212 INSURANCE 



insurance depends the subsequent mortality experience. With the 

 immense development of life insurance in all countries has gone the 

 advancement of insurance medicine, from the crude methods of the 

 London Equitable Society in 1762, when a health certificate was 

 required bearing the signatures of two witnesses, one of whom had 

 to be a physician, to the uniform blank for medical examiners pro- 

 posed a few years ago at the International Congress of Medical 

 Directors at Brussels. To-day there are few general practitioners 

 who have not, at one time or another, rendered services to life insur- 

 ance companies in the examination of proposed risks, and the number 

 of physicians regularly employed by these companies is constantly 

 increasing. 



Insurance medicine has a large and valuable literature of its own, 

 to which constant additions are being made as the result of special 

 researches and increasing experience in a vast field with rare oppor- 

 tunities for the development of expert skill. The highly scientific 

 character of this work is due, in a large measure, to the close relation 

 of cause and effect. Errors of judgment in physical diagnosis, or 

 the omission to note symptoms of incipient diseases, are certain to 

 be followed by an unfavorable mortality experience. While errors 

 of judgment on the part of the general practitioner outside of hospi- 

 tals as a rule remain unknown, such errors on the part of the medical 

 examiner are a matter of permanent record and comparatively easy 

 discovery. 



The neurology of the future will render even greater service to 

 insurance science than has been possible in the past. Brain diseases, 

 as a class, are unquestionably on the increase in this and other coun- 

 tries, and there is some trustworthy evidence to support the view 

 that insanity is increasing at a perceptible rate from year to year. 

 No extensive statistical investigation has been made into the alleged 

 increase in insanity, which may be attributed to the complex nature 

 of the problem, the difficulty of exact definition, the undefined border- 

 land of sanity and insanity, and many other causes; most of all, 

 however, to the'confusing effect of the improvement in the recovery- 

 rate and the decreasing death-rate in state and private institutions. 

 Actuarial skill can be of great service to the medical profession in 

 determining this question in much the same manner as in the inves- 

 tigation of the alleged increase in cancer by the eminent actuary, 

 Mr. George King, and Dr. Arthur Newsholme. 



Suicide may also properly be referred to here as one of the problems 

 of neurology and one of great importance to life insurance companies. 

 Suicide is on the increase in this and other countries. For illustra- 

 tion, in American cities the rate per 100,000 of population has 

 changed from 12.0 during 1890 to 18.4 during 1903. Qualified inves- 

 tigations into the probable causes responsible for this much-to-be- 



