The form of the surgeons' physical examinations is in response to the detailed and specific instructions given by the Pension Bureau. Physical examination includes information about signs and symptoms of diarrheal disease, including severity, frequency, and duration of disease, also contains self reported information on these conditions.
2. Variable Groups
Collection: Surgeons' Certificates
Diarrhea: Duration of Diarrhea, Severity, Season Diarrhea Occurs, Stool Description, Number of Stools, Length and Frequency of Attack
3. Historical Background
3.1 Original Sources
The Surgeons' Certificates are medical examinations of the veteran included in the Civil War pension record. The Board of Examining Surgeons evolved over time, until by 1890 it consisted of three members appointed and paid by the Department of the Interior. The primary purpose for performing a medical examination on a veteran was to determine the applicant's eligibility for pension assistance. Thus, the form and content of the medical examinations were directly related to how the pension system was administered and the resulting incentives faced by potential pension applicants.
Civil War pensions were available for veterans with disabilities as well as for deceased veterans' widows, minor children, dependent major children, and parents. Under the Act of July 14, 1862, the first pension legislation specific to the Civil War, the veteran was eligible only for disabilities (wounds or chronic illnesses) received during war-time. The Act of June 27, 1890 changed that requirement and expanded eligibility to include disabilities not directly related to wartime experience.
A veteran's pension record includes information on his birth, residences after discharge from the service, a summary of military and medical wartime experience, and family information, including a listing of spouses and children, whether living or dead. The pension file also includes the veteran's or the surviving dependent's application for a pension and the corresponding record of the Pension Bureau's action. Additionally, the file contains documents in support of the veteran's claim, including affidavits from comrades, neighbors, family members, and physicians. Because a veteran could, and often did, apply for a pension under several acts or submit additional applications because of an increase in disability or dissatisfaction with the Pension Board's decision, files usually contain more than one pension application and record of action; occasionally a pension file includes more than 20 sets of such forms.
For the Early Indicators study, the surgeons' certificate is one of the most important documents found in the veteran's pension record. In addition to providing identifying demographic and military service information, each certificate contains the statement of the claimant regarding his health and disability and some basic physiological measures such as height, weight, pulse rate, and respiration rate. In addition, the examining physicians provided numerical ratings for individual conditions and for disability in general. The bulk of the certificate contains the findings, descriptions, and diagnoses of the examining physicians.
Examining physicians were charged with a set of detailed instructions, which gave a measure of uniformity to the certificates. However, there was still substantial variation in the content of exams. Part of this variation is due to changes in examination procedures over time, but part is due to idiosyncratic variation in the methods of examining physicians. Of course, the content of an individual certificate was determined primarily by the health of the veteran being examined. Of particular importance was whether or not certain conditions qualified the applicant for pension support. In many cases, conditions were mentioned by examining physicians even if the applicant did not qualify for pension assistance.
3.2 An Initial Classification System: The Disease Screens
A fundamental challenge in making the information gathered from surgeon's certificates available for public use was the development of adequate data collection instruments, or "disease screens." The collection screens are the result of extensive analysis of the original surgeon's certificates, led by Nevin S. Scrimshaw, M.D. and Irwin H. Rosenberg, M.D. The screens were designed to give some basic structure to the data while still allowing for later modifications as more experience was amassed in the collection process. They constituted the format used by the data inputters, and also provided an initial classification scheme that organized the data for further standardization and classification. The structure of the disease screens is motivated by three primary factors. First, the data are grouped according to physiological systems (where possible). For example, there are individual screens for the cardiovascular, respiratory, genito-urinary, and gastro-intestinal systems. Variables are named in a way that identifies to which system (collection screen) they belong. For instance, variables such as c_murmur and c_enlarg are identified as cardiovascular variables because of the prefix "c_" that precedes the variables. Second, the form of the certificates themselves dictate the design of the screens. Examining physicians tended to group their observations according to disease systems. Some of these, such as cardiovascular and genito-urinary, are consistent with modern classification. Other groupings used by the physicians, however, were determined by the specific purpose of the examination, namely, to identify what were considered to be disabling conditions. Therefore, there were individual screens for diarrhea, hernias, hemorrhoids, rheumatism, and varicose veins. Organizing the screens according to the groupings, typically used by the examining physicians, considerably simplified the collection process. Finally, the grouping of different conditions is highly correlated with the disability ratings given to conditions. In general, the disease screens represented the level of detail that was commonly found in the ratings. For instance, ratings were usually given for the cardiovascular system as a whole without differentiating between different cardiovascular conditions, even though additional details were often provided about the cardiovascular system. A typical example of a physicians statement was "$8 for disease of heart." On the other hand, conditions such as hernias, chronic diarrhea, or varicose veins were given individual disease ratings. On each disease screen there is a field to enter the disability rating for that disease screen. Sometimes diseases from different screens are grouped together under a single rating amount, and at other times the only rating information provided was a single disability rating that gave the overall amount the physicians recommended the applicant receive. There are 21 main screens consisting of an entry screen and 20 individual disease screens. On the entry screen, inputters record all the identifying information concerning the veteran as well as his statement of disability to the pension board. The information provided by the physician is recorded on the 20 disease screens.
Mention of constipation is only found in d_dia when the surgeon gives a rating for constipation.
Constipation may also be found in d_frq if the constipation is related to the frequency of diarrhea, for example "constipation alternating with diarrhea."
The variables d_csdrh, d_cssfl, d_cssn, d_csfq, d_csln, d_csns, d_csst, and d_cssv describe where the information came from (for the d_dia, d_suf, d_sea, d_lng, d_nst, d_sds and d_sev variables, respectively), whether the claimant said it in his statement or the surgeon talked about it in the physical examination. Many times the claimant describes aspects of his diarrhea in detail in his statement, and these variables provide a way to capture that information even though the surgeon did not describe the diarrhea during the physical examination.
4. User Guide Table
|Variable Label||Variable Name||Data-Set||Source|
|d_dia [1-2]||Diarrhea or dysentery designation||DIS||Surgeon's Certificate|
|d_csdrh [1-2]||Source of information for diarrhea or dysentery designation||DIS||Surgeon's Certificate|
|d_suf [1-2][1-2]||Duration of diarrhea or dysentery||DIS||Surgeon's Certificate|
|d_cssf [1-2][1-2]||Source of information for duration of diarrhea or dysentery||DIS||Surgeon's Certificate|
|d_sea [1-2][1-4]||Season diarrhea or dysentery occurred||DIS||Surgeon's Certificate|
|d_cssn [1-2][1-4]||Source of information for season of diarrhea or dysentery||DIS||Surgeon's Certificate|
|d_frq [1-2][1-6]||Frequency of attacks||DIS||Surgeon's Certificate|
|d_csfq [1-2][1-6]||Source of information for frequency of attacks||DIS||Surgeon's Certificate|
|d_lng [1-2][1-2]||Length of attacks||DIS||Surgeon's Certificate|
|d_csln [1-2][1-2]||Source of information for length of attacks||DIS||Surgeon's Certificate|
|d_nst [1-2][1-4]||Number of stools||DIS||Surgeon's Certificate|
|d_csns [1-2][1-4]||Source of information for number of stools||DIS||Surgeon's Certificate|
|d_sds [1-2][1-6]||Stools description||DIS||Surgeon's Certificate|
|d_csst [1-2][1-6]||Source of information for stools description||DIS||Surgeon's Certificate|
|d_sev [1-2][1-5]||Severity of attacks||DIS||Surgeon's Certificate|
|d_cssv [1-2][1-5]||Source of information for severity of attacks||DIS||Surgeon's Certificate|
|d_rat [1-2][1-4]||Diarrhea or dysentery rating||DIS||Surgeon's Certificate|
|d_rel [1-2][01-15]||Diseases related to diarrhea or dysentery||DIS||Surgeon's Certificate|
|d_cmt [1-2][1-4]||Additional comments regarding diarrhea/dysentery||DIS||Surgeon's Certificate|