in contested life-insurance policies the points contested are with reference to what was actually meant by certain medical terms, such as diseases, habits tending to shorten life, etc.

It is astonishing what a difference of opinion prevails among even intelligent people as to what constitutes a temperate person, many an individual who takes several drinks of brandy or whisky a day considering himself perfectly temperate, and so stating to the medical examiner, utterly unconscious of his health being gradually undermined, and of his life being shortened by the daily use of alcohol. It is due to such a difference of opinion as to the effect of alcohol upon the system that the question of intemperance has given rise to so much discussion in cases of life-insurance. While it is undoubtedly true that there have been exceptional instances of individuals enjoying good health and living to a good old age who had been in the habit of drinking, and more particularly whisky, all their lives, nevertheless it cannot be denied that, as a general rule, the habitual use of alcohol in perverting nutrition induces disease of the heart, liver, and kidneys, and so tends to shorten life. It should be mentioned, however, that if the habits of the individual at the time of insurance were temperate, the fact that intemperance was subsequently developed would not debar the heirs from recovery upon the policy.

What has just been said of the use of alcohol with reference to the shortening of life applies equally to the influence of the morphia habit. The concealment of the fact that an applicant for a policy of life-insurance was an opium-eater at the time of application would justify the company in refusing to pay the heirs the insurance.

There is no doubt that insanity also tends to shorten

life, and with the view of avoiding future complications which might arise upon this point, every insurance policy should contain a direct question on insanity; the insurance company reserving to itself the privilege of insuring or not, according to the particular circumstances of the case.

Litigation in cases of life-insurance not unfrequently arises in consequence of the insured person committing suicide after the taking out of the policy. Under such circumstances a company would certainly be justified in refusing to pay the insurance, if it could be proved that the suicide was committed with the intention of paying off debts or leaving money to the heirs. If, however, the suicide was due to insanity, clearly developed after the policy had been taken out, the heirs would undoubtedly be entitled to the payment of the insurance.

From what has just been said of the relationship of the alcohol and opium habit, insanity, suicide, to life-insurance, it is obvious that, for the interest of the company, as well as for that of the insured, a most thorough examination should be made as to the health of the individual at the time of the application for the policy. Not only should all the printed questions of the policy be satisfactorily answered by the applicant, but the latter should be most carefully questioned orally by the medical examiner of the company. It is the concealment of the true state of the health of the applicant, either fraudulently or unintentionally, at the time that the policy was taken out, which gives rise to most of the lawsuits in cases of life-insurance.

Medical Malpractice.-Actions for damages for large amounts are so often brought against physicians on the charge of malpractice, that it is well for the medical profession to realize that the law affords, even to the most distinguished of its members, under such circumstances, no

especial protection. In order, therefore, to avoid the annoyance and loss of time always entailed by such suits, howsoever they may terminate, it is most important that practitioners should never guarantee or contract to effect a cure, even in the simplest kind of cases. Whatever the nature of the difficulties arising in the case may have been, however improbable that they should have occurred, or that they could have been foreseen, is immaterial, the law not accepting any such excuses for the failure on the part of the practitioner to fulfil his contract to cure.

Such being the case, how unwise would it be for a surgeon to promise that he will cure a deformity when the operation involved may be followed by pyæmia and death! or for the gynecologist to guarantee the safe removal of an abdominal tumor when there is always a risk that a fatal peritonitis may follow the operation! All that a practitioner can be expected to say is that he will do the best he can for his patient. The law only demands that he will exhibit in the practice of his profession a fair and competent degree of skill. It must be admitted, however, that it becomes difficult, if not impossible, to say, under certain circumstances, just what constitutes legally a reasonable or ordinary amount of professional skill. It is evident that the skill indispensable to the success of a physician or surgeon practising in a metropolis must be far greater than that demanded of one practising in a village. The legal term ordinary skill is, therefore, far from being a definite one, and from the very nature of the case must have a varied application. Not only ordinary skill, such as is demanded in the successful performance of a surgical operation, must be exhibited, but ordinary care and attention in the after-treatment must be paid the patient as well. The bandaging, the dressings, the diet must be all care

fully looked after, as neglect of the same, involving possibly the occurrence of secondary hemorrhage, mortification, pyæmia, or even only deformity, will render the practitioner justly liable to a suit for damages.

On the other hand, a practitioner should not be held responsible for not prescribing some particular remedy or for the failure of some one remedy to cure, since the greatest difference of opinion prevails among therapeutists as to the efficacy of all so-called "remedies." It is still a question among medical jurists whether a practitioner renders himself liable to prosecution in deviating somewhat from the usual manner of performing an operation, as, for example, in vaccinating on some part of the arm other than the part usually selected for that purpose. As a matter of fact, it may be mentioned, however, that in one instance in which the virus was introduced nearer to the elbow than usual and serious inflammation followed, the court ruled that the attending physician was responsible for all the bad consequences attending the case. As the law recognizes no particular school of medicine, homœopathists, eclectics, botanists, herb doctors have about the same standing legally as regular members of the profession. Every practitioner is supposed, however, to practise according to the system of medicine taught in the school of which he is a graduate. It might be supposed, therefore, that if a violent remedy was administered or a surgical operation performed, by an individual who had received no medical education whatever, in the event of serious consequences, death ensuing, the law would hold such a person criminally responsible. But, strange to say, there have been 'cases, as, for example, when a prolapsed uterus, being mistaken for a placenta, was torn out by a midwife and a fatal hemorrhage ensued; and yet the court ruled that

there was not sufficient evidence to convict the prisoner of the crime of murder, and he was acquitted. It is to be hoped, since the law, in Pennsylvania at least, requires the registration of all physicians, that any one convicted of practising medicine without the diploma of a reputable school will be summarily dealt with.

Medical Registration.-In this connection, for the benefit of young physicians just beginning the practice of their profession, it does not appear superfluous to quote the full text of the registration law: "It shall be the duty of every practising physician and of every practitioner of midwifery, on or before the first day of July next ensuing (the day on which the law goes into effect), to report his, her or their names and places of residence to the health officer at the office of the board of health, and it shall be the duty of the health officer to have the same properly registered in index form in suitable books. In the event of any of the persons above specified removing to any other place of residence, it shall be their duty to notify the health officer of the fact within thirty days after such removal, except where the persons removing shall cease to act in such official capacity as makes them subject to the provisions of this act."

Suits brought against physicians for malpractice are usually for damages-civil rather than criminal in character. By far the greater number of such cases are purely for the purpose of black-mail, the plaintiff usually securing the services of counsel with the understanding that if he wins the suit, his fee will be part of the damages awarded. Among such cases may be mentioned those in which a shortening of a limb, the stiffness of a joint, a certain deformity are alleged as having been due to the neglect of the surgeon in the treatment of a fracture or of a dislocation. In all such cases it is incumbent upon the