ANNUAL REPORT 
Compliments of Dr. Seaverns. 
-OF- 
Jedical Examiner-in-Chief, 
-OF- 
Royal Arcanum. 
1890. 
JOEL SEAVERNS, M. D. ANNUAL REPORT 
■OF- 
Medical Examiner-in-Chief 
-OF- 
Royal Arcanum. 
1890. 
JOEL SEAVERNS, M. D. J. A. Cummings Printing Company, 
252 Washington St., Boston. Medical Examiner-in-Chief’s Report. 
To the Officers and Members of the Supreme Council of the R. A.: 
Brethren : — I herewith present my report for the year ending 
December 31, 1889. 
I find upon examination of my records, that during that time 3223 
applications have been received at my office, being, as will be per- 
ceived, a number nearly a thousand in excess of any previous year. 
Of these, 1742 were from Councils under the jurisdiction of Grand 
Councils, the same having been referred to me by the State Medical 
Examiners, being nearly 300 more than in 1888. Of these : 
323 came from New York. 
297 “ “ Pennsylvania. 
322 “ “ New Jersey. 
150 “ “ Massachusetts. 
117 “ “ Georgia. 
96 “ “ Illinois. 
79 “ “ Virginia. 
72 “ “ Michigan. 
55 “ “ Ohio. 
44 “ “ Tennessee. 
39 “ “ Maryland. 
33 came from Wisconsin. 
27 “ “ Ontario. 
26 “ “ Indiana. 
25 “ “ Missouri. 
19 “ “ Connecticut. 
8 “ “ Rhode Island. 
5 “ “ New Brunswick. 
2 “ “ Nova Scotia. 
2 “ Iowa. 
1 “ “ Nebraska. 
Of the 1742 referred applications, 1084 were approved, 637 were 
rejected, and 21 have not been acted upon, or were sent for opinion, 
and action was not required. 
From the States under the jurisdiction of the Supreme Council, 
1481 applications have been received, of which 1255 were approved, 
207 rejected, and 19 have not been acted upon, either as being illegal 
or as never having been properly completed. 
Concerning these 3223 applications, I would state that about 1000 
have required farther information or correction, so that it has been 
necessary to correspond with the local Medical Examiner with regard 
to them. 
The correspondence during the year, with regard to so many 
papers, and with regard to kindred subjects, has been of course, 
larger than ever before, and for several months the letters have been 4 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
on an average over three hundred per month. (This it must be 
observed, is exclusive of the letter of advice which is sent with every 
envelope containing an approved application, or a notice of rejec- 
tion.) Most of them were in the nature of simple inquiries, but 
many of them involved considerable research and professional 
decisions. 
The actual number of deaths that have occurred during the year, as 
reported up to March 14, 1890, has been 748. Four others are included 
in the printed lists of persons who died previous to Jan. 1, 1889, but had 
not been previously included in my tables. I therefore have made up 
tables of the different classes of disease to include these, making my 
752 in all. The average membership during the year was 92,630, and 
taking the actual number of deaths, as given above (748), the death 
rate per thousand has been 8.08. 
These deaths were divided among the different States as follows :— 
New York, 144 
Massachusetts, .... 99 
Pennsylvania, .... 97 
Ohio, 56 
Illinois, 50 
Maryland, 37 
Michigan, 50 
New Jersey, 40 
Georgia, 27 
Virginia, 23 
Missouri, 17 
Ontario, 15 
Tennessee, 15 
Wisconsin, 14 
Indiana, 10 
District of Columbia, . . 9 
North Carolina, .... 8 
Iowa, 5 
Arkansas, 6 
Rhode Island, .... 5 
Nebraska, 4 
New Brunswick, ... 4 
Nova Scotia, .... 3 
Maine, ...... 2 
Connecticut, 3 
Kentucky, 2 
New Hampshire, 
West Virginia, .... 1 
748 
None died in California, Colorado, Delaware, Kansas, Minnesota, 
Prince Edward Island, Quebec, Utah, or Vermont. 
An examination of the number of deaths in each state as compared 
with the members in each in June last (which is approximately the 
average membership for the year) shows the following results. This 
table does not include the jurisdictions whose memberships were 
less than 500. 
RATE OF DEATHS PER THOUSAND BY STATES. MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
5 
State. 
Deaths. 
Membership. 
Rate per 1000. 
Arkansas . 
6 
535 
18.7 — 
District of Columbia 
9 
561 
16.0+ 
Georgia . 
27 
2,400 
11.2— 
Michigan . 
50 
5,026 
9.9+ 
North Carolina 
8 
858 
9.3+ 
Tennessee 
15 
1,628 
9.2+ 
Maryland 
37 
4,018 
9.2+ 
Virginia . 
23 
2,511 
9.1— 
New York 
144 
16,683 
8.6— 
Massachusetts 
99 
11,602 
8.5+ 
Pennsylvania 
97 
11,502 
8.4+ 
New Jersey . 
40 
4,820 
8.3— 
Ohio 
56 
7,260 
7.7+ 
Missouri . 
17 
2,580 
6.6— 
Wisconsin 
14 
2,162 
6.5— 
Illinois 
50 
7,728 
6.5— 
Rhode Island 
5 
845 
5.9+ 
Ontario 
15 
2,700 
5.6— 
Indiana . 
10 
2,041 
4.9— 
Maine . 
2 
513 
3.9+ 
Connecticut . 
3 
1,577 
1.9+ 
Our death list when classified to show the different forms of 
disease is as follows : 
Classes. 
Number of deaths. 
Percentage. 
Zymotic 
. . 70 
9.3 
Tubercular 
. . 109 
14.5 
Brain and spine 
. . 128 
17.0 
Heart and circulating organs 
. . 68 
9.0 
Lungs (not tubercular) 
. . 81 
10.8 
Digestive organs 
. . 83 
11.0 
Kidneys and urinary organs . 
. . 72 
9.6 
Casualties 
. . 64 
8.5 
Suicides 
. . 26 
3.5 
Cancer 
. . 34 
4.5 
Unclassified 
. . 17 
2.3 
752 
100.0 MEDICAL EX AMINE R-IN-CHIEF’S REPORT. 
COMPARISON WITH PREVIOUS TEARS. 
When drawn up in connection with the results of previous years 
the result is as follows : 
1880 
1881 
1882 
1883 
1884 
1885 
1886 
3887 
1888 
1889 
Av’ge. 
Zymotic... 
14 
19 
11.6 
8.8 
11.6 
10.7 
12.2 
9.9 
10.6 
93 
11.8 
Tubercular. 
13 
12 
17.8 
19.5 
20.3 
16.9 
15.9 
15.9 
14.7 
14.5 
16.0 
Brain 
16 
10 
13.7 
15.7 
15.6 
14.4 
15.5 
17.6 
17.6 
17.0 
15.3 
Heart 
9 
9 
8.7 
7.9 
9.1 
10 7 
1>.0 
11.8 
8.2 
9.0 
9.5 
Bungs 
13 
12 
14.1 
9.5 
12.4 
9.9 
11.6 
10.7 
13.7 
10.8 
11.8 
Digestive... 
9 
13 
11.2 
9.7 
7.7 
12.8 
9.0 
11.5 
10.9 
11.0 
10.6 
Kidneys ... 
9 
8 
5.0 
9.7 
6.4 
7.3 
7.0 
7.4 
8.9 
9.6 
7.8 
Casualties.. 
10 
9 
8.7 
7.7 
7.7 
5.9 
8.7 
7.1 
6.5 
8.5 
8.0 
Suicides 
5 
1 
3.3 
5.3 
3.0 
3.7 
3.1 
2.3 
4.3 
3.5 
3.4 
Cancer 
2 
fi 
3.7 
3.8 
3.0 
4.5 
3 0 
2.9 
3.9 
4.5 
3.8 
Unclassified 
0 
1 
2.0 
2.4 
3.1 
3.4 
2.0 
2.9 
0.2 
2.3 
1.9 
It is gratifying to find how low our rate of mortality has been 
from consumption and heart disease, since it is by the relative mor- 
tality from these two, in comparison with other diseases, that we 
judge to a certain extent at least of the skill and care with which the 
examinations have been made, though of course many other 
elements must enter into any such calculation. 
From this point of view it will be found that as regards the former, 
the consumptive deaths, our loss has been proportionally less thau in 
any year since 1881, though only fractionally less than last year. 
Still with a disease everywhere so rife as is phthisis we cannot 
expect to do better, and we are, I believe, doing quite as well as any 
insurance companies. 
With diseases of the heart, too, our loss has been smaller than 
our average for ten years, though a little larger than last year; the 
increase being eight-tenths of one per cent. This is not important. 
From brain disease our loss seems to have been relatively heavy, 
but has not exceeded the average. 
The deaths from acute lung diseases have been less than during 
the previous years, and diseases of the digestive organs have very 
slightly exceeded the number of the previous year and the average. 
The ratio of zymotic diseases has been small. 
Casualties have been frequent, and the losses from the Johnstown 
flood explain this, whilst suicide has been about at the average, and 
cancer a little in excess of our usual mortality. Diseases of the 
kidneys, too, without any special reason, have increased, and are 
nearly two per cent, beyond the average, MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
7 
The small rate of mortality, however, as stated on a previous 
page, 8.08 per thousand of members, shows that proper care and vigi- 
lance have been exercised. 
ZYMOTIC DISEASES. 
Seventy deaths were the results of the zymoses, of which forty were 
caused by typhoid fever, eighteen by malarial diseases and four bv 
yellow fever, the latter occun-ing two in Virginia, one in New York 
and one in New Jersey. 
Seven of the deaths happened in the spring, twenty in summer, 
twenty-four in autumn, and nineteen in the winter. 
Fifteen of them were in the State of New York, fifteen in Pennsyl- 
vania, six in Virginia, four each in Georgia, Massachusetts and Mary- 
land, three each in Illinois, Indiana and New Jersey, two in Michigan, 
and not more than one in any other State. 
The proportion of deaths from this class of diseases was smaller 
than since 1883, it being but 9.3 per cent., it having been 19 per 
cent, in 1881. 
CONSUMPTION. 
The deaths, 109, resulting from phthisis during the past year have 
been in a less ratio to the other classes than during the past eight 
years, even though I have included in this class deaths from hemor- 
rhage and abscess of the lungs, in not all of which was it clear that 
that there was c-hi’onic tubercular disease, or chronic disease of any 
kind. One death only from “ abscess of the lungs,” which seems 
to have been undoubtedly an acute case and not dependent on con- 
stitutional causes, has been included in diseases of the respiratory 
organs, not tubercular. The percentage was 14.5. 
They occurred in the different States as follows: 
New York 27 
Massachusetts 15 
Pennsylvania 14 
Illinois 13 
Ohio 10 
New Jersey 7 
Maryland 3 
Wisconsin, North Carolina, Michigan, Tennessee and Missouri 
had two each, and Maine, New Hampshire, Rhode Island, West Vir- 
ginia, District of Columbia, Georgia, Nebraska, Ontario and Nova 
Scotia, one each. 
Taking into view the number of members in the various States it 8 
MEDICAL EXAMINER-IN-CHTEF’s REPORT 
will appear that the number of deaths per thousand by consumption 
was, in 
North Carolina . . . . 2.33 
Illinois 1.67 
New York 1.62 
Ohio 1.52 
New Jersey 1.43 
Massachusetts . . . . 1.29 
Tennessee 1.23 
Pennsylvania .... 1.22 
Wisconsin 0.93 
Missouri 0.78 
Maryland 0.75 
Michigan 0.40 
There were no deaths from consumption in Arkansas, California, 
Colorado, Delaware, Indiana, Iowa, Kansas, Kentucky Minnesota, 
New Brunswick, Prince Edward’s Island, Utah, Vermont or Virginia, 
rather a notable list of States, considering that our membership in 
those States amounts to over 9635 persons. 
The rule noted in former years that those of our members who are 
to die of phthisis may be picked out very largely from those who are 
below the normal proportions of height and weight is again verified, 
and we find that 81 of the 109, or about 76 per cent., were below 
the normal weight and twelve were below the lowest limit of our 
tables, or more than 15 per cent, below the normal weight. Only 21 
of the 109, or about 19 per cent., were above the normal weight. 
As regards heredity, twelve had lost one or more members of their 
family by phthisis, six had lost a parent by consumption, though in two 
instances the parent was so old (70) that it seems more likely that 
the cause was chronic bronchitis rather than actual tubercular dis- 
ease. One had lost four sisters of consumption and was 42 years old 
when admitted. Of course it was argued that he had outlived any 
such danger. Another had lost two sisters of consumption and was 52 
when admitted. He remained a member over ten years and died of 
a scrofulous disease of lungs and other organs, probably not essen- 
tially different from tubercle. 
DEATHS WITHIN A YEAR FROM CONSUMPTION. 
It is a little mortifying to find that six members have died of 
phthisis during the past year who had not been members a year. 
No. 3670 of New York was a person aged 28, apparently in good 
health and flesh on joining, with an active out-door employment, an 
excellent family history, and recommended by one of our best ex- 
aminers. Our report of the case is that he took a severe cold in 
December, which was followed by pleurisy with water in the chest 
and resulted in consumption, proving fatal in February. He was MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
9 
under treatment in two hospitals and I think the case is correctly re- 
ported. There seems no reason to think that he was not sound when 
admitted; the consumption was undoubtedly the result of the 
pleurisy. 
No. 3692 of New York, 31 years of age, also appeared to be in 
good health when he joined, and had no blemish in his family 
history. He is said to have had cough, loss of flesh, and rapid de- 
cline, was a member of the Order eleven months and was ill about 
six. 
No. 3856 of Ontario, was a contractor, in robust health, but had 
lost a mother at 35 of some puerperal disease and a sister at 45 cf 
an “ unknown” cause. His disease lasted eight months and took 
the usual course of phthisis ; he was 51 years old on entrance. 
No. 3910 was the case of a physician 24 years old, who was small 
and of light weight. I think that there is little doubt that he was 
unfit for membership when he joined. He was hoarse at the time he 
was examined and soon developed lai’yngeal phthisis ; the fear of 
which ought to have induced the medical examiner to have kept him 
out. 
No. 4100 of Ohio, was 21 years old (5 feet, 5£ inches, 135 pounds), 
a book-keeper, with father and mother and paternal grandfather liv- 
ing, and ten living brothers and sisters. His three other grand 
parents were all over 60 years old at death. He was sick but eleven 
weeks and the case was undoubtedly one of acute tuberculosis. 
No. 4244 of Pennsylvania, was 29 at joining, was beneath the 
normal weight (5 feet, 10 inches, 145 pounds), but had no blemish in 
his family history. His illness lasted only eight weeks, and seems 
to have been very similar to that of the preceding case. 
These cases were all unfortunate, and yet the examiners were all 
men well known to be experienced and skilful, and there is no reason 
to think, except in one case above alluded to, that there was any 
deficiency of care or judgment at the time of the examination. It 
is unquestionable that men do at times pass from a state of health 
into rapid phthisis and we have certainly had an unusual pro- 
portion of these instances this year. I trust that the medical ex- 
aminers will heed the lesson and redouble their care in avoiding such 
cases. 
Were it not for these cases, I should feel justified in boasting that 
our success in keeping down the number of consumptive deaths had 
been excellent, as our proportion has been so small, and the average 
duration of membership among the consumptives so great. 10 
MEDICAL EXAMINER-IN-CHIEFA REPORT. 
Rather a high percentage (17.0) of deaths has occurred from 
diseases of the brain and spinal cord during the last year, amounting 
to 128. 
DISEASES OF THE BRAIN AND SPINE. 
Those variously enumerated as apoplexy, paralysis, congestion of 
the brain, cerebral hemorrhage, and cerebral embolism, probably be- 
longing in one general class, were 84 in all. Then there were 21 of 
those called softening, inflammation, meningitis, abscess, and orgauic 
brain disease, probably also of kindred nature to each other. Six 
cases of general paresis, one of mania-a-potu, and two of neuras- 
thenia or nervous exhaustion ; this is the diagnosis given by the 
medical attendant, though eminent men doubt whether this disease 
ever proves fatal, and Professor Gower of London, in his celebrated 
work on 14 Diseases of the Nervous System” declares that there is 
no justification for regarding neurasthenia as a definite malady, it 
being merely a collection of symptoms showing debility of the 
nervous system. 
Sixty-four of the deceased were over 50 at death, thirty were be- 
tween 40 and 50, twenty-nine between 30 and forty, and five were 
less than 30. 
Four died in less than one year after joining, but cerebral disease 
does not seem in either case to have been presaged by any symptom 
before the examination. No. 3671 was a book-keeper, 21 years old ; 
his illness set in suddenly with a chill, fever, violent headache, rest- 
lessness, aching of limbs, over-sensitiveness to touch. The dura- 
tion of his illness was five weeks and there was no autopsy and no 
family history of brain disease. 
In No. 3848, death occurred five months after joining and the 
final illness lasted three mouths. The symptoms were emaciation, 
pain in head, failure of memory and then of the other faculties ; he 
was in a comatose condition sixty hours before death. His father 
died of apoplexy at 57. 
No. 3914 occurred in a “ stockman,” 4 months after becoming a 
member. He was ill two weeks with cerebral congestion, delirium and 
death. It sounds as if it were quite possibly a case of alcoholism. 
No heredity. 
No. 4179 was a man 39 years old, five months a member of the R. 
A. While seated at breakfast he became suddenly paralyzed and 
unconscious, and died in three-quarters of an hour. His father had 
died of paralysis at 82, and his sister at 18 of spinal meningitis. MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
11 
No. 3885 is said to have died of “ Encephalo Malacia,” a word 
coined from the Greek to denote, I presume, “ softening of the 
brain.” The deceased is reported to have “become childish, with 
loss of mind and speech ; there was no autopsy.” It is well for us 
all to become acquainted with the nomenclature of disease. 
HEART AND CIRCULATORY ORGANS. 
We again this year have a comparatively small number of deaths 
from diseases of the heart and circulatory organs, namely, 68 in all, 
or 9.0 per cent, of our total mortality. 
One case only, No. 3726, died in less than a year after he was 
examined for the Order ; and the details of the case are as follows : 
He joined in June, 1888, and in the fall of that year traces of sugar 
were found in his urine ; in December he consulted a physician with 
regard to his heart, but no evidence of disease was detected there, 
but in January he had an attack like angina. At the last, in 
March, 1889, he was lying on the lounge, was taken with a sudden 
pain in the chest, and died in a few minutes. It is stated that he 
had recently obtained life insurance to the amount of $10,000 in an 
“ old line ” company. 
No other member died within a year, and only three within two 
years. The average duration of membership of the 68 cases alluded 
to was nearly seven years (83 months). 
Four of them were less than 30 years old at death, eight were 
between 30 and 40, sixteen between 40 and 50, and forty were 
over 50. 
Many of them died very soon after the commencement of the 
attack. 27 within 24 hours. Some were found dead in bed, some 
dropped by the roadside. No. 3649, a young man of 25, was run- 
ning to catch the boat, and fell lifeless. He was a reporter, and 
apparently in excellent health, and had never before shown signs of 
heart disease ; his father, however, had also died of heart disease. 
No. 4319 had been suffering from rapid and feeble heart action, 
but was going out when he fell, and lived but an hour. He, too, was 
but about 33 years old ; he had lost his mother by heart disease. 
As a rule, however, there were but few of our cardiac invalids 
who gave any history of hereditary tendency to heart disease, and 
comparatively few, too, who had a history of rheumatism. No. 3665 
was also a man of but 40 years, with an athletic form, good family 
history, and no rheumatism disclosed. His illness was about a year 
in duration, and he had cardiac asthma and shortness of breath ; 12 
MEDICAL EXAMTNER-IN-CHIEF’S REPORT. 
had been under treatment, but was at his office, and died instantly. 
A post-mortem examination showed hypertrophy of the heart 
(weighed two pounds, its usual weight being about nine ounces) and 
insufficiency of the aortic valves, with lime concretions on them. 
The description of No. 4097 is so striking that I quote it as I 
have it on my records, whether verbatim as given by the attending 
physician, or as copied by one or two clerks cannot be quite deter- 
mined. It reads as follows: “Slight fever, was afraid of death, 
woke up suddenly in a fright; paralysis of the heart came on while 
he was asleep, and he died suddenly.” 
DISEASES OF THE LUNGS (NOT PHTHISICAL). 
Acute lung disease has caused the deaths of but 81 members, or a 
ratio of 10.8 per cent. • 
More than two-thirds of the number (56) were ascribed to pneu- 
monia, the remainder being called congestion, bronchitis, pleurisy, 
pulmonary apoplexy, and so forth. 
9 died iu January. 
7 “ “ February. 
9 “ “ March. 
9 “ “ April. 
9 “ “ May. 
9 “ “ June. 
3 died in July. 
2 “ “ August. 
2 “ “ September. 
7 “ “ October. 
8 “ “ November. 
7 “ “ December. 
Eighteen of them were in New York, ten in Massachusetts, eight 
each in Pennsylvania and New Jersey, six in Illinois, five each in 
Ohio, Maryland, and Wisconsin, four in Michigan, and so on. 
One of the deaths from pneumonia, No. 3690, in Hamilton, Ont., 
resulted in four months after admission to the Arcanum, a thing 
which may very well happen from this disease, even if the risk on 
entrance is unexceptionable, but in this instance the attending physi- 
cian intimates that there “ may have been tubercular deposits in the 
apex of the right lung,” which, if true, would reflect no credit on 
our medical examiner. 
One member in Indiana, No. 3807, also died of pneumonia in 3£ 
months after joining the order. The history of the case is that of 
the ordinary run of the disease. 
Still another death, No. 3676, by pneumonia, occurred in New 
York in 9£ months after the member became a brother. The dura- 
tion of his illness was six weeks and two days. He had “regular 
pneumonia, going over to purulent infiltration, or gray hepatization, 
producing total obstruction.” MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
13 
There were no other deaths from acute lung affections among 
those who had been admitted to membership within a year. Most 
of those who died from these diseases were old members, many of 
them having belonged in our ranks eight to eleven years. 
DISEASES OF DIGESTIVE ORGANS. 
Eighty-three cases of diseases of the digestive organs have proved 
fatal to our members during the last year, or a percentage of 11. 
In 23 of the deceased the liver was the organ implicated, in 17 
they are said to have had peritonitis, four had gastric ulcer, four 
intestinal obstruction, and two intussusception. 
In quite a large proportion of cases the diagnosis was established 
by an autopsy, notably in the cases of gastric ulcer and intestinal 
obstruction. 
No. 3846, was a man of 40 years of age who had been eight 
years a member of the Arcanum. The duration of his last illness 
was 8 months. A splenic tumor was diagnosticated shortly after 
its commencement, and “ at death the spleen was found to weigh 
seven pounds ; degeneration had begun at its upper and internal 
aspect; he had suffered chiefly from pain, vertigo, and insomnia.” 
No. 3858 was the case of a man in Michigan who had cirrhosis of 
liver of several months’ duration; “had gradual wasting of flesh 
and strength, with dropsy of the bowels and the lower limbs. Had 
been in the habit of drinking liquor.” 
DISEASES OF THE KIDNEYS AND URINARY ORGANS. 
The deaths from this class of diseases during the past year have 
been 72 in all, the ratio to the total mortality being 9.6. 
Of these 44 resulted from nephritis, or other affections of the 
kidneys, being a percentage of 61 per cent. 
Diabetes mellitus caused 11 deaths or about 15 per cent. 
Five deaths followed cystitis, four were the effects of stone in the 
bladder, four of prostatic disease, and one man had syphilis, with a 
duration of four years. 
Only one died within a year after joining (No. 3824) ; he was a man 
53 years of age, a livery stable keeper, had urethritis followed by a 
stricture, and in six months by a perineal abscess ; when the abscess 
was lanced the member died the next day, whether from hemorrhage 
or septicaemia is not stated. 
One other died, after 22 months’ membership (No. 3857), from 14 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
acute Bright’s disease, the result of a severe cold ; he had severe 
pain in the back and head, dizziness, scanty and high-colored urine, 
much albumen, and finally coma. 
No. 3625 was carefully reported by one of our examiners, as 
follows: “Was ill for more than a year with headaches, loss of 
peristaltic action of the intestines, dyspepsia, irritability of the stom- 
ach, derangement of vision, hemorrhage into eye-balls and retina, 
albumen, and epithelial casts in urine. There was no autopsy.” 
No. 3687 was a case of Addison’s disease, as shown by post 
mortem examination,—disease of the supra renal capsules being 
found, together with heart clot and incipient phthisis. He was a 
man 38 years old, and by occupation a “ line-man.” His family 
history was good. 
The age of these men at death averaged 50 years ; 2 were below 
30 ; 14 between 30 and 40 ; 18 between 40 and 50, and 38, or more 
than half, were over 50 years old. The oldest one (over 70) died 
of prostatic abscess. 
The terrible disaster and flood at Johnstown, Pa., occurring early 
in the year, has helped to make up an unusually large number of 
casualties in the Order during the last year, and our number of 
deaths by accident is no less than 64, the percentage being 8.5. 
CASUALTIES. 
Six members of the Johnstown Council and one of the Blairsville 
Council perished in the roaring waters at that place, two of them 
being the Doctors Beam, one of whom was our medical examiner. 
Of accidents in other places ten were drowned in various ways, 
three being seamen, one an “ ordinary seaman,” who ought not 
according to our rules to have been admitted to the Order, one a 
“ bay-man,” probably an ordinary seaman to all intents and pur- 
poses, and the third a master mariner who was lost at sea whilst 
returning from Rio Janeiro. The others were the ordinary acci- 
dents of every-day life, the results of bathing, yachting, etc. 
Our list of losses among railroad men includes seven members 
this year, three of whom were engineers, one a fireman, one a con- 
ductor, one a baggage-master, and one a switchman ; all but the 
fireman were engaged in the proper performance of their duties. He 
had left his cab and gone to the rear to correct something out of 
place with the coupling, and whilst there engaged in conversation 
the parts of the train came together and crushed him. No. 4119 
had been recommended for membership most strongly on the ground MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
15 
that he occupied a position in which the duties were singularly free 
from danger. He was in charge of an engine which had for its 
duty to push loaded coal cars up an incline from the coal pits. The 
road was a Y-shaped piece, one branch of the Y running up the 
incline, the other branch and the base running along the foot of the 
hill. He had just pushed the loaded train up the hill, and left it in 
charge of a brakeman or conductor, who did not secure it properly. 
Our engineer had returned to the base of the Y when he caught 
sound of the noise of the cars, and knew they had escaped from 
the brakes and were running down upon him ; he at once put on 
steam to reach the other branch of the Y, but the escaped train 
dashed into his cab just at the junction of the two branches, and he 
was so crushed that he had to submit to amputation of both legs, 
which with the shock proved fatal. 
Of the two other engineers, one was thrown with his engine down 
an embankment, and one received concussion of the brain by his 
head hitting a sign-post by the side of the track. 
The baggage master was thrown from the open door of the 
baggage car whilst performing his duties therein. The conductor’s 
train was run into by a freight train which had not the right of way, 
and the switchman was caught while coupling cars, and his skull 
fractured. 
Six others were killed in railroad accidents, none of whom were 
railroad employees, though one was a mail agent. 
Four were killed by the accidental discharge of firearms, three by 
an overdose of opiates. 
Eight fell from windows, roofs, or similar places, and were 
fatally injured. 
And finally three were murdered, one being the celebrated case of 
Dr. Cronin, of Chicago, who was inveigled to a house in the 
suburbs, and there killed by the order of a secret political society. 
The doctor had been a member of our Order for more than nine 
years, and had for a long time, while resident in St. Louis, served 
acceptably as a medical examiner. 
No deaths by accident have occurred to any of our miners, and 
but one death occurred in their ranks, this one being caused by 
typhoid pneumonia. 
SUICIDES. 
Deaths by suicide have been 26 in number during the past year, a 
percentage of 3.5. It appears, on looking at our tables for the past 
ten years, that our average percentage has been 3.4. 16 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
The methods of death were in 17 instances by fire-arms, in two by 
drowning, in two by hanging, and in three by poisoning. In one 
instance the deceased flung himself before a railway train, and in one it 
is not stated how the death was procured. 
One took his life seven months after joining. Was a book-keeper 
of good form and good family history, and no reasons are assigned 
for the act. He was 41 years old at death. The death of another 
took place in 13 months after joining. He was a minister, 29 years 
old, with a good family history. No reasons are assigned. A third, 
a salesman, 31 years old, committed the deed when he had been a 
member 22 months. In him, too, there were no physical or family 
defects, and we have no explanations. No other one died within two 
years after they took up their membership with us, and their average 
duration of membership was six years. 
Their average age at death was 42 years. Two were under 30, 
eight between 30 and 40, eight between 40 and 50, and eight between 
50 and 60. 
As regards their sphere in life it would seem as if most of them, 
as was remarked in a previous report, were men of position and 
influence, and occupied places of responsibility, such as merchants, 
manufacturers, managers, carpet dealers, cotton buyers, provision 
dealers, secretaries, book-keepers, salesmen, barbers, printers, car- 
penters, and one was a minister, one a physician, one a saloon 
keeper, and one a clerk in a liquor store. 
As to the general question of suicides and their pecuniar}'relations 
with fraternal societies, the inquiry has been made of me by one of 
the principal officers of our Supreme Council, as to how the fre- 
quency of the act in the Arcanum compares with that in other simi- 
lar organizations. This is a question which I cannot answer 
satisfactorily, because of the difficulty of obtaining the necessary 
facts regarding these other societies in order to make the comparison. 
The American Legion of Honor, according to the recent biennial 
report of Dr. J. Foster Bush, late Medical Examiner-in-Chief, met 
with a loss of 40 by suicide in a total mortality of 1464, or a per- 
centage of 2.7. Availing myself of the able and instructive report 
on suicides, presented by Brothers Whitaker, Pound and Schryver to 
the Supreme Council in 1887, I find that at that time the rate of 
deaths by suicide in the Knights of Honor had been 3.69, and in the 
A. 0. U. W., in the years 1881, 1882, 1883 and 1884, the percentage 
was 4.03. Ours, as I stated in the opening paragraph of this sec- 
tion, was 3.4 per cent, for the last ten years. It might be added, MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
17 
too, that every endeavor has been made by me to include in the list 
of suicides all the deaths that were of that nature, and not to allow 
any such to be classed with accidents. I have no doubt, however, 
that in all organizations, suicides are often placed among the acci- 
dents, and that the efforts of friends to have them so considered, are 
often successful. It will probably be found that these deaths bear 
much the same ratio to other deaths in the Arcanum as they do in the 
other fraternal societies, there being no obvious reason why they 
should greatly differ. 
CANCER 
Only three had been members less than two years, and their cases 
have no especial interest in them. The average duration of mem- 
bership was over 77 months. 
The cases of cancer numbered 34, or were at the rate of 4.5 per cent. 
Seven cases showed disease of the rectum ; seven of the liver; six 
of the mouth, throat, or tongue ; five of the stomach, and there were 
many single cases involving various parts of the body. 
It seems very extraordinary, but there is not one of these cases 
in which cancer had ever before appeared in the family history, so 
far as is shown by the applications. There are, to be sure, sev- 
eral in which some of the family died at middle life of unknown 
causes, and in some of them, of course, this disease may have been 
present, but there is no definite statement of anything of the kind. 
It may be added that this does not occur by reason of applicants 
fearing to confess this fact, since for several years the presence of 
cancer, or of one case at least, in the family history has not been 
deemed a bar to admission. Only one case seems to point to any 
such feature in the hereditary descent, it being that of No. 4221, 
whose father is reported to have died at 58 of dyspepsia; this may 
have been the effect of a hidden cancer. 
Thers are no cases of sufficient interest to require a report. It 
may be observed, however, that an unusual number of cases were 
confirmed as to the diagnosis by an autopsy, ten out of thirty-four 
being so reported. 
The seventeen deaths that have been placed under this category 
are not, for the most part, stinking cases, but do not come readily 
under our previous headings. 
UNCLASSIFIED 
Two were cases of parotid abscess followed by septicaemia and 
death. 18 
MEDICAL EXAMINER-IN-OHIEF’s REPORT. 
Four were cases of alcoholism. No. 4004 had no occupation. 
Three years before death he began to drink, became insane, and was 
sent to an asylum, but after several months was discharged as cured ; 
again drank, mania again developed, but subsided until within a few 
days of death. Nervousness, muscular twitchings, hallucinations, 
and paralysis for seven days ended the scene. His age was 43 
years. The others differed from this only in minor details. 
Four were cases of “ pernicious anaemia,” with marked loss of 
strength, pallor, periodical attacks of vomiting and jaundice. An 
autopsy was made in one case, showing extreme anaemia of the 
internal organs, which seemed otherwise healthy. 
One case was that of “ Hodgkin’s disease,” or lymphadenoma, or 
enlargement of the lymphatic glands, as explained in a previous 
report. He was ill eighteen months, and was 66 years old at death. 
Four of the deaths resulted from general debility, nervous 
exhaustion, or general prostration of the vital powers. No. 3841 
was a manufacturer, who was ill only one week, seeming exhausted 
and prostrated by “ old age.” He was but 68 years old. 
No. 3936 died at 46 years ; he was a secretary, and mysteriously 
disappeared. Proof of death was waived by order of the Supreme 
Council. 
The last, dying from excessive obesity (No. 4014), was 69 years 
of age at his death. His illness progressed rapidly for years. 
“ Natural predisposition to obesity and liberal eating were causes 
which led to loss of mental and vital powers.” He was not in 
business. 
RAILROAD EMPLOYEES. 
The Supreme Council of the Royal Arcanum at its last session on 
June 7, 1889, resolved: “That in view of the complaint made by 
the Grand Council of the State of New Jersey, in reference to the 
rejection of railroad employees as such, the Medical Examiner-in- 
Chief be instructed to visit that jurisdiction, and in conjunction with 
its Grand Regent especially inform himself of the relative risks of 
the employees in the different railroads in that State, having refer- 
ence to their construction and mode of operation, and of the relative 
risk of employees arising from the several capacities in which they 
are employed.” 
In accordance with the above resolution and on receipt of an in- 
vitation from Grand Regent Douglass, I went to Jerse}7 City on 
November 19, 1889, and was there received most courteously and 
hospitably by a Committee of the Grand Council of New Jersey. MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
19 
On the next day I was waited on by a committee consisting of 
Past Regent W. Guy Weaver of Middlesex Council, Perth Amboy, 
N. .J., and Acting Regent Petter of Jersey City Council, who ac- 
companied me to the passenger yards of the Pennsylvania R. R., 
where I was shown the different methods of automatic coupling there 
used in connecting the passenger engines and cars, such as the 
Miller and Jenney, the methods of using the air brakes, as well as 
the duties of the passenger brakemen, conductors, firemen, and en- 
gineers in their several stations. 
Thence I was attended to the freight yards of the same road and 
saw there in detail the methods of making up and coupling trains, 
signalling and drilling them, the duties of the freight brakemen, the 
drillers, the switchmen and the freight conductors. 
Brother Weaver next escorted me to the yards of the Central R. R., 
of New Jersey, and explained to me the various signals, semaphores 
and automatic switching devices there in use, introduced me to en- 
gineers and other employees with whom I had free opportunities to 
converse and learn their views regarding the safety of their relative 
occupations. 
We next took a train on the Pennsylvania R. R. out to Rahway, in 
order to have the block system and the various details of the towers 
along the road practically shown to me, according to which the 
Pennsylvania and so many other of the principal roads are now 
operated. 
Other similar visits were also made to other yards in that city. 
At Perth Amboy we visited the Lehigh Valley “ coal pockets ” 
and saw the loading and unloading and coupling and drilling of coal 
cars ; their trains are manned by an engineer, foreman, and four 
brakemen, there being no conductor. Subsequently we were in- 
vited by Superintendent Brodhead of this road to make some trips 
up and down the road for the purpose of having the lights, signals, 
and other machinery of the road explained to me. 
On the next day Regent Petter accompanied me to Hoboken and 
introduced me to Brother F. J. Griffith, the assistant superintendent 
of the Delaware, Lackawanna and Western R. R. and a representa- 
tive to the Supreme Council. With him I spent a large part of the 
day in going through the yards, machine shops, etc., of this road, 
and again inspecting the various details which I had seen in the 
other yards. Brother Griffith introduced me to the yard master, 
who made me practically acquainted with his own duties and those 
of his assistants, the baggage masters, and various others. 20 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
This completed my tour of observation and ended a most instruc- 
tive visit. My warmest thanks are due to Grand Regent Douglass 
and the members of the Grand Council of New Jersey, and also to 
Brothers Weaver, Petter and Griffith, and all the brethren who con- 
tributed so much to my information and pleasure. 
In a previous report I had stated that engineers and firemen of the 
various roads would as a rule be accepted, and that freight conduc- 
tors would as a rule be rejected ; the latter was a point on which the 
railroad men wished me to change my decision, and they stated be- 
fore the Supreme Council that they did not, generally speaking, 
“ think the occupation of freight conductor should be considered 
extra hazardous. A passenger conductor’s certainly is not.” (By 
the way, no passenger conductor has ever been rejected in our 
Order on account of his occupation). 
Nothing became more evident to me or was perhaps more impor- 
tant than the degree to which the duties of certain men vary on 
different roads, and it soon became plain that whilst on one road the 
position of freight conductor was about as safe as that of any one 
on the train, on another it became almost as dangerous at times as 
that of freight brakeman, a grade of men whom none of our railroad 
men among the members of the Order ventured to recommend. On 
the Pennsylvania R. R. I was told that freight conductors do no 
coupling and do not leave their cabs except to give orders to en- 
gineers, firemen or brakemen. This is also so with certain through 
freight trains, and perhaps fast freight trains which convey fruit 
and other perishable materials. To these trains are granted certain 
extra privileges and the right of way the same as to the passenger 
trains, so that they are less liable to meet with accidents of all kinds. 
Of course the conductors of such trains are comparatively safe in 
their situations, perhaps as safe as passenger conductors. 
On the other hand (and the fact is important), I was told by one 
of the chief officials of another road that the freight conductors, 
although not required in the line of their duties to do it, make un- 
questionably more or less couplings of the cars every day of their 
lives, that whenever a car was to be taken on or off the train, and 
no brakeman was immediately on the spot to do it, the freight con- 
ductor allowed no delay but immediately stepped forward and did it 
himself ; this it was explained he did involuntarily, from the fact 
that he had himself been a freight brakeman and was familiar with 
their duties. 
Train despatches’ duties also vary greatly on different roads. MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
21 
On the Pennsylvania, that official sits in his office and with maps, 
wire or phone gives his orders to move the trains. On the D. L. & 
W., the train despatcher is ubiquitous, and gives orders to engineers 
and conductors in the yard, or wherever the trains and cars are. It 
is easy to see that the dangers of their position vary greatly. 
Names of occupations are given differently on different roads ; the 
switchman in some places stands on the ground near a switch and 
turns the track according to the orders received and is in no danger 
so long as he is a sober and intelligent being ; at another time in a 
freight yard he is the chief-driller or head-brakeman in a position 
full of danger. 
Car inspectors are sometimes those that superintend the repairs, 
mark the work to be done, and inspect that which has been done, 
but do no manual labor. But then, again, a car inspector or “ Gal- 
vanizer ” is one, who himself makes the repairs in yards or on tracks 
where cars are being moved continually, and is constantly in danger 
of accident or injury. 
COUPLING FREIGHT CARS. 
No one can couple freight cars without being from time to time in 
positions of danger. Freight cars upon different roads are made in 
such different patterns that when they are run together the bumpers 
on one may not meet the bumpers on another and thus the whole 
end of one car may come immediately in contact with the end of 
another so that not even a hand could remain between them without 
being crushed. On the other hand, with passenger cars and the 
Miller or Jenney couplings a man may stand safely between the 
cars when their connecting platforms are in contact. With the 
freight cars, various couplings are used and some are more difficult 
to use than others, for instance, the “ three link coupling,” which for 
the most part requires the use of both the brakeman’s hands to 
bring them into a position to be joined, is a very dangerous 
coupling. 
Whoever, therefore, assists in the duty of coupling freight cars, 
whether he be freight-brakeman, driller, yard-master, or assistant 
yard-master, baggage-master or freight conductor, for all of these 
officials from time to time do this kind of work, is in a dangerous 
position and must be considered an extra hazardous risk. 
Speaking of yard-masters, too, in the same connection, I was 
informed in one yard that said official no more thought of coupling 
cars or doing any kind of manual labor than the superintendent of 22 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
the road. In another yard I was told by the yard-master him- 
self that there was no kind of work done in his yard whether 
coupling, switching, or anything else, dangerous or not, that he 
did not take a part in, and that his assistants were expected like 
himself to assist in every detail, whenever by so doing they could 
assist in the proper despatch of business. 
Baggage-masters on different roads and in different parts of the 
same road are very variously exposed, and I have been strongly 
urged by a brother at Salamanca to shut them out entirely. On 
most of the branch roads it is customary for the baggage man to 
couple his car to the locomotive. This is more or less dangerous 
according to the kind of coupling in use ; if it be an automatic 
coupler the man is safe, if not, he will probably sooner or later be 
injured. Quite recently I took care of a baggage-master whose 
hand was crushed in doing his ordinary duty of coupling with a link 
and pin. The brother from Salamanca, however, alludes to another 
danger as follows: he says, “on through express trains, buffet- 
cars, the baggage car is part of the smoking car, and when the 
baggage car is part of the smoking car and when the baggage-mas- 
ter gets in there with his baggage there is no possible way for him to 
get out, and if there happens to be an accident you can imagine what 
he would be like with all those big trunks flying around him. There 
are,” he says, “ two of those trains that run out of Salamanca that 
have been put on within three years, and during that time two bag- 
gage-masters out of six have been killed, and no other person on the 
train was seriously hurt. One’s head was cut clean from the body, 
and the other had his life literally crushed out of him. Do not 
understand that both of these men were killed in the same car at the 
same time. This occurred in two different accidents, as they only 
have one baggage-master in a car.” 
Brother Weaver, to whom I sent this letter, believes that cars 
constructed as above described are very uncommon, and says that 
even if the baggage-master has no door communicating with the 
rest of the train, he surely has two very large side-doors. He says 
that it is a very rare thing to hear of a baggage-master being killed 
by his baggage, although such cases are heard of once in a while. 
He adds, too, that it must be remembered that there are baggage- 
masters on the local and suburban trains that do not handle two 
trunks in a week, but simply look after the packages of the passen- 
gers ; this class of baggage-masters greatly outnumbers all others, 
and are who couple their combined smoking and baggage MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
23 
car to the engine. He explains how this coupling is made, and says 
that in these cases a man can stand between the engine and the train 
without danger, by reason of the kind of connections used. 
Brother Griffith of the D. L. & W. also writes me that in his 
opinion “ all train men (except brakemen) on first-class roads are 
good risks, especially conductors and baggage-masters on passenger 
trains.” 
The mortality of baggage-masters in the Arcanum has been, I 
think, limited to two deaths, one being killed by being struck on the 
abdomen by the corner of a trunk, which was thrown from one car 
to the other, the other death occurring by the man’s falling from the 
open side-door of his car while the train was in motion. It might be 
added that one has been recently rejected because it appeared that 
besides coupling his car to the locomotive he was also, when not on 
his regular trips, employed in coupling and drilling cars in the yard. 
THE BLOCK SYSTEM. 
One of the improvements in railroading which has been made in 
recent years, and which it is claimed does an immense amount toward 
making the life of every railroad man more secure, is the “ block- 
system,” a plan by which the road is divided up into blocks or sec- 
tions over which the trains pass, and under which they are not allowed 
to pass from one to the other until they receive a signal that the next 
section is clear, and that they can enter upon it. On coming near 
the end of one section and the commencement of another the train- 
men will receive one of three signals, first that the coming section is 
all clear and they may go ahead, or second that it is occupied and 
they must not enter upon it at all but must stop, or third, that it 
is occupied by a receding train or some temporary obstacle, and 
they may proceed cautiously, the theory being that each train has 
the whole block to itself, and can never create a rear collision by 
bumping into a train in advance, or enter upon the new block or 
section until the train in advance has left it. 
This system, when rigidly enforced, must prevent, it would seem, 
the possibility of one train running into the rear of another, and 
when all the trains in one direction go on one track, and all those in 
the other direction on another, as is the rule, it would seem that the 
block system must eliminate all possible dangers from collisions. It 
is probably the most efficient device that has ever been put in use for 
the safety of the lives of the public and the railroad men. 
It is not, however, unfailing — no system can be which depends 24 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
on the vigilance and obedience of men, —and in this system the fail- 
ure of any one of several men to give the right signal at the right 
time, or the failure of any one of several men to read the signal 
aright and to act upon it at the right moment, may destroy for the 
time the whole value of the system. In proof of this, only a few 
weeks after I had the system explained to me between Rahway and 
Jersey City, trains A and B were going over that same piece of road, 
train A in advance. When train B came to a certain signal station, 
it received the order to proceed with care, as train A had not yet left 
that block. Train B proceeded with care, but not with care enough, 
and ran into train A, not doing a great amount of injury, but making 
wreckage enough to derail train C, coming in the other direction on 
the adjoining track. 
On the Old Colony Road near Providence, since then, as the 
passenger train was one day approaching its terminus, having received 
the signal that the block was clear, a switching engine upon a side 
track suddenly ran in on the main track, and a collision resulted, 
killing the engineer of the passenger train and doing an immense 
amount of damage. Precisely the same accident occurred on the 
same road a few months later as a passenger train was approaching 
Boston. Fortunately, no lives were lost in the latter instance. In 
both cases, so far as can be ascertained, the switching engineer 
entered the block without the slightest authority. 
I only mention these instances to show that danger cannot be 
wholly precluded by devices dependent on men’s watchfulness or 
obedience. All such devices may, however, wonderfully lessen the 
dangers of both passengers and employees, and make it more pru- 
dent to accept such men in the Arcanum and kindred societies. 
MORAL CONSIDERATIONS. 
In speaking of the various factors that combine to make the life 
of a railroad man less hazardous than formerly, my attention has 
been more than once drawn to the fact, and it is one of great impor- 
tance for the purposes of this inquiry, that railroad men of all 
classes and grades have in the last five or ten years made great im- 
provements in education and intelligence. This has been repeatedly 
pointed out to me with great pride — and it must be seen to be of 
immense importance—for the meetings of the engineers’ brother- 
hoods and the firemen’s societies, and whatever other similar organi- 
zations exist among all classes of railroad men, must greatly improve 
the members not only socially and morally, but technically in their MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
25 
skill in their handicraft, their knowledge of expedients, and their 
bravery and manliness in danger. 
For this reason, in addition to others, in judging of a man’s availa- 
bility as a candidate for the Arcanum, his general habits and morals 
and education ought so far as possible to be taken into the inquiry, 
and for this reason the railroad men claim that on the best roads, 
where the most safeguards are thrown around the men, and the best 
opportunities given them to read, write and educate themselves, the 
men are correspondingly less careless and reckless and are better 
risks ; and that it is the lower grades of men who occupy the poorest 
paid and most dangerous positions on the poorest roads, who ought 
not to be admitted to membership in the R. A. 
In connection with this line of thought a member of the Order, in 
writing me recently, recommending a railroad man, did so most 
urgently on the ground that he was a strict teetotaller, and for that 
reason less liable to accident; and he stated that about all the inju- 
ries among railroad men are due to the over-use of spirits — a state- 
ment which I regard as wholly unjust, because it seems to me from 
pretty extended observations, that temperance is so general among 
all grades of railroad men, except possibly the very lowest, that the 
element of drunkenness can safely be eliminated from the dangers to 
which railroad men are exposed. 
SINGLE TRACK ROADS. 
Opinions of my railroad friends differ as to the advisability of 
taking employees of these roads, according to the kinds of these 
roads with which they are familiar. One advises me to take none of 
them except after the applicant has proved that he can be safely 
admitted ; another one thinks that on the best roads they are not 
extra hazardous risks. On some roads, especially the poorer roads 
of the West and South, where the road is single tracked for the sake 
of cheapness, and where, therefore, the whole equipment and man- 
agement of the road is run by the cheapest methods, accidents are 
common. On others, as for instance, on some branches of the D. 
L. & W., everything is carried out on the most thorough methods, 
regardless of expense, and the dangers are reduced to a minimum. 
Still, for the most part, men on single track roads will be closely 
inquired into before they are allowed to obtain membership in the 
Arcanum. 
Thoroughly impressed, then, as I have been with the fact that it 
will be prudent for the Arcanum to considerably widen its portals to 
CONCLUSIONS AS TO RAILROADING. 26 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
these risks, if the selections be made with due regard to the road on 
which they work, my views, as modified by my visit to Jersey City, 
and by my correspondence with various brothers, who, from their 
official duties have a pretty full knowledge of the dangers to which 
railroad men are exposed, will now lead me for the most part to 
approve engineers on freight, passenger, and yard engines ; firemen 
on freight, passenger, and yard engines ; conductors on passenger 
trains, and brakemen on passenger trains, unless by coupling with 
dangerous couplings they place themselves in jeopardy. 
Freight conductors who travel on through freight trains, fast 
freight trains, and other trains, where they do no coupling, will 
probably be accepted. 
Train despatchers and yard masters who do not take an active 
part in drilling and handling cars, or perform their duties in danger- 
ous localities will also probably be accepted. 
But that I shall generally reject freight brakemen, *flagmen, 
switchmen, car inspectors (except the foreman car inspector), 
wipers, laborers (except section foremen), and usually the lower 
grades of employees, except where it can be shown that their duties 
are unusually free from danger. Foremen car inspectors and 
section foremen may doubtless be safely admitted. 
Round-house men, from the superintendent to the various 
mechanics, and down to the “ hostlers,” who feed, water, and groom 
the engines, will not, as a rule, be deemed extra-hazardous. 
Among the employments which were referred to at one of the 
sessions of the Supreme Council as being extra hazardous and there- 
fore requiring rejection in the Arcanum, was that of “ city firemen.” 
The matter has therefore been under consideration since that time 
and I have not approved such applications, except when duly author- 
ized parties who were conversant with the applicants’ duties certified 
that they might properly be insured. 
CITY FIREMEN. 
In this matter I have lately received valuable information from 
Dr. Stubbs, the State Medical Examiner of Illinois, and since then 
similar information from Dr. C. E. Bruce, Subordinate Examiner in 
New York City. 
From the former it appears that in the city of Chicago during the 
* The line of promotion, as a rule, among freight car men is as follows: the green 
hand becomes a brakeman on the middle of the train, next a switch-man, chief driller, or 
head brakeman, next a flagman, and uext a freight conductor. MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
27 
last six years the following have been the deaths among the members 
of the fire department. 
Year. 
Deaths. 
Membership. 
Rate. 
Deaths due to Occupation. 
1884 
2 
456 
4.39 
1 
1885 
6 
487 
10.27 
3 
1886 
none 
527 
none 
0 
1887 
9 
582 
15.47 
2 
1888 
4 
663 
6.03 
1 
1889 
3 
869 
3.45 
0 
Average 
4 
597 
6.70 
1 
Regarding the city of New York, Dr. Bruce gives me the follow- 
ing figures, which are still more favorable. Number of men 1000. 
Year. 
Total Deaths. 
From Injuries. 
1887 
14 
3 
1888 
11 
1 
1889 
10 
1 
1890 to April 23 
4 
1 
Dr. Bruce remarks very pertinently that this statement compares 
very favorably with any from the ordinary walks of life. 
Those killed at or going to fires among the Chicago department 
were one captain, three truckmen, two pipemen, and one driver. 
The grades are not given in the New York department. 
It is farther claimed, with respect to those from Chicago by Dr. 
Stubbs’ correspondent there, that the deaths from natural causes are 
not in excess of the normal rate ; and this seems to be true, the rate 
being a trifle less than four per thousand, but the list of deaths is 
extraordinary as regards their causes. There are twenty-four in all 
and eleven were killed accidentally, there being four other casualties 
besides those reported in the line of duty, and there were two sui- 
cides, four cases of consumption, three cases of cancer, one of pneu- 
monia, one of bronchitis, one of paralysis, one of Bright’s disease, 
and one of heart disease. This certainly is a pretty unusual list of 
constitutional diseases in twenty-four deaths, but is doubtless de- 
pendent on other causes than their occupation. 
But with reference to the amount of hazard involved in accepting 
these men as risks for life insurance, so far as their likelihood to re- 
ceive fatal accidents in the line of duty goes, seven such deaths in 
3584 members in Chicago and six such deaths in a membership of 
3300 in New York ought not to cause the rejection of these men as 
a class, 28 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
State Medical Examiner Reeve, of Wisconsin, has called my 
attention to the dangers that attend men employed in glass-blowing 
in their labors. He says that they work, as we all know, in apart- 
ments in which they are subject to the dangers incident to rapid 
changes of temperature in highly heatedrooms, and that their labored 
exertions in blowing leads to emphysema of the lungs and to other 
lung troubles. 
Dr. Langland of Wisconsin, who had recommended some of this 
class of men, wrote in connection therewith that “ these applicants 
claim that their occupation is not detrimental to health when ordi- 
nary precautions are taken and whiskey left alone ; intemperance 
they say is very prevalent among glass blowers, and the cause of 
early breaking down of health in quite a number of their members.” 
It is quite likely that the latter gentleman is right about the cause 
of a large mortality among glass-blowers, but his remarks seem to 
indicate that it is a general belief that the mortality is large among 
them, and care must therefore be taken in allowing them to join our 
ranks. 
With the view of ascertaining what can be learned from our own 
experience about these men, I have looked over our entire list of 
deaths since the foundation of the Order, and found that we have lost 
but five members from among those connected with this industry, 
and two of these were superintendents who cannot have been exposed 
to the personal risks which the laborers incur. These superintendents 
died, the one of cholera morbus, the other of intussusception. In the 
other three cases the men were glass-blowers and two died of phthisis 
and one of typhoid ; the latter had been a member but sixteen months, 
one of the phthisical men was a member forty-six months and the 
other more than eight years. I have no means of ascertaining how 
many men in this kind of work have already joined the Order, but from 
my recollection the applications have not been frequent. I trust the 
medical examiners will scrutinize each case before admission and 
take note of all facts bearing upon the subject and kindly report to 
me, as far as possible, the history of all glass-blowers who die in 
the Order. 
GLASS-BLOWING. 
AIMS OF THESE REPORTS. 
It should be noted that although the primary object of these re- 
ports is to inform the officers and members of the Supreme Council, 
as well as the whole membership of the Order, as to the results of MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
29 
the year in a medical point of view, what the medical examiners 
have done or what they have failed to do, yet the reports have a 
still farther work to do which is nearly as important, and that is to 
serve as a medium of communication between myself and the other 
medical examiners, and thus enable me to give them such advice 
and suggestions as seem to me necessary to make the work uniform 
and the decisions alike in all the jurisdictions ; hence if in some of 
these pages I seem to use medical terms too freely it will be only 
done for the purpose of making the point clear to medical men. 
ALBUMINURIA. 
I have written so much in my last two reports regarding the 
safety of admitting to the Order persons who have had albuminuria 
that I would not dwell farther on this topic were it not for the fact 
that at the meeting of the British Medical Association in Leeds, 
Eugland, in August last, the subject was freely discussed by some 
eminent practitioners who have heretofore published articles on the 
subject. 
Dr. George Johnson, the author of a book on “ Diseases of the 
Kidneys,” 1852, and of “ Lectures on Bright’s Disease,” 1873, has 
always consistently taken the ground in various articles published in 
medical journals that albuminuria is pathological and never physio- 
logical, in other words that it is an indication of disease and does 
not occur in health; still he too states that acute Bright’s disease is 
essentially a curable disease and that albuminuria may disappear in 
from a few days to many months, and he has seen cases of complete 
recovery after albuminuria had continued for one, two, or even three 
years, and he has published one case in which complete recovery 
occurred after seven years of persistent albuminuria, consequent on 
scarletinal nephritis. In almost every instance intermittent albumi- 
nuria, or as it is called, functional albuminuria, may be traced back 
to some recognized cause, such as acute nephritis. While these 
forms of albuminuria may be curable under suitable dietetic, medi- 
cinal, or hygienic treatment, yet in such cases the albuminuria is 
liable to prove persistent, and a persistent albuminuria ultimately 
results in a fatal degeneration of the kidneys. 
He says that he supposes that no medical officer would advise 
that an applicant with a decided trace of albumen in the urine should 
be accepted at the ordinary rate of premium. 
Dr. F. W. Pavy, after alluding to the well known fact that Wes- 
ton, the pedestrian, had temporary albuminuria after an attempt to 30 
MEDICAL EXAMINER-IN-CHIEF?S REPORT. 
walk 115 miles in 24 consecutive hours, and that candidates at ex- 
aminations after severe mental strain sometimes have albuminuria, 
and that cases of transient albuminuria may follow sudden immer- 
sion in cold water, thinks that cases of temporary albuminuria may 
be accepted in life insurance upon the payment of additional 
premium. 
Dr. Maguire said there were two classes of functional albuminuria, 
the first of high arterial tension, which is frequent in applicants with 
a family history of Bright’s disease ; the second with low arterial 
tension, who were usually men of weak frames and especially weak 
circulation. In the former class the albumen may be easily made to 
disappear under suitable treatment, but when present at the time of 
examination for insurance the life should be rejected. The second 
class if accepted at all should be received only at an increased 
premium. 
H. Pye Smith (referred to in last year’s report) says that casts 
may be absent in cases of renal cirrhosis or may be present in cases 
of temporary renal congestion. He would for practical purposes of 
prognosis compare albuminuria with hemoptysis ; it is always serious, 
though it does not always indicate organic disease. Even if there 
are indications of structional lesion of the kidneys the prognosis may 
be good, as Bright’s disease like phthisis may be curable. AVhen 
believed to be functional, it is better to defer the applicant for as- 
surance rather than to attempt to determine what is often an in- 
soluble question. 
Dr. Gairdner of the University of Glasgow said that the presence 
of serum-albumen in the urine even casually, as shown by the usual 
tests, must be regarded as a danger signal, and he thought that the 
only result that must follow in cases when the risk seems good but 
albumen is found to be present is that judgment must be postponed 
weeks or months. Circumstances may show that the occurrence is 
purely casual and almost accidental, or that a longer period of pro- 
bation may be required, or the case one that must be rejected. 
A. Rabagliati said the specific gravity of the urine should be oue 
element in making the decision, or indications of gout, or the pres- 
ence of casts ; but he should not agree with those who are disposed 
to take a favorable opinion of cases in which even a trace of albu- 
men was present. In 3246 deaths in the Scottish Widows’ Fund, 
7.8 per cent, were due to urinary diseases, and 4.3 per cent, to dis- 
eases of the kidney and nephritis. The average age at deaths of 
albuminuria was 57 years. He would rate up young lives moderately MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
31 
when albumen was present, rating up lives under 40, but leaving or 
rejecting absolutely those over 40 or 45. 
C. R. Drysdale believed that in life assurance the medical officer 
of a company must judge whether the applicant has temporary or 
permanent disease. In the latter case he cannot approve, in the 
former delay is advisable before reaching a decision. 
Dr. Saundby, believing that whilst there may be certain cases of 
albuminuria safely insurable, saiys the following features should 
reject: 1st. A history of Bright’s disease in a parent or any two 
near relatives. 2d. A personal history of past acute nephritis. 3d. 
A history of plumbism or gout. 4th. Cardiac hypertrophy, hard 
pulse, frequent nocturnal micturition, or retinal change. 5th. 
Where the age is over 40 years. 6th. When the urine shows casts. 
7th. When there is chronic dyspepsia. He disagreed with Dr. 
Pollock in his “ Medical Hand-book of Life Assurance,” * who says 
that albuminuria, formerly existing as a result of acute nephritis 
from cold or exposure, with an interval of perfect health for years, 
need not disqualify the proposer. 
Dr. Eddison, of the Leeds Infirmary, believed that every case 
which showed albumen by the ordinary tests, should certainly either 
be refused or postponed for later examination for six months or a 
year, and then rejected if the presence of albumen in the urine per- 
sisted, no matter how apparently otherwise healthy the applicant 
may be. 
Now I have taken up a good deal of space in quoting these opin- 
ions to show how difficult or impossible it would be for those whose 
applications come to us with the odium of having “traces of albu- 
men ” to pass all the tests which the association of physicians believe 
should be passed before the applicant should be received. I have 
explained previously that every person who cannot be received into 
an insurance company without being “ rated up,’’ as it is called, that 
is paying higher premiums than others of his age, ought, for that 
very reason, not to be admitted into the Arcanum at all. That is, 
that we ought not to take any who are not (so far as can be seen at 
least) as good risks as those with whom they are to be associated, 
who will have to pay for the deaths of these unfavorable risks when 
they do die. 
The Arcanum’s examination for kidney diseases includes ordinarily 
only an inquiry into the specific gravity, the presence of albumen, the 
* Referred to subsequently in this report. 32 
MEDICAL EXAMINER-IN-CHIEF’s REPORT. 
presence of sugar, and the reaction. If in any of these the candidate 
shows any inclinations of disease, he fails to reach our standard and 
should not be admitted. 
It should, perhaps, be added that there are certain of the new 
tests for albumen which are claimed to show albumen in smaller 
quantities than our old tests, heat and nitric acid. With regard to 
some of these there is a doubt in the minds, even of chemical experts, 
whether the cloudy band which is said to indicate the presence of 
albumen always does indicate it, and it is thought to be sometimes 
produced by something else ; and this belief was frequently alluded 
to in this discussion. I quoted last year the opiuion of Professor 
Edes that an albumen which was indicated only by some of these 
newer tests, and could not be demonstrated by the proper use of 
heat or nitric acid, was not of much significance, and this is no 
doubt true as a rule. Its constant presence as shown by these finer 
tests should no doubt be heeded, but need not positively reject, if in 
all other respects the candidate seems unexceptionable, and albumen 
cannot be shown by carefully conducted tests with nitric acid. A 
low specific gravity too is a danger-signal, when there is any 
reason to apprehend Bright’s disease; age is another: a gouty 
history or a history of any lead disease are still others ; and all must 
be borne in mind. 
DYSPEPSIA. 
Hardly a day elapses without my cautioning some medical ex- 
aminer that a person who suffers from dyspepsia is not so good a 
risk as one who does not, and that it may be necessary to reject an 
applicant on this account. It would hardly seem to be necessary to 
say to physicians that one is not in good health whose digestive 
organs are not capable of performing their full functions without 
suffering inconvenience or requiring medical treatment. It is very 
true that there are many persons who suffer more or less frequently 
from want of perfect digestion at all times, but are in spite of these 
symptoms, sufficiently well to allow them to attend to the calls of 
business and society without succumbing to their maladies or dis- 
comforts. These persons are for the most part those who eat too 
much, drink too much, or work beyond their strength ; and the mere 
statement of the causes of lheir dyspepsia must show to one who 
thinks that these causes may, besides giving discomfort, lead to 
sickness and thereby to premature death. It must also be borne in 
mind that whilst such persons may bear very well the labors and MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
33 
fatigues of everyday life whilst everything is passing off harmon- 
iously, yet that if the time comes when some intercurrent disease like 
pneumonia assails them, they will not have the stamina to withstand 
its attack, and they will become the early victims of “la grippe” 
or similar affections which are dangerous only to the weak. 
So much on general principles is apparent to all, but beyond 
this every educated and observant physician must know that these 
symptoms of indigestion may point to disease of the stomach as 
caused by cancer or dilatation of the stomach, or may result from 
that weakness of digestion observed in early phthisis, or to the acid 
eructations of incipient gout, or to the catarrh of the stomach, 
either acute, sub-acute, or chronic of Bright’s disease, or to the 
fiatuence, nausea, vomiting, and perhaps jaundice of cirrhosis or 
any chronic form of liver disease. 
The entrance of dyspeptics into the Order, even of those whose 
dyspepsia is so slight as hardly to receive mention in their applica- 
tions, is fraught with danger, except when the medical examiner is 
familiar with and fully remembers the symptoms and progress of 
the various chronic disorders which are sometimes ushered in or 
pointed out by indigestion and dyspepsia. The Supervising Ex- 
aminer ought not to allow any such cases to meet his approval until 
he has made pertinent inquiries into the applicant’s state and 
symptoms. 
Men with dyspepsia are certainly not first-class risks and may be 
at the gate-way that them to chronic disease of the stomach, 
lungs, kidneys or liver. We have insured already too many such 
applicants. 
BOOKS ON MEDICAL EXAMINATIONS FOR LIFE INSURANCE. 
Every medical examiner in the Order should have in his library for 
frequent reference at least one good work for instruction on the 
principles on which physical examinations for life insurance should 
be made, and the character of risks estimated. 
For this purpose Alien’s “Medical Examinations for Life Insur- 
ance ” and Sieveking’s “ Medical Adviser in Life Assurauce ” have 
been long in good repute, and probably are still most in use. The 
former is, however, a little behind the times, and always gave atten- 
tion to details rather than principles. The latter, on the other 
hand, though better written and broader in its treatment of the sub- 
ject, hardly gives sufficient attention to details. Both are, however, 
valuable and hardly to be dispensed with by an examiner. 34 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
During my summer vacation I made pretty diligent inquiry among 
medical centres as to what books on this subject there were in the 
field, and would like to call attention to some of them. Mention 
should perhaps first be made of the “ Life Insurance Examiner,” by 
Charles F. Stillman, as being one of the fullest and most ambitious 
works of the kind now extant. It is brought well down to the pres- 
ent time, gives a thorough treatise on the examination of urine, 
both chemical and microscopical, as well as very full methods for 
physical examination of the chest, and seems to me to err (on the 
safe side, perhaps) by being too elaborate and lengthy, and, there- 
fore, too expensive. It is a quarto book, published by “The Spec- 
tator Company,” New York and Chicago. 
There is a French book, “ Traite Complet de L’Examen Medical 
dans les Assurances sur la Vie,” which I have found excellent, 
though the author remains anonymous. He is stated to have been 
for a long time the director of one of the largest insurance compa- 
nies. He enunciates the principle which I have not seen elsewhere 
stated, though it is almost self evident when stated, that in general 
“ one should refuse an applicant who will be obliged sooner or later 
to undergo a surgical operation.” The book is well written and con- 
tains a great amount of interesting information. Published by L. 
Warmer, Paris. 
The best book for general purposes, I think, is a recent one called 
“ The Medical Hand-book of Life Assurance,” by Dr. J. E. Pollock 
and Mr. James Chisholm, Actuary. It is published by Cassell & 
Co., contains about two hundred pages, is well up to the present 
condition of modern medical knowledge, does not dwell much on 
methods and seems to be thoroughly digested. One may not always 
coincide with its conclusions on every point, but they are always 
worth considering. It is similar in style to Allen’s book, but better 
written. 
Finally my attention has just been di’awn to a new book, either in 
or just out of the press, whose prospectus only has been seen, but 
which seems to promise to be a work containing much valuable infor- 
mation. It is called “ How to examine for Life Insurance,” and is 
written by Dr. John M. Keating, President of “ The Association of 
Life Insurance Medical Directors.” The advertisement seems to 
indicate that it will be worthy of study, and that it will be a valuable 
work of reference. It is published at the price of two dollars, by 
Bahl & Fulton, Lock Box 207, Philadelphia, Pa. MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
35 
THE HAMILTON RESERVES. 
Up in Hamilton, Ontario, are some members of the Arcanum who 
are talking of seceding from the rest of the Older and setting up a 
little dominion of their own. They have published a manifesto de- 
claring that whereas the longevity in Ontario is superior to that in 
the United States, and whereas her medical examinations are less 
lax than in those outside of Ontario, and whereas the Councils of 
Ontario are putting more money into the Supreme Treasury than 
they are taking out, that therefore it is incumbent on them to with- 
draw from their less deserving brothers. 
They fortify their statements with extracts from my reports, 
which are accurately quoted, though sometimes rather ingeniously 
dovetailed together. 
On looking into the facts I find that for the three years ending Feb- 
ruary 28, 1884, no State had a lower death rate than Ontario, except 
Missouri, that for the next year none did better in this respect ex- 
cept Illinois and New Jersey, that during the next only eleven did 
better than she, Missouri, Illinois and New Jersey still leading her ; 
the following year she came forward again, Illinois and Connecticut, 
however, still in the van, but during the next twelve months she fell 
back, Illinois still ahead of her, together with Ohio, Indiana, Massa- 
chusetts, Michigan and Rhode Island ; the following year she gained 
one and outstripped Illinois, but was led by Michigan, Rhode Island, 
Wisconsin, Connecticut and Maine. This year she is again well to 
the front, Indiana, Maine and Connecticut being, however, success- 
ful competitors. 
From all this it appears that Ontario is, no doubt, a good and 
healthy province to reside in, but it is also apparent that she does 
not surpass all others, and if we take one other fact into considera- 
tion, which the Hamilton brethren have not referred to, namely 
that in each of the years above mentioned there have been besides 
those states which had fewer deaths than Ontario, certain other 
states which had no deaths at all, notably Minnesota, Kansas, Iowa, 
Colorado, Vermont and others, which though having a smaller num- 
ber of members than Ontario ought not certainly to be ignored in 
such a comparison, it will appear that the phrase used by the 
committee of Hamilton, “ the superior longevity existing in Ontario 
as compared with the United States” should read “ as compared 
with some of the United States.” 
The second claim of “lax medical examinations by medical 36 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
examiners of the Order outside of Ontario,” being virtually a claim 
that the examinations made by the medical examiners of Ontario 
were better than those made by medical examiners in the United 
States, I do not intend to investigate very closely, knowing quite 
well that the medical examiners of Ontario would make no such 
claim, and knowing that there are excellent examiners in both sec- 
tions whose relative merits have not been and cannot be fairly tested. 
I need not say that as a whole I have been well satisfied with the 
skill and capacity of the medical gentlemen of Ontario. 
The following extracts, however, from the report of the committee 
from Hamilton are so utterly unfair and misleading that they can 
only proceed from ignorance or something worse, and I feel per- 
sonally aggrieved by them as a supervising examiner. They say 
“ when we find men admitted again and again whose near relatives 
died of that fell disease.” Now in one year which he quotes, ten 
out of eighty-two consumptives had had consumptive relatives, in 
another year eight out of fifty-four had a similar history, in still 
another there were nineteen out of eighty-six with consumptive family 
history, in a fourth there were twelve such cases out of a hundred 
and one. Now this is a very small percentage of such cases among 
consumptives and is quoted by me for that reason. If the committee 
thinks these results inexcusable, would they suggest that we reject 
every applicant having any history of consumption in his family? 
If we do we will reject hundreds who are now admitted, and not 
only admitted but are found to be good risks — all this is a question 
for the supervising examiners to settle. The subordinate ex- 
aminers do examine and do recommend such applicants, examiners 
from Ontario as well as from the States ; the supervising examiners 
reject many such, but they do try to give the benefits of the Order to 
as many of them as they think will outgrow their family tendencies. 
Applications are referred to me from Ontario as well as from all 
other jurisdictions in which the applicants have lost a brother or 
sister, perhaps, from consumption ; now it would be comparatively 
easy to reject all such, but if we had always done so we should have 
kept out hundreds of men who are now valuable members of the 
Order, and the Order would have been just so much the weaker 
for it. Hundreds of these men have proved to be good risks and 
were properly admitted. 
They say still farther “ when we find men admitted who are 
below the normal weight in many cases.” Now there is but one 
from such a remark, which is that in the opinion MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
37 
of these gentlemen, men below the normal weight ought never to be 
admitted ; that is that no man six feet high ought to be admitted 
unless he weighs 180 pounds, and that no man of five feet and eight 
inches ought to be admitted unless he weighs 156 pounds ; 180 and 
156 pounds being the normal weight for men of those heights respec- 
tively. Not only is this a fair inference to be drawn from the para- 
graph, but it must also be inferred that in the opinion of these 
gentlemen the medical examiners of Ontario do not recommend for 
membership any who have lost any relative by consumption, or an}7 
who are even a pound below the normal weight, an opinion in which 
they are very much mistaken, I am glad to say. When the Arcanum 
keeps out of its ranks all who have any family tendency to consump- 
tion, and all who are beneath the normal weight, they will lessen our 
numbers in vast proportions, and even if they lessen our rate of con- 
sumptive deaths (which I very much doubt), they will not, I believe, 
lessen our total mortality. 
Tin committee, in the course of their remarks, make some pretty 
caustic comments on the fact that men “in a considerable number of 
instances die of phthisis within one year after admission,” but do not 
mention any who have died of this disease in Ontario, except one 
who had been a member nearly four years, and two who had been 
members more than three years before their decease. They have not 
inquired whether any died within a year. 
The inquiry would have shown them that since the establishment 
of the Ro}?al Arcanum in Ontario, 73 of its members have died in 
all, and that 16 of these, more than 20 per cent., had been members 
less than a year. Of this sixteen who died within a year, two died 
from casualties, three from pneumonia, one each from typhoid fever, 
peritonitis, Bright’s disease and diabetes, two from brain disease, 
two from heart disease and three from consumption. Two of this 
sixteen belonged to Kanawha and Regent Councils, whence this 
report emanates, (one, however, being caused by an accident). 
Dr. C. T. Campbell, the Provincial Medical Examiner, has 
answered their statement in a more judicial way and on bi’oader 
principles than has been attempted by me, in simply examining as I 
have done the figures and criticisms based upon my reports. 
I am very glad to agree with him that the death rate in Ontario is 
below the average, and that for the most part the selection of risks 
in Ontario has been very careful. I am not prepared to say that it 
has been more careful than in the average of the States, for this is 
not a question that can be settled, as he points out, by a brief time 
or any small number of deaths. 38 
MEDICAL EXAMLNER-IN-CHIEP’S REPORT. 
But he replies very sensibly I think, that, even if all the claims 
made by the committee were wholly true, that even then their conclu- 
sions would not be justified, nor would it follow that it would be for 
the interests of Ontario to withdraw from the Order. 
May we not rather hope that the organization there will continue 
to be the gem of the various jurisdictions, that its health and happi- 
ness will continue to be our model, that its examiners will continue 
to strive to lead the way for all the rest, and that whenever we look 
up into the firmament we may still see the same cold, pure diamond 
surmounting all the rest of the stars in the crown of the Royal Arca- 
num. 
In conclusion, we sincerely trust that Ontario will continue to 
maintaiu her favorable rate of longevity, that her medical examiners 
will continue to do their work thoroughly and well, and that above 
all and especially that the day of pestilence and desolation will never 
come when she will be obliged to draw more from the Supreme 
Treasury than she pays into it. 
STATE MEDICAL EXAMINERS. 
During my summer vacation Dr. Hanscom, the State Medical Ex- 
aminer of Massachusetts, performed the duties of my office in ad- 
dition to those of his own State, and, I am glad to say, very satis- 
factorily to all with whom he came in contact. I certainly have 
every reason to be grateful to him for the promptness, the care, and 
the good judgment he displayed in all his official acts, as well as the 
courtesy and patience with which he kept up the correspondence of 
the office. I found on my return that harmony and pleasant rela- 
tions between the medical men had been in no case intei’rupted. 
My relations through the year, as in former years, have been un- 
interruptedly social and friendly with all the State Medical Ex- 
aminers, and I have been indebted to them all for valuable sugges- 
tions and have had many opportunities to observe the close and care- 
ful scrutiny which the}7 have given to the cases upon whose merits 
they have had to decide; matters requiring professional learning 
and rational judgment are daily and hourly laid before them, and it 
has been a great encouragement to me to find that they do not act 
with too slavish reliance upon rules, nor so independently as to set at 
naught the teachings of our experience. 
New State Examiners have been appointed in Rhode Island and 
Nebraska, both of whom are a credit to our medical corps. Dr. 
Kenyon of the former State had had a long experience, and I was MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
39 
wholly and heartily glad at his appointment by the Supreme Regent. 
Dr. Carter of Nebraska had had less experience in our Order, but 
has applied himself diligently and studiously to a study of the 
proper management of his office. I regret to say, however, that the 
latter gentleman has just felt compelled to resign on account of 
being obliged to remove from the State. 
SUBORDINATE EXAMINERS 
The frequency with which the rapid growth of the Order has re- 
quired the appointment of new medical men as examiners has oc- 
casionally placed us at a disadvantage for a time at least, partly 
because it is not always possible to obtain the services of the man 
whom we should prefer, partly because the flattering reports we get 
regarding these new medical officers are not always sustained by the 
results of their work, and they turn out to be less competent than 
we thought we had good reason to expect, partly because in all oc- 
cupations we find men who do not try to do their work with that spirit 
of thoroughness and minuteness which are so necessary in examining 
men’s lives for insurance, and partly, as it sometimes appears, be- 
cause the deputies in forming new Councils would rather have the 
assistance of a young, enthusiastic physician than an old, conserva- 
tive one, and select, therefore, a doctor who will bend all his energies 
towards getting men in, and will not be too conscientious in invest- 
igating the conditions which may result in keeping them out. 
In those, however, who have been long in our Order and who 
have a reputation to uphold as men of good care and proper judg- 
ment, a reputation dearer to them than their fees, we can place 
great reliance, and feel an intense satisfaction in knowing that when 
they cordially recommend a candidate as a good risk they are not 
misled by haste, deceived by carelessness, or imposed upon by 
fraud. The risk may possibly prove to be a poor one, but we know 
that the investigation was close and that all the appliances of scien- 
tific research were called into play in testing the man’s real state. 
For one I feel great pride in our medical examiners as a body 
and thank them sincerely for earnest purposes, skilful investigation 
and honest opinions. 
THE POSITION OP THE MEDICAL EXAMINER-IN-CHIEF. 
The Medical Examiner-in-Chief does not like to seem to urge 
again his own self aggrandizement, but is firmly of the opinion that 
the system of administration of the R. A. will be distinctly benefited 40 
MEDICAL EXAMINER-IN-CHIEF’S REPORT. 
by having the medical department recognized officially in the 
Supreme Council, and the chief medical officer made a member (by 
virtue of his office) of that august body. In this way and in no other 
can the sixteen hundred medical officers of the Arcanum receive an 
official recognition and have an official representative in our ruling 
body. I trust that at the coming session the necessary steps will 
be taken to do a long-delayed act of justice to the medical depart- 
ment of the R. A. 
In ending this report permit me to say that it is iu no merely 
formal or official way that I state how cordially and without excep- 
tion I have been supported in doing the duties of my office by Supreme 
Regent Watts, nor how intelligently, from a medical point of view, 
he has favored the rigorous care and watchfulness by all the exami- 
ners, so necessary in accepting only the best men for the Order. 
Our medical men need to feel that they will be upheld if they do their 
duties fearlessly and with an earnest and honest purpose simply to 
make thorough examinations and to form judicious decisions ; and that 
they need not deviate one iota from the paths of simple integrity 
and honest professional duty to win the favor of those above them 
or make themselves popular in their own neighborhoods. They have 
felt that in the hands of Supreme Regent Watts they could feel 
surest of approval by neglecting no duty and by manliness. I am 
confident that they all join with me in expressing our warmest 
thanks to him for his encouragement in all these matters. 
CONCLUSION. 
My thanks are due, as they are on every returning year, to 
Brother Robson, the Supreme Secretary, for courtesies and atten- 
tions and a compliance with my requests for information, which as- 
sists me materially in the performance of my daily duties, not less 
than in the preparation of these reports. 
The Committee on Finauce of the Supreme Couucil are also grate- 
fully thanked for their assistance in helping me to send to all the 
Medical Examiners my yearly statements and suggestions, and in 
meeting the necessary expenses of my office. 
Respectfully submitted iu V. M. C., 
JOEL SEAVERNS, M. D., 
Medical Examiner-in-Chief, R. A.