view the question under annotation herein arises as to the effect of a declaration of an emergency without a declaration intended to free the act from the referendum. There are two general theories as to the effect of the legislative declaration of an emergency in passing an act, without enacting the safety clause to free it from the operation of the referendum. According to one view, the declaration of an emergency without the enactment of the safety clause is ineffectual to cause the act to go into effect at once, but such act does not go into effect until the expiration of the time fixed for the filing of referendum petitions. Arkansas Tax Commission v. Moore (1912) 103 Ark. 48, 145 S. W. 199; RE SHOUP (reported herewith) ante, 526; Birdzell, J., and Grace, J., in State ex rel. Langer v. Crawford (1917) 36 N. D. 385, 162 N. W. 710, Ann. Cas. 1917E, 955; Sears v. Multnomah County (1907) 49 Or. 42, 88 Pac. 522; State ex rel. Richards v. Whisman (1915) 36 S. D. 260, L.R.A. 1917B, 1, 154 N. W. 707, overruling State ex rel. Lavin v. Bacon (1901). 14 S. D. 394, 85 N. W. 605. Or after its approval by the people if the referendum is invoked. Arkansas Tax Commission v. Moore (Ark.) supra. In Arkansas Tax Commission v. Moore (Ark.) supra, the legislative act in question concluded as follows: "This act shall take effect and be in force from and after its passage." It seems this was treated as the declaration of an emergency, but it was also urged that by this declaration the legislature thereby determined that the act in question belonged to the class excepted from the operation of the referendum. This contention was denied, and the court, after stating what is quoted in the reported case (RE SHOUP, ante, 526), continued: "It was not intended that an act passed by the legislature should take effect conditionally, and subject to the referendum, and continue in force from its passage if the referendum was not ordered, or that an act once in force should be suspended by the referendum till its approval by the people. The concluding provision of the Revenue Act and the others fixing dates for the performance of certain things before the act could become operative under the constitutional amendment, unless it comes within the exception, do not manifest an intention upon the part of the legislature to put it into effect as a law necessary for the immediate preservation of public peace, health, or safety, and were not meant for and are not a legislative determination that the act should take effect as such; and it could not, therefore, take effect until ninety days after the final adjournment of the session of the legislature at which it was passed, or after its approval by the people, if the referendum is revoked." It is stated in Sears v. Multnomah County (1907) 49 Or. 42, 88 Pac. 522, that the view that an act may take effect under a general emergency clause and yet be subject to the referendum is clearly contrary to the intent of the amendment, and would produce disastrous results. It has been held that the legislature cannot constitutionally confer upon a county the referendum as to acts that have taken effect, since that involves the power of repeal. Meade v. Dane County (1914) 155 Wis. 634, 145 N. W. 239. It is the view of some of these courts that the general constitutional provision relating to emergency legislation is amended by the provision relating to the referendum; and that emergency legislation is confined to legislation of the character specified in the latter provision. This is the view of Birdzell and Grace, JJ., in State ex rel. Langer v. Crawford (1917) 36 N. D. 385, 162 N. W. 710, Ann. Cas. 1917E, 955, Grace, Judge, thus expresses his thought: "Section 67 [the constitutional provision relating to general emergency legislation] as it originally stood and before amended and in part repealed is entirely inconsistent with the later constitutional amendment thereto contained in the referendum law. Either § 67 in so far as it is inconsistent with the referendum law must fall, or the later express will of the people in the referendum law must fall. They are inconsistent. They cannot stand together. One or the other must be inoperative. There cannot be two emergency clauses." Grace, Judge, then refers to the limitations placed upon the enactment of emergency legislation by stating that the "people in their sovereign capacity amended § 67, so as to meet all such emergencies, and they said that the only emergencies that would necessitate the immediate enactment of a law would be such necessity as would affect the health, peace, or safety of the people of the state." That the general constitutional provision relating to emergency legislation is amended by the provision relating to the referendum is the view, also, of the court in Sears v. Multnomah County (1907) 49 Or. 52, 88 Pac. 522. This is the view also of State ex rel. Richards v. Whisman (1915) 36 S. D. 260, L.R.A.1917B, 1, 154 N. W. 707, overruling State ex rel. Lavin v. Bacon (1901) 14 S. D. 394, 85 N. W. 605. This seems to be the theory of Bennett Trust Co. v. Sengstacken (1911) 58 Or. 333, 113 Pac. 863. Other courts hold that the legislative declaration that an act shall go into operation immediately is effective to put the law into immediate operation notwithstanding there is no declaration intended to free it from the referendum. State ex rel. Collins v. Jackson (1919) 119 Miss. 727, 81 So. 1; Bruce, Ch. J., and Robinson, J., in State ex rel. Langer v. Crawford (N. D.) supra. The fact that the law is in effect is held, however, not to prevent the filing of a referendum petition, but it is in effect until such a referendum petition is filed, in which event its operation is suspended and its fate as a law is determined by a vote of the people. State ex rel. Collins v. Jackson (Miss.) supra. Bruce, Ch. J., in State ex rel. Langer v. Crawford (N. D.) supra, is of the opinion that an emergency act is subject to a referendum although it takes immediate effect, but no opinion is expressed whether the act is suspended by the filing of a referendum. petition or only by an adverse result at the referendum election. Robinson, J., expresses no opinion whether an act put into immediate effect is subject to the referendum. The court in Arkansas Tax Commission v. Moore (1912) 103 Ark. 48, 145 S. W. 199, supra, takes the view that in providing for the referendum it was not intended to provide for a referendum upon acts that had already gone into effect, while the opposite view is taken by the Mississippi court. The Constitution of Mississippi was regarded as persuasive of this question by the court in State ex rel. Collins v. Jackson (Miss.) supra. It expressly provided that in case of laws necessary for the immediate preservation of public peace, health, or safety, the legislature might declare such to become immediately effective, and that "if a referendum petition is filed against such emergency measure, such measure shall be a law until it is voted upon by the people, and if it is then rejected by a majority of the voters voting thereon, it shall be thereby repealed." The court states that a law passed under this provision is of a higher nature than a law otherwise passed, in that it becomes effective immediately, and cannot be suspended by the filing of referendum petitions, but remains in force and effect until an adverse vote of the people upon it, in which case it is repealed; while in case of other laws that have been put into immediate effect, under the general constitutional provision, the law is suspended by the filing of the referendum petition. A dissenting opinion by Ethridge, J., takes the view that the constitutional provision relating to the referendum clearly implies that the act is not operative in any of its parts by the filing of a petition for referendum. Apparently this question was involved in Keator v. Whittaker (1912) 104 Tex. 628, 143 S. W: 607, but the facts are not sufficiently stated in the report of that case to enable the questions there involved to be determined. The emergency declaration, and the declaration intended to free the act from the operation of the referendum, seem not to be distinguished under the Maine Constitution, which contains an emergency clause in connection with the initiative and referendum as follows: "Section 16. No act or joint resolution of the legislature, except such orders or resolutions as pertain solely to facilitating the performance of the business of the legislature, at either branch, or of any committee or officer thereof, or appropriate money therefor or for the payment of salaries fixed by law, shall take effect until ninety days after the recess of the legislature passing it, unless in case of emergency (which, with the facts constituting the emergency, shall be expressed in the preamble of the act), the legislature shall, by a vote of two thirds of all the members elected to each house, otherwise direct. An emergency bill shall include only such measures as are immediately necessary for the preservation of the public peace, health, or safety; and shall not include (1) an infringement of the right of home rule for municipalities," etc. In Lemaire v. Crockett (1917) 116 Me. 263, 101 Atl. 302, an act of the state legislature to which was attached an emergency clause, but which violated the provision of the Constitution that an emergency bill should not include an infringement of the right of home rule for municipalities, was held not to take effect until ninety days after the recess of the legislature, thus becoming a nonemergency act, permitting in the meantime the invoking of the referendum, instead of taking effect immediately. The court said that the act itself was valid, but the emergency clause was invalid, and the legislature was expressly prohibited from attaching it, but the two are clearly separable, and the act stands while the emergency provision falls. In Maryland, certain classes of legislation are excepted from the operation of the referendum, and as to these classes the general constitutional provision relating to emergency legislation is held to apply. Beall v. State (1917) 131 Md. 669, 103 Atl. 99. W. A. E. CLINTON C. GAGE V. BOARD OF CONTROL OF PONTIAC STATE HOSPITAL, Plff. in 1. An employer who is not notified immediately of an accidental injury to his employee is liable for his reasonable expenses in procuring medical treatment for the remainder of the three weeks after receiving notice, under a statute making him liable during the first three weeks after the injury to furnish free medical and hospital services and medicine when necessary. [See note on this question beginning on page 545.] -necessity of notice of injury. 2. Ordinarily, to render an employer liable for the expense of medical services rendered an employee under a statute making him liable for such services during the first three weeks after injury, he must be notified of the injury and given an opportunity to select the physician and furnish the needed service himself. - excusing failure to give notice. 3. Notice to the employer which is necessary to render him liable for medical services rendered an injured employee is excused where the injury is of such nature that the delay in giving the notice and awaiting the employer's service will endanger the employee's life. Trial question of fact – emergency requiring prompt medical attention. 4. Whether or not the emergency is such, in case of an injury to an employee, as to justify his procuring medical service without notifying the employer of his injury, where the employer is made liable by statute for the necessary medical service for a specified time after the injury, is a question of fact. CERTIORARI to the Industrial Accident Board to review its award to plaintiff in a proceeding brought under the Workmen's Compensation Act to recover compensation for accidental injuries sustained by him while in the employ of defendant. Affirmed. The facts are stated in the opinion of the court. Messrs. Alexander J. Groesbeck, Attorney General, and Clare Retan, Assistant Attorney General, for plaintiff in certiorari: By the provisions of § 5434 of the Compiled Laws of 1915, defendant was entitled to furnish medical and hospital services if it so desired. Milwaukee v. Miller, 154 Wis. 652, L.R.A.1916A, 7, 144 N. W. 688, Ann. Cas. 1915B, 847, 4 N. C. C. A. 149; Keigher v. General Electric Co. 173 App. Div. 207, 158 N. Y. Supp. 939. Defendant was entitled to notice of plaintiff's injury and a reasonable opportunity to furnish medical and hospital service. Milwaukee v. Miller, supra; Colfax County v. Butler County, 83 Neb. 803, 120 N. W. 444; Parker v. Monroe, 128 La. 951, 55 So. 587; United States v. Sheridan-Kirk Contract Co. 149 Fed. 809; Mallon v. Water Comrs. 144 Mo. App. 104, 128 S. W. 764. Mr. A. Floyd Blakeslee for defendant in certiorari. Steere, J., delivered the opinion of the court: In this case defendant questions the validity of an award of $189 made against it by the State Industrial Accident Board in favor of plaintiff, for medical, surgical, and hospital expenses incurred by him as the result of an accidental injury which he sustained on September 15, 1917, while in defendant's employ. The necessity for such services and the reasonableness of the charges made therefor are apparently not questioned, but it is contended that defendant was entitled under the Employers' Liability Law to notice of plaintiff's injury and need of medical attendance by reason of it, and a reasonable opportunity to itself furnish all needed medical, surgical, and hospital service, before plaintiff could legally secure the same of others at defendant's expense. This contention is based on the provisions of § 4, pt. 2, of the Workmen's Compensation Act (Comp. Laws 1915, § 5434), which is as follows: "During the first three weeks after the injury the employer shall furnish, or cause to be furnished, reasonable medical and hospital services and medicines when they are needed." Plaintiff's injury was a hernia. The facts are practically undisputed, and the case has been adjusted in all other respects by appropriate proceedings before the Industrial Accident Board, based on an agreement in regard to compensation approved by the board. The issue raised is pointedly presented and concisely argued by counsel on both sides, and by them narrowed to the question of whether, under the claimed exigencies shown here, the injured party may, pending reasonable notice to the employer of the necessity for medical and surgical attention, and until the latter after reasonable notice furnishes the same, secure such attention at the expense of the employer. Counsel for plaintiff frankly concedes it inferable from the duty imposed by the statute that in the majority of cases and as a general rule the employer should be entitled to furnish, or dictate where an injured employee shall obtain, the necessary (206 Mich. 25, 172 N. W. 536.) medical, surgical, and hospital attendance, and broadly admits such general rule proper for the protection of both parties, "in order to prevent an unscrupulous physician from exploiting the injury to his own benefit and to prevent, perhaps, a possibility of malingering on the part of the injured employee." But no such evil elements are claimed or suggested as present in this case, and it is urged for plaintiff to be also fairly inferable, from the act as a whole and the particular subject to which the section applies, that the injured party may secure such services at the expense of the employer in exceptional cases involving manifestations of emergency and demanding prompt attention, as in the instant case, and whether such excepting conditions existed is a question of fact for the accident board to determine. Plaintiff's home was on Johnson avenue in the city of Pontiac. He was when injured, and had been for many years, employed by defendant at the Pontiac State Hospital for the Insane, in its building department. On the day of his injury he was working in a tunnel, where it was somewhat dark, and in attempting to lift or carry out some material experienced an injury, the nature of which he did not then apparently understand or localize, but which caused him to suspend work, telling his "boss," who was the superintendent, that he was sick and had to go home, which he did, arriving there between 9 and 10 o'clock, as his wife testified, not yet knowing what ailed him. Shortly before noon he discovered that he was suffering from a hernia. During the day he experienced increasing pain and grew weaker. His wife summoned their family physician, Dr. Fox, who called shortly after supper, and found plaintiff suffering with a strangulated femoral hernia, which in the doctor's opinion demanded prompt surgical action, and he at once called in for consultation a surgeon in whom he had confidence, named Dr. Howlett, and an immediate operation was deemed by them necessary to save the patient's life. He was thereupon taken in an ambulance to the Pontiac City Hospital before dark that evening, and operated upon almost immediately, remaining in the hospital nineteen days. He made a good recovery, and at the time of hearing before the board had returned to his work in defendant's employ. The bill in question is for surgical and medical attendance, ambulance and hospital expenses, the largest item being $100 for the operation, furnished within three weeks after the injury. Of the necessity for prompt action after the physicians had determined Gage's condition Dr. Fox testified in part as follows: Q. Was there any particular urgency there? A. Very much so; yes. Q. What was the hurry? A. What we call strangulated hernia. It is where the bowel goes down and becomes strangulated. It is strangulated there, and the bands go round to the outer part, and the circulation is shut off. It is sometimes only a few hours before gangrene will set in in the bowels, which means almost certain death. Q. For that reason you considered that an immediate operation was necessary? A. Yes, sir. Q. In your opinion a delay would have been fatal? A. Yes, sir. In the morning this man would have been beyond help. The Pontiac State Hospital is one of the state asylums for the insane, formerly designated as the "Eastern Michigan Asylum" (Comp. Laws 1915, § 1311), but given its present name in 1911, without change of character or functions, by an act devoted to "changing the names of the Michigan asylums for the insane" (Comp. Laws 1915, §. 1365). These institutions have, under the statute providing for them, a medical superintendent, with adequate medical and surgical staff for the purposes of the insti |