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 the general condition of the claimant, with descriptions of pulse, respiration, blood pressure, temperature, skin, teeth, strength, gait and indications of disability from manual labor and need for aid and attendance of another person, also includes self reported information on history of scurvy.
2. Variable Groups
Collection: Surgeons' Certificates
Basic Exam Information-Entry/Recruit Information: Claimant's name, Recruit ID number, Examination number, Application type, Military information, Board and claimant address, Examination date, Previous pension rating, Claimant's birthplace and age at time of exam, Height, Weight, and Appearance, Occupation and description, Pulse and respiration rates, Temperature, and Blood Pressure, Claimant's statement, Disease screen pointer, Total rating
Basic Exam Information- General Appearance: General health, Skin condition, Teeth and Gums, Posture, Gait, Muscles, Ability to perform manual labor, General health condition rating
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 physician's 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.
The g_csscv variable describes where the information for variable g_scvevr comes from, whether the claimant said it in his statement or the surgeon talked about it in the physical exam.
Additional information found in the g_cmt variable:
- clarifying information about the g_manlab variable, descriptions about the claimant's inability to perform manual labor
- clarifying information about the g_reqaid variable, descriptions about what aid and attendance the claimant requires
- flat feet
- tongue anemic, raw, abraded, indented with teeth marks
- comparative weight measurements
- abdominal measurements
Ratings (variables a_totrat and _rat):
The surgeons were instructed to give a recommended rating to the Pension board. This rating was one piece of information used to determine the amount of money awarded to the claimant. This rating may be found on the a_totrat variable or the _rat variable for each of the systems or diseases. The a_totrat variable contains either an aggregate rating, which is a sum of related disabilities (see below for description of related disabilities), or when there are multiple conditions examined with only one rating given with no indication of which condition it is for. The _rat variable for each system or disease may contain a rating for the entire system/organ or disease, such as the cardiovascular system or the varicose veins, or it may be specific to one condition within a system, such as bronchitis instead of respiratory system, or paralysis instead of nervous system. These ratings are usually numeric, and may be a dollar amount ($4) or a fraction (4/18); they may also be word phrases (total, 3rd grade, equal to loss of hand or foot, less than the ankylosis of wrist or ankle).
Related diseases (_rel variables):
The _rel variable for each system or disease preserves relationships between conditions described by the surgeon in the physical examination, these may be cause/effect relationships or when multiple conditions or organs are rated together with a single rating. Conditions may be related with both a cause/effect relationship and be rated together.
Examples of how the _rel variables are used:
If the surgeons state a cause/effect relationship, the two disease will be linked in their respective _rel variables with causing/resulting from statements, such as "rheumatism causing heart" in the r_rel variable, and "heart resulting from rheumatism" in the c_rel variable. When given, modifiers such as "could," "may," "possibly," "probably," and "likely" are also recorded.
When a disease causes conditions in multiple organs or systems, these are often examined together, with one rating given for every condition related to that disease, in this case each involved condition/system will be linked together with a rated with statement in the _rel variable of each respective system. For example, 1/2 rating for diarrhea that includes conditions in the gastrointestinal system and rectum will look like this:
- in variable d_rat: "½"
- in variable d_rel: "rated with gastro," and "rated with rectum"
- in variable q_rel: "rated with diarrhea," and "rated with rectum"
- in variable m_rel: "rated with diarrhea," and "rated with gastro"
A certificate that uses the phrase "aggregate permanent disability for earning a support by manual labor is due to A, B, and C and warrants a rate of X dollars a month" will be recorded in the following manner:
- dollar amount recorded in variable a_totrat
- "see total" in variable _rat for condition/disease A
- Conditions A, B, and C linked together in variable _rel
For example, the phrase "We find the aggregate permanent disability for earning support by manual labor is due to chronic diarrhea, rheumatism, and gsw of foot and warrants a rate of $17 per month" will look like this:
- in variable a_totrat: "$17"
- in variable d_rat: "see total"
- in variable d_rel: "rated with rheumatism", and "rated with gsw foot"
- in variable r_rel: "rated with diarrhea," and "rated with gsw foot"
- in variable w_rel: "rated with diarrhea," and "rated with rheumatism"
4. User Guide Table
|Variable Label||Variable Name||Data-Set||Source|
|a_*qc||Quality code||DIS||Quality Codes|
|a_recnm [1-3]||Claimant's name||DIS||Surgeons' Certificate|
|recidnum||Identification number||DIS||Early Indicators Project|
|examnum||Examination number||DIS||Variable generated by data collection screens|
|a_apptyp||Application type||DIS||Surgeons' Certificate|
|a_mlrnk [1-5]||Military rank||DIS||Surgeons' Certificate|
|a_mlcmp [1-5]||Military company||DIS||Surgeons' Certificate|
|a_mlrg [1-5]||Military regiment||DIS||Surgeons' Certificate|
|a_mlsta [1-5]||Military state||DIS||Surgeons' Certificate|
|a_mldsc [1-4]||Military description||DIS||Surgeons' Certificate|
|a_brdstr||Street address of board of examining physicians||DIS||Surgeons' Certificate|
|a_brdcty||City of board of examining physicians||DIS||Surgeons' Certificate|
|a_brdcnt||County of board of examining physicians||DIS||Surgeons' Certificate|
|a_brdst||State of board of examining physicians||DIS||Surgeons' Certificate|
|a_cltstr||Claimant's street address||DIS||Surgeons' Certificate|
|a_cltcty||Claimant's city||DIS||Surgeons' Certificate|
|a_cltcnt||Claimant's county||DIS||Surgeons' Certificate|
|a_cltst||Claimant's state||DIS||Surgeons' Certificate|
|a_xmdate||Date of examination||DIS||Surgeons' Certificate|
|a_prated||Previous pension rating- dollar amount||DIS||Surgeons' Certificate|
|a_pratef||Previous pension rating- fraction||DIS||Surgeons' Certificate|
|a_ratfor||What previous pension is for||DIS||Surgeons' Certificate|
|a_brtcty||Claimant's birth city||DIS||Surgeons' Certificate|
|a_brtcnt||Claimant's birth county||DIS||Surgeons' Certificate|
|a_brtst||Claimant's birth state||DIS||Surgeons' Certificate|
|a_age||Claimant's age at time of examination||DIS||Surgeons' Certificate|
|a_hgtft||Claimant's height, feet||DIS||Surgeons' Certificate|
|a_hgtin||Claimant's height, inches||DIS||Surgeons' Certificate|
|a_weight||Claimant's weight||DIS||Surgeons' Certificate|
|a_complx||Claimant's complexion||DIS||Surgeons' Certificate|
|a_eyes||Claimant's eye color||DIS||Surgeons' Certificate|
|a_hair||Claimant's hair color||DIS||Surgeons' Certificate|
|a_marks||Permanent marks||DIS||Surgeons' Certificate|
|a_ocpat [1-5]||Claimant's occupation||DIS||Surgeons' Certificate|
|a_ocdsc [1-5]||Occupation description||DIS||Surgeons' Certificate|
|a_ocoan[1-5]||1950 Census occupation code (two-digit level)||DIS||1950 Census Occupation Codes|
|a_ocoad[1-5]||1950 Census occupation code description (two-digit level)||DIS||1950 Census Occupation Codes|
|a_ococn[1-5]||1950 Census occupation code (three-digit level)||DIS||1950 Census Occupation Codes|
|a_ococd[1-5]||1950 Census occupation code description (three-digit level)||DIS||1950 Census Occupation Codes|
|a_occod [1-5]||Wilcox occupation code||DIS||Wilcox occupation codes|
|a_plssit||Claimant's pulse rate sitting||DIS||Surgeons' Certificate|
|a_plsstn||Claimant's pulse rate standing||DIS||Surgeons' Certificate|
|a_plsxrc||Claimant's pulse rate after exercise||DIS||Surgeons' Certificate|
|a_plsun [1-2]||Claimant's unspecified pulse rate||DIS||Surgeons' Certificate|
|a_rspsit||Claimant's respiration rate sitting||DIS||Surgeons' Certificate|
|a_rspstn||Claimant's respiration rate standing||DIS||Surgeons' Certificate|
|a_rspxrc||Claimant's respiration rate after exercise||DIS||Surgeons' Certificate|
|a_rspun [1-2]||Claimant's unspecified respiration rate||DIS||Surgeons' Certificate|
|a_temp||Claimant's temperature||DIS||Surgeons' Certificate|
|a_bldprs||Claimant's blood pressure||DIS||Surgeons' Certificate|
|a_clst [0-12]||Claimant's statement||DIS||Surgeons' Certificate|
|a_dis [01-22]||Disease screen pointer||DIS||Variable generated by data collection screens|
|a_totrat||Total or aggregate rating||DIS||Surgeons' Certificate|