- Email: [email protected]
LIFE ASSURANCE MEDICAL OFFICERS ASSOCIATION.
1656 Council will be
to renew to me, that I have your in whatever is best for the Council and in the conduct of its business. I have learned, during a somewhat long service as the chairman of the Pharmacopoeia Committee and of the Business Committee, to cooperate for the improvement of our proceeding’s with almost every member of the Council. I have learned, therefore, to work with you individually. I hope you will continue to work with me in the new responsibilities which you by your votes have imposed upon me. I thank you for the honour you have conferred on me and I would like to shake hands now with every member of the Council. All the members of the Council present then filed past the presidential chair, each as he passed shaking hands with Dr. MacAlister and offering him congratulations. The Council, with Dr. MacAlister in the chair, then proceeded to dispose of the remaining business on the
willing
support and cooperation
programme. 1’en;
or
Anzended
Regulations.
Dr. NORMAN MOORE moved :That in the opinion of the Council it is desirable that when new or amended regulations are adopted by the Council a formal statement should be placed on the minutes as to the effect of the new or amended regulations upon previous regulations on the same subject.
He said that owing to what had occurred during the present session of the Council an authoritative statement on this matter was required. He thought that if his motion were carried it would add to clearness and save trouble. Dr. lVIcVAIL seconded the motion which was agreed to.
Registers of Medical and Dental Students. proposed the following motion:-
Dr. MACKAY
That the Council reaffirms its resolution No. 3 upon the minufes of its meeting of May 30th, 1904, in so far as that resolution refers to the establishment and maintenance of registers of medical and dental students, but without reference to the financial proposals therein contained, and remits to the Executive Committee to formulate a scheme for carrying the resolution into effect and to report thereon.
Sir WILLIAM THOMSON seconded the motion. Sir CHRISTOPHER NixoN appealed to Dr. Mackay to pone this motion till the next session of the Council. Dr. MACKAY by leave withdrew his motion.
post-
Diplomas irc Tropical Medicine. The following communication from the University Liverpool was considered :-
of
Oct. 28th, 1904. CrETLEMEy.—I beg to apply on behalf of the University of Liverpool for recognition by registration in the Medical Register of the diploma in tropical medicine of that University. I inclose circulars showing the conditions under which the diploma is granted, from which you will observe that it is only conferred upon medical practitioners. I am, Gentlemen, your obedient servant, D lU.U’.JHh.,
Dean of the Faculty of Medicine.
The PRESIDENT said that the answer which he suggested the Council should make to this communication was that in the absence of legislation enabling them to do so the Council had no authority to authorise the registration of the
diploma of tropical medicine as an additional qualification. The suggestion of the President was agreed to.
Mr. BROWN asked the President whether the Senate of the University of Cambridge had communicated to the General Medical Council its decision to establish an examination and to grant diplomas in tropical medicine and hygiene. The PRESIDENT replied that no such communication had been made to the Council.
Ileports of Inspectors
and Visitors.
Sir JOHN BATTY Tu]iE moved:That the legal advisers of the Council be requested to state an opinion on Sub-section 3 of Section 3 of the Medical Act (1886), whether the obligation rests on the Council to forward the reports of inspectors and visitors to the Privy Council in their entirety, irrespective of what they may contain. Dr. MACKAY seconded the motion which was agreed to. Sir WILLIAM: THOMSON moved:That the report of an inspector and a visitor regarding any examination shall in the first place be sent to the President of the Council for perusal so that, should the meaning of any remarks or conclusions made thereon appear to be obscure the matter mav be referred back to the inspector and the visitor for explanation before the report is formally submitted to the Examination Committee.
He said that he merely desired that the document should be edited and should come down to the Examination Committee without any liability of being misapprehended. They should
not then have to say that
they could not understand some of the observations of the report. Dr. BRUCE seconded the motion. Mr. BROWN moved as an amendment that the motion be referred to the Executive Committee and that it should draw up a report on what alterations should be made in the standing orders. Dr. Lt1B.DSAY STEVEN seconded the amendment. After a brief discussion both the motion and the amendment were withdrawn. The
Trcaszr and the
Sir CHRISTOPHER NixoN moved
COllne’Îl.
:-
That in forwarding the repty of the General Medical Council to the letter of the Privy Council of Nov. lst this Council desires to bring formally before the Lord President the suggestion made ill the President of the Council, dated May 1st, 1903, memorandum of the that the Treasury should te urged to grant a sum sufficient to defray the expenses of the disciplinary funcaions of the Council.
Sir WILLIAM THOMSON seconded the motion. Sir JOHN BATTY TUKE thought that this was a hopeless motion. It had not the slightest chance. Mr. TOMES asked Sir William Turner if he ever took any steps in asking for a grant. Sir WILLIAM TURNER said that he had on more than one occasion taken steps in asking for a grant. Government officials wanted to save the Treasury from making grants if the money could be got in other directions. He felt that there was serious opposition in the Council to proposals to raise the money they required either by a registration fee on students or by increased fees to be put on those who for the first time came on the Medical Register. It seemed to him that the Council should endeavour to see if it could not, through an immediate communication to the Privy Council, get the latter to approach the Treasury on this matter. Unless they made up their minds and let it go to the Privy Council and the Treasury that this was their unanimous desire, he quite agreed with those who said that they would make nothing of it. If thev could let it be known that it was their unanimous wish, then he ventured to point out that there were sufficiently strong arguments which could be brought to bear. They might bv their persistency, perhaps, prevail upon the Treasury authorities to make an allowance to them. A sum of 1500 a year would meet all that was required. It was no use going to the Treasury with a
divided Council. Dr. NoRMAN MOORE suggested that it would be better to postpone the consideration of this motion till the next session of the Council. Sir CHRISTOPHER NixoN said that he gathered it was the desire of the Council that the motion should be withdrawn. The motion was by leave withdrawn. This exhausted the business on the programme and the session ended.
LIFE
INSANITY
ASSURANCE MEDICAL ASSOCIATION. AND
EPILEPSY
IX
RELATION
A MEETING of this society was adjourned to Nov. 2ud, Sir DvcE dent, being in the chair.
TO
OFFICERS
LIFE ASSURANCE.
Oct. 5th, and DUCKWORTH, the Presiheld
on
Sir WILLIAM R. GowERS read a paper on Insanity and Epilepsy in Relation to Life Assurance, which was published in full in THE LANCET of Oct. 15th, p. 1061. The PRESIDENT said that the duty of assurance medical officers was to hold the balance between what was legitimate in medicine and what was legitimate for the benefit of the offices. His experience was that the history of an applicant for assurance having an insane relative was far from uncommon-perhaps nearer one in 25 than one in 50. He believed that suicides had become more frequent in recent years and that among assured persons the great majority of them were the result of financial pressure. Dr. G. H. SAVAGE said that he agreed almost entirely with the opinions expressed by Sir William Gowers in his summing up. To say definitely that people suffering from insanity should or should not be assured was beside the mark: each individual case must be considered. If a patient had an attack of melancholia before he was 25 years )f age lie would probably not recommend the assurance
1657 of his life; if there had been two attacks he would not recommend the life on any consideration. This was not only on account of the suicidal tendency but because persons: ,
,
suffering from melancholia were likely to develop secondary troubles. The melancholic type was also very readily transmitted by heredity, on which account he would hesitate to recommend a life when there was a history of melancholia among the ancestors (parents or uncles). There had been some cases in which he had recommended the assurance of the life of a lunatic. Dr. CHARLES A. MKHCIKR said that among the insane there were both insurable and non-insurable cases. In no circumstances would he recommend a life in a case of acute insanity which was either now existing or had recovered, but he would not extend that prohibition to cases in which the acute insanity had been followed by a permanently damaged brain and a chronic insane condition, for, as Dr. Savage had said, such lives were often prolonged beyond the natural span. Epilepsy per se need not render a life uninsurable. Paranoia per se had no tendency to shorten life and fixed delusion as a rule had no tendency to shorten life. Dr. G. A. HERON said that before giving an opinion as to assuring the life of an insane person it would be advisable for the ordinary life assurance officer to obtain the advice of a specialist in insanity. When applicants for assurance had a strong hereditary tendency to insanity the prospect of their living easy lives or otherwise ought to be considered, for worry was a frequent cause of insanity. The discussion was then adjourned to Nov. 2nd. On that day Sir DvcK DucKWORTH was again in the chair and the proceedings commenced with a paper read by Dr. ROBERT JONES on Insanity and Epilepsy in Regard to the Duration of Life. Of this paper we have only space to print the conclusions which were as follows. 1. Insanity per se was inimical to life. It was a deterioration, mental and physical. It caused more deaths in every quinquennium among the certified insane in asylums than in corresponding periods among the general population. Cases least affected were those holding fixed ideas, sometimes called paranoiacs or persons suffering from delusional insanity, as were also those in whom an acute attack of insanity had left moderate but chronic weak-mindedness. Congenital weak-mindedness diminished the expectation of life. 2. The most powerful and the most frequent antecedent of insanity and of epilepsy was either ancestral insanity or epilepsy. 3. All medical forms of inquiry used in insurance omces should ask whether there was a history of ancestral insanity (parents and grandparents) and collaterals (uncles and aunts). 4. A suicidal tendency was eminently heritable-often appearing at the same age in the offspring as in the ancestor. 5. Suicides in asylums occurred less frequently by one half than in the general population during the period of greatest liability. 6. Phthisis was a strong converging factor towards insanity. 7. Epilepsy shortened lifemore so by an average of ten years than insanity. 8. Antecedent syphilis in many assurable cases could not be definitely ascertained either by admission of the fact or by its sequelas and general paralysis occurred not more often than in about 1 per cent. of all cases which had contracted
syphilis.
I
histories of the 127 suicides. Dr. Muirhead had made a similar investigation with regard to the importance of heredity in phthisis and had come to the conclusion that the occurrence of both neuroses and phthisis in the family history had been immensely overrated as adverse factors in life assurance. Dr. SIDNEY CoupLANn said that people who were chronically insane were protected from the stress and turmoil to which sane people were subject and that no doubt was one reason why many of them lived to a great age, but the general asylum mortality was very much higher than that of the population at large, the average age at death in all insane institutions being about 50 years. It would therefore seem that insanity, or rather some forms of it, was an indication of inherent imperfection of tissue that conduced to premature death. Insanity was so often the outcome of physical ill-health that its existence in an applicant for insurance would not add anything to the ground for rejection, because the applicant would be rejected on the physical ground. An insurance society might be doing an injustice to itself in rejecting an insane person because he was a potential suicide. The proportion of suicides in asylums was not very much more than the proportion of suicides amongst the whole of the community. Dr. R. PERCY SilTH said that there were many patients in asylums whose lives were assurable and would be very profitable to the offices which accepted them. The risk of suicide in asylums was very small. General paralytics ought not to be accepted on any condition but unfortunately the disease was sometimes overlooked and he had two or three times seen general paralytics who had been recently accepted as first-class lives at an insurance office. Dr. R. HINGSTON Fox said that the present mortality of the insane, excluding the pauper class and idiots, was about 6 or 7 per cent., that is, about three times the mortality of the general population over the age of 20 years. There was an The enormous excess of deaths from phthisis in the insane. death-rate from phthisis in asylums was 11 times that which was recorded amongst insured males in the Scottish Widows’ Fund Assurance Society-namely, 155 against 13’5 per 10,000. The facts were similar with regard to bronchitis and diseases of the heart and kidneys. Not only was the death-rate from all these causes higher but the deaths occurred at an earlier age than among the sane. Dr. Fox considered that a family history of insanity was an adverse factor in life assurance, not merely for the risk of the occurrence of insanity in the proposer, but for the greater risk that some other form of vital weakness might be derived from the stock, the insanity being an evidence of that
weakness. Dr. F. DE HAVILLAKD HALL gave the results of an examination which he had made of the statistical records of the Rock Life Office, extending over nearly the same period of time as Dr. Muirhead’s statistics and relating to 3066 cases ; many remarkable discrepancies, however, existed between his results and Dr..Muirhead’s. For instance, in Dr. Muirhead’s cases the proportion of general paralysis was five times as great as among his own. He was afraid that unless all syphilitic applicants were excluded there would occasionally be considerable losses to insurance companies by early claims for cases of general paralysis. He was strongly opposed to the waiving of the suicide clause :the knowledge that his family would be left unprovided for would in some instances act as a deterrent to a would-be suicide. Dr. S. W. CARRUTHERS sent a communication which was read by the secretary. It was largely statistical and dealt chiefly with the family history of insanity, with the deathrate from insanity among insured lives, with suicide, and with epilepsy. Dr. F. PARKES WEBER said that two years ago he published a short note on Syphilis in Relation to Life Assurance upholding the view that syphilis was an important factor in the causation of fatal disease. He believed that assurance losses from general paralysis could not be prevented even by declining every applicant presenting a history of syphilis. Insured persons attacked by
Dr. Cr.AUD 2BIuIRHEcB.D contributed a paper entitled "Notes on the Family Histories of 127 Suicides who were members of the Scottish Widows’ Fund Assurance Society at the time of their death." These deaths were all of males, occurred during the period 1874 to 1894 inclusive, and were equivalent to 2-13 per 10,000 living. The number of males of 20 years of age and upwards in England and Wales per 10,000 living who committed suicide amounted to 2’17. The number of male suicides in Prussia per 10,000 living between the years 1869-90 amounted to 2’73. Farr in his " Vital Statistics’’quoted from the tables of the Equitable Assurance Society of 1834 to the effect that about 2’0 per 10,000 assured in that society. had been found to commit suicide every year. It would thus appear that the number of deaths from suicides among the assured had not materially increased during the last 60 years and that the number among the assured and the community at large in England and Wales was very nearly alike. Dr. Muirhead investigated general paralysis either contracted syphilis after insuring the family history of these 127 suicides so far as it was their lives or else at the time of insurance they did not know revealed in the schedules with the remark that inquiry that they had syphilis or wilfully withheld the fact. In under this heading was limited as a rule to the imme- conclusion he referred to the bearing of agoraphobia and diate family-i.e., to father, mother, brothers, and sisters. acrophobia on life assurance. The result was that only a very small number (11 in 1 THE all) of neurotic relatives were disclosed in the family LANCET, Sept. 27th, 1902, p. 867.
to renew to me, that I have your in whatever is best for the Council and in the conduct of its business. I have learned, during a somewhat long service as the chairman of the Pharmacopoeia Committee and of the Business Committee, to cooperate for the improvement of our proceeding’s with almost every member of the Council. I have learned, therefore, to work with you individually. I hope you will continue to work with me in the new responsibilities which you by your votes have imposed upon me. I thank you for the honour you have conferred on me and I would like to shake hands now with every member of the Council. All the members of the Council present then filed past the presidential chair, each as he passed shaking hands with Dr. MacAlister and offering him congratulations. The Council, with Dr. MacAlister in the chair, then proceeded to dispose of the remaining business on the
willing
support and cooperation
programme. 1’en;
or
Anzended
Regulations.
Dr. NORMAN MOORE moved :That in the opinion of the Council it is desirable that when new or amended regulations are adopted by the Council a formal statement should be placed on the minutes as to the effect of the new or amended regulations upon previous regulations on the same subject.
He said that owing to what had occurred during the present session of the Council an authoritative statement on this matter was required. He thought that if his motion were carried it would add to clearness and save trouble. Dr. lVIcVAIL seconded the motion which was agreed to.
Registers of Medical and Dental Students. proposed the following motion:-
Dr. MACKAY
That the Council reaffirms its resolution No. 3 upon the minufes of its meeting of May 30th, 1904, in so far as that resolution refers to the establishment and maintenance of registers of medical and dental students, but without reference to the financial proposals therein contained, and remits to the Executive Committee to formulate a scheme for carrying the resolution into effect and to report thereon.
Sir WILLIAM THOMSON seconded the motion. Sir CHRISTOPHER NixoN appealed to Dr. Mackay to pone this motion till the next session of the Council. Dr. MACKAY by leave withdrew his motion.
post-
Diplomas irc Tropical Medicine. The following communication from the University Liverpool was considered :-
of
Oct. 28th, 1904. CrETLEMEy.—I beg to apply on behalf of the University of Liverpool for recognition by registration in the Medical Register of the diploma in tropical medicine of that University. I inclose circulars showing the conditions under which the diploma is granted, from which you will observe that it is only conferred upon medical practitioners. I am, Gentlemen, your obedient servant, D lU.U’.JHh.,
Dean of the Faculty of Medicine.
The PRESIDENT said that the answer which he suggested the Council should make to this communication was that in the absence of legislation enabling them to do so the Council had no authority to authorise the registration of the
diploma of tropical medicine as an additional qualification. The suggestion of the President was agreed to.
Mr. BROWN asked the President whether the Senate of the University of Cambridge had communicated to the General Medical Council its decision to establish an examination and to grant diplomas in tropical medicine and hygiene. The PRESIDENT replied that no such communication had been made to the Council.
Ileports of Inspectors
and Visitors.
Sir JOHN BATTY Tu]iE moved:That the legal advisers of the Council be requested to state an opinion on Sub-section 3 of Section 3 of the Medical Act (1886), whether the obligation rests on the Council to forward the reports of inspectors and visitors to the Privy Council in their entirety, irrespective of what they may contain. Dr. MACKAY seconded the motion which was agreed to. Sir WILLIAM: THOMSON moved:That the report of an inspector and a visitor regarding any examination shall in the first place be sent to the President of the Council for perusal so that, should the meaning of any remarks or conclusions made thereon appear to be obscure the matter mav be referred back to the inspector and the visitor for explanation before the report is formally submitted to the Examination Committee.
He said that he merely desired that the document should be edited and should come down to the Examination Committee without any liability of being misapprehended. They should
not then have to say that
they could not understand some of the observations of the report. Dr. BRUCE seconded the motion. Mr. BROWN moved as an amendment that the motion be referred to the Executive Committee and that it should draw up a report on what alterations should be made in the standing orders. Dr. Lt1B.DSAY STEVEN seconded the amendment. After a brief discussion both the motion and the amendment were withdrawn. The
Trcaszr and the
Sir CHRISTOPHER NixoN moved
COllne’Îl.
:-
That in forwarding the repty of the General Medical Council to the letter of the Privy Council of Nov. lst this Council desires to bring formally before the Lord President the suggestion made ill the President of the Council, dated May 1st, 1903, memorandum of the that the Treasury should te urged to grant a sum sufficient to defray the expenses of the disciplinary funcaions of the Council.
Sir WILLIAM THOMSON seconded the motion. Sir JOHN BATTY TUKE thought that this was a hopeless motion. It had not the slightest chance. Mr. TOMES asked Sir William Turner if he ever took any steps in asking for a grant. Sir WILLIAM TURNER said that he had on more than one occasion taken steps in asking for a grant. Government officials wanted to save the Treasury from making grants if the money could be got in other directions. He felt that there was serious opposition in the Council to proposals to raise the money they required either by a registration fee on students or by increased fees to be put on those who for the first time came on the Medical Register. It seemed to him that the Council should endeavour to see if it could not, through an immediate communication to the Privy Council, get the latter to approach the Treasury on this matter. Unless they made up their minds and let it go to the Privy Council and the Treasury that this was their unanimous desire, he quite agreed with those who said that they would make nothing of it. If thev could let it be known that it was their unanimous wish, then he ventured to point out that there were sufficiently strong arguments which could be brought to bear. They might bv their persistency, perhaps, prevail upon the Treasury authorities to make an allowance to them. A sum of 1500 a year would meet all that was required. It was no use going to the Treasury with a
divided Council. Dr. NoRMAN MOORE suggested that it would be better to postpone the consideration of this motion till the next session of the Council. Sir CHRISTOPHER NixoN said that he gathered it was the desire of the Council that the motion should be withdrawn. The motion was by leave withdrawn. This exhausted the business on the programme and the session ended.
LIFE
INSANITY
ASSURANCE MEDICAL ASSOCIATION. AND
EPILEPSY
IX
RELATION
A MEETING of this society was adjourned to Nov. 2ud, Sir DvcE dent, being in the chair.
TO
OFFICERS
LIFE ASSURANCE.
Oct. 5th, and DUCKWORTH, the Presiheld
on
Sir WILLIAM R. GowERS read a paper on Insanity and Epilepsy in Relation to Life Assurance, which was published in full in THE LANCET of Oct. 15th, p. 1061. The PRESIDENT said that the duty of assurance medical officers was to hold the balance between what was legitimate in medicine and what was legitimate for the benefit of the offices. His experience was that the history of an applicant for assurance having an insane relative was far from uncommon-perhaps nearer one in 25 than one in 50. He believed that suicides had become more frequent in recent years and that among assured persons the great majority of them were the result of financial pressure. Dr. G. H. SAVAGE said that he agreed almost entirely with the opinions expressed by Sir William Gowers in his summing up. To say definitely that people suffering from insanity should or should not be assured was beside the mark: each individual case must be considered. If a patient had an attack of melancholia before he was 25 years )f age lie would probably not recommend the assurance
1657 of his life; if there had been two attacks he would not recommend the life on any consideration. This was not only on account of the suicidal tendency but because persons: ,
,
suffering from melancholia were likely to develop secondary troubles. The melancholic type was also very readily transmitted by heredity, on which account he would hesitate to recommend a life when there was a history of melancholia among the ancestors (parents or uncles). There had been some cases in which he had recommended the assurance of the life of a lunatic. Dr. CHARLES A. MKHCIKR said that among the insane there were both insurable and non-insurable cases. In no circumstances would he recommend a life in a case of acute insanity which was either now existing or had recovered, but he would not extend that prohibition to cases in which the acute insanity had been followed by a permanently damaged brain and a chronic insane condition, for, as Dr. Savage had said, such lives were often prolonged beyond the natural span. Epilepsy per se need not render a life uninsurable. Paranoia per se had no tendency to shorten life and fixed delusion as a rule had no tendency to shorten life. Dr. G. A. HERON said that before giving an opinion as to assuring the life of an insane person it would be advisable for the ordinary life assurance officer to obtain the advice of a specialist in insanity. When applicants for assurance had a strong hereditary tendency to insanity the prospect of their living easy lives or otherwise ought to be considered, for worry was a frequent cause of insanity. The discussion was then adjourned to Nov. 2nd. On that day Sir DvcK DucKWORTH was again in the chair and the proceedings commenced with a paper read by Dr. ROBERT JONES on Insanity and Epilepsy in Regard to the Duration of Life. Of this paper we have only space to print the conclusions which were as follows. 1. Insanity per se was inimical to life. It was a deterioration, mental and physical. It caused more deaths in every quinquennium among the certified insane in asylums than in corresponding periods among the general population. Cases least affected were those holding fixed ideas, sometimes called paranoiacs or persons suffering from delusional insanity, as were also those in whom an acute attack of insanity had left moderate but chronic weak-mindedness. Congenital weak-mindedness diminished the expectation of life. 2. The most powerful and the most frequent antecedent of insanity and of epilepsy was either ancestral insanity or epilepsy. 3. All medical forms of inquiry used in insurance omces should ask whether there was a history of ancestral insanity (parents and grandparents) and collaterals (uncles and aunts). 4. A suicidal tendency was eminently heritable-often appearing at the same age in the offspring as in the ancestor. 5. Suicides in asylums occurred less frequently by one half than in the general population during the period of greatest liability. 6. Phthisis was a strong converging factor towards insanity. 7. Epilepsy shortened lifemore so by an average of ten years than insanity. 8. Antecedent syphilis in many assurable cases could not be definitely ascertained either by admission of the fact or by its sequelas and general paralysis occurred not more often than in about 1 per cent. of all cases which had contracted
syphilis.
I
histories of the 127 suicides. Dr. Muirhead had made a similar investigation with regard to the importance of heredity in phthisis and had come to the conclusion that the occurrence of both neuroses and phthisis in the family history had been immensely overrated as adverse factors in life assurance. Dr. SIDNEY CoupLANn said that people who were chronically insane were protected from the stress and turmoil to which sane people were subject and that no doubt was one reason why many of them lived to a great age, but the general asylum mortality was very much higher than that of the population at large, the average age at death in all insane institutions being about 50 years. It would therefore seem that insanity, or rather some forms of it, was an indication of inherent imperfection of tissue that conduced to premature death. Insanity was so often the outcome of physical ill-health that its existence in an applicant for insurance would not add anything to the ground for rejection, because the applicant would be rejected on the physical ground. An insurance society might be doing an injustice to itself in rejecting an insane person because he was a potential suicide. The proportion of suicides in asylums was not very much more than the proportion of suicides amongst the whole of the community. Dr. R. PERCY SilTH said that there were many patients in asylums whose lives were assurable and would be very profitable to the offices which accepted them. The risk of suicide in asylums was very small. General paralytics ought not to be accepted on any condition but unfortunately the disease was sometimes overlooked and he had two or three times seen general paralytics who had been recently accepted as first-class lives at an insurance office. Dr. R. HINGSTON Fox said that the present mortality of the insane, excluding the pauper class and idiots, was about 6 or 7 per cent., that is, about three times the mortality of the general population over the age of 20 years. There was an The enormous excess of deaths from phthisis in the insane. death-rate from phthisis in asylums was 11 times that which was recorded amongst insured males in the Scottish Widows’ Fund Assurance Society-namely, 155 against 13’5 per 10,000. The facts were similar with regard to bronchitis and diseases of the heart and kidneys. Not only was the death-rate from all these causes higher but the deaths occurred at an earlier age than among the sane. Dr. Fox considered that a family history of insanity was an adverse factor in life assurance, not merely for the risk of the occurrence of insanity in the proposer, but for the greater risk that some other form of vital weakness might be derived from the stock, the insanity being an evidence of that
weakness. Dr. F. DE HAVILLAKD HALL gave the results of an examination which he had made of the statistical records of the Rock Life Office, extending over nearly the same period of time as Dr. Muirhead’s statistics and relating to 3066 cases ; many remarkable discrepancies, however, existed between his results and Dr..Muirhead’s. For instance, in Dr. Muirhead’s cases the proportion of general paralysis was five times as great as among his own. He was afraid that unless all syphilitic applicants were excluded there would occasionally be considerable losses to insurance companies by early claims for cases of general paralysis. He was strongly opposed to the waiving of the suicide clause :the knowledge that his family would be left unprovided for would in some instances act as a deterrent to a would-be suicide. Dr. S. W. CARRUTHERS sent a communication which was read by the secretary. It was largely statistical and dealt chiefly with the family history of insanity, with the deathrate from insanity among insured lives, with suicide, and with epilepsy. Dr. F. PARKES WEBER said that two years ago he published a short note on Syphilis in Relation to Life Assurance upholding the view that syphilis was an important factor in the causation of fatal disease. He believed that assurance losses from general paralysis could not be prevented even by declining every applicant presenting a history of syphilis. Insured persons attacked by
Dr. Cr.AUD 2BIuIRHEcB.D contributed a paper entitled "Notes on the Family Histories of 127 Suicides who were members of the Scottish Widows’ Fund Assurance Society at the time of their death." These deaths were all of males, occurred during the period 1874 to 1894 inclusive, and were equivalent to 2-13 per 10,000 living. The number of males of 20 years of age and upwards in England and Wales per 10,000 living who committed suicide amounted to 2’17. The number of male suicides in Prussia per 10,000 living between the years 1869-90 amounted to 2’73. Farr in his " Vital Statistics’’quoted from the tables of the Equitable Assurance Society of 1834 to the effect that about 2’0 per 10,000 assured in that society. had been found to commit suicide every year. It would thus appear that the number of deaths from suicides among the assured had not materially increased during the last 60 years and that the number among the assured and the community at large in England and Wales was very nearly alike. Dr. Muirhead investigated general paralysis either contracted syphilis after insuring the family history of these 127 suicides so far as it was their lives or else at the time of insurance they did not know revealed in the schedules with the remark that inquiry that they had syphilis or wilfully withheld the fact. In under this heading was limited as a rule to the imme- conclusion he referred to the bearing of agoraphobia and diate family-i.e., to father, mother, brothers, and sisters. acrophobia on life assurance. The result was that only a very small number (11 in 1 THE all) of neurotic relatives were disclosed in the family LANCET, Sept. 27th, 1902, p. 867.