INSURED LIVES 
AS AFFECTED 
BY 
GOUT 
Published by 
The Mutual Life Insurance Company 
OF NEW YORK 
1895 With the Compliments oe 
The Mutual Life Insurance Company of New York 
President. 
20748 INSURED LIVES 
AS AFFECTED 
BY 
GOUT 
Published by 
The Mutual Life Insurance Company 
OF NEW YORK 
1895 Copyrighted by 
The Mutual Life Insurance Company of New York, 
May, 1895. President’s Office, 
The Mutual Life Insurance Company 
OF NEW YORK. 
By reason of its age, magnitude and varied experi- 
ence the records of The Mutual Life Insurance Company 
of New York are of especial value to all persons inter- 
ested in approved scientific methods of conducting the 
business. It has always been the object of the Company 
by its publications and compilations to freely give to all 
its fellow workers the advantage of its experience in all 
branches. 
In accordance with this practice the present paper is 
submitted, giving the result of investigations on the part 
of the Medical Officers of the Company with a view to 
ascertain the effect of Gout upon the longevity of insured 
lives. Subsequent pamphlets of a similar character will 
be issued, giving the statistics and inferences as to the 
like effect of other constitutional diseases. 
RICHARD A. McGURDY, 
President. 
April 30th, 1895. Permission is granted to make verbatim quotations from this pamphlet if due credit 
is given to The Mutual Life Insurance Company of New York, the owner of the copyright. GOUT. 
Richard A. McCurdy, Esq., 
President. 
Sir: 
At the suggestion and request of the General Manager 
I have read the report of the iVctuary on the experience 
of the Company with gouty persons, and have carefully 
considered the medical aspect of the subject. His records 
show that forty-eight (48) gouty persons have been 
insured in this Company between and 1888, and that 
from these risks the pecuniary loss to the Company has 
been four times greater than what he considers the 
normal loss should have been. He has subdivided the 
risks according to duration of the insurance, the ages of 
the insured, the proportionate height and weight of the 
insured, and the date at which they were accepted, and 
in all these divisions finds the same extraordinary increase 
of loss, and the presumption remains that this increased 
mortality is due to the fact that the lives of the insured 6 
were deteriorated and shortened by their gout. The 
number of cases is too small to admit of much general- 
ization, and therefore I have carefully gone over each 
individual case to see whether this view would be sus- 
tained, or whether there were any other circumstances 
which might account for the loss. Gouty persons have 
always been looked upon as poor subjects for insurance, 
and medical opinions are almost unanimous that gout 
tends to shorten life in the great majority of cases, while 
recognizing the fact that, exceptionally, they reach to a 
very advanced age. The action and rules of The Mutual 
Life have always been in accordance with this medical 
opinion, and it was only in exceptional cases that anyone 
was accepted who had a gouty record. No Medical 
Examiner, however, would say that every person who 
might have ever had the slightest possible symptom of 
gout should be always uninsurable, and therefore, in a 
few exceptional cases, they have recommended the issu- 
ance of policies. How carefully this selection has been 
made, and how few such cases have been insured, appears 
from the report of the Actuary, that, up to the end of the 
year 1887, when over 300,000 policies had been issued, 
only fifty-eight (58) policies have been issued to 
eight (48) persons in whose applications was any statement 
indicating a history of gout. These forty-eight (48) cases 
were undoubtedly considered the exceptional cases of 
gout that were safely insurable, and yet their acceptance 7 
has proved to have been very unfortunate for the Com- 
pany. Most of these applicants were residents of our 
large cities, examined by skillful Examiners, and many 
of them seen by the Examiners of the Home Office. 
The Actuary’s figures of the Company’s experience 
and loss are given from the pecuniary amount at risk and 
subsequent loss, rather than from the number of lives, 
and as this experience is very limited and consequently 
liable to error, I have considered and examined the cases 
as lives rather than by policies. A few accidental losses 
from lives with a large amount of insurance might easily 
lead to erroneous conclusions. As an instance in point, 
the Actuary has divided the risks by a definite period: 
those insured before 1872 and those after that date; in 
both these periods the loss is very excessive; in the latter, 
he states that the normal loss should have been $10,000, 
while the actual loss was $40,000. Now we find that 
from 1872, eighteen (18) lives were insured in amounts 
ranging from $1,000 to $30,000. Of these eighteen (18) 
persons two died, and both held large policies, one $30,000, 
the largest policy that had ever been issued to a gouty 
subject; the other had $10,000 in two policies. Death had 
struck the largest policy-holders. The mortality might 
have been greater than it actually was and the loss less 
than normal. Moreover, the first ($30,000) was an unfit 
subject for insurance, and died from disease induced by 
his intemperate habits, three years after insurance. The 8 
circumstances connected with his life were concealed 
from the Company at the time of his insurance, and were 
only ascertained on investigation after his death. In the 
second case ($10,000), there is uncertainty as to whether 
the applicant had ever had gout at all, although it was so 
reported at first. The matter was not entirely cleared up, 
but the applicant was accepted after consideration by the 
Medical Department at the Home Office, on the certificate 
of his family physician that he had never known of his 
having had the disease. He died of acute pneumonia of 
two days’ duration. 
Of the forty-eight cases reported by the Actuary, I 
think that four should be omitted, as one was evidently 
reported as gouty by mistake and the other three had 
never had any acute attack of gout, and the total number 
is thus reduced to forty-four. The history of the insur- 
ance in these cases, from the time of the first report of the 
existence of gout until they ceased to be members of the 
Company, is as follows: Subdividing them according to 
the dates at which they were insured, of those 
Insured from 
1843 to i858- i858 to 1872. 1872 to 1887. 
Lapsed - - 2 Forfeited - 1 Forfeited - 1 
Forfeited - 4 Surrendered 2 Surrendered 1 
Surrendered - 3 Died - 9 Died - 2 
Died - 4 In force - 1 In force - 14 
Total - - 13 Total - - 13 Total - - 18 9 
In the first of these periods four policies were issued for 
a term of a few years only and expired by limitation or 
were forfeited, presumably when they had effected the 
temporary insurance which was intended. The other two 
periods do not include any of these term insurances and 
may be taken together with the remark that naturally 
there are more deaths and fewer policies remaining in 
force among those issued before 1872, owing to the lapse 
of time. Attention is especially called to the very small 
number of those who have forfeited or surrendered their 
insurance; of the thirty-one insured only two have for- 
feited, and three surrendered their insurance. I under- 
stand that this is far below the usual experience, and it 
may best be explained by the very circumstances that the 
persons are gouty and appreciate the fact that their lives 
are unsound, and it is therefore important for them to 
keep up their insurance, and the apprehension that if 
their policies should be terminated it would not be easy 
for them to secure others. Of the forty-four cases insured 
fifteen have died, a mortality of thirty-four per cent., 
which far exceeds that of the Company’s experience in 
general. These fifteen deaths are too few to generalize 
upon, and must be examined individually. The table on 
the following page shows a synopsis of the important 
facts in each case: IO 
No. 
Age at 
Insurance 
Age at 
Death 
Duration of 
Insurance 
Cause 
of Death 
Remarks 
I 
39 
47 
8-5 
Dropsy. 
In subsequent examination 
still reported as having rheu- 
matic gout. 
2 
39 
50 
10.9 
Heart 
disease. 
3 
58 
67 
9.1 
Dropsy. 
4 
39 
69 
3° 
Apoplexy. 
5 
34 
35 
i-7 
Gout. 
Application states that he 
had gout in foot about five 
years ago. Temperate and 
active in habits. 
6 
67 
74 
6.4 
Pneumonia. 
Gout in toes about four years 
ago; none before or since. 
Was subsequently examined 
and insured, and no mention 
is made of gout. 
7 
40 
57 
17.4 
Tumor 
of liver. 
8 
48 
64 
16 
Heart 
disease. 
Endowment at 65 years. 
Ten payments. 
9 
43 
52 
9.2 
Heart 
disease. 
Had rheumatic gout before 
nineteen years of age. None 
since. 
IO 
53 
74 
21.9 
Heart 
disease. 
About eight years ago thinks 
he had something like gout; 
was never laid up with it. 
11 
48 
55 
6-5 
Pneumonia. 
Ten year endowment. 
12 
34 
49 
14-3 
Bright’s 
disease and 
rheumatic 
gout. 
13 
5° 
57 
6.10 
Pneumonia. 
Death certificate mentions 
as other diseases asthma and 
gout. Father had gout. Ten 
year endowment advised. 
14 
5o 
54 
3-3 
Bright’s 
disease. 
15 
60 
62 
1.11 
Pneumonia. 11 
Gout usually makes its appearance in the fourth or 
fifth decade of life, though we find exceptional cases 
originating earlier or later. Five of these cases were 
insured when between 30 and 40 years of life, and among 
them we have both our worst and our best experiences. 
Two insured at 34 years of age died directly from “the 
effects of gout,” as stated in the death proofs. Another 
insured at 39 lived 30 years, thus surpassing his expec- 
tancy of life. Two were insured when above 60 years of 
age. Neither reached their expectancy, or proved good 
risks to the Company, although in both cases there was 
little history of gout. Two cases only reached to 70 years 
of age; one of them was insured at the age of 67 and died 
at 74, after less than seven years of insurance; the other 
was insured at 53 and died at 74, with a duration of insur- 
ance of 21 years, 9 months, which was more than the 
expectancy. The duration in these cases was as follows: 
Under 5 years - - - - 3 
5 to 10 years - 6 
10 to 20 years - - - - - 4 
Above 20 years - 2 
Total - - - - - 15 
Examining the causes of death, we find 
Gout - - - - - - 2 cases. 
Heart disease .... 4 cases. 
Bright’s disease - - - i case. 
Dropsy ..... 2 cases. 12 
Apoplexy - - - - i case. 
Acute pneumonia ... 4 cases. 
Tumor of liver - - - - 1 case. 
Total - - - - - 15 cases. 
In two cases gout is described as the cause of death, 
but it is well recognized that diseases of the heart, and of 
the kidneys, dropS}q and apoplexy frequently result from 
gout and are the immediate cause of death in gouty 
subjects. 
On examining carefully each individual case, it is 
sometimes impossible to prove, and difficult even to sus- 
pect, that the gout had any influence whatever in hasten- 
ing death. In the majority of cases, however, it not only 
appears probable, but may be reasonably inferred, that 
the fatal disease and premature death were directly due to 
the gouty diathesis. A very careful study of the cases 
fails to show any other apparent cause for the excessive 
mortality. 
The Actuary’s report has shown that the actual loss 
from these gouty persons has been excessive. If they had 
been perfectly sound lives there would have been some 
deaths, and some loss, but in addition to these there have 
been other deaths, two of them directly attributed to gout, 
and several others in which the influence of gout was 
considered proved. Moreover, these persons recognize 
the fact that their viability is impaired and the chances of 13 
average longevity diminished, and, consequently, seldom 
surrender or forfeit their policies, thus making a selection 
against the Company. 
The Company's total experience is small, too small to 
establish general conclusions, and we would hesitate now 
to ascribe this increased loss to gout, and would consider 
that it might be the result of coincidences rather than 
cause and effect, were it not that our conclusions are borne 
out by the judgment of the physicians and the experience 
of other life insurance companies which have had more 
risks of this class. Of medical opinions I will give a few 
quotations from the most recent authorities: 
“The outlook for a gouty patient is hardly ever 
favorable. 
“Commonly the course of the disease is ever a down- 
ward one, and may be cut short at any period by the 
rapidly coming organic degenerations, or by many of the 
accidental intercurrent maladies to which these patients 
seem especially liable. 
“ The earlier in life gout makes its appearance, the 
more unfavorable it is for the subject.”—Longstreth, on 
Rheumatism and Gout, p. 254. 
“ That gout shortens life in the majority of cases is 
unquestionable. The prognosis varies with the rapidity 
with which the constitutional dyscrasia is developed, and 14 
this rapidity will depend on the intensity of the inheri- 
tance and the mode of life. Some gouty subjects escape 
the vascular and visceral complications of the disease for 
a long period, although crippled and deformed by its artic- 
ular ravages, and attain advanced age; others may suc- 
cumb in comparative youth to its most profound lesions.” 
W. IT. Draper in Pepper’s System of Medicine, Vol. 2, p. 127. 
“Gout has a decided tendency to shorten life and 
insurance companies, being fully aware of the fact, are 
not backward in acting upon it by increasing the amount 
of premiums for the insurance of the lives of those who 
have suffered from this disease. Gouty patients some- 
times live to a good old age, and occasionally in the latter 
part of their lives the fits become milder and less frequent. 
Examples prove the liability of gouty subjects to be sud- 
denly cut off by comparatively slight accidents. I 
consider that even a single fit of gout, however slight, 
should be looked upon as an intimation that the patient 
cannot go on with impunity with his present habits of life; 
it is a warning that either he must change them, or 
expect returns of the disease which as time advances are 
certain to increase both in frequency and duration and 
are likely to embitter and shorten existence.”—A. B. 
Gar rod, Treatise on Gout and Rheumatic Gout. 
Sir Dyer Duckworth, in his recent “Treatise on 
Gout,” has a chapter on Life Assurance. He says that 15 
each case must be carefully considered by itself, but the 
question in his mind seems to be how far such risks are 
impaired, and at what extra rates should be valued 
in accordance with the practice of English Life Insurance 
Companies. In “The Medical Handbook of Life Assur- 
ance,” by Dr. Pollock and Mr. Chisholm, it is said that 
the tendency has been in past years to under-estimate the 
importance of extra risk arising from gout. 
British Life Insurance Companies are accustomed to 
insure gouty subjects, charging such extra rate as may be 
deemed proper for each case, generally an advance of about 
io per cent. The Actuary has quoted Mr. Meikle as stating 
that ‘The mortality on lives charged extra for gout is 
greatly in excess of that for any other infirmity.” I find, 
also, a “Report on Gouty Lives,” drawn up in 1879 by the 
Actuary and Medical Officer of the Equity and Law Life 
Office. This Company had an experience of seventy-three 
cases in which an extra premium for gout had been 
required: “Had these been healthy lives, and accepted 
at the ordinary rates, the deaths ‘ expected ’ and allowed 
for at the tables would have been thirteen. But, at the 
ages at which they were rated at the office, sixteen or 
seventeen deaths were allowed for. The number of 
deaths which actually occurred was twenty-one. Of the 
twenty-one cases not one, even at the ‘ Office ages, ’ reached 
the calculated expectancy, although a few nearly reached 16 
it. So that in these, the most favorable cases in the list, 
it is fair to assume from this point of view that the gouty 
constitution was instrumental in shortening life. This 
general survey confirms strikingly the conclusion to 
which the figures point, viz.: that gout adds so seriously 
to the risk of premature death, that undoubted cases of 
the disease, or even those in which there is distinct reason 
to suspect its existence, ought not to be accepted at ordi- 
nary rates, or with so small an addition as three or five 
years as has hitherto been customary.” The experience 
of the Equity and Law Life Office shows that an extra 
rating of io per cent, in all cases of gout is not sufficient 
to cover the risk, and it is suggested that a rating of 25 
per cent, would be a proper rule. In a postscript to the 
paper the following addition is made: “Since writing 
this paper, I have seen the results of a similar investiga- 
tion, made to test my conclusions, into the gout class of 
another Assurance Societ}q where the number of cases 
was 321 (the of observed life were 3984.5, or 12.4 
on the average of each case), and the deaths 183. The 
experience derived from this body of facts, though less 
adverse than those given above, is strongly confirmative 
of my conclusions, both as to the need of a substantial 
increase of premium—probably not less than 20 per cent. 
—and as to the close connection between the causes of 
increase and the causes of death.”—Dr. E. Symes Thomp- 
son, Med. Times and Gazette, iSyy, Vol. /, p. 611. !7 
Judging, then, from the opinions of the most experi- 
enced physicians, and from the results obtained in the 
British companies which insure many gouty persons at 
higher rates, and from the experience of our own Company 
in a few selected cases, the insurance of persons wTith a 
gouty history and constitution is always hazardous, and 
even more hazardous than has been generally supposed. 
The rule of the practice should be, as it has 
hitherto been, that such persons are uninsurable at ordi- 
nary rates and on the plain life plan. If exceptions are 
made to the rule, they should be fewer and made with 
more discrimination than hitherto. In every case, the 
presumption is against the acceptance of an applicant 
who has had gout, and the case must be proved to be 
suitable for an exception, after more than ordinary 
scrutiny and investigation. In this way the danger of 
loss will be reduced to a minimum. The cases which 
might form such exceptions cannot be defined, and each 
must be individually decided by the responsible Medical 
Adviser of the Company, but I think they should be 
limited to the following: 
i. There should he an entire absence of hereditary 
tendency. 
ftff 2. The first attack of gout shall not have appeared 
before 30 years of age. 
3. The attacks shall have been very few in number, 18 
and slight in character, and that several years shall have 
elapsed since the last attack. 
4. That the person shall not have had gravel, frequent 
uric acid deposits in the urine, or symptoms of lithaemia. 
5. The habits must be abstemious, both in eating 
and drinking, and the applicant must have given evidence 
that he appreciates the necessity for this course of life. 
Respectfully submitted, 
E. J. Marsh, M. D. 
October 21, 1893. 
Note.—At a recent meeting of the Life Assurance Medical Officers’ Association, a paper on 
“ Gout, and Life Risks ” was read by Dr. J. Symes Thompson, and discussed by the other members 
of the Society. No new statistics were given, but the general tenor of opinion was in accordance 
with the views expressed in this report; the remarks and arguments dealing chiefly with the amount 
of impairment, and the increased rating that should be required. —The Lancet, Dec. 8, 1894, p. 1348. 
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