Document 15qbZ0V65gKE1wY1oe4k2rMGZ

Guide for M edical Examiners % \ GUIDE FOR MEDICAL- EXAMINERS Medical Examiners receive their appointment^ di rectly from the Home Office, after careful investigation by our Medical Referee, and no agent has any controlling voice in the matter either as to primary nomination or subsequent selection. Examiners will, therefore, realize that, in the performance of their duties, they are re sponsible to the Company alone and not to any person interested in the risk as agent or otherwise. Medical Examiners are selected to officiate in the particular fields defined in their letters of appointment, and are not expected to make examinations elsewhere. Removal of one's residence, therefore, to a new locality may be considered as equivalent to a resignation of the olliee of Examiner. And when one so changes his resi dence he should at once notify the Home Office, suggest ing to them the name of a competent .and trustworthy successor in the field he is leaving, and at the same time acquaint them with his new address. Appointments as Examiner are valid during the pleasure of the Company until the age of seventy years, after which Examiners are subject to retirement because of age. In places of considerable size it is our custom to ap point one "Examiner" and one or more "Alternate Examiners." Agents are instructed to employ the Ex aminer in every instance, if possible, the services of the Alternate Examiner being only required in the absence or disability of the Examiner. The fee for a medical examination, including analysis of urine as to reaction, specific gravity, and presence of albumen or sugar, will he five dollars. When a microscopic examination is required by our rules, or directed from the Home Office (and in such instances only), a fee of five dollars additional will be allowed. ., These fees are held to cover all subsequent investiga tion that may be necessary in connection with a given application; as, for example, when further analysis of the urine is required, or re-examination of the heart or lungs asked for. No extra fee is paid for traveling expenses unless previously authorized by the Home Office. Fees are in all cases paid to Medical Examiners by the Company, and remain the same without regard to the acceptance or rejection of risks. When very large policies (the Company's limit being $50,000) are asked for, and in some exceptional in stances, examinations by two physicians may he re quired by the Home Office. Such examinations should never be conducted jointly, but each Examiner must make his examination independently and apart from the other. When an Examiner has knowledge respecting an ap plicant leading him to regard the risk as undesirable, he should decline to make the examination, unless specially directed to do so from the Home Office, And, also, he should immediately notify the Company on one of the confidential letter sheets provided for such purposes, stating the reasons for his refusal to examine, together with the name, age, and residence of the applicant. In every instance where an Examiner declines or postpones an applicant, or finds him for any reason unacceptable, whether an application has been made out or not, one of our confidential blanks above referred to should he filled in and mailed to the Company at once. Medical Examiners' Reports are always to he made upon the printed blanks provided by the Company for that purpose. They must he in the handwriting of the Examiner and written in ink, with all alterations, inter lineations, and -erasures authenticated by the addition of his initials. The Company regards such reports as confidential communications, not to be made public without the consent of the Examiner. 1 Every examination must be made in private, no agent nor other third party being present during any part of < 0 it. When.possible, we prefer to have examinations made in the private office of the Examiner, but if, for any reason, this is found impracticable, we expect our Examiner to be willing to accommodate the applicant and agent by going elsewhere. He must, however, insist that the place selected shall be sufficiently quiet and free from interruption to permit of careful, thorough, and accurate investigation. It may occasionally occur that the information elic ited will be of such a character that the Examiner will hesitate to place it upon the- fteport as fully as is de sirable. In these cases we invite correspondence with the Medical Director at the Home Office, where all such communications are held strictly confidential; and in every case where the applicant requests it, or the Exam iner deems it advisable, the Report itself is to be sealed in an envelope supplied for the purpose before being delivered to the agent for transmission to us, or it may be mailed direct to the Home office. No examination should be entered upon until the applicant has completed and signed his application. The-Examiner should then read over the application in order to obtain a general idea of the character of the risk, noting such points as he may wish to investigate during his examination. All communications concerning the Examiner's duties should be addressed to " The Connecticut Mutual Life Insurance Company, Hartford, Conn.," and all in structions will he received by him direct from the Home Office. The Connecticut Mutual Life Insurance Company ask's its Medical Examiners to carefully consider that their relation to the Company is peculiarly a confidential one. They are its trusted agents to procure for it infor mation not otherwise attainable, upon which principally will depend the selection of its risks, and upon these fundamentally depend its success and safety. The man ner in which they as Medical Examiners perform their duties directly and vitally affects the value of the pro vision here made for the families of policy-holders, who alone are members of the Company. Improper selection increases the rate of mortality * 6 and the cost of insurance. It is the constant aim of the managers of this Company to give its present members their insurance at the lowest attainable cost, and to ex tend the benefits of the association to those new members only whose admission will conduce to this end. They, therefore, desire only those lives whose chances of attain ing the full limit of human longevity are unimpaired by present or past disease or injury, by unfavorable habits, location, or occupation, or by derivation from a diseased ancestry. In this they must rely chiefly upon the skill, care, and integrity of their Medical Examiners, whose scope of inquiries is by no means limited by the blanks, nor by any inelastic methods. For further information than that found in these pages pertinent to various doubtful questions that neces sarily must constantly arise Examiners are respectfully referred to such special treatises as Greene's " Examina tions for Life Insurance," Stillman's " The Life Insur ance Examiner," Keating's " How to Examine, for Life Insurance," Sieveking's " Medical Adviser in Life As surance," and others of a similar character. The Application and Examiner's Report, in which will be found all needed suggestions as to the mode of procedure, are intended to cover these three vital points, viz.: the family history, the personal history, and the present physical and mental condition of the applicant. Investigation in these three directions must develop and determine the quality of the risk. Examiners will notice that the Application and Ex aminer's Report are upon separate sheets of paper, and that all questions relating to the family and personal history' asked in the application are substantially re peated in the Examiner's Report. Our object in this arrangement is twofold: First. We desire that the Medical Examiner shall acquaint himself with all the statements of the applicant. Second. We wish not only that the applicant shall be cross-examined as to the matters contained in his ap plication, and all doubtful and indefinite statements cleared up by the Medical Examiner, who must assure himself that the 'questions are fully comprehended and l7 1 intelligently answered, but also that his answers to the m questions in the Medical Examiner's Blank shall be I I thoroughly independent and original answers. By this method we seek to secure accurate and com plete data upon which to estimate the advisability of accepting the risk. We have reason to know that in some cases the , habit prevails among Examiners of copying the answers previously made in the Application into the Examiner's Report without asking them anew. A moment's reflec tion will show that such a' course directly defeats one of the principal objects of our methods. We desire, there fore, to emphasize the rule that every such question in the Examiner's Report must he asked 6y the Examiner and answered by the Applicant independent of any pre vious reply to a similar question. When conflicting statements occur the Examiner is always expected to in , quire carefully and explain the matter fully in his Re* port. When doubtful, ambiguous, or indefinite answers are given, it is incumbent upon the Examiner to clear them up, requiring the Applicant to obtain additional | | information, when possible, if necessary to a proper eom]J prehension of the case. Having done this, he is to em body ail the facts in his Report to us together with his estimate of the risk. The question of moral hazard should be carefully considered by the Medical Examiner. A little tact in questioning will enable the physician to form an opinion as to whether the insurance sought is being honestly taken, or whether the applicant is " loading up " in view of some impending crisis. Whenever there is reason for suspicion we request a confidential communication from the Examiner upon the subject. Special attention is called to some points incidental to the selection of female risks for Life Insurance. The extra hazards over male risks are chiefly three: 1st. The moral hazard. 2d. Difficulties attending the personal examination. 3d. Increased mortality during menstrual activity. We aim to eliminate the first by restricting our busi ness to insurance upon the lives of women for amounts not exceeding $10,000 upon any single life and to those _ 8' upon whom other lives are financially dependent or who have independent means either from property or from their own earnings. These restrictions will he carefully observed in order to avoid the moral hazard attendant upon taking risks on lives which, as a class, are not productive, but are ordinarily themselves dependent. We desire our Ex aminers to keep this point in mind, and, whenever they see ground for suspicion of such hazard, to confer with the applicant's family physician, or adopt such other means as they think best to satisfy themselves, and re port the facts to us. To guard ourselves on the second and third points of extra hazard we must rely mainly upon the acuteness and intelligence of our Medical Examiners. Experience shows an increased death rate of females over males up to 45 years of age, and the causes most common are consumption, cancer, and uterine affections; therefore all clothing that hinders a proper and satis factory exploration of the chest and abdomen, such as waists, corsets, or tight bands, should he removed pre vious to examination. Notice whether the lungs and abdominal organs are habitually restricted by improper dress, and carefully inquire into the condition of the breasts and uterine organs. If pregnancy exists, postpone the case until confinement and lactation are passed and the menstrua! function has become established regularly for at least three months. Ascertain whether the occupation and environment are injurious or such as to invite disease, and whether the general habits of life are healthful. Urinalysis in the case of females will, not infrequently, show the presence of albumen, blood, and pus, due to menstrual or leucorrhoeal discharge. Such cases call for the use of the microscope and the examination of more than one specimen of urine. Answers to all questions should he precise but ample enough to convey a clear idea of the case, past and present, and of the reasons for reaching the conclusions arrived at. As it is deemed desirable, in the case of females, to have certain statements considered confiden tial, a special blank is provided for them, which Examin 'L ers are to fill out, and, when completed, witness the signature of the applicant thereto. This done, the state ment must be placed in one of our envelopes (which agents will supply), sealed, and the Examiner's name and P. O. address affixed before handing it to the agent for transmission to the Company. The rating of a risk in the Examiner's Report is ex pected to be based upon the ease as a whole, including this additional statement, and 'therefore we require in the case of females that this special blank be filled out before the Examiner takes up the ordinary Medical Ex aminer's Report. In conclusion we present to our Medical Examiners a business view of a certain matter which is probably regarded by most physicians in a usual professional light, in order to make clear if we can the fact that there are two distinct and even antagonistic points of view, and to define and accent the one to which ordinary professional life does not accustom him, but which is the one a life insurance company must always take and be strictly guided by if it would make a safe selection of risks: we mean the way in which any departure from a normal standard should he regarded by him in forming anu expressing his opinions as to the desirability as a risk of an applicant undergoing examination at his hands. The habitual point of view in which the practicing physician holds every person coming into his hands is that of a patient: a person being treated or looked at with a view to being treated, for the removal of an ab normal condition. That removal, its methods, its proba bilities of success, all the resulting chances and condi tions of treatment, are the matters of supreme interest to both physician and patient, and they determine the mental and moral attitude of each and are the key to whatever action is had. The question with the physician is, Can this man he cured? What are his chances of recovery ? Do they balance for or against him ? What encouragement can T give him? How much can I call upon his hope and stimulate it to give moral aid to my treatment? Are the chances so good that I can give him practically positive favorable assurance? Or must I be content to accent strongly to his anxious ear only a fair probability? Or make the most of only a possibil ity? Or must I warn him to set his house in order? These are the problems that consciously or uncon sciously pass through the physician's mind and deter mine both his professional and his humane attitude toward his patient and, for the time at least, his friend. And knowing the practical value of mental and moral states in. a patient, and their effect in promoting or re tarding recovery, he naturally seeks to estimate and represent at their honest utmost the force and value of the favorable chances. He makes, and is warranted by his whole professional duty and purpose in making, as favorable a prognosis as possible. He counts up as many chances of living as possible. It is the chances of living and of recovery upon which his mind constantly dwells and which he deals out as stimulatingly as pos sible to his patient. And this is right. It is both scientific and humane. But this is not the point of view, such is not the at titude toward an applicant, and these are not the ques tions with a life insurance company. Its question is. When will this man die? What is there in his history, his inheritances, his condition, that grade him below a perfect normal? And how far below? And as it is impossible to guess who will be the indi vidual exceptions in an abnormal group the company must test the vital effect of every departure from a normal standard, not by the physician's first question, whether this individual will possibly or probably recover normality; but taking a group, say of 1,000 men of the given abnormality observed in the case of the individual, it asks, How much more rapid will their mortality be, how much shorter average time will they live, than 1,000 such without the abnormality? The physician hopes and strives to rescue his patient from the mortal ity of the group in which his trouble places him. The life insurance company knows that this is too great an uncertainty for it to count upon; that it cannot pick out from the group the man who may not suffer with it; that it must expect and cannot escape the average mor tality of the group, and that therefore it must assume that each man will suffer that mortality. 11 . It cannot undertake to say that this man or that man will probably recover; that in this case or that ease the progress of diseased or abnormal conditions will be wholly suspended, or be more or less rapid. It cannot deal with questions of prognosis. It has no way of dealing with individual chances. It must, therefore, wholly exclude questions of prognosis by excluding all cases . where the condition of the applicant is for any cause, in personal or family history, such as to raise them. Its question is, Does this man certainly belong to the class of long livers; not, Can he probably be rescued from the class of shorter livers: Is he sound; not, Can he be probably cured of unsoundness or possibly escape its average consequences ? We do not undertake to grade our risks according to degree of abnormality and charge a premium according to the prospect of death. We can only undertake to in sure those who are entitled to the same scale of pre miums; who are subject to only the same average mor tality. Our premiums are computed for risks selected for their soundness. We cannot afford to take any other.' We cannot justly make sound men pay for un sound men. Mutuality means an equal basis of cost. Our question is. Is this man thoroughly sound in per sonal condition and his inheritances? not. How near does he come to it? nor, Can he probably escape the effects of his unsoundness? for that is, so far as we are concerned, mere guesswork. W'e know that the unsound group taken as a whole cannot escape a higher death rate. It is only because we can group men that we can take their risks at all. We must, therefore, govern ourselves rigidly by the mortality of the group. Class becomes all-important. Men's risks will cost us according to the average mortality of the class to which they belong. We must classify correctly. We must therefore ask our Examiners to bear always in mind that when they undertake an examination for us their professional attitude entirely changes. They have no longer before them the question whether under their treatment the individual would probably be recovered from any unsoundness or so defended from its results as to suffer no effect upon his normal chances of life, but simply whether he is sound; whether there is anything they have reached the usual physical maturity of their in h-is condition or history that affects unfavorably those age. In the old whether degeneration, arterial and -normal chances. We ask them to see with our eyes and otherwise, has advanced noticeably. The old person for us. whose faculties are active and arteries soft is often a And we ask them to also bear in mind that the atti safe risk, but great care must be exercised to avoid the tude of a patient toward his physician is very different individual who is at any age prematurely old. from that of an applicant toward an Examiner. The Amputations. State point and cause of amputation patient is frank with his doctor, tells Mm all he wishes and condition of stump. If artificial limb is used, state to know, and is inclined to magnify his symptoms and if it is easily worn or gives rise to pain and serious in exaggerate their importance. Not so is an applicant convenience. Only those cases will be considered which with an Examiner. He answers the questions which are do not interfere with the health and activity of the'ap asked, usually tells only as much as is unavoidable, plicant. minimizes whatever is out of the way, naturally makes Appendicitis. State frequency and duration of at out as favorable a case for himself as he can, and if he tacks; whether any operation, and if so, date of same; is conscious of unfavorable conditions which are not whether appendix was removed; whether recovery was plainly visible, he is reticent and leaves the Examiner to prompt and uncomplicated, and how long since complete find out what he can for himself. Especial care is neces recovery. State present condition of cicatrix, and sary in the examination of persons who have been once whether any tendency to hernia. Is any support needed? declined or postponed. Their desire to secure insurance Asthma. State age when first noticed, frequency, * and to prove themselves sound is apt to color their views character, and duration of attacks; whether nocturnal, and statements about themselves very strongly. The and at particular seasons of the year only; whether same is true of applicants for very large amounts. cough, expectoration, or dyspnoea, and whether there is Some Examiners are careful to present complete and complete relief during interval of attacks. Is there em true answers to the questions respecting specific facts, physema, cardiac disease, Bright's disease, or nasal but seek to avoid responsibility for those general conclu polypus, or other local cause ? State if there is heredi sions which involve their personal judgment on the case tary tendency, and what treatment is used during at r presented. But there are many things open to the view of the thoroughly competent and conscientiously careful tacks, and with what result. Has change of climate or occupation been necessitated? 'Examiner which no question wholly calls out, but which Blindness. Total blindness always disqualifies. ought to affect his personal conclusions as they ought to When partial state cause, duration, whether progressive, affect us if we knew them as he sees them. The facts and present condition of eyes. which he records present to us a problem. He sees Bronchitis. If present, disqualifies. If there have other facts which we do not see. He sees the man in his been recurrent or recent attacks, be especially careful . totality. We therefore ask him to look at our problem to ascertain the cause and. that the present condition of in the light of all he sees and knows, and to tell us, but lungs is normal. from our point of view, how he would solve it, giving us the benefit of every doubt, h Calculus. See Colie. Colic. . We ask your special attention to the following in Hepatic. State frequency and duration of attacks, connection with your examinations for us: Age. Applicants are accepted between the ages of 1 with date of last attach; whether calculi have been passed and found; whether any operation has been per 16 and 65, both inclusive, and in certain instances up to formed, and if so, with what results. What is present < 69 Yg years of age. In the young we wish to know that condition of liver and gall bladder? 14 Intestinal. State cause, frequency, and duration of attacks, with location of pain. Renal. State how many attacks, with dates and duration, and whether calculi have been passed and found. Has there been any surgical operation, and if so, with what results? What is the present condition of kidneys as to size, location, and tenderness? Deafness. Total deafness disqualifies. Tf partial, state cause, duration, whether discharge, past or present, and the present condition of tympanal and cavity. Always state whether ordinary conversation is heard readily. Dizziness. See Vertigo. Dyspepsia. State frequency, duration, and severity, and date of last attack; what change in diet is or has been necessary; whether any loss of weight or tendency to melancholia. In cases accompanied by consumption or insanity in the family history especial care is re quired. Epilepsy. Disqualifies. Family History. Where ages, causes of death, etc., are unknown, or very uncertain. Examiners will require the applicant to ascertain them, or, if this appears im practicable, endeavor at least to establish the general' hereditary tendencies and longevity of the family, and that deaths were not caused by consumption, insanity, paralysis, apoplexy, beart disease, or any transmissible disease. Fits. Ascertain the nature, cause, frequency, and date of last attack. Were they epileptic? . Gout. Our experience shows that great care is needed in these cases. State past and present conditions fully. Give frequency and duration of attacks, and what treatment is used during them. Habits. Stimulants and Narcotics. Let your in vestigation under this head be thorough and painstaking. It is extremely important that we know the full truth as to what, when, and-how often an applicant uses alcoholic stimulants or narcotics. We expect our Examiners in a tactful manner to ascertain the facts, and not to be satisfied with indefinite statements such as " moderate," " occasional," " when I feel like it," and the like. Scru 15 tinize the applicant carefully, and, if you have cause to A doubt the accuracy of his statements, try in other ways \ I to obtain the facts and write us promptly regarding the matter. If their daily or frequent use is suspected, assure yourself that the stomach, liver, kidneys, and nervous system are free from any evidence of injury. Examiners should regard this as one of their most im portant duties to guard the interests of the Company in these matters, and not allow us to assume risk on lives of this class without having had all the facts obtainable' placed before us. . Heart Murmurs. State whether organic or func tional. Organic murmurs alway disqualify. ' Functional. State location of greatest intensity, area covered by, and character of the murmur, whether heard 'when' respiration is suspended, whether intensity is in creased or otherwise by exercise or by lying down, and whether it is entirely absent under any of these con ditions. Be especially careful in such cases to note and state whether the normal sounds are heard in their proper locations. Hip Joint Disease. State whether traumatic or otherwise, the duration of disease, present condition of joint, and amount of deformity. Nervous Prostration. There is often a good deal of misunderstanding in the. use of this term. Examiners should inquire carefully and state if true neurasthenia is meant, or only a temporary debility. State duration and severity of attack, whether recurrent, and whether there has been complete recovery. Neuralgia. State location of pain, and history of the, affection from its beginning. Discriminate from myalgia, and ascertain the cause of attacks and whal treatment has been employed. Have opiates been used ? Occupation. Great care should be exercised to give a clear idea of occupation. Such terms as " clerk," " merchant," " mechanic," and all indefinite or technical terms such as " cutter," " finisher," " presser," and the like must be explained as to the particular kind ef work the applicant is engaged in. Inquiry as to any un healthful conditions associated with occupation, such as bad air, dust, dampness, cold or intense heat or light, should be carefully made and the facts specifically stated. Palpitation of the Heart. In our experience this is a serious symptom and not to be lightly passed over. Carefully ascertain its cause, examine the heart with great care as to size, position, and action, alike in stand ing, sitting, and prone positions, both when applicant has been quiet for some time and after active exercise. State all your findings clearly and fully. Pleurisy. Our experience teache^us that a history of pleurisy should always excite a suspicion of tubercu losis, particularly if recurrent and the applicant past 40 years of age. Examine every such case with unusual care, all clothing removed from chest. Is vocal fremitus normal in all parts of the chest? Are the respiratory sounds full and clear everywhere ? Is the percussion note normal and alike on both sides? Is the chest ex panded evenly, or is there restriction at some points? Examiners cannot be too careful in these cases. Pneumonia. See Pleurisy. All that is said there applies with equal force to pneumonia. Pregnancy. Postpone until confinement and lacta tion are passed and the menstrual function has be come regularly established for at least three months. . Pulse. Rale. The pulse should be counted a full minute, both in sitting and standing positions. If below 54, or above 90, count again after some delay, or on a second day. If constantly high, take temperature under tongue. Nervous people frequently have high pulse Tate due to the excitement of examination. In these cases the Examiner may be able to count it while listening to the respiration, the applicant's attention being distracted from the heart. A rapid pulse always necessitates the careful exclusion of incipient phthisis, febrile, nervous, and cardiac affections, and the habitual use of stimu lants. With slow pulse exclude fatty heart, hepatic, nervous, and digestive disorders. . . Rhythm. If pulse is irregular or intermittent, state whether exercise increases or dimishes it, and also whether this condition is congenital. . Tension. State if increased or diminished, and note carefully any evidences of vascular disease and tendency to heart, renal or nervous disease. 1 ' ' ' % ' . ' ^ . Reflexes. In cases of so-called muscular rheuma tism or myalgia, and whenever there is stiffness of mus cles or any loss of control of extremities, the patella reflex should be taken and the result recorded in your report. . Rheumatism. State if acute inflammatory,, or chronic; the duration, number, and full history of at tacks; what joints were involved; whether there was any cardiac complication, and if any deformity or re striction of motion remains. ' Scrofula. State just what is meant by the applicant when using this term. State if there is history of en larged glands or suppuration, ascertain if the glands were removed, and if possible the result of microscopic examination. Spitting of Blood. State frequency and date of last attack, whether clear blood or bloody mucus was raised, and whether there was cough or the blood was vomited. Give us as complete a history of the case as you can possibly obtain. Sunstroke. Is important if recent or long con tinued, therefore state date and duration of attack. Search carefully for any remaining effects and state whether there are any discoverable. Syphilis. Discriminate between true chancre and chancroid, and state which. Give date of initial lesion and character of symptoms that have been noticed. Look carefully for any cicatrix or other evidence of past disease. State what treatment was enydoyed and how long continued, and, if a married man, inquire and state if he has healthy children and whether there have been any still births. Always, examine carefully for degen erative changes in the nervous or circulatory organs. Urinary Analysis. Analysis of a specimen of urine passed by the applicant in the Examiner's presence is required in every case. Be sure that the urine is that of the applicant, and examine it within 24 hours after it is voided. . BRIEF RULES FOR URINALYSIS. Albumen. After noting the' color, reaction, and specific gravity, fill a clean test tube half full of the IS clear urine (previously filtered if turbid), and holding it at an angle of 45 degrees, allow nitric acid to trickle gently down its side and form a stratum, under the urine, at the bottom of the tubl^ If carefully done the two fluids will not mingle. Should any hazy or whitish cloud be observed at the point where the urine and acid meet, apply heat, and if the cloud remains albumen may be considered present. Note. Urine containing resinous matters, as when a patient is taking turpentine or balsam copaiva, will sometimes give a whitish-yellow cloudiness, similar to albumen, with nitric and hydrochloric acids. The addi tion of alcohol will cause this to disappear at once. It is important to hold the test tube in a proper light in order to distinguish slight changes, where only a small amount of albumen is present. The best way is that advised by Dr. John Munn, viz.: Place some dark ma terial over the lower part of the window, as a back ground, and draw the shade down to it. Now, holding the test-tube a little way from this background, lift the shade forward, enough to allow the rays of light to pass through the tube without shining into the eyes. In such a light and against the dark background very slight opacity becomes visible. Sugar. Pill a clean test-tube to the depth of half an inch with Fehling's standard test solution and boil it. If it is pure and reliable it will remain clear and of a dark blue color. While the clear solution is hot, add. the urine, a few drops at a time. Sugar will cause a deep yellow or orange-colored precipitate before the amount of urine added equals the quantity of test solu tion employed. If there is no change, once more heat to boiling and stand it one side. When cool, if there is no change sugar may be considered absent. Squibb's Fehliug Test Solution is reliable and can be obtained through any druggist. Unless the reaction for sugar is positive the. fermentation test should be used in addi tion to the above, as a number of conditions not due to the presence of sugar frequently cause turbidity or a greenish color with Fehling's test. Specific gravity. When the specific gravity is above or below normal, or albumen or sugar are present in 19 very small quantity, it will be well to collect the total secretion of 24 hours and examine a sample of this mixed urine. Microscopic examination is always to be made when the amount of insurance applied for is $25,000 or more, and when in a case otherwise acceptable there is a sus picion of disease requiring its aid for assurance, as where there is a history of calculus, or cystitis, and at other times only as directed from the Home Office. Every specimen examined microscopically must have been allowed to stand and settle for two hours, or the centrifuge must be used to procure the sediment. Vertigo. State frequency and duration of attacks, whether accompanied by mental confusion or uncon sciousness, by scintillations of light, or unnatural sounds in the ears, by pain, nausea or vomiting. Examine carefully for evidences of epilepsy, neurasthenia, and heart, renal or digestive diseases. Weight. Heavy weights have not been found to be desirable risks after fifty years of age. In all such cases state whether the weight is occasioned by fat. Are the muscles hard and firm? Has the applicant a large, bony frame? Is it a family peculiarity? And if so, state iii which members of the family it has been noticed, is the applicant active and quick in his movements ? Ts be a frfee user of alcoholic stimulant^, or a very heavy eater ? Information on all these points is needed to determine the safety of the risk. Light weights have been found to be undesirable, particularly if associated with dyspepsia or a consump tive family history. State if the weight is a family peculiarity, and if appetite and digestion ate good. Is the applicant of a wiry build ? Is he particularly nerv ous? Any sudden change in weight should be very care fully investigated and the facts clearly stated. AMERICAN TABLE OF MORTALITY. Age. -- \------- Surviv ing. Per cent, of Mortality Expecta tion of Life. Age. Percent. Surviv of ing. Mortality Expecta tion of Life. 10 100,000 11 99 251 12 98,505 13 97,762 14 97,022 .7490 .7516 .7543 .7569 .7596 15 96,285 .7634 16 95,550 .7661 17 94,818 .7688 18 94,089 .7727 19 93,362 .7765 20 92,637 .7805 21 91,914 .7855 22 91,192 .7906 23 90,471 .7958 24 89,751 .8011 25 89,032 .8065 26 88,314 .8130 27 87,596 .8197 28 86.878 .8264 29 86,160 .8345 30 85,441 .8427 31 84,721 .8510 32 84,000 .8607 33 83,277 .8718 34 82,551 .8831 35 81,822 .8946 36 81,090 .9089 37 80,353 .9234 38 79,611 .9408 39 78,862 9586 40 78,106 .9794 41 77,341 1.0008 42 76,567 1.0252 43 75,782 1.0517 44 74,985 1.0829 45 74,173 1.1163 46 73,345 1.1562 47 72,497 1.2000 48 71,627 1.2509 49 70,731 1.3106 50 69,804 1.3781 51 68,842 1.4541 52 67,841 1.5389 53 66,797 1.6333 54 65.7061 1 7396 43.7 48.1 47.4 46.8 46.2 45.5 44.9 44.2 43.5 42.9 42.2 41.5 40.9 40.2 39.5 38.8 38.1 37.4 36.7 36.0 35.3 34 0 33.9 33.2 32.5 31.8 31.1 30.3 29.6 28.9 28.2 27.5 26.7 26.0 25.3 24.5 23.8 23.1 22.4 21.6 20.9 20.2 19.5 18.8 18.1 55 64,563 1.8571 56 63,364 1.9885 57 62,101 2.1335 58 60,779 2.2936 59 59,385 2.4720 60 57,917 2.6693 61 56,371 2.8880 62 54,743 3.129? 63 53,030 3.3943 64 51,230 3.6873 65 49,341 4.0129 66 47,361 4.3707 67 45,291 4.7647 68 43,133 5.2002 69 40,890 5.6762 70 38,569 6.1993 71 36,178 6.7665 72 33,730 7.3733 73 31,243 8.0178 74 28,738 8.7028 75 26,237 9.4371 76 9.3 761 10.2311 77 21,330 11.1064 78 18,961 12.0827 79 16,670 13.1734 80 14,474 14.4466 81 12,383 15.8605 82 10,419 17.4297 83 8,603 19.1561 84 6,955 21.1359 85 5,485 23.5552 86 4,193 26.5681 87 3,079 30.3020 88 2,146 34.6692 89 1,402 39.5863 90 847 45.4545 91 462 53.2468 92 216 63.4259 93 79 73.4177 94 21 85.7143 95 3 100.0000 17.4 16.7 16.0 15.4 14.7 14.1 13.5 12.9 12.3 11.7 11.1 10.5 10.0 9.5 9.0 8.5 8.0 7.5 7.1 6.7 6.3 5.9 5.5 5.1 4.7 4.4 4.0 3.7 3.4 3.1 2.8 2.5 2.2 1.9 1.7 1.4 1.2 1.0 0.8 0.6 0.5 TABLE OF HEIGHT AND WEIGHT AT VARYING AGES. Eased upon an Analysis of 74,162 accepted Male Applicants for Life Insurance, as reported to The Association of Life Insurance Medical Directors, 1897. The Light Figures are 20 per cent, over and under the average. Ages. J5-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 5 ft. 0 in. J 2 3 -4 5 6 7 8 9 10 JJ 60 J 2 3 96 100 J20 125 144 150 98 101 122 126 146 151 99 102 J24 J28 149 154 102 105 J27 131 152 157 105 108 J3J J35 157 162 107 110 J34 J38 161 166 110 -114 J38 J42 166 170 lid 118 142 147 170 176 117 121 146 J5J 175 181 120 124 150 J55 180 186 123 127 J54 J59 185 191 127 131 J59 164 191 197 132 165 198' 136 170 204 130 142 J70 J77 204 212 141 147 176 184 211 221 145 152 J8J 190 217 228 102 J28 154 103 J29 155 105 J3J 157 107 J34 161 110 J38 166 113 141 169 116 J45 174 120 J50 180 123 J54 185 127 159 191 131 164 197 135 169 203 140 175 210 145 J8J 217 150 188 226 156 195 234 105 131 157 105 131 157 106 133 160 109 J36 163 112 J40 168 114 143 172 118 J47 176 122 152 182 120 157 188 130 162 194 134 167 200 138 173 208 143 179 215 148 185 222 154 192 230 160 200 ' 240 106 133 160 107 134 161 109 136 163 111 139 167 114 143 172 117 146 175 120 150 180 124 155 186 128 160 192 132 165 198 136 170 204 140 175 210 144 180 216 149 186 223 155 194 233 163 203 244 107 107 134 134 161 161 109 109 136 136 163 163 110 110 138 138 166 166 113 113 141 141 169 169 115 116 144 145 173 174 118 119 147 149 176 179 121 122 151 153 181 184 125 126 156 158 187 190 129. 130 161 163 198 196 133 134 166 167 199 200 137 138 171 172 205 206 142 177 212 142 177 212 146 146 183 182 220 218 151 150 189 188 227 . 226 157 155 196 194 235 233 163 161 204 201 245 241 107 134 161 109 136 163 110 138 166 113 141 169 116 145 174 119 149 179 122 153 184 126 158 190 130 163 196 134 168 202 188 173 208 142 178 214 146 183 220 151 189 227 155 194 233 158 198 238 105 131 157 107 134 161 110 137 164 112 140 168 115 144 173 118 148 178 122 153 184 126 158 190 130 163 196 134 168 202 139 174 209 144 180 216 148 185 222 151 189 227 154 192 230 112 140 168 114 143 172 118 147 176 121 151 181 125 156 187 130 162 194 134 168 202 139 174 209 144 180 216 148 185 222 151 189 227 154 192 230