w ith tiie Compliments of 
The Mutual Life I nsurance Company of New York 
‘President. 
2 >339 
REPORTS 
ON 
ASTHMA 
AND ON 
BILIARY AND RENAL 
COLIC AND CALCULUS 
Published by 
The Mutual Life Insurance Company 
OF NEW YORK 
1895 Copyrighted by 
The Mutual Life Insurance Company of New York, 
August, 1895. REPORTS ON ASTHMA 
AND ON 
Biliary and Renal Colic and Calculus 
Mr. Richard A. McCurdy, 
President. 
Sir : 
I respectfully present for your consideration the 
following report: 
REPORT ON ASTHMA, AS AFFECTING APPLICANTS FOR 
LIFE INSURANCE. 
A history of asthma in an applicant has been 
considered as incompatible with his acceptance as a 
satisfactory risk in this Company. This opinion has 
been grounded: ist, on our knowledge that the term 
“asthma” is often used in a loose manner to indicate 
any form of short and difficult breathing, and a con- 
sequent suspicion that it may have originated from and 
be a sign of obscure organic disease of the lungs, heart 
or kidneys; and, 2d, on the medical history of asth- 
matics, which shows that repeated paroxysms of real 4 
asthma develop serious pathological changes in the lungs 
and heart, and thus shorten life. 
On carefully reviewing the question, I am now of 
opinion that this rule of the exclusion of all asth- 
matics has been too rigidly enforced, and that, though 
any present or past occurrence of asthma should be 
considered a blemish, it should not necessarily be taken 
as a bar to insurance. The first mentioned objection 
can usually be overcome by a satisfactory physical 
examination; then, if the symptoms and history denote 
true asthma, a further inquiry may indicate the severity 
of the disease and whether serious consequences are 
likely to ensue. Some cases of asthma are due to special 
causes which are of only occasional occurrence and 
which may be avoided. Such special causes are the 
pollen of grasses and other plants, effluvia from cer- 
tain animals, articles of food, inhalation of sulphur- 
ous and other gases, etc. When a person ascertains 
the cause which produces his asthmatic paroxysms, he 
may be depended upon to use all care and prudence 
in avoiding it, and the disease very seldom becomes a 
hazard to his life. In another class of cases it is found 
that the paroxysms, instead of becoming more frequent 
and severe, on the contrary become milder and less 
frequent, and that there is a natural tendency towards 
recovery; this is said to be the course especially when the 
disease appears in childhood or youth. Many of these 5 
persons would be insurable, notwithstanding the blemish 
of their past physical history, provided that the organs 
had remained sound and normal. 
I have designated some of the conditions which 
would, in my opinion, justify exceptions to our usual 
rule of exclusion. In deciding upon these applications 
each case must be considered independently, and no 
definite rule as to the number of past attacks, the period 
intervening since the last paroxysm or the exact age 
of the applicant can be laid down. The Medical Director 
in reviewing the case must remember that the presump- 
tion is against the applicant; he should require full and 
definite information on all important points, and must 
then decide whether an exception can be made. The 
suggestions of Dr. H. Hyde Salter, for the directions 
in which the investigation should be made and the 
grounds on which the decision should be based (al- 
though intended for a physician when consulted by 
a patient), are equally profitable for a Medical Director 
of a Life Insurance Company, and I will, therefore, give 
them in full: 
“If, then, an asthmatic were to present himself to 
me, and ask my opinion as to his prospects, I should, 
having ascertained his age, and carefully scrutinized 
the condition of his chest, put to him the following 
questions: How long do your attacks last? How often 6 
do they occur? Do you lose all traces of shortness or 
difficulty of breathing between the attacks, or is the 
breathing always a little difficult? Do you habitually 
cough and spit? Does the disease appear gaining on 
you, or the reverse? Is the exciting cause of the attacks 
clear, and can you undertake that it shall not recur? 
“If the patient is young, the chest sound, the attacks 
short, the intervals long; if there is no permanent short- 
ness of breath, no cough or expectoration; if the attacks 
are getting milder or rarer, and if the existing cause is 
clear and such as may be obviated, then a favorable 
prognosis may be given.” 
Approval of these exceptional cases should be given, 
however, only when the applicant is otherwise perfectly 
sound and free from flaw in his family and personal 
record. Especially if there be even a slight tendency 
to overweight, gout, or any nervous affection, as head- 
ache or other neuralgia, he should not be accepted. 
Respectfully, 
E. J. Marsh, M. D., 
Medical Director. 
January 13, 1894. 7 
Mr. Richard A. McCurdy, 
President. 
Sir : 
I respectfully present for your consideration the 
following 
REPORT ON RENAL AND BILIARY COLIC AND CALCULUS. 
These diseases and conditions may properly be 
considered together, because, although affecting differ- 
ent organs, there is a similarity in their nature, cause 
and dangers, and moreover the rules of the Company 
have been the same regarding each. In deciding upon 
acceptance of risk it has been considered that a history 
of one attack would require postponement for five years 
from the date of such attack, and that two attacks would 
necessitate the absolute refusal of the applicant. 
A calculus or stone is a concretion from the liquid 
urine or bile deposited in the pelvis or membranous 
sac of the kidney or in the gall bladder. The colic is 
the severe pain caused by the passage of the calculus 
through a narrow tube or duct to the bladder or bowel. 
The history of a past attack of colic has, therefore, of 
itself no injurious significance as regards the prospect 
of longevity. As long as the calculus or stone remains 
in the kidney or gall bladder, the person is in constant 
peril of his life, but, when it has finally passed out and 8 
been expelled from the body, he is safe from this 
threatening danger. 
The reason for the postponement or rejection of 
these applicants is based on the belief that such a per- 
son is especially liable to a recurrence of the trouble. 
This danger of a second attack is inferred from two 
reasons : 
1. These calculi are not always found singly, and 
even though one be expelled others may be retained; 
if so, the danger still exists as there wdll soon be 
recurring attacks of colic. This is the case for both 
varieties, but especially so for gall stones. Moreover, 
a severe attack of colic does not indicate that the stone 
has passed, as it frequently slips back, and there may 
be a constant succession of attacks lasting through 
many months before the receptacle in the kidney or 
liver is finally emptied. Therefore, it is proper and 
judicious to wait a certain time before pronouncing 
such a person insurable. A period of from one to two 
years ought to be sufficient to give reasonable assurance 
of cure or recovery. 
2. Danger from renewed formation or deposit. It 
is generally believed that the formation of these calculi 
is due to some constitutional tendency or predisposition 
on the part of the individual, sometimes congenital and 
inherited, generally acquired by special circumstances 9 
and habits of life. This tendency is often exhibited by 
the appearance of fine sand or gravel in the urine, or 
by dyspeptic and “bilious” disorders, which, however, 
attract little attention until the sudden attack of severe 
pain reveals the fact that the calculus has actually 
formed; when the calculus has been expelled the pa- 
tient appears to be again in perfect health, but the 
attack has indicated the constitutional predisposition 
and new formations are to be feared. I can find no 
medical reports or statistics which show the proportion 
of cases in which there is recurrence of these calculi, 
but it is known that they frequently do recur, unless 
perhaps fortunately the pain and suffering of the first 
attack may induce the patients to change habits of 
life which have induced or aggravate the constitu- 
tional tendency. It is, however, only in a limited 
number of cases that there is any second attack, and 
the tendency may pass away with time or be neutral- 
ized by care. The lapse of time is the only satisfac- 
tory evidence of the cure, and although it must be 
feared that the liability may continue through the 
entire life, still, as far as Life Insurance is considered, 
it is not a reasonable fear, and after a few years of 
perfect health the applicant might be properly accepted 
with a very minimum of risk. I do not believe that 
the danger would be any greater than now arises from 
our rules for rheumatics; this disease also proceeds 10 
from an underlying constitutional tendency. One attack 
of rheumatism causes expectation of a second, and I 
believe that the risk to longevity is equally great there- 
from, and yet rheumatics with one or two attacks are 
insured. 
3. In addition to the dangers arising from the 
presence of the calculus, the underlying condition of the 
system is of itself a matter for important consideration, 
as it may be considered that the acute attack is merely 
the sign of a morbid constitutional tendency, just as a 
first attack of gout is more important as an indication 
than as a positive fact by itself. This constitutional 
diathesis is supposed to indicate early degenerative 
conditions of the heart, arteries, liver and kidneys, and 
therefore to augur badly for a prolonged life; it may 
be more or less pronounced and its degree can he 
determined only by a consideration of all the signs and 
circumstances of the case. The formation of a calculus 
is a sign pointing to this condition, which, when supported 
by other unfavorable circumstances of physical history, 
habits and age, should call for the refusal of the 
applicant, but under favorable circumstances might be 
overlooked, as being probably dependent upon temporary 
causes. 
After careful consideration of the whole subject, I 
would advise that the present general rule of the 
Company, as to the insurance of applicants with a 11 
history of gravel or gall-stone, be modified so that under 
favorable circumstances, 
1. One attack should call for postponement for two 
years only. 
2. Two attacks, postponement for five years from 
last attack, provided that the applicant during all this 
period be in perfect health, with nothing pointing to a 
recurrence of the disease, that he be of good physique, 
and of active and temperate habits of life. If, however, 
there be any tendency to accumulation of fat, any dys- 
pepsia, biliousness, deposits in urine or other symptoms of 
lithaemia, the slightest gouty tendency, habitual excess 
or indiscretion in diet, he should be either altogether 
rejected or postponed for at least double the period 
mentioned. Attention should also be paid to the 
probability of incorrect diagnosis, as a history of gravel 
or biliary colic is not infrequently given when the 
symptoms have been slight, and caused only by acid 
urine or inspissated bile. 
In making these recommendations I am aware that 
the Actuary has recently reported that the experience 
of the Company in cases which have been insured 
with a history of gravel has been very unfavorable, 
and that the loss on these risks has been greater than 
the normal loss. But, after examining his statistics, 
I am not satisfied that the loss was in any way due 
to the fact that these persons had had gravel, or to 12 
the underlying condition which it might be sup- 
posed to indicate. As the custom of the Company 
has been to decline most of these cases, the experience 
has been small, and there have been only eight deaths 
reported by him. In the majority of these eight, neither 
the history of the gravel, the condition of the patient, 
nor the cause of death render it probable that the loss 
was due to this physical history; in a few cases only is 
the possibility of such a connection suggested. 
In preparing this report, I have investigated also 
the death proofs for all cases during several past years 
in which death was caused by biliary, renal or vesical 
calculi, and also carefully reviewed the statements made 
in a number of applications which have been declined 
on account of a history of these diseases, and I have 
endeavored to avail myself of the experience of the 
Company in this respect, as well as of the best opinions 
of recent medical literature, and it is on the basis of 
this study that I have arrived at the recommendation 
above given. 
Respectfully, 
E. J. Marsh, M. D., 
Medical Director. 
January 24, 1894. 
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