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THE LANCET.

LONDON: SATURDAY, NOVEMBER 16, 1850.

PROFESSOR CHRISTISON AND LIFE ASSURANCE COMPANIES.

THE Edinburgh Olont7ily Journal, for October, contains an

article by Professor CmnsTrsoN, on the adjustment of theclaims at present made by the medical profession on theAssurance Companies. We cannot allow this article to passwithout comment, because, however much we respect the

author, we do not agree with many of the arguments and con-clusions it contains.

Dr. CjiRiSTisoN admits that in purely Mutual companies themedical fees should be paid by the companies, and not by theassurers, as individuals. His reasons for this are much the

- same as those we have again and again advanced in the dis-cussion of the matter. They are:-"Because here the company is neither more nor less than

the assured. If the fee is to be paid at all, there is really noother party to pay it, and as it matters little whether theassured pay in their individual or corporate capacity, and thereis undoubted convenience to all parties that they do so in thelatter, the company should charge itself both with the ex-pense and the trouble."

These considerations we have often urged, and they arequite beyond all question. In the case of strictly Mutualcompanies, not one word can be honestly advanced in supportof those which refuse to pay medical men their fees.

But we believe Dr. CHRISTISON stands in the relation of

medical adviser to a Proprietary life assurance office, and weby no means agree with his estimate of the rights of theseoffices to the valuable services of medical men without remu-

neration from the directors. Dr. CHRIsTrsoON argues that the

onus probandi, the duty of proving his soundness, rests withthe proposer; that the life-office pays its own medical ex-

aminers ; that though the insurance company undoubtedlybenefits by the insurance of lives, and consequently by thecertificate of the ordinary medical attendant, still the assureralso benefits by the insurance, and by the certificate. He in-

stances cases of doubtful lives, in which no secrecy was ob-

served, but every ailment set forth in the certificate, the factof the certificate beipg sufficient to prevent the societies fromrefusing payment on the occurrence, of death. From these

and other considerations of a similar kind, Dr. CHRISTISONconcludes,-

" It seems clear, then, that the medical attendant’s certi-ficate-fee cannot be justly made a charge to be borne byordinary assurance companies.... Certificate-fees, therefore,ought to be paid, and they should be paid by those whodirectly require them-viz., the parties who propose to as-sure."

The remedies which Dr. CHRISTISON would propose, are,that medical fees should be relinquished altogether in assu-rances for small sums; that the fees should in ordinary casesbe collected by the companies from their clients, and paidover to the medical men; but that in cases in which the life

may be rejected by the offices, the certificate-fees should bepaid by the company.Now, we join issue with Dr. CHRISTISON on the most impor-

tant point which he discusses. With a singular want of logic,the worthy professor admits that the certificate fee is of

value to both parties, to the assurer and to the company,yet he proposes that the expense, for whet he admits to be

a service to both parties, shall be borne by one ’ alone.He admits that the benefit is mutual, but would make the

payment altogether one-sided. If we were inclined to admit

the premises of Dr. CHRISTISON, it should follow, in commonhonesty, that the expense of the certificate - fee, since it

benefits both assurers and directors, should be borne equallyby both. If Dr. CnRiSTisoN had faith in his own reasonings,he should at least divide the payment of the fee.But we maintain, in direct opposition to Dr. CuRisTisoN, that

in "those assurance companies which divide the profits, notamong the assured, but among the shareholders," the benefitof the medical certificate is more direct to the company thanin almost any other case. No doubt life assurance is a

benefit to the assurer, but it, the business, is still more

a benefit to the company, consisting of the directors andshareholders. It is well known, that in consequence of

the large profits, the directors get good salaries, the share-holders large dividends, and that the shares bear largepremiums. When we hear of millions being accumulatedas the profits of life-assurance business, it is idle to

say that the great profits do not fall to the companies. In life

assurance the best chances are kept by the company. The

modes in which assurance offices generally get business,practically give the lie to the pretence that life assurance is

not profitable enough to the directors and shareholders ofproprietary companies. Those companies especially are theywhich offer liberal commissions to agents who bring business.As we write, we have before us the receipt for the annual

policy on a life insured in a proprietary office some yearssince, at the age of thirty-four, for .61000. The annual pre.mium is ’26 10s. This office is one that refuses to pay me-

dical fees, but pays the ordinary commission to solicitors and

agents. On this policy, ten per cent. on the premium was paidto the solicitor through whom the assurance was effected forthe first year, and five per cent. for every succeeding year. The

probable mean duration of a healthy life at thirty-four years of

age,according to the calculations of Mr. Farr, is thirty-one years.Supposing the assurer to live the average time of a person in

health, the solicitor will have received no less a sum thanoC42 8s., besides interest; while the paltry single payment ofael Is. to the medical referee was refused! The medicalreferee wrote a responsible report. Positively, the only troubleincurred by the solicitor was in writing a letter to the secre-tary, to inform him that the party in question was about toinsure in the - Office, on his recommendation. Is this

justice ? We confess to some astonishment that insuranceoffices should find any apologists in their resistance to whatappears to us the simplest point of honesty. It is from a con-

sideration of these and similar circumstances that many me-

dical men now refuse, as a matter of honour, to receive anyfees from assurers. But in this we think they are wrong. Weanticipate that Dr. CHRisTIoON’s arguments will have little

influence with those who have studied the subject in all its

bearings.We are not moved by Dr. CuBisTisoN’s sneers at the medical

press for agitating this subject. Corporate faith is so dull, thatwe question if life assurance companies would ever have troubledthemselves about the payment of medical men, unless we had

thoroughly agitated the matter, and forced it upon their notice.Nay, we question if Dr. CHRISTISON himself would have made itthe subject of an article. We find our reward in the steady

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support of the profession against the illiberal offices, and in the

list, augmenting almost weekly, of assurance companies which

pay the fee for medical reports. The Post-Office Directoryfor 1850 gives a list of 102 Life Offices. By referring to ourown weekly list, our readers will perceive that 48 offices, or

very nearly half, have come over to the side of honesty andliberality. The paying offices include, too, many of the mostrespectable offices in existence. Dr. CHITISTISON wonders that

the medical advisers of life offices do not come forward, andendeavour to arrange the points in dispute between the pro-fession and the companies. We wonder likewise; and weshould be delighted to see them stirring in such a praise-worthy duty, (a. duty they should have thought of long ago,)though there is but one settlement claimed by the profession,and one only which it will accept.

M. TRIERS, speaking of the great arrangements of Napoleon,during the first Polish campaign, says, that in ordinary histo-ries of war, we see only armies completely formed, and readyto enter into action; but it can scarcely be imagined whatefforts it costs to bring the armed man to his post equipped, fed,trained, and lastly, cured, if he has been sick or wounded. In

this enumeration, M. TRIERS has omitted the care necessary topreserve health, and to prevent sickness-the greatest andmost important branch of our profession, although as yet butimperfectly cultivated and understood, in civil life especially.This branch has been properly designated State Medicine; andit is to its practical application, in so far as the science is nowunderstood, that we owe the present health of our fleets andarmies.

All the difficulties enumerated by M. TRIERS are, he says,increased, in proportion to the change of climate, or the dis-tance which the army moves from the point of departure.Most generals and governments neglect this kind of attention,and their armies melt away visibly, as did ours at Walcheren,Rangoon, and in China. Those only who practise them withperseverance and skill find means to keep their troops nunie-rous and well disposed.With the " difficulties" here spoken of, our statesmen and ’’

civilians have never grappled, and they are up to this hour in-

capable of appreciating a tithe of them. But our generals,colonels, surgeons, staff and regimental, and commissaries,all who have any experience in war, are very conversant withdifficulties which often overwhelm them. Not so, however,the official sitting at his desk. There are no difficulties in

using pen, ink, paper, pounce, and red tape. The whole thingis done at once; and there end all his difficulties.We hope we have, on recent occasions, said enough to show,

that into the hands of dilettantes the medical department ofthe army should on no account be placed; and there is oneinan in England, whose voice should be raised against thisgreat public injury-Sir JAMES M’GRIGOR. Against the

dimbles of offices already over-worked and over-crowded,and against the fingers of dilettantes, his honest protest shouldbe recorded. His official career is closed, and he ought per-sonally to have nothing more to seek or to expect from menin power. He is therefore completely independent, and freefrom official influences.In the very probable event of an inquiry into the subject in

Parliament, we hope that a protest from so becoming a sourcemay be found for the enlightenment of our representatives.

A personal experience and knowledge of the subject, such asare possessed by no other man, ought to render a formal dis-claimer from Sir JAMES M’GRIGOR irresistible.

The past to this distinguished officer is one of most honour-able contemplation; the present is an equally honourable re-

tirement ; but there is, we hope, a great future for the profes-

sion to which he belongs, and to the department over whichhe so long and so honourably presided.

To be the means of setting this department to rights, for thebenefit of the soldier, were " a crowning victory" worthy ofSir JAMES M’GRIGOR,’S whole career. From no other man

could such a service come with so much grace; from no other

man could a protest against ignorant mismanagement comewith such effect.

IT gives us considerable regret to observe the small numberof candidates who have passed the examinations for the de-gree of bachelor of medicine at the University of London,which are just concluded. At this, the annual examinationfor the degree, only twelve gentlemen have successfullystriven for the honour. We cannot but look on this circum-

stance as one of great significance to the medical interests ofthe University. Considering the high esteem in which thedegrees of this University are held, and the high character ofthe examinations, and considering the large number of highly-educated young men who are to be found in the various medical

schools and colleges throughout the kingdom, there must existsome peculiar circumstances which tend to diminish the

number of aspirants for the London degrees. King’s College,with its large body of students, produces but one bachelor inthe present year; and Guy’s Hospital sends another. The

following hospitals and schools have failed to send forth asingle M.B.--namely, St. Bartholomew’s, the London HospitalSt. George’s, the Middlesex, and Charing-Cross. Of the pro-vincial schools, Manchester has contributed two bachelors; butwe miss altogether, in the pass lists, this year, the schools of

Liverpool, Queen’s College, Birmingham, Bristol, Sheffield,Hull, and Newcastle. As we have observed, there must be somecause for the falling off in the number of graduates. We canattribute it, we are bound to say, to nothing but the wretchedand mistaken policy of the Senate in refusing all Universityrights to the graduates. In accordance with the principlesupon which the University was founded, the graduates haverespectfully sought for some change in its constitution

which should give them a real existence within its bosom.The natural boon and just right which they craved, have,however, been denied them. The University of London

claims to remain a despotic body, while royal commissions areissuing for the reform of the old Universities of Oxford andCambridge. London cannot remain as she is, and we fear,without some provisions which shall enlist the affection andsupport of her own graduates, the medical section of theUniversity at least, will become less and less powerful.The graduates respectfully asked for convocation; all theyreceived was a public day, on which they were at libertyto decorate themselves in caps and gowns, and have the

barren honour of meeting their chancellor and the senate.The stimulus given by the public day to the interests of theUniversity may be estimated from the fact, that the first ofthese celebrations was held last year at King’s College, and

, the sult is a solitary bachelor from King’s College medical

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department. We trust such indications will not be lost onthe senate. Let that body advocate a constitution for the

University; a legitimate development of the principles offreedom upon which it was founded, and there will, we ven-ture to say, be no lack of graduates. Without these conces-

sions, the University cannot become great in the departmentof medicine, which once promised to be, and which might stillbe made, its chief boast and support.

ASYLUM FOR THE INDIGENT INSANE OF THEEDUCATED CLASSES.

To the Editor of THE LANCET.

SIR,—I have perused, with great satisfaction, in THE LANCETof Oct. 19, the remarks of Dr. Conolly, and his " Suggestionsfor the Establishment of an Asylum for the Indigent Insaneof the Educated Classes," and those who have had opportuni-ties of judging will not hesitate in corroborating the state-ments made in that letter, as to the privations endured by theaffiicted of those classes, and which not only press heavilyupon the unfortunate sufferers, but also upon their familiesand connexions, entailing, in most instances, a great amount iof suffering, poverty, and distress. ’

For many years past, this state of matters has given muchconsideration and anxiety to benevolent and philanthropicmen, and many means have been devised for its amelioration,and attempts have been made, which, in some instances, havebeen attended with success, but which fall far short to meetthe demands made upon them. Still, public attention hasbeen drawn to the want of, and the necessity of supplying,such accommodation.

In accordance with these feelings, the trustees of the Man-chester Royal Lunatic Hospital decided to act, when an op-portunity was given them, four years ago, of rebuilding theirinstitution, and, as far as was practicable, adapting it for

carrying out the most enlightened and humane methods oftreatment which human foresight and experience could devise.These, during the eleven months the hospital has been opened,have been practised, and the success has been most favourableand satisfactory.The surplus of revenue obtained from those patients who

pay the higher rates of board, together with the annual sub-scriptions raised in Manchester, and by parties at a distance,are thrown together into one fund, called the " BenevolentFund," out of which such allowances are made (by a reductionof the rates of board) as, upon application to the committee,appears to be necessary to meet the wants of the case.

Hitherto, no one has been admitted gratuitously, but verymany have been admitted at terms varying from one-third totwo-thirds of the usual rates.

By the existence of this fund, the trustees are enabled togive not only the best method of treatment, and the other ad-vantages of a public institution, to those who can afford to pay,but to those of the middle and educated classes, who cannotdo so, a direct relief and benefit.In conclusion, I beg to say, that a " healthful, cheerful,

asylum for the insane of the educated classes, (indigentas well as wealthy,) furnished with every appliance that ex-perience or ingenuity could suggest, for the comfort and im-provement of patients of this particular description, and theterms of which are moderate," is already in existence in theneighbourhood of Manchester; and that, however much thewants of such an institution may still be felt in many of ourlarge towns, in this matter Manchester has done, and is doingher duty, in having provided an establishment for the indigentas well as the wealthy insane of the educated classes.

I am, Sir, your most obedient servant,TnoMAs DicKsoN, L.R.C.S. E., Med. Super.

Manchester Royal Lnnatic Hospital, Cheadle,near Manchester, Nov. 6, 1850.

]ROYAL FREE HOSPITAL.—Charitable bequests tothis institution: of:l000, free of legacy duty, from the late Mr.Jeremiah Olive, of York-terrace, Regent’s-park; £500 froma public body; and of:l00 from a deceased clergyman. Weunderstand the hospital will realize only of:600 of the .E1000left to it by the late Mr. Cuthbert, the estate affording butsix-tenths of the money bequeathed.

THOMAS DICKSON, L.R.C.S. E., Med. Super.Manchester Royal Lunatic Hospital, Cheadle,

near Manchester, Nov. 6, 1850.

Medical News.

ROYAL COLLEGE OF SURGEONS.—The followinggentlemen, having undergone the necessary examinations forthe diploma, were admitted members of the college, at themeeting of the Court of Examiners, on the 8th inst.:-

ALLEN, PATERSON, Waltham Abbey, Essex.ASPINALL, THOMAS, Over Darwen, Lancashire.BUTTON, ARTHUR MICHAEL, Bury St. Edmunds, Suffolk.HEATH, RICHARD, London.LARCOMSE, SAMUEL SLEE, Langport, Somerset.M’MULLAN, CHARLES CLARKE, Belfast.MopRis, TREVOR, Chepstow, Monmouthshire.PRESTON, ANTHONY TAYLOR, Manchester.SYKES, JOHN, Mile End-road.WILLIAMS, JOSEPH, Portloe, Cornwall.

At the same meeting of the court, Messrs. JoHN WARD andCHARLES SAYER HuGO passed their examinations for navalsurgeons; these gentlemen had previously been admittedmembers of the college, their diplomas bearing date, respec-tively, May 8,1846, and March 12,1847.THE FELLOWSHIP.—The following were the ques-

tions submitted to the junior candidates for this distinction,at the examination last week at the Royal College of Sur-geons:—

1. Find the interest of X324 8s. 4d. for four years ninemonths, at four per cent. per annum.

2. If 400 men, working eight hours a day, are requiredto do a piece of work in thirty days, find how many menwould be required to do the same in sixteen days, workingten hours a day.

3. Required the number, consisting of two digits togethermaking ten, to which, if thirty-six be added, the digits will beinverted.

4. Prove that the three angles of any triangle are togetherequal to two right angles.

Also, that the exterior angles of any polygon, formed byproducing all its sides, each in one direction, are togetherequal to four right angles.

5. Prove that a straight line drawn at right angles to thediameter of a circle, from the extremity of it, falls withoutthe circle.

6. Prove that there is equilibrium on the inclined planewhen the power is to the weight as the height of the plane toits length, the plane being smooth, and the power acting in adirection parallel to the plane.When the plane is rough, find the most advantageous direc-

tion in which the power can act, according as the object is toprevent a body from sliding down the plane, or to drag thesame body up.

7. Prove that in every rigid body there exists a point atwhich the whole weight may be supposed to be collectedwithout effecting the conditions of the body’s equilibrium.What is this point called ? In what sense must the propo-

sition be understood, when the point in question falls outsidethe body ?

8. Prove from elementary principles that the pressure sus.tained by a given small area in the side or bottom of a vesselcontaining water, depends only on the depth of the area be-low the surface of the water, and not on the form or dimensions of the vessel.

9. Explain the action of the siphon.What would take place if a siphon in action were placed

under the receiver of an air-pump, and the air exhausted ?10. Enunciate the laws of the reflexion and refraction of

light.11. Explain the construction and functions of the eye, in so

far as it may be regarded merely as an optical instrument.Explain the nature of the defects of long sight and short

sight, and the reason why they can be corrected by the use oflenses.The candidates were also called upon to translate into

English portions of the works of Cicero, and of the OdysseaHomeri, &c.

: The professional examination of the candidates will take) place on Tuesday and Thursday, the 3rd and 5th of December

next.

; VALEDICTORY COMPLIMENT TO DR. HENRY DAVIES.- A few of this gentleman’s attached friends met on Monday

) last, at the Hanover-sqnare Rooms. Sir C. M. Clarke kindlytcame to town to take the chair. There were also present Sir, Charles F. Forbes, Drs. Locock, Bright, Lee, Cape, J. Clarke,