home, yet in this state no other place is available. There is great need of one or more psychopathic hospitals, which need will be increased when nervous and mental cases are returned to us from the army. But if we cannot reasonably expect to secure psychopathic hospitals in the immediate future, let us try as a profession to influence the boards of managers of the various general hospitals to secure at as early a date as possible a number of psychopathic wards, where the acute mental and nervous case may receive treatment, which will inevitably result in a relatively less number of commitments to the state hospitals.

DR. BRODSKY (Westport): I wish to compliment Dr. Thompson for his paper. The points brought up there together with Dr. Haviland's remarks are very important, especially now when we are at war. The war will bring a large percentage of nervous and mental cases. I do not have any criticism to offer except to emphasize once more the need of psychopatic wards in view of a large number of the so-called symptomatic mental cases, the importance of which is not recognized by the general practitioners and also some psychiatrists. Imagine a patient in a confusional state as result of uremia is locked up in a cell at the police headquarters for three or four days until he could be placed in some institution for mental diseases. I recall also a case with septic endocarditis with aphasia who was rejected from a general hospital because of his delirious condition; this patient was carried from one place to another for twenty-four hours before arrangements could be made for his care in a private sanitarium for mental diseases. These facts emphasize the necessity of establishing psychopathic wards in this state.

DR. THOMPSON (Hartford): I think it is fairly a safe prediction that in a few years Dr. Haviland will have a psychopathic hospital under state

care.

Life Insurance-Some Points of Medical Interest.

ROBERT L. ROWLEY, M.D., HARTFORD.

In the United States there are probably about 145,000 physicians. Not all of these are engaged in private practice. Many have retired from practice; others are engaged in research work, or in teaching; and still others devote themselves to work which is largely administrative or executive in character.

It has been rather conservatively estimated that at least 35 per cent of the physicians in this country make some examinations for life insurance.

Many physicians make but few examinations; others depend upon this work for a large part of their income.

With the above estimate as a basis, it appears that there are about 350 members of the Connecticut State Medical Society who make some examinations for life insurance. To those members a paper on the topic that has been chosen should be of particular interest and to the others it can be assumed, I believe, to be of at least academic interest.

When your Programme Committee honored me with an invitation to present a paper on the subject of life insurance I concluded that, in the short time at our disposal in this meeting, I could best engage your interest by means of some charts that show the effects upon the prospects of life that may be attributed to certain physical impairments.

May we consider for a moment the development of the idea of insurance, more particularly insurance on lives, and the relationship of the medical profession to the business of life insurance?

The simplest and most general conception of insurance is a provision made by a group of persons, each singly in danger of some loss the incidence of which cannot be foreseen, that when such loss shall occur to any one of them it shall be distributed over the whole group. Its essential elements, therefore, are

foresight and coöperation; the former the special distinction of civilized man; the latter the means of social progress.

But foresight is possible only in the degree in which the consequences of conduct are assured; that is, it depends on an ascertained regularity in the forces of nature and the order of society. To the savage, life is a lottery. The impulses of the gambler are dominated by his hopes and fears. As nature is studied and subdued, and as society is developed, the element of chance is slowly eliminated from life.

In a progressive society, education, science, invention, the arts of production, with regular government and civil order, steadily work together to narrow the realm of chance and extend that of foresight.

But there remains an event that may disturb all anticipations, and in spite of man's best wisdom and effort may deprive him of the fruits of his labor,-that event is premature death.

A useful life has an economical value; but no skill can make certain its continuance to its normal close. In the reasonable expectation that it will last until a competence is gained or the family ceases to be dependent, young men marry; but some will die too soon; and in the aggregate multitudes are left destitute.

The idea of insurance begins when the liability to loss is recognized as common, and provision is made beforehand to meet it from a common fund. The efficient organization of communities or groups for this purpose is an essentially modern achievement of social science. But the history of the conception in its formative stages is extremely obscure.

The earliest insurances on lives were purely gambling ventures, entered into by small groups of individuals. There were no available records of births and deaths nor of the ages at death and, consequently, no mortality tables by which the probable length of life at given ages could be foretold. The principles of insurance, as exemplified in marine insurance and in fire insurance, had become a distinct part of the common stock of thought in enlightened nations, and no doubt this fact served as a stimulus for the studies along scientific lines that led to the construction of our earliest mortality tables in the latter part of the 17th century.

Following close upon this work and in the early part of the 18th century, there were formed in England some fifty life insurance projects, none of which, however, proved to have any lasting merit. Not until 1762, with the formation in London of the Society for Equitable Assurance on Lives and Survivorships, did life insurance become established upon a sound and permanent basis. The "Old Equitable," as it is sometimes called, is still flourishing, though in a modest way.

Candidates for membership in the insurance associations were required to appear before a board of laymen and were put through a sort of cross examination as to health, habits, etc. In the Saxon Guilds it is recorded that candidates were required to be holy, pious and good. In one of the Societies provision was made that any applicant, when required by the trustees, should produce a certificate of his age and also an affidavit that he had not any known distemper upon him, and that he was in a very good state of health.

Any person of the clergy or laity "excepting such as live in the marshy and unhealthy parts of England" might be admitted by proxy if known to the trustees as a person of good report; also if not above 50 years of age and would furnish a certificate signed by the ministers of three neighboring parishes, testifying that they did believe him to be in health and of such age as he declared himself to be.

From testimony such as this it becomes apparent that in the earlier days the physician was not identified with this business. The contract between the individual and the company was regarded in the light of any other contract between two parties, not necessitating the interference of skilled evidence.

But as time passed and the nature of the business and the conditions affecting its successful conduct became better understood, it was found that neither party was in a position to value the data upon which the contract was to be based unless the state of health of the applicant and the various contingencies bearing upon his prospects of life were duly estimated. Consequently the physician was destined to become an essential aid in the furtherance of the business of life insurance.

In the records of the Old Equitable of London it will be found that in 1779 a suggestion was made to the Board of Directors that a medical man be appointed to assist them in the selection of new members.

That this suggestion was not adopted until many years later was perhaps due to the unusual period of prosperity of the company, resulting from its rapid growth and favorable mortality and also the rise in value of investments. It appears that the employment of medical examiners in the field began about 1820, and not until some years later was it customary to have at the Home Office a medical officer or adviser.

Although the necessity of a medical scrutiny into the value of all lives submitted for insurance had become an acknowledged fact, the manner in which the inquiry was conducted varied in the different offices and the examination was for the most part cursory in nature.

The phenomenal growth and development of life insurance in this country began about the middle of the 19th century with the formation of some of the strongest and best known companies of the present time.

In all of the American companies formed in that period and subsequently, selection of risks through the aid of medical examiners was practiced from the outset.

In the early days a few printed questions, with certificate of friend, agent, family physician and examiner formed the appli

cation.

With the growth and refinement of the business of life insurance, there came a need for a better mortality, and in consequence the requirements have been gradually increased, in keeping with the advancements in medical science, and the application blanks have been made to contain more searching questions as to personal health record and family history, and the physical examination of the applicant has become more elaborate than formerly.

In this connection it is of interest to refer briefly to two matters that are of comparatively recent adoption in the examination of applicants for life insurance; namely examination of urine and examination of blood pressure.