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Varieties. The oblique inguinal and femoral varieties are more dangerous than the umbilical and direct; the irreducible than the reducible. order to obtain insurance, a suitable truss must be worn to prevent the descent of the intestine. Cases of double hernia are still more hazardous, and some authorities advise rejection in every instance. A hernia that has been cured by operation is very liable to recur.

Diagnosis. Enlarged glands and tumors, retained testicle or hydrocele are frequently mistaken for hernia, and vice versa. Great care is therefore requisite in settling the question of diagnosis. One of the most reliable signs of hernia is the direct impulse, felt by the finger of the surgeon, when the applicant coughs; and in the majority of cases, proper posing of the patient, combined with taxis, will succeed in reducing the hernia.

Statistics. From the Medical Directors' Report of the Mutual Life Insurance Company of New York, covering the first thirty years of that company's experience, we state the following conclusions: "The total deaths irom hernia were only five. In none of these cases had an operation been performed; in only two did the hernia exist at the time of insurance." From that record the conclusion was reached that the presence of a hernia adds little to the risk of death, provided a proper truss is worn. That company has insured large numbers of ruptured persons, and yet in a period of thirty years only two have died from that cause.

FISTULA IN ANO.

Fistula is generally a local disease and amenable to proper surgical treatment. The anus should be examined for this condition, and its cause ascertained, if it exists. Unhealed it is a source of exhaustion.

Causes.-Fistula is usually caused by local ulceration of the parts from hemorrhoids, dysentery or mechanical injury, but it is not infrequently a local expression of the tuberculous taint.

Disqualification.-It should disqualify-(1.) When it is one of the symptoms of tuberculosis. (2.) When it does not yield to correct treatment, and becomes a constant source of exhaustion.

Mortality. Among over 5000 deaths in the Mutual Life Insurance Company, covering the first thirty years of its experience, only two died from fistula in ano.

An applicant possessing fistula should be postponed until a surgeon's certificate is received, stating that the condition is cured.

WEIGHT AND HEIGHT.

Although a large proportion of applicants may be able to give their weight within a few pounds, the Examiner should make it a rule to weigh

the persons, and subscribe of his own knowledge to this important factor. And the same precaution applies to height.

HEIGHT. The maximum of height is usually attained at the age of twenty-five, the rate of increase being ten inches between the ages of eleven and eighteen, and but two inches from that age to maturity. When the increment of the latter epoch exceeds two inches, it is indicative of a corresponding exhaustion of the nutritive powers and militates against the chances of long life, as a general rule.

Average height of adult males in America is five feet eight inches; of adult females, about five feet two inches. Emigrants from Europe average under five feet six inches, with the exception of Sclavs, Poles and Hun garians, who equal the American standard of height. Five feet seven inches is the mean for emigrants from the British Islands. In the United States, the height of the country people is said to be above that of the city bred, while in Europe the reverse is true; which shows that the favoring influences of hygienic surroundings are variable in different people and places.

EXTREMES OF HEIGHT.-Very tall men are commonly deficient in muscular and respiratory power, and suffer a tendency to diseases of the heart and lungs. They are more subject to rupture, varicose veins and chronic ulcers of the lower extremities. When suffering from acute affections, a chronic form of the same disease is likely to supervene and break down the constitution. Very short men are apt to suffer from lack of development and vitality, and fall easier victims to acute and epidemic diseases. The downward range from the average height is safer than the upward, provided the organs of respira tion, circulation and innervation are in a normal condition, because the small person is more easily nourished and is not as apt to overtax his strength.

In persons exceeding the average stature, one often finds a development of bone and muscle at the expense of the vital internal organs, with the consequent deterioration of life expectation.

WEIGHT. The average weight among males varies, according to age, from 145 to 160 pounds. Excessive obesity at any age vitiates the risk, especially if it has appeared with comparative suddenness, and cannot be recognized as an inherited tendency in an otherwise healthy family. At the same time, it must be remembered that the human race is prone to corpulency after maturity, so that it may be safe to allow a discrepancy of fifteen or twenty pounds in either direction, from the published tables, when the family and personal histories are good.

Comparative Weight of the Sexes.-At the age of twelve years the weight of males and females is equal, but both before and after that period the male exceeds the female both in size and weight. Quetelet asserts that the female reaches her maximum weight later in life than the male. Progressive increase of weight from birth to the decline of life is normal and independ ent of the maturity of growth, which occurs at the age of twenty-five years. The later increase of weight is due to the deposit of adipose tissue under

the skin and within the cavities of the body. The tendencies to fatty degenerations and apoplexy must not be overlooked. Sedentary occupations, with an ample food supply, cause increase of weight.

Diminution of weight ensues from active muscular exercise in the open air, accompanied by a restricted diet. Local emaciation points to incipient phthisis, and is denoted by wasting of the thorax and bones, before it is noticeable elsewhere.

Sudden changes of weight demand careful consideration, and are more untoward than habitual departures from the normal standard. The rapid occurrence of corpulence suggests an abnormal state of nutrition, as would result from sedentary habits, intemperance and internal organic diseases. Rapid emaciation denotes the approach of some form of wasting constitutional disease.

RELATIVE HEIGHT AND WEIGHT.-A normal variation of twenty per cent is allowable under favorable conditions. Dr. Brinton says: "An adult male in good health, five feet six inches high, ought to weigh rather more than 140 pounds, and for every inch above or below this height we may add or subtract five pounds."

Relative Chest Measurement.-This indicates the proportions of height to weight. Brent's rule, measurements to be made over the nipples, is the standard.

Irrespective of height, the circumference of the chest increases one inch for every ten pounds increase of weight.

Maximum Chest.-Two-thirds of the stature equals the circumference of the chest.

Medium Chest.-Half of the stature plus one-fifteenth of the stature, equals the circumference of the chest.

Minimum Chest.-Half of the stature minus one sixty-first of the stature, equals the circumference of the chest.

Persons over forty years old may be allowed an increase of about two pounds for every inch above five feet, as follows:

The following table gives the over and under-weight limits; and if the applicant is either above or below the figures here stated, he should be rejected by the Examiner, unless his physique be unusually excellent, or it be an hereditary trait. In either case the Examiner should state the reasons for his acceptance very fully. If the condition be temporary, the applicant should be postponed.

EXAMINATION OF THE CHEST.

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YINCE so large a proportion of the deaths in adult life occur from pul monary and cardiac diseases, it is especially important that the Examiner should exercise great care in the physical exploration of this region of the body.

It is not always that an applicant can be examined in a physician's office, or in the office of the company. Very frequently the exigencies of business require the examination to be conducted in his own place of business, where it is simply impossible to have his clothing removed, so that the Examiner is often called upon to make a thorough examination without having an applicant entirely stripped, and the author would suggest the plan shown in the accompanying engraving as being available at all times. and in all places, and as one also to which the applicant is not liable to object. Direct the applicant to remove the coat and vest, and then drop the suspenders. He is then to release his shirt, which is to be rolled up as far as possible, and held directly under the chin by the hands of the applicant himself. This method is expeditious and satisfactory to the applicant, who usually objects to undergoing the discomfort of removing all his clothing above the waist.

EXAMINATION OF THE LUNGS.

A well-developed thorax is usually considered an indication of vital capacity and endurance. Respiration may be defined as a mechanical, involuntary process, consisting of inspiration and expiration.

Residual air is the term applied to that portion which cannot be expelled from the lungs by the most forcible expiration.

Supplementary, or reserve air, can be expelled by forcible expiration. The breathing, or tidal air, is the portion used in ordinary respiration. The complementary air is that portion which can be inhaled by means of the greatest inspiration.

The number of respirations per minute in a normal adult at rest is from fifteen to twenty. They exceed this number in childhood, in high altitudes, and during exercise; they are diminished in old age and by the action of certain medicines and diseases.

There is a constant ratio between the rate of respiration and the pulse; in health it is as one to four and one-half. Any marked deviation from this