POINTS HUMOROUS AND OTHERWISE ABOUT LIFE INSURANCE
Printed in Twentieth Century.
I made up my mind to get my life insured. As i had heard some one say it was not wise to put all of one's eggs into the same basket, I decided to apply for a small policy in two of the leading companies at the same time. I was never seriously ill in my life, so when I was informed that I had been "held off" by the examining physician of one company who found theoretical traces of diseased kidneys, I was a good deal astonished. Professional etiquette prevented the examining physician of the other company from passing me until this matter was settled, although he confessed that he could find no such traces himself. In his opinion my weak spot was my lungs. "But doctor," said I, "I've got lungs like a bellows. I was stroke oar at college."
"It doesn't make any difference to our doctor whether you were stroke oar or a stroke of lightning if he discovers that any of your ancestors died of consumption," remarked the agent, who had lost his temper. "You ought to have had better sense than to tell Dr. Pulmonary that your great aunt coughed before she died. He'd find evidence of lung trouble in a copper-bottomed boiler if it wheezed letting off steam. Who examined you over at the other place? Old Albumen? I'll bet ten dollars he'd find traces of his pet disorder in a ham if he examined one."
I was getting a little piqued. I concluded to put my application in to several other companies and take the first policy issued. In pursuance of this idea I was examined by Dr. Palpitation of the M. of N. Y. company, and he discovered that I was liable to drop off at any time from heart failure. He said that he did not wish to alarm me, but I needed medical care and a very wise and sustained course of treatment.
At this stage of the proceedings I went to the only physician I had ever employed for any slight ills during my past career and had him put me through a thorough and exhaustive physical examination without disclosing anything of my motive for so doing. He pronounced me fit for the coming boat race, which was to be an unusually trying one.
"Any trace of albumen, doctor?" I asked.
"None – not a trace."
"Nothing wrong with my heart or lungs?"
"Look here, boy. If you never die until they give out, you're going under from old age. I tell you, you are as sound a man as ever lived. There is absolutely nothing to hang a suspicion of any disorder on. For my sake I wish there was," he added, laughing and slapping his pocket.
The next day I had a call from the doctor who had examined me for the E. of Y. He said that he'd like to have a second pass at my eyes. He thought there was a look in one of them that indicated softening of the brain. I laughed.
He remarked that people in the first stages of that trouble usually took it just that way. It was a symptom.
"You confounded old fool!" said I, losing my temper. "Are you in earnest? I supposed you were joking from the first but if you're talking as good sense as you've got just leave this office. I – "
He left.
He reported to his company that I was in a more advanced stage of the disorder than he had at first feared. I had arrived at the unnecessarily irritable condition. Of course my case was settled with that company. Professional etiquette again stepped in, and the doctor for the M. B. of C. took another whack at my liver. He said that the organ was badly enlarged and he'd hold me off for one year to see if it would return to its normal proportions. According to his diagnosis fully nine-tenths of the population of New York were carrying around livers that were enough to tire out an ox. He could tell a big livered man as far as he could see him, and he pointed out five who passed while he was talking.
He said that enlargment of the liver was getting to be a very real danger to the population of all of the chief cities, and if the cause was not soon discovered by the medical profession and a reducing process, so to speak, clapped on to the metropolitan liver, life insurance companies would have to keep a mighty sharp eye on all applicants, or the death rates would wreck the most prosperous of them in pretty short order.
I was led to infer from the way he poked and prodded around me and measured and sounded that my liver was rather badly sagged at one side and that the other lobe was swelled up like a bladder. It seems as if a person would notice a thing like that himself, but the doctor said that as like as not I'd never have discovered it at all if he had not – fortunately for me – been called in to examine me.
He said that he never prescribed for men, he is required to examine for insurance, but he told me to take a certain remedy for the next three months and then report to him. Meantime his company would "hold me off."
"We won't reject you outright," he explained "because this thing may be only temporary – may not be organic – and it wouldn't be a fair thing to your heirs to decline you outright, because that would most likely prevent you from ever getting life insurance anywhere in the future."
That was a new idea to me and gave me a good deal of a scare.
It occurred to me that the future of a man's family – where it depended on the insurance money of its head – was subject to considerable uncertainty from the various fads of the doctors.
Here I was in danger of being rejected – pronounced an unsound risk – by four separate and distinct companies for four separate and distinct ailments of which my own doctor could find not the least trace and I could feel not the faintest twinge.
If any one of them decided positively against me the future of my family was nil – so far as insurance went, for the examining physician of no other company would be bold enough or sufficiently lacking in "professional courtesy" to pronounce in my favor, whether he could find anything wrong with me himself or not. I began to realize that what I had so far looked upon as rather a good joke might be serious after all.
It occurred to me, too, that it would be a good deal more far reaching than I had supposed.
If Old Pulmonary – as the agent called him – stuck to his theory of my lungs, not only I, but my children, would be unable to get insurance. It would establish a family history – a "heredity" – hard to get rid of. My little joke in speaking of the fact that my aunt had been said to cough before she died, together with Dr. Pulmonary's ability to scent lung trouble in the breathing apparatus of a porous plaster, might lead to a serious complication not only for me but for my children. I concluded to make a clean breast of it. I did not quite dare tell Dr. Pulmonary that I had been deliberately guying the profession – and in fact that was not my first intention – but I asked if he did not think it a little odd that no two of them had held me off for the same reason and that each one had found indications of the particular disorder for which he had a special leaning. He pricked up his ears at once and asked all about the others. I told him that one had found albumen, another enlarged liver, and the third was afraid of heart failure or softening of the brain, and one was still waiting, because he could find no trouble – on account of professional etiquette – before reporting at all.
"Meantime my own doctor – the one who has known me from childhood – pronounces me fit for a scull race," said I a little drily.
"Does your physician know of these examinations?*' he inquired.
"No, he doesn't," I responded rather hotly this time, "or no doubt he'd have discovered that I had inflammatory rheumatism and gangrene. He is a good deal of a professional ethic man, himself."
The doctor turned and walked into his private room, promising to overhaul the papers again and talk with his subordinate.
I hunted up the agent who had first called upon me and complained that this sort of nonsense had gone about as far as I wanted it to go. "That old donkey at the head of your medical department upholds the idiotic report of the young gosling that first examined me here, notwithstanding the fact that he says himself that he can't find the first trace of the trouble. Now, if insurance companies employ impecunious young physicians with little experience, because they can get them cheap, and then insist upon it that professional etiquette forbids any other examiner from correcting their blunders, it seems to me – "
The agent had been looking about carefully to be sure that no one overheard.
At this point he said:
"Sh! Don't talk so loud. You see young Cardiac, who had you first, passed a man a short while ago who died in about six months and it was discovered that he had only a part of one lung and had been that way for years. The referee – Old Pulmonary is our referee, you know – gave him a pretty bad scare, and he's afraid to pass anybody at all since. 'Fraid he'll lose his place. All the agents are mad about it. Manage to hold their men over for examination until he leaves the office and then take 'em to another one of the examiners. He'll refuse every body now for a while – or hold him off. Fully one-half the men he examined last month were rejected outright or held over. I didn't know it when I took you to him or I'd have taken you to some one else to be examined."
"That would be all very well," said I, "if it wasn't for the absurdity of what the doctors are pleased to call professional etiquette, which prevents any other examiner for any other company from finding a man so held or rejected, sound. In the first place nearly all the big companies refuse to allow any but an 'old school' or 'regular' allopathic physician to examine a man. Then if that examiner has a fad, or makes a mistake, they are all banded together to sustain him in it and not to correct it, even if they can't find the first symptom of a disease about him. I tell you it is not only outrageous to the man and his family, but the result will be that men who know it will refuse to place themselves in any such danger. They won't want a family record of hereditary diseases made and put on file to stare them and their descendants in the face just for the sake of professional etiquette toward some young M. D., who just as like as not got his place from the fact that he married a daughter of a director of the company and had to be supported some way and hadn't the skill to do it in an open field in his profession. Men are not going to stand it. It will injure them, and it is bound to react on the company too. I'd never have applied at all if I'd known of it in time. What business has a company to ask whether an applicant has or has not been rejected by another company? If their own examiner can't find anything wrong with him, isn't that enough? This thing of the doctors of all the companies combining to keep a record against a man is outrageous. Why can't a company depend on the capacity of its own medical staff? If it wants any other information of a medical nature, why isn't the applicant's own family physician quite enough? I consider the thing a good deal of an outrage, and the company that omits from its papers the sort of questions that result in this absurd and oppressive professional etiquette folderol, is going to be the company of the future. Intelligent men know too well the chaotic state of medical science to be willing to risk it. Why, good Lord, man, that softening of the brain – paresis – idiot over at the £. of Y. can, and no doubt will, give me a record that may cling to me and my family in a way that might, in many a business or other contingency, cause the very greatest hardship." I looked up and saw that the medical referee who had really indicated that he meant to reconsider my case was standing where he had heard me.
His face was a study6 He was angry clear through. He would have (in a medical journal or debate) taken issue with, and proved the utter incapacity of nine-tenths of the profession, but to have a layman criticise their action when it might mean even life or death to him and his was more than the doctor's adherence to professional etiquette could bear.
"I'll bet you four dollars, John, that you not only won't get a policy here now but that no other company will pass you," said he under his breath. "The old man is on the war path."
That was eight months ago and I'm "held off" in eleven companies now. I was never sick in my life. I'm as sound in person and in heredity as any man who ever lived, but I am at the mercy of that absurdest of all covers for personal incapacity – professional etiquette – combined with the unreasonable fact that insurance companies require an applicant to tell their examiners just what piece of idiotic prejudice has been launched at him by the doctor of every other company, so that they can all hold together and fit his case to the reports, and not the reports to the facts in his case as they find them.
Meantime, Jack Howard, who died last week, poor fellow, was accepted by five of them because the first examiner who got hold of him, not being a kidney fiend but having his whole mind on lung trouble – and Jack had splendid lungs – didn't discover that he was in the last stages of Bright's disease. His family made $27,000 out of professional etiquette, and mine – when I die – will most likely lose that much, together with a reputation for a sound heredity which may affect the insurers to the third and fourth generation of them that love truth and tell that their father was rejected by all the leading life insurance companies for pulmonary trouble, heart disease, kidney affection, paresis, and enlargement of the liver. Meantime the first good company that shows enough sense and sufficient confidence in its own medical men to omit that sort of questions from its form of examination is going to get me – and a good many others like me.
COMMON SENSE IN SURGERY
There are certain forms of expression which once heard fit themselves into the mind so firmly, and re-appear in one connection or another so frequently, that one scarcely recognizes the fact even when one changes a word or two in order to make the original idea fit the case in point. So when I stood watching the ingenious method by which the trainers of the English fox-hounds induced each dog to perform his own surgical operations after a hunt, I remarked, with no recognition of the plagiarism from Dr. Holmes, "Every dog his own doctor."
"No," replied the trainer, with a fine sense of distinction which I had not before observed – "no; I am the doctor; the dogs are the surgeons. I prescribe; they perform the operation. They do that part far better than I could; but they wouldn't do it in time to save the pain and trouble of a much more serious operation that they could not perform, if I did not set them at it in time, and keep them at work until all danger of inflammation is past."
It was after a hunt. The dogs – splendid blooded fellows, a great pack of over sixty of them – had gotten many thorns and briers in their feet. They came back limping, foot-sore, and with troubled eyes that looked up piteously for relief from their pain. They were very hungry too, after the long chase; but "No doctor will allow a patient to eat just before a surgical operation," remarked the trainer, dryly. "Now watch."
He threw open a door leading into an outer room of the splendid Hunt Club Kennel, and gave the word of command.
There was a rush, and the entire pack burst through the wide entrance. Then every dog lay suddenly down, and began with great vigor to lick his feet.
Why? Simply because in rushing through that door they had waded through a wide, shallow trough or sink of pretty warm soup. This basin was sunk in the stone floor, and reached entirely across the door, and was too wide to jump over, even had it been visible from the outside, which it was not.
The dogs had plunged into it before they knew it was there, and were instantly out of its rather uncomfortable heat.
Each dog worked at his feet with vigor. He was hungry. The soup was good; but dogs object to soup on their feet. This process was continued and repeated until it was thought that all thorns and briers and pebbles had been licked and picked from the crippled feet. Then the dogs were fed and put to bed – or allowed to lie down and sleep – in their fresh straw-filled bunks.
"A doctor and a surgeon may be the same person," remarked the philosophical trainer, oracularly, "but they seldom are. If you whine – as the dogs do when their feet hurt after a hunt – or if you limp or complain, a doctor guesses what is the matter with you. Then he guesses what will cure you. If both guesses are right, you are in luck, and he is a skilful diagnostician. In nine cases out of ten he is giving you something harmless, while he is taking a second and a third look at you (at your expense, of course) to guess over after himself."
His medical pessimism and his surgical optimism amused and entertained me, and I encouraged him to go on.
"Now with a surgeon it is different. Surgery is an exact science. Before I took this position I was a surgeon's assistant in a hospital. In some places we are called trained nurses. In our place we were called surgeons' assistants. That's why I make such a distinction between doctors and surgeons. I've seen the two work side by side so long. I've seen some of the funniest mistakes made, and I've seen mistakes that were not funny. I've seen post-mortem examinations that would have made a surgeon ashamed that he had ever been born, looked upon by the doctor who treated the case as not at all strange; didn't stagger him a bit in his own opinion of himself and his scientific knowledge next time. I remember one case. It was a Japanese boy. He was as solid as a little ox, but he told Dr. G – that he'd been taking a homoeopathic prescription for a cold. That was enough for Dr. G – . A red rag in the van of a bovine animal is nothing to the word 'homoeopathy' to Dr. G – . Hydropathy gives him fits, and eclecticism almost, lays him out. Not long ago he sat on a jury which sent to prison a man who had failed in a case of 'mind cure.' That gave deep delight to his 'regular' soul. Well, Dr. G – questioned the little Jap, who could not speak good English, and had the national inclination to agree with whatever you say. Ever been in Japan? No? Well, they are a droll lot. Always strive to agree with all you say or suggest.
"'Did you ever spit blood?' asked Dr. G – , by-and-by, after he could find nothing else wrong except the little cold for which the homoeopathic physician was treating the boy.
"'Once,' replied that youthful victim.
"'Aha! we are getting at the root of this matter now,' said Dr. G – . 'Now tell me truly. Be careful! Did you spit much blood?'
"'Yes, sir; a good deal.'
"The doctor sniffed. He always knew that a homoeopathic humbug could not diagnose a case, and would be likely to get just about as near the facts as a light cold would come to tuberculosis.
"'How long did this last?' he inquired of the smiling boy.
"'I think – it seems to me —
"'A half-hour?' queried the doctor; 'twenty minutes?'
"'I think so. Yes, sir. About half an hour – twenty minutes,' responded the obliging youth.
"I heard that talk. Common-sense told me the boy's lungs were all right; but it was none of my business, and so I watched him treated, off and on, for lung trouble for over a month before I got a chance to ask him any questions. Then I asked, incidentally:
"'What made you spit that blood that time, Gihi?' "'I didn't know I ought to swallow him,' he replied, wide-eyed and anxious. 'Dentist pull tooth He say to me, "Spit blood here." I do like he tell me. Your doctor say ver' bad for lungs, spit blood. Next time I swallow him.'
"I helped another practitioner, in good and regular standing, to examine a man's heart. He found a pretty bad wheeze in the left side. I had to nurse that man. He had been on a bat, and all on earth that ailed him was that spree, but he got treated for heart trouble. It scared the man almost to death.
"I'd learned how a heart should sound, so one day I tried his. He was in bed then, and it sounded all right, so when the doctor came in, I took him aside, and told him that I didn't want to interfere, but that man was scared about to death over his heart, and it seemed to me it was all right – sounded like other hearts – and his pulse was all right too. The doctor was mad as a March h*are, though he had told me to make two or three tests, and keep the record for him against the time of his next visit. Well, to make a long matter short, the final discovery was – the man don't know it yet, and he is going around in dread of dropping off any minute with heart failure – that at the first examination the man had removed only his coat and vest, and his new suspender on his starched shirt had made the squeak. That is a cold fact, and that man paid over eighty dollars for the treatment he had for his heart, or rather, for his suspender."
I was so interested in the drollery of this ex-nurse, and in his scorn for one branch of a profession, while he entertained almost a superstitious awe and admiration for surgery per se, that I decided upon my return to New York to visit a great surgeon, and ask him to allow me to see an operation that would fairly represent the advance-guard so to speak, the upward reach of the profession as it is to day.
We all know the physician who follows his profession strictly and solely as a means of support. Most of us also happily know something of one or more medical men who are a credit to humanity, in that they subordinate their ability to extort money from suffering to their desire to relieve pain, even though such relief conduces not to their own financial opulence. Very few of us who are not close students of the medical profession realize, I think, some of the magnificent developments not only of surgery, but of the character of the surgeon. We are led to think of them as rather hard and brutal men. The side of their work and nature that means tenderness and devotion to the relief of those who, but for the skilled and brave surgeon, must die or suffer for life, is seldom laid before us. The quiet, sweet, and simple devotion of such men does not reach the public ear.
The operation of which I learned, and which is the first of its kind on record, was so strange, so great, and so far-reaching in its suggestion and promise that it seemed to me it could not fail to interest and inspire the general reader, who never sees a medical or surgical journal, and who would not read it if he did.
Can you think of an operation that would create a mind? Can you conceive of the meaning to humanity of a discovery that would transform a congenital imbecile into a rational being? Such an operation was the one I was privileged to see.
The patient was a child about one year old, of good parentage and of healthy bodily growth, aside from the fact that its skull was that of a new-born child, and it had hardened and solidified into that shape and size. The "soft spot" was not there, and the sutures or seams of the skull had grown fast and solid, so that the brain within was cramped and compressed by its unyielding bony covering.
The body could grow – did grow – but the poor little compressed brain, the director of the intelligent and voluntary actions of the body, was kept at its first estate. Even worse than this, its struggle with its bony cage made a pressure which caused distortion and aimless or unmeaning movement – the arm and leg turned in, in that helpless, pathetic way that tells of imbecility. In short, the baby was a physically healthy imbecile – the most pathetic object on this sad earth. Upon examination, the surgeon, a gentle, sweet-natured man, whose enthusiasm for his profession – for the relief of suffering – makes him the object of devotion of many to whom he has given life and health, and the inspirer and final appeal for many a brother practitioner, discovered what he believed to be the trouble. Led by that most uncommon of all things, common sense, he believed that this little victim of nature's mistake might be changed from a condition far worse than death to one of comfort for itself, and to those who now looked upon it only in anguish of soul.
After explaining to the parents and the surgeons who had come to witness the wonderful experiment (for, after all, at this stage it was but an experiment based upon common-sense) that it might fail; after a modest and simple statement of his reason for undertaking so dangerous an operation, with no precedent before him; after explaining that the parents fully understood that not to try it meant hopeless idiocy, and that the trial might mean death – he began the work. I shall try to tell what it was in language that is not scientific, and may seem to those accustomed to surgical terms inadequate and unlearned; but to those who are not technical medical students I believe the less technical language will be far clearer.
The child's skull was laid bare in front. Two tracks were cut from a little above the base (or top) of the nose up and over to the back of the head. One of these tracks was cut on each side, the surgeon explained, because it would give equal expansion to the two sides of the brain, and because it would cause death to cut through the middle of the top of the head, where lies "the superior longitudinal sinus." He left, therefore, the solid track of bone through the middle, and cut two grooves or tracks through the bone, one on either side, where nature (when she does not make a mistake) leaves soft or yielding edges, by means of which the normal skull expands to fit the needs of the brain within.
The trench made displaced, or cut away, one-quarter of an inch of solid bone all the way from near the base of the nose to the back part of the head. In the middle of the top of the head on each side a cross-wise cut was made, and one inch of bone divided. Another cut was made on either side, slanting toward the ears. This was one inch and a half long. The surgeon then tenderly inserted his forefinger, pressed the internal mass loose from the bones where it adhered, and pushed the bones wider apart. This process widened the trenches to one inch.
The wound was now dressed with the wonderfully effective new aseptics, and the flesh and skin closed over. The operation had taken an hour and a half. There was little bleeding. The baby was, of course, unconscious during the entire time. Oh, the blessings of anaesthetics! And now comes the wonderful result of this bold and radical but tender and humane operation.
The baby rallied well. In three days it showed improved intelligence. In eight days this improvement was marked. From a creature that sat listless, deformed, and unmindful of all about it, it began to "take notice," like other children. From an "it," it had been transformed into a "he." It had been given personality. It ate and slept fairly well.
On the tenth day the wound was exposed and dressed. It had healed, or "united by first intention," as the doctors say; and again one can but exclaim, "Oh, those wonderful aseptic dressings!" It had united without suppuration. It was a clean wound, cleanly healing.
One month after the operation the feet and hands had straightened out, and lost their jerky, aimless movements. The child is now a child. It acts and thinks like other children, laughs and cooes and makes glad the hearts of those who love it.
Not like other children of its age, perhaps, for it has several months yet to "catch up," but the last report, in one of the leading medical journals, said:
"One month after the operation the change in its condition was surprising and gratifying. The deformities in the extremities had entirely disappeared, and there was evidently a remarkable increase in intelligence. It noticed those about it, took hold of objects offered it, laughed, and behaved much as children of ordinary development at six or eight months. The pupils were no longer widely dilated, but appeared normal. It eats and sleeps well, and is in general greatly improved as a result of the operation."
If in one month the little imprisoned brain was able to "catch up" six or eight months, we may surely believe that the remaining four or five months which it lost, because nature sealed the little thinking-machine firmly in too small a casket, will be wiped away also, and the little victim of nature's mistake be given full and normal opportunity through the skill and genius of man.7
Could anything be more wonderful? Could any operation open to the future of the race wider possibilities and offer more brilliant hope? I may quote here farther from the same medical journal the report of Dr. Wyeth, himself:
"The operation differs from any yet done. Lanne-longue, Keen, and others cut a trench about a quarter of an inch in width, and on one side, at a single operation. It seemed to me if the brain was penned in by premature ossification of the cranial bones, these should be torn loose and permanently lifted, thus allowing a thorough expansion. Should only temporary benefit be secured, the operation should be repeated. Experience alone can demonstrate whether the expansion of the brain will be able to spread the cranial bones to such an extent that it may reach even an ordinary development. The condition of these patients is so hopeless and deplorable that, in my opinion, very great risk is justifiable in any surgical interference which offers even a hope of amelioration."
Thus the race is quietly achieving mastery over the blind forces of nature, and the steady hand of science, coupled with tenderness and sincerity, is pushing back some of the worst horrors of life, and throwing a flood of light and hope into the future! It makes one's step lighter and one's face happier only to think of these marvellous achievements and victories. A new impulse of hope and happiness dawns upon life. I owed this new inspiration to my pessimistic acquaintance – he of the Hunt Club Kennel – and the introduction he gave me to the rudiments of applied surgery. It was indeed a long sweep from the one operation to the other.