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Special Articles.ALL-SICKNESS INSURANCE RATES FOR

WOMEN PROPOSERS.

THE excess of sickness among working womenover corresponding groups of men in analogousoccupations has long puzzled those who would fainbelieve that it is a myth invented by anti-feministsto keep women out of the labour market. As far asthe class of teachers goes, Dr. Letitia Fairfield, in anaddress to the London Association of the MedicalWomen’s Federation, which is published on p. 5of our present issue, confirms the fact that themorbidity-rate is much higher among women thanamong men teachers. If confirmation were wantedof the circumstance it could be sought in the verylimited facilities offered by insurance companies towomen to take out sickness policies. The followingcompanies do not entertain proposals from womenfor policies which include the risk of all sickness :Royal Insurance Company, Scottish Union andNational Insurance Company, Yorkshire InsuranceCompany, Employers’ Liability Assurance Corpora-tion, Cornhill Insurance Company, Excess InsuranceCompany, London and Liverpool and Globe InsuranceCompany, Ltd. Certain companies offer accidentand sickness insurance to women, but only to thoseengaged in a profession or occupation. Others limitpolicies still further, accepting only unmarriedprofessional women. An analysis of some of thepolicies open to women, which does not pretend to beeither exhaustive or complete, is set out below. Onlypolicies which include all sickness are dealt with andonly the more important details are included.

Eagle, Star, and British Dominions Insurance Co.Since 1919 policies have been issued to women.

Women between 16 and 60 actively engaged in abusiness or profession can insure against all accidentsand all illnesses under Table 3 at an annual premiumof 22, .84, or 28. For the last-named sum the followingbenefits may be obtained : In the event of accidentcausing (a) death, 2500 ; (b) loss of one hand, foot,or eye, 2250 ; (c) permanent total disablement (otherthan loss of limb or limbs), 23 a week for 52 weeks,afterwards 250 a year ; (d) loss of both hands, feet,or eyes ; or one hand and one foot; or one hand orone foot or one eye, an annuity for life of 250 ;(e) temporary total disablement, per week up to52 weeks, .83 ; (f) in the event of illness or diseasecausing total and irremediable blindness, or per-manent general paralysis, E3 a week for the first26 weeks of disablement, followed by an annuity ofz50 ; in the event of illness or disease causingtemporary total disablement (with or without con-finement to the house), 23 a week, payable for26 weeks. To obtain the same benefits and certainadditional ones, of which perhaps the most appreciatedmust be the benefit named under (g) for 52 weeks asagainst 26, a male proposer in Class I. would payan annual premium of only £ 6-that is, three-quarters ’,of that paid by a woman engaged in clerical, Ieducational, domestic, and superintending duties, orby shop assistants not using machinery. Dancingmistresses, dressmakers (working), gardeners, healthvisitors, and shop assistants using hand machinerypay 10 per cent. extra for this policy, and car-drivers,farm hands, masseuses, nurses, and policewomen 20 percent. extra. Marriage on the part of a workingwoman does not affect her policy, but death, loss, ordisablement resulting from child-bearing or fromvenereal disease are excluded. Women not activelvengaged in a business or profession can be insuredunder Table 3A, paying the same annual premium, 28.The risks of accident are evidently considered less

great : for example, the death benefit is <&bgr;600 insteadof .8500, and for temporary total disablement following

accident 24 instead of 23 is payable for 52 weeks.Under Table 3A for temporary total disablement dueto disease, with confinement to the house, 24 a weekis paid up to 26 weeks ; without confinement tohouse, 22 a week up to four weeks.

Friends’ Provident and Century Life Office.Insurance under Table 2 is offered against accidents

and all illnesses to women engaged in a business orprofession. Policies are issued only to single womenand cease upon the marriage of the insured. Thebenefits obtainable for an annual premium of 6are (a) death by accident, 2500 ; (b) loss of two limbs,or of both eyes, or of one limb and one eye, byaccident, 2500 ; (c) loss of one limb or one eye byaccident, 2250 ; (d) temporary total disablement byaccident, 23 a week for 52 weeks ; (e) temporarypartial disablement by accident, up to 52 weeks,21 a week ; (f temporary total disablement by illnessof any kind involving at least one week’s disablement,

&pound; :3 a week up to 26 weeks ; (g) convalescence, 21 10s.a week up to four weeks. The premiums quoted applyto proposers between the ages of 18 and 40 engagedin clerical, educational, commercial, and the likeoccupations. The company issue a

" minimum cost "policy to male proposers for an annual premiumof 24 10s. a year-again three-quarters of the premiumpayable by women. For this (a) the sum to bereceived in the event of death resulting from anaccident is <E500 ; (b) for total disablement due toaccident or sickness of any kind a sum of 24 a weekis paid, up to a cumulative period of 26 weeks inrespect of each accident, or in case of sickness toa cumulative period of 26 weeks in respect of allillness occurring in any one year of insurance ?(c) medical and surgical fees are paid up to a sumequivalent to one-sixth of the benefit payable inrespect of temporary total disablement.

Ocean Accident and Guarantee Corporation.Women between 18 and 50, married or unmarried,

who are engaged in a profession or business andincurring average risk can for a premium of S9 9s.a year obtain the following benefits : In case ofaccident causing death, or loss of hands or feet or eyes,or of one hand or foot and one eye, or of one handand one foot, 2600 ; loss of one hand or foot or eye,2300 ; total disablement, per week, .S3 ; partial.disablement, per week, 15s. Permanent total dis-ablement not otherwise compensated : For the first52 weeks of disablement, per week, .S3 ; for thefollowing ten years an annuity of S50, which annuityis also payable in the case of total and irremediableblindness, or permanent paralysis of two limbs, notcaused by accident. Total disablement caused bycertain specified illnesses, per week, S3 ; total dis-ablement for not less than seven days caused by anyother sickness, per week, S3. Death or disablementconsequent upon pregnancy and childbirth is excluded.The weekly compensations are payable up to 52 weeksand confinement to the house is not exacted.The all-sickness and accident policy offered to

male proposers by this company gives exactly parallelbenefits for an annual premium of 26 6s. to those inClass I. occupations (including medical practitioners).The sole difference in the prospectus appears to bethat the limit of age for male entrants is 55(against 50). The difference of premium is as twoto three between males and females in this company- that is slightly less favourable to the females thanin some of the others, but, on the other hand, noextra benefits are offered to the males.

London Guarantee and Accident Company.This company offers all-sickness and accident

insurance to women engaged in professional, com-mercial, and industrial life. The benefits include thefollowing : 225 on death from accident or sickness ;an annuity of S50 on permanent disablement throughloss of two limbs or two eyes, or on permanentloss of sight of two eyes by disease, or on

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permanent paralysis of two limbs by disease ; 2500on loss of one limb and one eye following accident;j6250 on loss of one limb or one eye by accident ;ae3 a week on temporary total disablement, andil a week on temporary partial disablement, causedby accident, in each case up to 52 weeks in respectof any one accident; 23 a week on temporary totaldisablement, caused by sickness, without confinementto house (up to four weeks) ; E3 a week on temporarytotal disablement caused by sickness with confine-ment to house (up to 26 weeks for any one sickness) ;23 a week during convalescence from sickness (up tofour weeks). For these benefits women in Class I.(engaged in professional, educational, and clericalduties, and non-hazardous shop risks) pay an annualpremium of 26 10s. Death, loss, or disablementthrough accident or sickness associated with or

incidental to child-bearing is not covered. Policiesare renewable from year to year by the joint consentof the policyholder and the company, but insuranceceases when the policyholder reaches 55. The age-limit for entrants is 20 to 45. The personal accidentand sickness insurance offered to male proposers(Table 4 " Standard ") differs so greatly in thedetails of benefits offered that it is not easilycomparable.

Law Accident Insurance Society.This company offers to women, for selected lives

only, policy W.3, covering accidents and all sickness.The benefits obtainable for women entering betweenthe ages of 18 and 50, and ceasing when the assuredreaches 60, are as follows : Death by accident, 2500 ;loss of two limbs or two eyes, or one limb and one eye,JE500 ; loss of one limb or one eye, 2250. Temporarytotal disablement by accident or sickness (a) involvingconfinement to house, weekly 22 ; (b) without con-finement to house, weekly 21. Temporary partialdisablement by accident, weekly 10s. The weeklycompensation is payable up to 52 weeks for accidentsand up to 13 weeks for sickness. For these benefits

women engaged in non-hazardous business or profes-sional duties pay a premium of ;B4 10s. per annum,and women not engaged in any business or professionpay 26 per annum. Policies are annual contracts.Accidents or illnesses associated with or incidental tochild-bearing are not covered.

Medical Sickness Annuity and Life Insurance.Permanent sickness and accident policies are issued

to women medical and dental practitioners, subjectto the following special conditions : (1) the age atentry must not exceed 35 next birthday ; (2) thoseholding whole-time salaried appointments may onlytake policies under Table A3 (Women), excluding firstthree months illness, or A3/6 (Women) excludingfirst six months illness. Under Table A (Women)a doctor or a dentist not excluded by this conditionmay, for example, insure 26 6s. a week for the first26 weeks of total incapacity and 93 3s. a week there-after. up to the age of 65, for an annual premiumof B15 8s. if her age next birthday is 30. Sicknessbenefit is payable from the first day of incapacity.Confinement to bed, bedroom, or house is notexacted. The benefits granted include the risk ofmarriage, but exclude all sickness benefit from thetime of pregnancy to three months after the termina-tion of pregnancy, and no premium is payable forsuch period of exclusion. In the event of the assureddiscontinuing practice for any reason other thanincapacity all liability of the company under thepolicy ceases.The sickness and accident benefit policy (Table A)

offered to male doctors and dentists is comparableas regards benefits received. A man whose age is30 next birthday would, however, obtain thesebenefits for an annual premium of 210 18s. 6d., andthe holding of a full-time appointment does notdisqualify him for this policy. Moreover, the age ofentry for male proposers may be as late as 55 nextbirthday, and there is no clause providing for thecessation of liability under the policy if the proposer

ceases practice for any reason. Male proposers mayalso insure under Table A2, receiving the same benefitas under Table A, with quinquennial rebate of 5 percent. of all premiums paid during such period if noclaim has been made under the policy during thesaid quinquennium. This alternative is not offeredto female proposers. The special feature of thissociety’s all-sickness and accident contracts for bothsexes is that once a policy has been granted it cannotbe discontinued by the society except on account offraud, non-payment of the premium, or permanentresidence abroad.

Conctusion.

It seems quite possible that the caution exercisedby those companies who refuse to entertain proposalsfrom women, even at high rates, is excessive. Therecan be but few figures available on which the sicknessrate has been worked out, and it is probable that theactuarial calculation of the risk from publishedstatistics is not based on figures which give a truepicture of the health of the modern working woman.It should be easy to collect information as to themorbidity-rate in nurses at general hospitals. Thisis a most strenuous occupation, but we believe thatsick leave is relatively rare not only during the fouryears’ training, but also anuong staff nurses andsisters in the permanent service of the hospitals.It-is even possible that were women encouraged toinsure against sickness the morbidity-rate mightimprove, since the dread of falling ill is often at leasta contributory cause of bad health. We have set outin some detail the facilities which are open to womenin the hope that they may be useful to practitionerswho wish to provide against this source of anxietyamong their patients. It seems likely that if a largenumber of policies were taken out it might be foundpossible to drop the rates, for at the moment theymust be largely speculative. Further investigations,similar to that carried out by Dr. Fairfield, mayyield valuable results.

SOME RECENT STUDIES OF DYSENTERY.

Cultivation of the Amceba.MANY problems, bacteriological, clinical, attd

therapeutical, still remain to be solved in dealingwith the various forms of dysentery. Recent work,particularly on the bacteriological aspect of. theproblem, has brought to light some interesting facts.Drs. W. C. Boeck and J. Drbohlav have describedthe cultivation of the Entamaeba histolytica. Thecultivation of this organism has only once: before beencarried out successfully by Culter in 1918, and hiswork has been severely criticised and not hithertoconfirmed. The initial cultivation of the E. histolyticaby Boeck and Drbohlav was achieved by accident.A small amount of faeces was inoculated into twotubes of Locke egg-serum medium as a routineprocedure in a study of intestinal flagellates, and onexamination of the cultures a few days later manyamoebae were found. These were identified as

E. histolytica, and further culture experiments showedthat the best media for the purpose were Locke egg-serum and Locke egg-albumin. An initial alkalinereaction of pH 7-2 to 7’8 is necessary and the optimumtemperature is 37&deg; C. The fact that non-parasiticsaprophytic amcebae occasionally occurring in thefaeces can readily be grown in artificial media madeit very necessary to test the pathogenicity of theorganisms cultivated by Boeck and Drbohlav, andthese authors therefore carried out a series of animalinoculation experiments with kittens. Rectal inocula-tions of amoebse direct from an infected patient andalso from cultures produced typical dysentery,ulcerative colitis, and hepatic abscess in these animals.The virulence of the organisms was not affected byprolonged cultivation.

1 Amer. Jour. of Hyg., 1925, v., 371.