Diabetes, which is a fairly important cause of death past midlife, presented a paradox in that the development of insulin therapy saved the lives of many thousands of diabetics, while at the same time the death rate displayed an actual increase in the early 20th century since pre-insulin days. In explanation it must be remembered, first, that the very success of this therapy brought greater attention to diabetes, and undoubtedly brought to light many cases which previously would have escaped proper diagnosis; and second, insulin added to the length of life of the average diabetic, without curing him.
Deaths thus postponed tend to accumulate at the higher ages. An important fact, however, is that diabetics, thanks to insulin, can now generally lead normal lives. That many reap the advantage of modern treatment and lower life insurance rates is partially due to the Metropolitan Life Insurance Company, which spread the knowledge of life insurance basics and about the drug far and wide for many years. It also made a number of important statistical researches in this field which clarified the natural history of diabetes. Appendicitis, a disease without a marked age incidence, declined sharply in the middle of the 20th century as well.
The mortality among policyholders at that time in history was the lowest in Metropolitan history. This improvement reflected not only important advances in diagnosis and surgery, but also productive efforts along public health lines by the company and other agencies. They disseminated information to the public to help them recognize the early signs of the disease, when prompt medical and surgical treatment is of most avail; and prevented many serious complications by warning against the use of laxatives in the presence of abdominal pain. The extensive use of the sulfa drugs during 1941-1943 in cases of appendicitis with peritonitis also played an important role in bringing the death rate down to its low level.
The record of achievement in disease control would be incomplete without mention of the virtual elimination of typhoid fever. In 1911 it was an important cause of death among Metropolitan policyholders, but following that time, mortality from this disease was negligible. While community efforts, through the provision of pure water supplies and adequate sewage systems, were largely responsible for wiping out typhoid, the Metropolitan did yeoman service in organizing public sentiment in support of bond issues to pay for these sanitary improvements and in the promotion of other measures for the control of the disease.
Accidents have an importance for life insurance companies offering low life insurance rates and no exam term life insurance beyond their actual magnitude as causes of death. The Metropolitan, as well as most other companies, developed special benefits which provided for an additional payment equal to the face value of the policy in the event of death by accidental means. Industrial policies, with certain broad exceptions, granted this benefit without specific extra premiums to policyholders; ordinary policies made this available to the insured at a small extra cost. Claim payments on the double indemnity provision averaged about $4,500,000 a year in the 1940s in the Metropolitan.
Just as the physician and the public health worker were successful in their fight against disease, so were various agencies, including the Metropolitan, whom engaged in equally productive efforts to control accidents. The mortality rate from accidents in 1941 among the company’s industrial policyholders was about six tenths of what it was in 1911. While accidents generally constituted a very considerable item in the total death rate, they rose to first place in the list of causes at ages 5 to 14 among girls and 5 to 39 among boys and men.
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