Weight as an Indication of the Character of Risks for Life Insurance.* BY JOEL SEAVERNS, M. D., of Roxbury, Mass. The Royal Arcanum, a beneficiary organization, which has to-day nearly 50,000 members, in all the States of the Union except the Gulf States, and has paid out since Jan- uary, 1868, over $3,000,000 in life insurance to the families of its deceased members, has among its records up to March 1, 1884, details of the deaths of 974 men between the ages of twenty-one and sixty. These details include, together with the family and personal history of the indi- viduals, statements of their age, occupation, height, weight, rate of pulse and respiration, results of auscultation and percussion of chest, and an examination of the renal secretion, certified to by a medical examiner on their en- trance to the Society. At their deaths is added to these facts a certificate signed by the attending physician, giving the duration of the fatal illness, its supposed cause, symp- toms, and diagnosis, and the results of the autopsy if one is held. From this storehouse of facts, to which I have been allowed access, many important generalizations may be drawn, bearing upon the selection of lives for life insur- ance. On only one point to-day, that of weight, and its relation to height, I address you. You are all aware that for life-insurance purposes, tables have been constructed giving what is considered the natural standard of weight and height. These tables vary but little in different works on this subject, and that which I shall refer to to-day is embodied in the tables here given. The general directions in companies and societies are that, while this proportion is the natural one, a variation of twenty per cent from it in either direction is not to be deemed a cause for rejection. I am inclined to think that as regards the candidates of light weight (those whose weight is below the standard), less latitude should be allowed, and that a variation of even fifteen per cent in that direction makes the risk hazardous, that every applicant whose weight is materially below the standard, even ten to fifteen per cent, should be examined with the utmost care, not only to ascertain whether he has actually at that time any disease, but whether there may not be * Read before the Massachusetts Medical Society, June Ii, 1884, and recommended for publication. some tendency to disease, some weakened, malformed, or imperfectly developed organ, £ome functional ill perform- ance of the vital processes of digestion, assimilation, or absorption, which, if conditions of life should be unfavor- able, may prove to be the starting point of constitutional disease. Men are thin for various reasons : some because in their families is a hereditary tendency to be so; some because they have diseased lungs, heart, or digestive organs ; some because they have recently been sick or are overworked, or have too much anxiety and care, or are illy fed ; and the examiner should in each instance gravely scrutinize the problem to see what is in that case the special cause of this effect, and whether it may not be a cause that threat- ens to shorten a man’s years, or at least an influence which shows in what direction to look for future illness or death. And thus, for instance, if there has been in the family his- tory any case of hereditary disease — especially of consti- tutional wasting disease — or if there has been in the personal history any of those symptoms or diseases that so often precede tuberculosis, such as impaired digestion, haemorrhoidal tumors, fistulas, etc., and the applicant is at what may be called the consumptive age (under thirty-five or forty years old), he should be unhesitatingly rejected, as one who is not likely to live out his estimated expec fancy. With reference to this question I have made an exami- nation of these 974 deaths with this showing: Amongst them were 138 men, who at their admission were fifteen per cent or more below the standard of weight that we have referred to, and of this 138, eighty-five, or about sixty- two per cent, died of chronic disease, seven from accident or suicide, and only forty-six of acute diseases. Of the eighty-five chronic cases, forty-two were from phthisis, tabes mesenterica, or pulmonary haemorrhage; seven died of organic disease of the brain or medulla, caries of the ver- tebrae, progressive muscular atrophy, and general paralysis of the insane ; six died from cancer; three from diseases of the liver; nine from urinary diseases (five of Bright’s dis- ease, two from diabetes mellitus, one from chronic cystitis and abcess of the kidneys, and one of stone in the bladder); five died of organic disease of the heart; one of pernicious anaemia, and one of “ general debility.” The acute cases included pneumonia and other lung diseases, typhoid fever, and diseases of the digestive organs. Ninety-one of these men were under forty years of age when admitted, thirty between forty and fifty, and only seventeen more than fifty. Twenty-two died in less than a year after admission, twenty-nine in between one and two years, thirty-four in between two and three years, thirty-six in between three and four years, thirteen in between four and five years, and but four lived more than five years. The average duration of their membership was about thirty-one months. Now of these 138 only thirty-three were twenty per cent below the normal standard, 105 being in that border-land between what is usually considered safe and the line which I claim should be the dividing boundary; twenty-four of the thirty-three lightest ones were cases of chronic disease, thirteen being of phthisis. Only nine were more than twenty-five per cent below the standard, and all but two of these died of some organic disease, four from phthisis. This is, in brief, a summary of the deaths of such of the 974 deceased members as were at the time of their admis- sion fifteen per cent or more below the usual weight, and in order that the results may be shown more clearly to you I have drawn them up in tabular form and printed them, that you may at a single glance see how extraordinarily prone to constitutional disease are such candidates. And I feel confident that the table will prove conclusively that such risks ought not to be accepted in life insurance. LIST OF 138 DEATHS AMONG PERSONS WHO WEIGHED FIFTEEN PER CENT OR MORE BELOW THE NORMAL STANDARD. Height. Standard Weight. Fifteen per Cent Twenty per Cent Feet Inches* Pounds. less. less. Pounds. Pounds 5 0 120 102 96 5 1 124 105 99 5 2 128 1084 102 5 3 132 112 106 5 4 136 Il6 109 5 5 140 119 112 5 6 144 122 115 5 7 15° 127 120 5 8 156 133 125 5 9 162 138 ■ 130 5 IO 168 143 135 5 II 174 148 140 b O 180 153 144 0) 1/3 4) 4) C • A O ►j 5 Numbe Age. +? e bD-Td *5 g ;S> > 3 616 44 5 8 127 32 Bright’s Disease. 619 22 5 1° 140 45 Phthisis. 621 54 6 0 145 30 General Debility. 625 48 5 9 125 48 Intussusception. 628 31 5 6 120 20 Phthisis. 629 5° 5 8 125 39 Pneumonia. 644 49 5 11V2 145 59 Phthisis following Pneumonia. 653 23 5 10 134 56 Catarrho-Malarial Fever. 664 49 5 9 135 9 Diabetes Mellitus. 666 34 5 i°a/2 144 44 Phthisis. 690 37 135 55 Phthisis. 696 24 136 18 Cancer. 699 25 5 6 120 37 Phthisis. 703 27 5 10V2 126 27 Phthisis. 707 42 5 6 120 53 Typhoid Pneumonia. 7°9 35 5 8 130 43 Stone in Bladder. 7J3 24 5 10 138 24 Phthisis. 716 42 5 10 140 57 Disease of Lungs and Heart, Chronic. 7r9 27 5 io 135 28 Phthisis. 722 23 5 10 140 19 Measles, 730 28 5 10 130 15 Phthisis. 762 51 5 9V2 125 29 Typhoid Pneumonia. 769 35 5 9 135 48 Pulmonary Haemorrhage, Phthisis. 773 40 5 8i/2 125 57 Softening of Brain. 779 21 5 3 no 18 Phthisis. 780 51 5 sy2 135 16 Apoplexy. 784 38 5 i°y2 145 40 Congestive Chill. 789 32 6 0 150 35 Typhoid. 790 31 6 150 41 Bright’s. 791 35 5 11 136 43 Phthisis. 792 59 5 6 122 41 Cerebral Haemorrhage. 797 22 5 i°y2 128 23 Phthisis. 801 28 510 135 31 Marasmus. 807 32 511 127 47 Phthisis. 8l2 38 510 140 45 Softening of Liver. 816 47 510 130 57 Progressive Muscular Atrophy. 819 828 34 28 51% 5 n% 125 143 7% 48 Typhoid. Phthisis. 839 46 5 9 135 32 Paralysis of Heart. 842 5° 5 84 130 44 General Paralysis of Insane. 846 33 5 10 140 10 Caries of Spine. 860 23 5 ny2 148 46 Inflammation of Brain, Acute. 874 22 5 io1/! 140 44 Typhlitis. 898 48 511 147 34 Apoplexy. 902 49 510 125 31 Congestion of Liver, Acute. 903 28 511 145 51 Casualty. 920 34 6 0 143 14 Pneumonia. 922 38 510 135 31 Pleuro-Pneumoma. 923 43 6 0 145 48 Pneumonia. 929 28 510 135 2 Suicide. 937 31 411 98 69 Drowned. 940 25 6 0 145 56 Phthisis. 944 22 510 140 19 Pneumonia. 945 5° 6 0 150 66 Cancer. 955 36 5 9V2 125 65 Drowned. 960 28 5 9 135 in 63 Typhoid. 972 21 5 5% 40 Paralysis of Heart. LIST OF 122 DEATHS AMONG PERSONS WHO WERE MORE THAN FIF- TEEN PER CENT IN EXCESS OF THE NORMAL STANDARD WEIGHT. Height, Feet and Inches. Standard Weight. Pounds. Fifteen per Cent Excess. Pounds. Twenty-five per Cent Excess. Pounds. 5 O 120 138 150 5 I 124 142 y2 155 5 2 128 147 160 5 3 132 152 165 5 4 136 156 170 5 5 140 161 175 5 6 144 166 180 5 7 150 172 187% 5 8 156 178 195 5 9 162 186 203% 5 IO 168 193 210 5 II 174 200 218 6 O 180 207 225 O CD Jo ! § 6 .Sf'O £ .be tT > Cause of Death. < W" £ 13 2 26 511 245 Brain (Congestion). 6 57 5 6 175 Heart (Cardiac Asthma). II 36 5 1° 235 Heart (Embolism). 14 36 5 1% 200 Yellow Fever. 17 36 5 10, 210 3 Brain (Paralysis). 20 50 5 n% 260 Heart (Fatty). 41 35 5 8 225 IO Bright’s. 78 43 5 8 200 II Ulcer of Stomach. 92 44 5 9 192 18 Casualty. 97 45 5 6 190 17 Gastric Ulcer. 99 46 5 9 198 21 Suicide. 115 4i 5 6% 190 12 Cholera. •34 54 5 10 215 29 Rheumatism and Heart. 135 35 5 8 180 4 Cerebritis. 145 56 5 200 19 Brain Congestion. 162 39 5 9xk 194 34 Spinal Injury. u ►*« a £ 3 163 59 5 4 160 9 Apoplexy. 169 57 6 1 220 4 Brain (Softening). 191 34 5 9V2 195 27 Typho-Malaria. 194 53 5 4% 175 20 Cystitis. 204 40 5 1072 215 28 Narcotism. 210 4i 5 7,/ 185 18 Lungs, Congestion. 212 59 5 4% 165 24 Heart, Valvular Disease. 213 42 5 5% 193 3° Bright’s Disease. 216 46 5 8 200 20 Casualty. 217 25 5 8% 200 IO Suicide. 219 36 5 8 ,, 185 2 Casualty. 223 42 245 12 Pneumonia. 236 45 5 10 2 lO 9 Pneumonia. 251 48 6 3 240 9 Brain Inflammation. 252 59 5 6 200 14 Heart, Valvular. 262 45 5 8 191 20 Hepatitis (Acute). 266 54 5 8% 190 17 Atheroma. 273 47 5 9,, 205 21 Brain (Congestion). 289 43 5 5% 5 8% 182 22 Hsematemesis. 291 45 212 15 Jaundice (Acute). 294 4i 5 8% 5 8% 185 12 Heart, Hypertrophy. 300 30 200 15 Casualty. 312 37 5 9V2 195 11 Myelitis. 313 43 5 7 176 38 Heart. 315 3° 5 210 45 Typhoid Fever. 316 37 5 7V2 195 29 Bright’s Disease. 323 37 5 7,, 180 17 Endocarditis. 324 28 5 fk 195 II Typhoid Fever. 332 54 5 8% 185 14 Casualty. 334 4i 5 7 175 28 Bright’s Disease. 372 45 5 8 180 44 Heart. 373 36 5 ” 235 44 Aortic Aneurism. 374 40 5 7 180 53 Bright’s Disease. Bright’s Disease. 389 43 5 9 198 9 404 59 5 9 191 34 Typhoid Fever. 422 5° 5 8 190 34 Pneumonia. 439 35 5 10 195 22 Bright’s Disease. 457 52 6 0 248 28 Heart Fatty. 460 48 5 4V2 193 29 Apoplexy. 46s 38 5 io,, 235 33 Typhoid Fever. 468 58 5 Iolk 220 is Apoplexy. 469 44 5 I°V2 225 31 Carbuncle. 480 36 6 0 229 I Suicide. 483 46 5 8„ 180 41 Heart (Rheumatism). Bright’s Disease. 491 58 5 7% 186 22 506 58 5 5% 195 36 Apoplexy. 512 38 5 4% 185 4 Brain (Congestion). 513 5*4 39 44 5 3 5 “ 157 215 31 Rheumatism (Acute). Bright’s Disease. 515 36 5 8„ 180 44 Caries of Spine. 52i 44 6 0% 235 IO Heart (Paralysis). 523 52 6 1 220 4 Casualty. 524 32 5 7,, 180 2 Bowels (Congestion). 53i 40 510% 206 27 Liver (Atrophy). 534 46 5 9V2 250 33 Abscesses. 535 40 5 8% J90 51 Brain (Softening). 539 37 5 9% 200 20 Typhoid Fever. 548 56 5 9 200 5 Cerebritis. 549 48 5 8„ 179 42 Bright’s Disease. 55° 59 5 5% 180 37 Casualty. 56s 45 5 8 185 8 Casualty. 573 5i 5 S1/^ 194 22 Spinal Sclerosis. 577 45 5 6 187 3° Pneumonia. 578 23 s 9 , 200 3° Malarial Fever. 582 54 5 11% 240 35 Heart (Rheumatism). 58s 588 43 59 5 8 5 7% 185 176 47 52 Bowels (Haemorrhage). Liver (Degeneration). 59i 33 6 2 234 57 Pneumonia. 596 32 5 6 172 56 Casualty. 599 53 5 8 196 3 Bowels (Inflammation)! 601 37 5 10% 204 13 Suicide. 603 54 5 n 223 21 Pneumonia. 614 5i 5 6 169 20 Apoplexy. 6'5 56 5 8 210 24 Heart (Paralysis). 626 49 5 11 225 44 Heart (Paralysis). 649 35 5 9 200 21 Enteric Fever. 669 52 5 5 185 51 Apoplexy^. 671 52 5 8 185 2 I Suicide. 679 43 5 10 200 45 Apoplexy. 682 57 5 *?, 200 57 Bright’s Disease. 683 47 5 8V2 185 12 Casualty. 688 58 5 8% 214 IO Brain. 689 59 5 r? 205 22 Brain (Paralysis . 694 5° 5 9! 200 21 Cancer. 698 4i 5 3 160 26 Casualty. 725 36 5 8 187 51 Nephritis. 742 37 6 1 230 13 Bowels. 755 54 5 8 192 l6 Heart. 759 54 5 9 190 54 Bright’s Disease. 760 59 5 10 220 31 Brain (Softening). 799 34 5 7 180 43 Cancer. 804 3i 5 7 182 53 Bladder. 823 47 5 6,, I70 7 Heart (Paralysis). 825 38 5 6% 180 43 Nephritis (Acute). 831 58 5 8% 236 17 Apoplexy. 838 48 S 6 174 72 Apoplexy. 845 36 5 8^ 235 41 (Edema of Glottis. 852 57 5 4 182 45 Heart (Fatty). ?63 5i 5 5 165 21 Suicide. 872 37 5 6 I70 67 Liver (Atrophy). Bright’s Disease. 906 54 S 7,, 212 60 915 38 5 6% I70 52 Tetanus. 935 5° 6 0 245 66 Heart (Valvular). 962 33 5 7% 193 42 Diabetes. 969 50 5 7 175 74 Apoplexy. 971 5i 5 4 180 54 Cancer. Let us now reverse the picture. Among the 974 deaths were those of 122 members who, on joining the Society, were fifteen per cent or more above the weight assumed to be the normal one. Of these, leaving out fifteen who died of casualities and five who committed suicide, fifty-six, or about forty- six per cent, died of some lingering illness, and forty-six of acute attacks. Twenty-six of the deaths were from disease of the brain or spine (twelve being apopletic) ; twenty-four from dis- ease of the heart and circulatory system ; sixteen from disease of the kidneys and urinary organs (including twelve of Bright’s disease) ; eleven died from disease of the abdominal organs ; fourteen from zymotic diseases ; and seven of acute lung diseases. None died of phthisis, and but three of cancer. It will be remembered that among the light weights, ninety out of 138 were under forty years of age on joining, but of these now under consideration eighty-three of 122 were over forty when admitted, forty-three between fifty and sixty, and only four were less than thirty. Their average age was forty-five years. Twenty-eight died in less than a year after being taken into the society ; thirty-six in between one and two years ; twenty-four in between two and three years ; seventeen in between three and four years ; twelve in between four and five years ; and but five lived more than five years. The average duration of their membership was twenty- seven months. Now in that border-land, as I have called it, between fifteen per cent and twenty per cent, among the heavy weights there were but forty-seven who have died (whilst there were, it will be remembered, 105 of the light weights), and of this forty-seven, twenty died of cerebral or cardiac affections, eleven from casualties and suicides, eight of zymotic and intestinal disease, six from urinary complica- tions, and two from cancer. It is not until we get beyond the twenty per cent line in this class that the principal part of the deaths occur, namely, seventy-five, thirty being from brain or heart dis- order. Going still farther, it appears that there were forty-nine whose weight was more than twe7ity-five per cent in excess of the standard, some of these exceeding forty per cent, and a few reaching even fifty per cent beyond that rate. But of these excessive weights the cause of death was hardly what might have been anticipated, for there is no increased preponderance of brain or heart dis- ease, the figures of those over twenty-five per cent being twenty-two in those diseases, six of diseases of the kidneys, six casualties, nine zymotic and digestive diseases, and all other causes six, the character of the changes which proved fatal seeming to be rather those peculiar to senile degeneration than those of fatty changes, it being borne in mind that more than a third of the men of excessive weight were over fifty years old, and more than two-thirds over forty. If, in summing up, the results of the two classes of cases be compared, it is to be noticed, first, that the number of those dying who are deficient in weight is greater than of those who have a superabundance of adipose tissue. This point cannot be accurately tested, of course, without knowing how many of each class have been admitted to the order, and this could only be done by too great labor ; but I am satisfied that the number of those admitted who are fifteen per cent or more above weight is greatly in excess of those fifteen per cent or more below the standard, while the deaths, as has just been said, are more frequent among the latter. It further appears, too, that as to the character of dis- eases to which they succumb there are more of those light in weight who die of chronic constitutional diseases, and more of those heavy in weight who die of accident, zymo- tic or acute diseases, though many of the latter fall vic- tims to diseases of the arteries and the heart. Sudden deaths also are much more frequent with the heavy weights. Still farther, it seems that the deaths are not so frequent of the heavy men who are but little (fifteen to twenty per cent) above the standard as among the light weights who are fifteen to twenty per cent below. The conclusion which I have therefore reached from these observations is, very briefly, this : that for life in- surance purposes men whose weight is above that laid down in the usual tables are better risks than those whose weight is less; that among the latter (light weights) the usual variation of twenty per cent which is assumed to be within safe limits, is not safe, and that if we accept men, especially young men, whose weight is fifteen per cent below the standard, we are approaching dangerous stand- ing ground, and inviting, as it were, deaths from phthisis and wasting diseases ; and when we reflect how great is the mortality from phthisis in all insurance organizations we cannot too strongly emphasize the necessity of con- stant vigilance in this direction, and of not only exploring most carefully the chests of such men, but also of taking into account all these other features, which I think often precede the changes in lung tissue discernible by the ear, and may be observed at what may be called the pre- tuberculous stage. With the heavy weights the case is different: free from danger of phthisis, we must, to be sure, take the greatest care to see that the heart and kidneys are healthy, and that the family history does not point to cerebral disease. With these points well guarded, I am satfsfied that an ex- cess of twenty-five per cent in weight is not dangerous in men who have not injured or are not injuring themselves by alcohol. It may be said very truly that much in both classes must depend on the family history and inborn tendencies to disease of the parties, and that in this resume I have not dwelt on this subject, but in most of the cases here cited, the family history did not indicate danger from con- stitutional disease, because the greater number of such applicants as have anything unfavorable in those respects are rejected when they apply. These tables, therefore, have been made up largely and almost entirely of men whose deficiency or excess of weight was the only unfavor- able feature at the time of their being accepted, this feature not having been then regarded as sufficiently important to have a determining effect on the question of rejection.— Boston Medical and Surgical Journal.