amine some of the facts connected with opium-eating, in order, if possible. so see how far it really tends to shorten life. In the case of the Earl of Mar, it appeared to be a fair inference that the habit did not shorten his life, for he is represented to have indulged in it for thirty years; and for twenty-eight years, according to the statements of his friends, no injurious effects had followed. Christison subsequently collected from numerous sources no fewer than twenty-five cases, from which we learn that opium has been taken in large quantities for forty years together without producing any marked injury to health.

On the whole, however, we are bound to conclude that the habit of opium-eating is, as a rule, injurious to health, and is therefore calculated to shorten life. In any proposal for life insurance, the insurers should be informed of this habit when it exists, and no medical man should sanction its concealment merely because many persons addicted to it have lived for years in apparently tolerable health. One of the questions put to a medical man is, whether he knows any material circumstances touching the health or habits of the person, to which the other inquiries in the certificate do not extend, and, if so, he is required to state them. Now, without going the length of saying that the life of an opium-eater is uninsurable upon a common risk, the habit is itself sufficiently material to require that it should be declared in reply to such a question as this. The practice may be, and often is, concealed from a medical attendant; then the insured, if not candid in avowing its existence, must expose his representatives to the risk of losing all benefit under a policy. Independently of medical facts, which appear to favor both sides of the question, a jury would prob ably be guided to a verdict by the effect actually produced on the constitution of a person who has been addicted to the practice. If it has continued many years, and there is no proof of his health having in consequence undergone any remarkable change, this might be regarded by the jury as the best possible evidence in favor of the concealment not being in such a case material. The insurers could not equitably complain of the verdict in the Earl of Mar's case, for as he began opium-eating at twenty-seven, and died at fifty-seven, without any obviously injurious effects being produced by the use of the drug, it could not be said that in his case at least the practice had shortened life. It is rarely in our power to apply any better or more practical test than this, under circumstances in which medical facts appear to bear both ways. The case is very different from intemperance in the use of alcoholic liquids; and no one can doubt that in this form the results must be inevitably to impair health and shorten life. The facts here bear one way, and if instances of longevity can be adduced among spirit-drinkers, they are well known and generally admitted to be exceptions to the rule. The queries put by insurance offices are now so explicit that they must be considered as including the habit of opiumeating; and there does not appear to be any just pretence for evading the admission of the practice, either on the part of the insured or (if known to him) of his medical attendant.

Tobacco-smoking.-The prevalent habit of smoking tobacco has never been adequately regarded in relation to life insurance. Although excessive smokers are liable to attacks of dyspepsia, loss of muscular and nervous power, weakness, amaurosis, and other derangements of the system, there is no evidence to show that the practice has a tendency to shorten life. The habit should be stated in the certificate, if known to the medical referee and to be of an inveterate kind. (See Ann. d'Hyg., 1866, t. 2, p. 152.) This would at least prevent objections on the part of a captious

VOIDANCE OF POLICIES BY SUICIDE.

787

company. There is no rule of law on this point, if we except a dictum of Lord Mansfield: "The insured need not mention what the insurer ought to know, what he takes upon himself the knowledge of, what he waives being informed of, the insurer need not be told general topics of speculation."

Insanity. When we are called upon to say what diseases have a tendency to shorten life, there is commonly no difficulty in giving a reply, since the name of the disease, its known effects upon the body, the degree of the mortality produced by it, and its intractableness are data upon which a medical opinion may be easily expressed. There are some diseases, however, respecting which it is not so easy to return an answer; and among these may be mentioned insanity, which has already given rise to discussion in a court of law. The treatment of this malady falls out of the usual line of practice; and there are comparatively few in the profession who have made themselves acquainted with statistical details respecting it.

There was formerly a notion that insanity had a tendency to prolong life; but statistics have shown that the insane are more liable than the sane to various diseases, and that when attacked they sink more easily under them; hence the mortality of the insane, cæteris paribus, is much above the average of that of the sane population. Among other fatal diseases, the insane are specially liable to attacks of paralysis and epilepsy; and paralysis, however slight, is commonly the forerunner of death in these cases. In private asylums, the mortality is always less than in public hospitals; but researches have proved that the mortality of the insane has been much reduced by the introduction of an improved system of management and treatment.

Observations have shown that the mortality among male is greater than among female lunatics, and the more advanced the age the greater the proportionate rate of mortality. The concealment of insanity in any of its forms, or even the concealment of a known hereditary tendency to this malady, would be considered material, insomuch as either condition forms a special question to which a direct answer should be returned.

-----

Suicide. Among the conditions in policies of insurance, there is generally a stipulation in the contract that the policy shall be void if the person who insures his life commits suicide. Thus a medical question may arise as to whether suicide was or was not committed in a particular case. A person may die from poison, wounds, drowning, or other forms of asphyxia; and it may be difficult to say whether, in certain cases, the death arose from accident, suicide, or from violence inflicted by another. Such cases are often left in great uncertainty at coroner's inquests-the evidence received being imperfect or insufficient; because in cases of sudden death, provided there be no suspicion of murder, it is considered of little moment to make a strict inquiry. If the life of the deceased should happen to be insured under a policy containing this condition respecting suicide, the question may become of great importance to the interest of the insurers, and they will require clear evidence that the death was natural or accidental, and not suicidal, before paying the amount of the policy. The cause of death should in all cases of violence be determined by a medical man; this will put an end to any dispute concerning the payment of the policy, and relieve the representatives from the trouble and expense of litigation. If the death be sudden, and any suspicious circumstances are left unexplained, a civil action may follow. We are not, therefore, safe if at a coroner's inquest we suppose that we have only to satisfy a jury by a

788

INSURANCE MURDERS.

hasty opinion expressed from an external view of the body, or an ill-conducted inspection, merely because it may appear to us quite certain that the deceased could not have been murdered. Should the deceased be one of that class of persons on whose lives insurances are commonly effected, the whole of the circumstances connected with the examination of the body, and the medical opinion of the cause of death, must come to light, and, if the examination was carelessly performed, will probably be made the subject of a severe cross-examination. There have been several painful exposures of this kind, because the medical witness thought any kind of evidence would serve the purpose of a coroner's jury. The verdict of a jury at an inquest is not binding on a company; they have not only a right, but often good reason to dispute it, and they frequently exercise this privilege. The insurance companies are exposed to all kinds of frauds, actually leading, as in the case of burial clubs (a kind of life insurance), to the perpetration of murder for the sake of the small amount insured.

Among the medico-legal questions connected with this subject is the following: Does the proviso in the policy respecting suicide include all acts of self-destruction; or is it restricted only to those cases in which a sane or a partially insane person consciously destroys himself? This question has been elsewhere fully considered. The act of suicide does not necessarily indicate insanity; but even if it did, the rule of law, as settled by a majority of the judges in reference to this proviso in cases of life insurance, is that, whenever an insured person destroys himself intentionally, whatever may be the state of his mind, the policy is void. If a person, whether sane or insane, kills himself unintentionally, then the insurers are liable; but the onus of proof in this case lies upon the plaintiffs, i. e. those who would benefit by the policy. A question here arises-Can an insane person be said to have the same "intention" to destroy himself that could be ascribed to one who was sane? Is not the intention affected by the state of insanity. This may in some measure depend on the degree which the mental disorder has reached. According to Tardieu, the decision of a French tribunal on this subject, Aug. 8, 1854, was to the following effect: "Whosoever has caused his own death under an attack of insanity cannot be considered to have fallen a victim to 'suicide' in the sense in which this term is used in policies of insurance." (Ann. d'Hyg., 1864, t. 2, p. 394.) According to the practice of some British offices, the act of suicide does not render a policy void; but in the Government life insurances there is a provision to the effect that they will be void in case of death by the hands of justice or by suicide.

Insurance Murders.-The insurance of the lives of others has been considered to be objectionable, on the ground that it tends to create an interest in the death of a person, and thus to lead to secret acts of murder. The 14 George III., c. 48, expressly enacts that no insurance on a life shall be valid, unless the person insuring has a direct legitimate interest in the person whose life is insured. This statute was enacted for the purpose of preventing gambling in policies, and to guard society against the risk of persons insuring, and then contriving the death of the insured, for the sake of the payments to be made under the policy. Its effect is simply to render the policy void; it does not require that the premiums shall be refunded, nor does it award any penalty to the offenders. As policies of life insurance may be bought and sold like other property, they may fall into the hands of persons who have no other interest in them than the desire that such policies should speedily become claims by the death of the insured. The interest of such holders, it has been justly observed, lies in the death, and not in the life, of the insured.

INSURANCE MURDERS.

789

The revelations at Liverpool (Reg. v. Flannagan and Higgins, Liverpool Feb. Ass., 1884), and the case of Reg. v. Powell, (Worcester Spring Ass., 1888), and the Deptford murder cases in 1889, show what terrible prevalence there is of murder for the purpose of procuring insurance moneys; and point to the extreme necessity that exists, in consequence of the lax way in which small policies are effected, of medical men being careful as to the giving of death certificates.

1

790 MEDICO-LEGAL SURGERY-MILITARY SURGERY.

[MEDICO-LEGAL SURGERY.

CHAPTER LXIX.

THE IMPORTANCE OF THIS BRANCH OF MEDICAL JURISPRUDENCE.-MILITARY SURGERY. -NAVAL SURGERY.-RAILWAY SURGERY.-ACCIDENTS ON RAILWAYS.—DAMAGE CASES. RAILWAY SURGEONS.--THE RAILWAY HOSPITAL SYSTEM.-TRANSPORTATION OF DEAD BODIES.-HEALTH PRECAUTIONS.-CASES OF INFECTIOUS DISEASES.

MEDICO-LEGAL SURGERY should be considered under three separate and distinct heads: Military Surgery; Naval Surgery; and Railway Surgery.

MILITARY SURGERY.

In all countries the military surgeon forms a fixed and distinct arm of the service of the army of the nation; and its relation to medico-legal science has been well defined in the past.

Through the courtesy of Surgeon D. L. Huntington, M. D., Deputy Surgeon-general of the United States Army, the general features of the army organization of the American military surgeon may be stated as follows: The Army Medical Department constitutes one of the bureaus of the War Department, and is composed of one surgeon-general with the rank of brigadier-general; six surgeons with the rank of colonel and styled assistant surgeon-general; ten surgeons with the rank of lieutenant-colonel, styled deputy surgeon-general; fifty surgeons with the rank of major; and one hundred and ten assistant surgeons. All assistant surgeons enter the corps by competitive examination and are commissioned as first lieutenants; after five years, and upon passing successfully the required examination, they are promoted to the rank of captain. Promotion throughout the corps is by seniority. There are no regimental surgeons, but medical officers for posts, armies, and commands are detailed for whatever duty may be required.

The Medical Department of the Army also comprises the Hospital Corps, made up of hospital stewards, acting hospital stewards, and privates, the number of each determined by the necessities of the service. The Hospital Corps is divided among the several posts where troops are stationed, and in force proportionate to the size of the post.

The army medical officer of whatever grade is a regularly commissioned staff officer, appointed by the President and confirmed by the Senate, holding his commission for life unless deprived of same by sentence of courtmartial. The medical officer cannot assume command except in his own department, but by virtue of his commission he may command all enlisted men like other commissioned officers. Medical officers, by virtue of commission, are entitled to sit on courts-martial, boards of inquiry, and other boards or commissions, taking their places by seniority.

Each military department is entitled to a medical officer on the department staff, known as the chief surgeon of the department, and in times of war, or of active field duty, a chief surgeon of an army, army corps, or division is detailed to duty with the general officer commanding such forces.