Medical exam for Papa Charles's pension application: 3/22/1899
The medical exam to confirm Papa Charles's eligibility for a government disability pension
Full size image is below.
1899-03-22: ~AUDIO~---images---comment---transcript---notes---links---site navigation
1899-03-22: audio---~IMAGES~---comment---transcript---notes---links---site navigation
Front of the formImage #1 of two for this formScroll up for the audio reading.Scroll down for the transcript.
Back of the formImage #2 of two for this formScroll up for the audio reading.Scroll down for the transcript.
1899-03-22: audio---images---~COMMENT~---transcript---notes---links---site navigation
Papa Charles undergoes a physical examination in order to qualify for a government disability pension. My transcript and audio recording are made all the more imperfect by the fact that I've never taken an interest in medicine and biology.
1899-03-22: audio---images---comment---~TRANSCRIPT~---notes---links---site navigation
3--111.
SURGEON'S CERTIFICATE
Insert character and number of claim.
Act of June 27, 1890
Pension claim No. 1218278
Name of claimant. Charles F. Stokey
Ohio Company H 195 Reg't Ohio Inf.
Claimant's post-office address. 907 W. 9th St. Canton Ohio
Address of Board. Massillon, Ohio
Date of examination March 22, 1899
Cause of disability Stomach bowel and liver trouble
He receives a pension of [illegible] dollars per month.
Here give the claimant's statement (briefly and consistently as possible) in regard to the [illegible] of his disabilities and the manner in which they affect him.
He makes the following statement on which he bases his claim for Original.
Have pain in my stomach and bowels. I have attack every day of sick stomach with headache and extreme constipation. Have tenderness over the liver, attackes of vomiting of bile. Have catarrh of nose and throat.
Attention is invited to the outlines of the human skeleton and figure upon the back of this certificate, which should be used to indicate precisely the location of a disease or injury, the entrance and exit of a missile, an amputation, etc.
We hereby certify that upon examination we find the following objective conditions:
Pulse rate, [sitting, standing, after exercise] 76 80 94, respiration [sitting, standing, after exercise] 22 22 24, temperature, 98.6 , height, 5 feet 4 1/2 inches; actual weight, 130 pounds; age, 54 years.
Here give a full description of the disabilities, in accordance with Back of Instruction.
He has tenderness over the stomach but no indurations his tongue is coated, and has eructations of gas Rate 6/18
His abdominal walls are thin and relaxed. He has tenderness over the whole abdomen. The bowels are not distended with gas and there are no nodulations present. Rate 6/18
The actual [illegible] origin of every existing disability must be fully set forth.
Whenever a disability is shown or is believed to be due to or aggravated by vicious habits the opinion of the board must be stated. When not due to such habits this need not be stated.
He has two external files and one internal they are 1/4 in. in diameter. The exterior ones are not ulcerated and not inclined to. The internal one is ulcerated and bleeds. The rectal mucus membrane is red and covered with threds of [illegible] membrane. He states that he has a number of times [illegible] of the bowel. The sphincter area is relaxed. The rectum is empty having made it so by rectal irrigation. Rate 8/18
Each disability must be rated separately, the act of Congress of March 3, 1895, requiring "that the report of such examining surgeons must specifically state the rating which, in their judgment, the applicant is entitled to."
His liver extends below the border of the ribs two inches, is tender. His skin is sallow the [illegible] is jaundiced, he is anemic and the mucus membrane of his lips are without color. His muscles are small and weak. Rate 4/18
His nares are red and congested and the alae of the nose are distended. The laryngeal walls are red and the pharynx is granular. Rate 2/18
When rates are recommended solely on subjective evidence the strongest reasons must be given therefor.
All other organs are normal and no signs of vicious habits.
From the effects of the above ailments he is disabled 7/8 of his time.
Illegible signatures of Pres., Sec'y, and Treas.
N.B. Do not use the backs of certificates for any purpose other than indicated by printed matter thereon. When additional space is needed to complete report of examination use blank certificate (3-111g) properly numbered, and attach it to the back and upper margin of this sheet. Marginal entries must never be made.
The examination must not be made by one member of a board except upon special order of the Commissioner of Pensions.
(This certificate to be filled in and signed by the secretary when the full board is present.)
I hereby certify that Dr. [illegible], Dr. [illegible], and Dr. [illegible] were personally present and actually participated in the examination of Chas F. Stokey, the claimant in this case, on 22 day of March, 1899
[illegible]
(Signature)
(This certificate to be filled in by the member of the board acting as secretary, and signed by the applicant, when a full board is not present.)
"I, _________, the applicant for (increase or original) pension referred to in this medical certificate, hereby consent to be examined by Dr. ___________ and Dr. ___________, the examining surgeon here present (waiving examination by full board). on this _________ day of ______, 18__."
(Signature) _______________
COVER AREA
SURGEON'S CERTIFICATE
IN CASE OF
Charles F. Stokey
Co H, 195 Reg't Ohio Inf.
APPLICANT FOR original
No. 1218278
DATE OF EXAMINATION:
March 22, 1899
[illegible signature], Pres. |
[illegible signature], Sec'y | Board
[illegible signature], Treas |
Post office, Massillon
County, Stark
State, Ohio
P.S. Write your post office address plainly and in full.
BACK AREA
[human skeleton and figure]
Single surgeons will use this blank, changing "we" to read "I." They will erase the words "Pres.," "Sec'y.," "Treas.," and "Board" where the words appear, and sign at the foot of the certificate, and also on the back of the same.
"All examinations shall be thorough and searching, and the certificate contain a full description of the physical condition of the claimant at the time, which shall include all the physical and rational signs and a statement of all the structural changes." [Extract from Section 4, Act of Congress approved July 25, 1882.]
SURGEON'S CERTIFICATE
Insert character and number of claim.
Act of June 27, 1890
Pension claim No. 1218278
Name of claimant. Charles F. Stokey
Ohio Company H 195 Reg't Ohio Inf.
Claimant's post-office address. 907 W. 9th St. Canton Ohio
Address of Board. Massillon, Ohio
Date of examination March 22, 1899
Cause of disability Stomach bowel and liver trouble
He receives a pension of [illegible] dollars per month.
Here give the claimant's statement (briefly and consistently as possible) in regard to the [illegible] of his disabilities and the manner in which they affect him.
He makes the following statement on which he bases his claim for Original.
Have pain in my stomach and bowels. I have attack every day of sick stomach with headache and extreme constipation. Have tenderness over the liver, attackes of vomiting of bile. Have catarrh of nose and throat.
Attention is invited to the outlines of the human skeleton and figure upon the back of this certificate, which should be used to indicate precisely the location of a disease or injury, the entrance and exit of a missile, an amputation, etc.
We hereby certify that upon examination we find the following objective conditions:
Pulse rate, [sitting, standing, after exercise] 76 80 94, respiration [sitting, standing, after exercise] 22 22 24, temperature, 98.6 , height, 5 feet 4 1/2 inches; actual weight, 130 pounds; age, 54 years.
Here give a full description of the disabilities, in accordance with Back of Instruction.
He has tenderness over the stomach but no indurations his tongue is coated, and has eructations of gas Rate 6/18
His abdominal walls are thin and relaxed. He has tenderness over the whole abdomen. The bowels are not distended with gas and there are no nodulations present. Rate 6/18
The actual [illegible] origin of every existing disability must be fully set forth.
Whenever a disability is shown or is believed to be due to or aggravated by vicious habits the opinion of the board must be stated. When not due to such habits this need not be stated.
He has two external files and one internal they are 1/4 in. in diameter. The exterior ones are not ulcerated and not inclined to. The internal one is ulcerated and bleeds. The rectal mucus membrane is red and covered with threds of [illegible] membrane. He states that he has a number of times [illegible] of the bowel. The sphincter area is relaxed. The rectum is empty having made it so by rectal irrigation. Rate 8/18
Each disability must be rated separately, the act of Congress of March 3, 1895, requiring "that the report of such examining surgeons must specifically state the rating which, in their judgment, the applicant is entitled to."
His liver extends below the border of the ribs two inches, is tender. His skin is sallow the [illegible] is jaundiced, he is anemic and the mucus membrane of his lips are without color. His muscles are small and weak. Rate 4/18
His nares are red and congested and the alae of the nose are distended. The laryngeal walls are red and the pharynx is granular. Rate 2/18
When rates are recommended solely on subjective evidence the strongest reasons must be given therefor.
All other organs are normal and no signs of vicious habits.
From the effects of the above ailments he is disabled 7/8 of his time.
Illegible signatures of Pres., Sec'y, and Treas.
N.B. Do not use the backs of certificates for any purpose other than indicated by printed matter thereon. When additional space is needed to complete report of examination use blank certificate (3-111g) properly numbered, and attach it to the back and upper margin of this sheet. Marginal entries must never be made.
The examination must not be made by one member of a board except upon special order of the Commissioner of Pensions.
(This certificate to be filled in and signed by the secretary when the full board is present.)
I hereby certify that Dr. [illegible], Dr. [illegible], and Dr. [illegible] were personally present and actually participated in the examination of Chas F. Stokey, the claimant in this case, on 22 day of March, 1899
[illegible]
(Signature)
(This certificate to be filled in by the member of the board acting as secretary, and signed by the applicant, when a full board is not present.)
"I, _________, the applicant for (increase or original) pension referred to in this medical certificate, hereby consent to be examined by Dr. ___________ and Dr. ___________, the examining surgeon here present (waiving examination by full board). on this _________ day of ______, 18__."
(Signature) _______________
COVER AREA
SURGEON'S CERTIFICATE
IN CASE OF
Charles F. Stokey
Co H, 195 Reg't Ohio Inf.
APPLICANT FOR original
No. 1218278
DATE OF EXAMINATION:
March 22, 1899
[illegible signature], Pres. |
[illegible signature], Sec'y | Board
[illegible signature], Treas |
Post office, Massillon
County, Stark
State, Ohio
P.S. Write your post office address plainly and in full.
BACK AREA
[human skeleton and figure]
Single surgeons will use this blank, changing "we" to read "I." They will erase the words "Pres.," "Sec'y.," "Treas.," and "Board" where the words appear, and sign at the foot of the certificate, and also on the back of the same.
"All examinations shall be thorough and searching, and the certificate contain a full description of the physical condition of the claimant at the time, which shall include all the physical and rational signs and a statement of all the structural changes." [Extract from Section 4, Act of Congress approved July 25, 1882.]
1899-03-22: audio---images---comment---transcript---~NOTES~---links---site navigation
1.
This is one of many documents that Barbara received when she requested Papa Charles's Civil War documents from the government.
You can find links to all the documents that I've uploaded so far in:
2.
height, 5 feet 4 1/2 inches; actual weight, 130 pounds; age, 54 years.
I wonder if Mama Margaret was taller than Papa Charles.
This is one of many documents that Barbara received when she requested Papa Charles's Civil War documents from the government.
- The previous document in the series is: 1899-03-11 FAMILY INFO IN PAPA CHARLES'S PENSION APPLICATION
- The next document in the series is: 1899-05-17 APPROVAL OF PAPA CHARLES'S DISABILITY PENSION
You can find links to all the documents that I've uploaded so far in:
2.
height, 5 feet 4 1/2 inches; actual weight, 130 pounds; age, 54 years.
I wonder if Mama Margaret was taller than Papa Charles.
1899-03-22: audio---images---comment---transcript---notes---~LINKS~---site navigation
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