paralysis, 
Rheumatism, 
Rupture, 
Scrofula, 
Small Pox, 
Spitting of Blood, 
Syphilis, 
Vertigo, 
Yellow Fever. 
Aneurism. It is comparatively rare that this dis- 
ease is noted, but for very obvious reasons, it should 
reject. 
Apoplexy. A decided attack should disqualify: 
a person who has once had a seizure however slight, or 
is predisposed that way, is an unsafe risk. 
Asthma. When but rare in its recurrence and un- 29 
complicated with organic changes of the heart, lungs or 
other important viscus, it need not be occasion for re- 
jection. Its cause should be carefully sought for and its 
nature well considered. 
Bronchitis. When of frequent recurrence, and 
productive of much constitutional disturbance, leaving 
behind it a protracted cough, hectic or emaciation, this 
might properly be regarded as a disqualifying disease. 
Colic. An occasional attack of colic is of little 
consequence : the list embraces the disease or rather the 
symptom, to suggest the possible existence of such an 
affection among painters, type setters and operatives in 
lead works. When of frequent occurrence with one of 
this class, the case should demand deliberation. 
Consumption. All companies have a "holy hor- 
ror" of consumptive cases, and do not want them on 
any terms. It is here that the Examiner is called upon 
more to study premonitions than the disease already 
well established and apparent in the system, and in all 
instances where there is the slightest suspicion of a 
phthisical taint or direction in the system, it is incum- 
bent upon him to examine closely for any signs or 
symptoms, that might gradually but surely develop 
into fatal disease. 
Disease of the Heart. This is another class of 
diseases which always reject when organic: expert in 
diagnosis, the Examiner can distinguish between func- 
tional disorders and those of an organic character, and 
determine the probable significance of the former symp- 
toms. 
Disease of urinary organs. It is not sufficient to 30 
say that the person has disease of the urinary organs, 
but the exact nature of the disease must be stated, and 
whether it involves the kidneys, bladder, prostate or 
urethra. Bright's disease, calculus and diabetes reject, 
as also chronic inflammation of kidneys. One or more 
uncomplicated attacks of Gonorrhea would not impair 
the risk, but stricture would have to be attentively con- 
sidered in its bearings upon the risk. It might be 
serious as being impermeable and permanent, or but 
slight and sympathetic. 
Disease of digestive organs. This inquiry is in- 
tended to point to the existence of Dysentery, Diar- 
rhoea, and Dyspepsia, not that the former existence of 
any of them should exclude, but that the character and 
duration should be investigated. If the former disease 
is present, the risk should not be accepted: Diarrhoea 
if present would have a more serious aspect if the sub- 
ject contracted it in the army, and had not been exempt 
from it except for a few days or weeks at a time. 
Dropsy. A symptom of morbid action, it demands 
attention, not so much because of the condition itself, 
as indicative of pathological changes in some organ, as 
heart, liver, lungs or kidneys. In these cases tests 
should be applied with the view to detect the presence 
of albumen and to determine the sp. gr. The same 
means should be employed in diseases of urinary organs. 
Epilepsy. This disease-and the term includes 
Fits-should disqualify: oft-recurring seizures impair 
the mind and expose the subject to accidents. 
Fistula. According to Prof. Allen-the author 
of an excellent treatise on LifesEaoiaimxntns, Fistula 31 
in ano should disqualify, if it is among the signs of 
tuberculosis, if it has proved obstinate under correct 
treatment, or if it is large, burrowing and exhausting. 
Gout. From the well-known habit of acute Gout 
to recur from time to time, the Examiner would be re- 
luctant to accept, especially if the disease were heredi- 
tary. The mode of living that excited it, would also 
have some weight in the forming his decision. 
Inflammation of Lungs. A person subject to fre- 
quent attacks as some are known to be, would not be a 
favorable case for insurance. A former attack need not 
disqualify, especially if it occurred between the ages ot 
six and twenty, as we have the authority of Prof. Wood 
that such attacks appear to be remarkably mild. 
Hcemorrhoids. When slight, of little moment, but 
when very severe and exhaustive, would direct investi- 
gation to neighboring organs and parts. 
Habitual Cough. A cough acknowledged should 
prompt to an examination not only of the lungs, but of 
the throat passages in order to determine if there is 
any thickening of the fauces or other change there. A 
previous " very bad cold " confessed, might also origi- 
nate a suspicion as to the soundness of the pulmonary 
parts. With such a case before him, the Examiner 
would seek to find if there were loss of voice, laryngeal 
irritation, great debility, a sense of tightness across the 
chest, or pain. 
LivFr Complaint. The character of the complaint 
should be specified in the answer. A slight hepatic 
disorder is of little moment, but where there has been 
an abscess, or where, after trouble with this organ, an 32 
icterode appearance of the skin is left, and the eyes are 
habitually tinged with yellow, we should reject, and 
especially if the subject were living in a malarial sec- 
tion. In such localities on this Peninsula, though the 
ordinary Bilious Remittent Fever is commonly very 
tractable and little likely to affect the general health 
permanently, some residents become surcharged with 
the malarial poison and give constant evidence of im- 
paired physique. The decision in all of these com- 
plaints would be influenced by their character. 
Neuralgia. This symptom is not embraced in the 
list to disqualify of itself, but to point the Medical Ex- 
aminer to possible organic lesions or to some special 
condition of system. 
Palpitation. This, like the preceding, is a symp- 
tom, and designed to direct investigation as to the 
cause. 
Paralysis. General Palsy, Hemiplegia and Para- 
plegia would disqualify at once. There are many cases 
of local paralysis from severing of nerve by bullet, 
among those who were wounded in the late war, that 
need not necessarily be rejected : but when such paral- 
ysis is associated with disease of brain or spinal cord, 
or with an apoplectic tendency, it would be sufficient 
ground for rejection. 
Rheumatism. The character of former attacks must 
al wavs be distinctly stated: whether acute, chronic or 
metastatic : how many attacks, and if there appears to 
be a rheumatic diathesis: the fate of the application 
would depend upon these points : simple muscular rheu- 
matism would be of little significance, as it is an in- 33 
diction from which few are exempt, while occasionally 
recurring attacks of the acute would reject, and a chron- 
ic rheumatic condition would prompt the Examiner tp/ 
direct his attention to the heart. 
Rupture. The rules adopted by the best authori- 
ties are, always reject when the descent of the intestine 
is not prevented by a truss of suitable construction, 
and when there is a double hernia: there are other cir- 
cumstances under which hernia may reject, for these the 
Examiners discretion should be his guide. When a 
person confesses to the existence of rupture, make the 
necessary examination and report the kind. In accept- 
ing a case of the simplest kind, the proviso that a truss 
shall be habitually worn is always added. 
Scrofula. The external kind is meant here; that 
which displays itself in the lymphatic glands: most of 
such cases point to a strumous diathesis, and are accord- 
ingly unsafe. Old ulcers upon the limbs and abscesses 
the product of the condition, would reject. 
Small Pox. A former attack of this disease would 
not disqualify unless it had left its mark upon the lungs, 
or other important parts. 
Spitting of Blood. True ILemoptosis is to be dis- 
tinguished from hemorrhage from mouth, fauces or pos* 
terior nares. The expectoration of a teaspoonful of 
blood, except from a severe temporary congestion or 
concussion of lungs from injury, or from Pneumonia, 
would promptly exclude. Even the plea of temporary 
congestion would not satisfy ; as to produce this symp- 
tom, some defect in the pulmonary organization must 34 
exist. In females, a slight hsemoptosis is not so signifi- 
cant, as it may be due to vicarious causes. 
Syphilis. Our custom has been to decline these 
cases not only when present, but when the former ex- 
istence of them was admitted, unless a long time has in- 
tervened since there were any manifestations of such a 
vice in the system. 
Vertigo. From the disposition of these vertiginous 
spells to merge into epilepsy ultimately, it behooves the 
Examiner to be cautious in accepting. 
Yellow Fever. If the applicant has ever had .this 
disease, the system should be well scrutinized for 
evidences of the mischief it may have caused. 
If, on the face of the application the applicant 
admits that he has had some one disease, which is gene- 
rally regarded as of moment in influencing the future 
condition of the organization, the Examiner should 
never fail to make reference to this circumstance in his 
report, concisely explaining it by the aid which he re- 
ceives from his own discernment and the applicants 
representations. The omission to allude to or comment 
upon any such confessed disease, would argue a want of 
attention to and appreciation of points of first im- 
portance. IV. 
THE PERSONAL EXAMINATION. 
The Examiner has carefully read, it is assumed, the 
application, and noted all the points of Life Insurance 
import, and is now prepared to proceed with his exami- 
nation in the regular order laid down in the form. 
1. Name. Never omit to give the name here! as 
plain as is the design of the blank, many Examiners fail 
to fill it. 
2. Weight, Height, Figure, General appearance 
and Measurement of Chest. 
Weight and Height. Due attention is to be paid 
to the relation of the age to the height, and the ratio of 
the height to the weight. Certain rules are laid down 
in the books, governing the relative normal proportions, 
though the departures from these rules may be wide, 
and still the physique be good. Dr. Brinton, is authority 
for the following: " as a rule, it may be laid down that 
an adult male, in good health, 66 inches in stature, ought 
to weigh rather more than ten stones or 140 pounds 
avoirdupois, and for every inch above and below this 
height, we may respectively add and subtract about five 
pounds." 36 
The subjoined table is generally used for reference: 
HEIGHT. 
WEIGHT. 
MEDIUM CHEST. 
5 
feet 1 
inch. 
Should 
weigh 
120 lbs. 
34.06 inch. 
4 4 
2 
4. 
4 4 
44 
125 
44 
35.13 
44 
5 
u 
3 
44 
44 
4 4 
130 
44 
35.70 
44 
5 
4 
44 
44 
44 
135 
44 
36.26 
44 
u 
5 
44 
44 
44 
140 
44 
36.83 
44 
b 
u 
6 
44 
44 
143 
44 
37.50 
44 
5 
44 
7 
44 
44 
44 
145 
44 
38.16 
44 
5 
44 
8 
44 
44 
44 
148 
4 4 
38.53 
4 4 
.) 
44 
9 
44 
44 
44 
155 
4 4 
39.10 
44 
5 
44 
10 
44 
44 
44 
160 
44 
39 96 
.4 
5 
44 
11 
44 
4 4 
44 
165 
44 
40.23 
44 
6 
44 
44 
44 
170 
44 
40.80 
44 
On this point, Prof. Allen states that five feet and eight 
inches may be taken as the medium in this country for 
adult males, and that as a rule, the medium height is 
endowed with the greatest endurance. 
The examination of a very tall person would very 
naturally remind the Examiner to inquire as to the ex- 
istence of varicose veins or ulcers upon the lower ex- 
tremities, while the examination of one much below the 
ordinary standard as to height and size, would lead him 
to study what has caused this arrest of development, and 
whether the family generally were small. The presen- 
tation of an obese man would reasonably suggest the 
query: is his increase so constant as to be likely to lead 
to diseased action? When there is such an approach to 
obesity, the measurement of the abdomen should be 
taken, and the results recorded on the margin under the 
head of " Remarks." 
When the standard weight is exceeded greatly, the 
Examiner should give the character of the figure, stat- 
ing whether there is obesity or development of muscle : 
whether the figure is well rounded and such as to give 
a sense of symmetry, or whether the adipose tissue pre- 37 
dominates over the muscular and interferes with the 
freedom of the man's movements. Is there elasticity, 
activity, or is he a bon vivant, and likely to increase his 
weight by indulgence at the table? 
Figure. There are certain persons who impress 
the Examiner at once as having all the elements of vi- 
tality and longevity in an eminent degree; they have 
muscularity, erectness, symmetry, large, rounded, well 
developed chest, and have an apparent consciousness of 
health and strength-all of which conspire to give con- 
confidence to the Examiner in acceptance, whilst there 
are others who are tall and narrow shouldered and 
whose figure is drooping and bent, giving an impression 
of defect from spinal irritation, habit or muscular 
weakness. 
General appearance. Medical physiogomy as 
Dunglison terms it, is a material aid often-times in serv- 
ing the Examiner to form his judgment. Its province 
is to glean information from countenance, complexion 
and eyes. The face may be a valuable index as denot- 
ing vascular derangements, plethoric habits, indulgence 
at table, a free use of stimulants or a tendency to apo- 
plexy ; or it may arouse suspicion of existence of can- 
cerous diathesis or tuberculous disease, or may point to 
disease of heart or liver. 
Measurement of chest. The measurement is taken 
with a graduated tape line under the inferior angles of 
the scapulae and over the nipples: the measurement 
should be taken under the vest, and noted on expiration, 
and then the person examined should be instructed to 
make a decided inspiratory effort, during which the tape 
is kept in its place to mark the difference. 38 
The extent of a healthy expansion of chest is said 
to be three inches, but our observation would lead us to 
believe that it is below this, though some persons far 
exceed this: one instance we have noted on an applica- 
tion for insurance (and the chest was measured carefully, 
and in the presence of witnesses) where the man, a 
worker in wood and 46 years of age, expanded six 
inches. 
Though the spirometer is not regarded by any 
means as a safe guide in detecting any abnormal condi- 
tion of lungs, it may be looked upon as an auxiliary to 
other methods, though in noting the capacity of the 
lungs by this instrument, weight and age, it must be 
remembered, influence the quantity of air that is inspired 
and expired. We are accustomed to use in our office, 
one of Brown's spirometers, and though it does not 
serve us materially in our examinations, it acts as a 
supplementary means in enabling us sometimes to so- 
lidify our decision 
The following table of the quantity of air given out 
by forced expiration after the deepest inspiration, is 
given by Dr. Hutchison-the result of many examina- 
tions by his spirometer. 
Height. 
From obser- 
vation. 
Cubic inches. 
Regular pro- 
gression. 
Cubic inches. 
5 
ft. 
- 
5 
ft. 
1 
in. 
174 
174 
5 
u 
1 
in. 
- 
5 
ll 
2 
it 
177 
182 
5 
ll 
2 
u 
- 
5 
ll 
3 
u 
189 
190 
5 
ll 
3 
ll 
- 
6 
ll 
4 
u 
193 
198 
5 
ll 
4 
ll 
- 
5 
ll 
5 
it 
201 
206 
5 
II 
5 
ll 
- 
5 
ll 
6 
it 
214 
214 
5 
ll 
6 
ll 
- 
5 
ll 
7 
u 
229 
222 
5 
ll 
7 
ll 
- 
5 
ll 
8 
ii 
228 
230 
5 
U 
8 
ll 
- 
5 
ll 
7 
ii 
237 
238 
5 
u 
9 
ll 
- 
5 
ll 
11 
u 
246 
246 
5 
ll 
10 
la 
- 
5 
ll 
11 
u 
248 
254 
5 
ll 
11 
ll 
- 
6 
U 
259 
262 
RESPIROMETER TABLE-" HUTCHINSON'S." 39 
In the general effort to determine the condition of 
the lungs, inspection and palpation should always be 
resorted to, in order to detect any irregularities in its 
conformation, any hollowing under the clavicle, any 
great difference in the two sides, any approach to 
" pigeon breast " as indicative of abnormal state of lungs 
with deficient capacity, or any other gibbosities. An 
inspection might bring to light marks of former pustu- 
lation, the signs of a blister, the scarifications in cupping : 
here would be a point gained at once, for such evidences 
would denote the former existence of some disease of 
lung or pleura. 
3. Respiration. This embraces the clearness and 
distinctness of the respiratory murmur over both lungs, 
the fullness, ease and regularity of the respiration, and 
the indications of disease of the respiratory organs. 
The respiratory acts should be studied in their relations 
to the circulation-the ratio of the inspirations to the 
beat of the pulse, which has been fixed by some author- 
ities as 1 to 4| in healthy subjects. 
The following figures of frequency of inspiration in 
those of an insurable age, are taken from Quetelet's 
Table. 
Age. 
Average. 
Inspiration. 
Max. 
Min. 
15 to 20 
20 
24 
16 
20 to 24 
18.7 
24 
14 
25 to 30 
16 
.21 
15 
30 to 50 
18.1 
23 
11 
As the examiner is expected to detect any indications 
ot disease in the lungs, it is incumbent on him to study 
carefully the sounds given out by auscultation and per- 
cussion, and to record the nature of those sounds when 
he has observed any unnatural ones. 40 
Eor convenience of reference we have taken from 
Dr. Glominger's Manual, the following table : 
Sounds. 
Relative to Disease. 
Inspiration and expiration. Associated with. 
Mucous rattle. 
Co-existing with both. Bronchitis, after secre- 
tion has been estab- 
lished. 
Sub. Mucous. 
Predominating in in- Capillary Bronchitis, 
spiration. 
Cavernous. 
Co-existing with both Vomicae in Phthisis, Di- 
acts. latation of Bronchitis 
Humid Crackling. 
More distinct in inspi- Softening in tubercles, 
ration. 
Dry Crackling. 
Exclusively in inspi- Softening, 
ration. 
Crepitation or Ronchus. 
Co existing in inspira- Pneumonia, 
tion. 
Secondary Crepitation. 
Oo-existing in both. Pneumonia. 
Sonorous rattles. 
Inspiration and expi- Bronchitis, 
ration. 
Friction sounds. 
In both acts. Pleurisy. 
As to the indications of disease of the respiratory 
organs, all the usual means for discovering a departure 
from a healthy condition, or a tendency to a deviation 
from the normal standard are to be availed of. The en- 
tire field is to be traversed in quest of any proof in a 
suspected case. The Examiner is not dealing with an 
established affection, patent to the most obtuse observer, 
for such cases rarely come before him, but he is seeking 
to discover the signs that may be lurking ; and he should 
examine carefully the throat for any thickening of the 
fauces: should inquire if the common colds are frequent 
and protracted: as to the character of the sputa and the 
quantity: as to laryngeal ulceration : as to any former 
sense of tightness or constriction across the chest: any 
asthmatic symptoms, and how frequently they appear. 41 
As deaths from diseases of the respiratory system 
bear such a great ratio to the deaths from all other di- 
seases, in the mortuary records of Insurance companies, 
the Medical Examiner cannot be too careful and circum- 
spect in his investigations in this field of inquiry: all of 
his acumen and skill is required in the effort to uncover 
the smallest hidden seeds of disease: even the voice is 
to be brought in evidence as to condition of lungs, for 
when sharp, clear and capable of prolongation, normal 
respiration is denoted: when husky, weak, hoarse, harsh, 
it may mark disease of throat or lungs. 
4. Heart and Blood vessels. The inquiries to be 
made in this direction are to elicit the facts as to the 
uniformity of the heart's action; whether it is free and 
steady, whether its sounds and rhythm are regular and 
normal, and whether there are any indications of disease 
of this organ or of the circulatory system-discoveries 
which are of the utmost importance, since, like the pre- 
ceding diseases, these disorders may be present in the 
system without plainly manifesting themselves by ex- 
ternal marks; unlike many diseases, they do not hang 
out their signs for every one to read, and their physiog- 
nomy is not so unmistakable, being enveloped, as it 
were, in an aspect of most vigorous health, which ap- 
parent health is likely to terminate abruptly in death. 
The aids to a diagnosis-auscultation, inspection and 
palpation are to be employed. The sounds are to be 
remarked and their significance studied; sometimes very 
useful knowledge may be obtained by an inspection of 
the chest, with measurement from the spinous process 
of the vertebrae to the ensiform cartilage of each side. 42 
In enlargement the pulsations will be plainly seen, ap- 
pearing to move painfully the thoracic wall of the left 
side, and a tape line will show a sensible increase of the 
same side, while the hand applied to the cardiac region 
will have communicated to it a peculiar thrill. 
When there is a question as to the character of any 
disorder; whether it is organic or functional, the Exami- 
ner should make one or more examinations with a suf- 
ficient interval of time to give opportunity for compari- 
sons. 
In this connection, he should inquire as to the ex- 
istence of aneurism, varicose veins, varicocele, palpita- 
tions, the effect upon the heart of active exercise, of 
ascent of stairs, of heights, of long walks, of fright and 
of excitement, and also make careful inquiries as to the 
former existence of acute Rheumatism. 
5. The Pulse. As indicative of the heart's action 
and to some extent of the condition of the nervous sys- 
tem, this question has its significance. The pulse should 
be noted when the person is sitting: it is not well to 
note it at the first stage of the examination, as the sub- 
ject is apt to be excited somewhat then, as it is well 
known it is much influenced by excitant causes : the as- 
sociation of an examination in the minds of some is 
sufficient to quicken the circulation : hence it is well to 
place the finger upon the radial artery more than once 
during the progress of the examination, timing the 
beats. 
It should be remembered also that the pulse may 
be affected by indigestion, by violent exercise, stimula- 
ting drinks, tea or coffee, and the emotions; hence the 43 
care to discriminate between arterial excitement from 
any one of these causes, and that having its origin in 
organic disease. 
Remembering that the natural pulse in the adult 
male has a range from 65 to 80 or 85 during the insurable 
age, the Examiner should endeavor to discover the cause 
when its departure from that standard, either below or 
above, is very wide. 
6. The points in this question have been adverted 
to elsewhere. 
7. Disease of the brain, muscular, or nervous 
systems. Inquire as to the former existence of any 
symptoms of insanity, spasms, convulsions, paralysis, 
epilepsy, apoplexy, muscular rigidity, and spinal in- 
flammation or irritation. 
8. Disease of the abdominal, or urinary organs. 
When there has been any disease of significance in a 
life insurance point of view, affecting these organs, 
specify what it was : there is a wide range of diversity 
in the character of these complaints, and it is not suffi- 
cient to generalize and say that the applicant has had 
urinary disorder, or a slight affection of the bowels; but 
a careful mental survey of the whole field should be 
made, and the specific complaint recorded : former dys- 
enteries, army diarrhoea of long standing, dyspepsia, dis- 
ease of the Liver, hemorrhoids, hcematemesis, disease in- 
volving kidneys, bladder, the presence of albumen in the 
urine, diabetes-all of these possibilities are to be con- 
sidered. The question as to the regularity of the alvine 
discharges should be asked, and if there is any difficulty 
in the passage of water. 44 
in revealing the abdominal functions, good teeth 
have their part in making up an estimate of the health, 
as they point to a regard of hygienic rules. Good ap- 
petite, good digestion and good temperament are classed 
as essential requisites for long life. 
9. Have the person's ancestors, parents, broth- 
ers, OR SISTERS BEEN AFFLICTED WITH PULMONARY OR OTHER 
hereditary diseases ? The propounding of this ques- 
tion on the face of the application, and then on the 
Medical examination, shows its great importance, and 
the primary necessity of hunting up these "heir looms 
of infirmity" transmitted by kindred. 
10. A. To what extent does the person use 
alcoholic stimulants? Much, in the view of a prudent 
Insurance Company, depends upon the answer to this 
question. The greater the experience in this class of 
cases, the more is the apprehension in dealing with them, 
as intemperance is recognized as a disease, and reform 
considered almost as difficult as the cure of the most 
inveterate diseases, and it is not surprising that Insurance 
Companies regard these cases with peculiar disfavor. 
The sanguine temperament of the philanthropist and 
reformer sees little to give encouragement, in view of 
the relatively few reformations of persons who have for 
some considerable time been addicted, to any marked 
extent, to the use of stimulants. 
A former attack of Delirium Tremens makes the 
risk a very unsafe one, and the case should not be ac- 
cepted unless a sufficient number of years have elapsed 
to give positive proof that there is no longer any danger 
that the man will lapse into his old habits. 45 
When the Examiner has reason to suspect that the 
"applicant has led or leads other than a sober and tem- 
perate life," he should direct his search towards the 
brain, nervous system and stomach, studying the man 
with all the penetration possible. 
B. To WHAT EXTENT DOES THE PERSON USE TOBACCO? 
That the use of tobacco is of some moment in a Life 
Insurance point of view, is shown by the position of 
this question : but we do not rank it with alcohol in its 
general effect upon the system. That it can be and is 
harmful in some instances, we believe; and especially 
when used by a person with weak lungs or suffering 
from debility, when the habit is accompanied with in- 
ordinate salivary secretion : and it can effect the nervous 
system. But it is not well to take the position that it 
is in all cases prejudicial to the health when used in 
moderation, depriving the man of his strength as al- 
ledged by some, diminishing his power of endurance, 
reducing the tone of his system, inducing habitual nar- 
cotism and acting in hostility to the vital principle. 
C. To WHAT EXTENT DOES THE PERSON USE OPIUM ? 
If this pernicious habit is indulged in to the extent 
claimed by many, it is needful for the Examiner to be 
wary, more especially since the person examined will 
not assist him in getting at the facts. The signs are to 
be sought in the face, complexion, eyes, in restless- 
ness and tremulousness. Of all the applications re- 
ceived at the Home Office, no other answer than a nega- 
tive one has been returned to the question as to the use 
of this drug. Its habitual use for any cause or under 
any plea, would unhesitatingly exclude, since this habit 46 
is more hopelessly fixed, more remorseless in the pun- 
ishment of its victims than ardent spirits, and just as 
sure in its fatal results. 
11. Has the person now, or has he ever had, any 
SERIOUS DISEASE, PERSONAL INJURY, THE LOSS OF ANY LIMB, 
or rupture ? Since the termination of the late war, 
this question is often answered affirmatively, and the 
Medical Examiner is as often required to specify the in- 
jury. 
In mechanical or surgical injuries, note what drain 
was made upon the forces of the system at the time of 
the reception of the injury, and what charge there is at 
present, from this source, upon the vital powers. If 
there has been an amputation or other operation, state 
what necessitated it, and the condition and appearance 
of the stump or cicatrix. In a case of gun-shot wound, 
record what organ or member was involved. 
If, on inspection, any deformity is found, or any 
abnormal development, state the character and extent, 
adding a description of any ulcers, sinus or glandular 
enlargements. 
As before remarked, since the war, there are many 
persons with wounds presenting themselves, and though 
it is impossible to classify such wounds, giving the dis- 
qualifying ones, they being of all grades and character, 
and involving nearly all parts of the physical structure, 
yet it is fitting that some general suggestions upon this 
point be given. 
In making an analysis of the results of the injury, 
determine if the nerve-force of the limb or part has been 
destroyed or impaired materially: if mobility of joint 47 
has been diminished: if cicatrices are extensive and in- 
volve the muscular fibre, and have contracted the integ- 
ument seriously: if the former wounds ever break out 
and suppurate, and how long since they have discharged: 
if the wound was accompanied with fracture : is there 
deformity or atrophy of the limb ? 
Continuing the examination, ascertain if there is 
severe neuralgia at times in the limb : if the member is 
likely to prove a source of irritation to the system, act- 
ing as a foreign body, and reducing the vital powers by 
profuse discharges or constant pains : is the circulation 
impaired in the part ? is there any likelihood that ne- 
crosis of bone, continuous nerve irritation, weakening 
discharges from the old wounds, increasing atrophy or 
entire disuse of limb with positive embarrassment from 
retention, would necessitate, at any future time, ampu- 
tation or resection ? 
As to amputations, those above the knee and at the 
shoulder joint are disqualifying ones. In this physical 
loss, there is more liability to local disease : there has 
been an interruption of circulation, and the forces of 
the neighboring parts have been impaired, and nature 
has been taxed to repair the injury; there has been too 
great a dismemberment, too material a loss of structure 
to admit of the harmony of action previously main- 
tained ; even in amputations of the leg below the knee 
and of the arm, it is reasonable to suppose that the sys- 
tem has received a shock in the sudden necessity which 
was forced upon it, of making fresh circulatory arrange- 
ments, and adapting itself to the new and unnatural 
order of things : there is no longer integrity of parts, 48 
and there is ever wanting that symmetry which Bichat 
styles the essential character of the organs of the animal 
life of man. 
In the case of a cripple or one who from surgical 
injury has impaired mobility of lower limbs, his inabil- 
ity to protect himself is to be considered as a disquali- 
fying cause: if his power of locomotion has been sensi- 
bly impaired he has not the same facility for escaping 
from a burning building or from passing vehicles in the 
streets; he may be otherwise in perfect health, and all 
his functions be regularly carried on, but the chance is, 
such will not be the case: he still remains imperfect, 
and the disability that debars him from active exercise 
would be apt to leave the digestive functions to be im- 
properly carried on. 
12. Females. Delicacy forbids that the examina- 
tion of a female should ever be conducted in the pres- 
ence of the agent. And though a female of delicacy 
may shrink from the examination, the object of which 
is to pry into her physical condition, the interests of the 
Company require that such an examination shall be 
thorough and such as to bring to light all the main facts 
necessary to the proper comprehension of the case. 
Those who have passed the climacteric period, 
other things being equal, are the most acceptable, 
though younger ones are accepted, if first class of the 
kind. Inquiry should be made as to the condition of 
the uterine function, the necessity of instrumental aid 
in former labors, the occurrence of puerperal fever and 
miscarriages. The number of children she has borne 
may influence the risk, if they have been numerous and 49 
with little interval between births : miscarriages would 
also affect the health. Organic disease of the uterus 
and scirrhus of the breast would decline, whilst the lat- 
ter affection existing or having existed in mother or 
sister would be sufficient to occasion more than a doubt 
as to the propriety of acceptance. 
For very obvious reasons, risks of young girls 
whose catamenial functions are not established, are 
not desired: the stage of transition from girlhood 
to womanhood is too often characterized by dan- 
ger to make the risks good ones. The change is too 
radical to be affected without some constitutional dis- 
turbance; hence it is always best to defer the risk until 
nature has asserted herself in the perfect establishment 
of that function. 
In case of pregnancy never accept, but postpone 
until after accouchement, and until time has shown if any 
bad result ensues. 
It is assumed by some Insurance Companies that 
female risks in this country have not proved profitable 
ones, but the qualification is added that this fact is due 
to the impracticability of making thorough and far 
searching examinations generally, and as to the relative 
longevity of the male and female, there has prevailed 
the impression with many Life Insurance Companies 
that there is a greater risk with the female than the male, 
and there has been an indisposition on the part of these 
companies to take female risks except under the most 
favorable circumstances: but this impression is becom- 
ing less general, and more favor is shown woman. In 
Holland it has been shown from statistics that the fe- 50 
inales who were insured, lived longer than the males, 
and as confirmatory of this advantage of the female 
risk, it has been declared that the perils of maternity 
and the risks of the child bearing period, are offsetted 
in the male by the risks he encounters in his avocations 
in dangerous places, as mines, on ships, steamers, and 
in factories, and during his service as soldier or sailor : 
again she has the advantage over the male in that but 
comparatively few die from intemperance. 
A French writer has demonstrated that " the ex- 
pectation of female life was greater at all ages than the 
expectation of male life: " and others have declared 
that the premiums should be less than for males of the 
same ages. With such testimony as this, the " Dela- 
ware Mutual " does not hesitate to take good female 
risks. 
13. A. Is THE APPLICANT IN ALL RESPECTS A FIRST- 
CLASS, HEALTHY RISK ? AND B. Do YOU RECOMMEND THAT 
a Policy be granted for the full amount applied for? 
The Medical Examiner, by patient investigation, 
and the exercise of his highest diagnostic skill, having, 
to his own satisfaction, determined the physical status 
of the person, is now prepared to sum up the results of 
his inquiries, and record them in his answers to these 
questions. It is assumed that by his penetration he has 
had conveyed to his mind, the significance of any pre- 
vious disease or symptom of disease which by its recur- 
rence or continuance, would, according to known path- 
ological principles, be likely, permanantly, to affect the 
system; that he has pushed his investigations by all the 
means at his command and has studied all the accessor- 51 
ies that might have a bearing upon the life prospects of 
the party, and is now ready not only to form an intelli- 
gent opinion, but to assist the Chief Medical Examiner 
in forming one also. 
The great central reflection should be, will this per- 
son survive the period of expectation ? all success hinges 
upon the correctness of the Examiners judgment, acu- 
men and professional discretion in this direction. To 
show what the term of this expectation is, the following 
rule has been given by competent authorities : " at ages 
ranging from 20 or 25 up to 45, use the fixed number 
96 : deduct the present age of the person whose expect- 
ancy you desire to know from this number, and the half 
of the remainder will give the expectancy within a few 
months." " For ages above 45, take 90 for the fixed 
number and proceed as before." In another table the 
fixed number is 86, and for females, a year is added to 
the fixed number. This rule may be very useful in 
some instances. 
In the examination or summing up, when any 
point has been discovered or suggested to the mind 
which influences the fate of the risk, or which would be 
likely to originate a doubt in the mind of a prudent Ex- 
aminer, as to the advisability of its acceptance, this 
point should be distinctly stated, with the concomitant 
circumstances which would tend to throw any light up- 
on it or have any bearing upon it in any wise, thus ren- 
dering the justness of his decision as obvious to the 
Chief Medical Examiner as to himself. 
He should be precise in statements, giving facts, 
withholding no material circumstance having reference 52 
to the case, and so attentive to all the points designed 
to be brought out, that the sum of his observations on 
the case before him and recorded, shall serve the offi- 
cials at the Home office as a portraiture of the man 
whose application they are to pronounce upon ; they 
need as faithful a picture as skilful medical observation 
can depict in the compass of the responses to the in- 
quiries as to physical condition and appearance. 
It would be well for the Medical Examiner to class- 
ify the risks, designating them in the concluding answer 
as a " splendid risk," "very good " and " fair. " The 
answers should be precise and without any ambiguity. 
No evasive answer is admissible to the questions, " is 
the applicant in all respects a first-class healthy risk ?" 
and " do you recommend that a policy be granted for 
the full amount applied for ?" Such terms as " I be- 
lieve so," " in my opinion," should not be used : "yes" 
or " no" is required and should be unqualifiedly given. 
It will not do to say, that if certain contingencies 
do not happen, certain exciting causes do not intervene, 
the person may live to an advanced age: the considera- 
tion of the chances is referred to the Examiner for an 
expression of his judgment, and it is expected that he 
should pronounce definitely upon these chances, and 
accept the responsibility. He is the medium through 
which the Company receives its knowledge of the man 
and his chances of life-extension, and if he fails to im- 
part, in a positive manner, the requisite knowledge, he 
has failed in the discharge of duties for which he was 
especially commissioned. 
The Examiner may at times be much perplexed as 53 
to his concluding response, or be totally unable to form 
an opinion which would be entirely satisfactory to him- 
self : he may apprehend an error of judgment on his 
part, and feel that he cannot conscientiously record a 
decision: under these circumstances it might be well to 
refer the whole matter to the Company, giving both the 
favorable and unfavorable points of the case, with the 
impressions he derives from its review: but such refer- 
ence it is believed, is not often necessary. If he cannot 
conscientiously approve the case as a first-class risk, as 
such a risk is generally understood by Insurance Com- 
panies, he should unhesitatingly say " no but at the 
same time he can express his opinion as to the grade of 
the risk, characterizing it as a hazardous or extra hazard- 
ous one. 
Lacking the endowment of that prescience which 
only could guide one as to the course and termination 
of any certain diseased action which he is considering 
in its possible relations to the risk now and in the time 
to come, he is forced to a reliance upon his own judg- 
ment, and upon his knowledge of pathological laws in- 
fluencing the usual progress and results of such morbid 
conditions under like circumstances. 
Sometimes the Examiner in his survey of the case, 
having detected some one defective point in personality 
or family history, which might reasonably, in the opinion 
of some, weaken the entireness of the case as a risk, 
may offset this depreciating circumstance with other 
facts which are likely to favor the case, such as good 
habits, regular mode of living, active life, favorable 
occupation, and easy, comfortable circumstances, and 54 
determine that the risk may be safely accepted, and 
accordingly recommend it. Having thus, in his analysis, 
given both the favoring and adverse features, with his 
ultimate opinion, the Company becomes accountable for 
the results of a difference of judgments, having reserved 
to itself the prerogative of dissenting from or endorsing 
the opinion of the Examiner. 
In the mental survey of the varied elements that 
go to constitute a risk, and then of the risk itself as a 
totality, there may be cases in which the circumstance 
of business embarrassments and financial difficulties, 
would be equivalent to an impairing principle, and as 
such would have to be considered as possibly affecting 
the whole: for it is well known that the continued liar- 
rassments and cares of a business entailing frequent 
losses, with pecuniary troubles of an embarrassing 
nature, act as depressing causes: the nervous system 
may be in a state of extreme tension all the time, the 
sleep fitful and unrefreshing, the appetite impaired, the 
energies of the body weakened and the man become a 
prey to the first disease that assails him. Within our 
own life insurance experience, we have had occasion to 
observe the wisdom of recognizing these considerations 
of moment in the estimation of some risks. 
If any support of the proposition that the mind in- 
fluences the duration of human life were required, it 
could be found in the observation of the lives of annui- 
tants, whose comparative exemption from business cares 
and anxieties is assured by the certain provision made 
for their support, and whose tenacity of life has become 
proverbial: and authorities in this connection declare that 55 
these mental influences on longevity, are more potent 
and marked than the occupation of the body, which is 
universally accepted as a modifying circumstance. 
When there is any great doubt as to the desirability 
of a risk, the Insurance Company is to have the benefit 
of the doubt; for it is more important that the interests of 
the many be protected, than that a few disqualified per- 
sons be uninsured. 
Sometimes between Examiner and agent, it is deem- 
ed a matter of policy to accept a risk which is manifest- 
ly more than ordinarily unsafe: there may be circum- 
stances which at first sight, would appear to render it 
judicious to accept such a risk; the Company may de- 
sire to introduce itself in a certain locality: it may be 
solicitous to gain the influence of some certain person 
and to add strength to its organization by receiving him 
though his risk is questionable ; or it may want to secure 
his services as an agent, who will work the harder for 
his acceptance. The Medical Examiner, under such a 
pressure, might possibly be disposed to strain a point 
and show a liberality of proceeding by accepting him, 
thinking that it would eventually be for the interests of 
the Company, by securing a greater amount of influence 
in its favor in that locality. Just such reasoning has 
been employed in instances within our own sphere of 
observation. If there is any policy at all in such un- 
warranted generosity, it is essentially a bad policy, for 
aside from the ultimate pecuniary loss entailed by such 
inevitably hazardous risks, such a procedure, instead of 56 
acting as a favorable introduction of the Company into 
that locality, would serve at once to beget distrust in 
the minds of the community, as to the conduct of the 
Company's affairs. Sensible men would at once deter- 
mine, and justly too, that the Company which accepted 
such risks, could not long be perpetuated; confidence 
would at once be destroyed, and the ends had in view 
would be promptly defeated. 
Another point to be observed is, that all examina- 
tions, as far as is practicable, should be confidential as 
between the Examiner and Company. The Agent 
should not be present, and the person asking for insur- 
ance ought never to be allowed to know the record of 
the Examiner, or to see the application after it has reach- 
ed the Examiner's hands. The result as conveyed to 
him from the Home Office should content him. Many 
persons have a curiosity to see the summing up of their 
case, and the opinion of the Medical man as to their con- 
dition; this curiosity should be repressed as far as is 
proper. 
There may be instances where explanation to the 
party as to the cause of rejection is needed, and it can 
generally be given in a manner that will be satisfactory 
to a reasonable man. It is allowable to save him all the 
humiliation possible. Most men are proud of vigorous 
health, and are commensurately humbled by any physi- 
cal imperfection ; but motives of delicacy for the feel- 
ings of the rejected should never be suffered to warp 
the judgment of the Medical Examiner, or the fear of 
offending the party deter him from the conscientious 
discharge of his duty: 57 
This liability to offend the examined, is accepted 
by the Examiner when he becomes an officer of the 
Company, and he should not seek to avoid such risk. 
The relation of patient or friend should not be a bar to 
the faithful discharge of his office, or outweigh the in- 
terests of the Company which have been committed and 
accepted as a sacred trust. 
In the language of Dr. Gloninger in his Medical 
Examiner's Manual, " The physician should know nei- 
ther friend nor foe: his duty i/ bound up as an honor- 
able man in the Company he represents: he obtains his 
remuneration, and for the time being he surrenders the 
special amenities of his profession and becomes as sto- 
ical as a judgee" 
The last point to be urged is that the Examiner 
separate himself, as it were, from the Agent. He has 
at times to combat the solicitude of agents to have cases 
accepted: this desire on the part of agents is natural 
and reasonable, as their fees are usually consequent up- 
on the acceptance of the risks. An agent will some- 
times endeavor to sway the judgment of the Medical 
man in the consideration of the matter, and cause him 
to pervert his office for his own benefit. (These in- 
stances are occasionally brought to the notice of the 
Company.) 
The Examiner should never, in the least degree, be 
influenced by regard for the interests of agents or so- 
licitors, but should ever have in view the interests of 
the Institution, ignoring all other claims. Let him nev- 
er hesitate to reject when his judgment informs him 
that it is for the well-being of the Company That the ap- 58 
plicant shall not be received. He should carefully form 
his opinion on the merits of the case, and maintain it 
conscientiously. 
Very Respectfully, 
D. W. MAULL, 
Chief Medical Examiner. 
Wilmington, Del., July, 1869.