Document 1QmEL3zbyG32xO8Jam3y6Xbad

FILE NAME: Maryland Casualty Company (MCC) DATE: 1958 Mar DOC#: MCC016 DOCUMENT DESCRIPTION: The Insurance Index [Article - Occupational & Environmental Cancer] Quote: Cant'd ftom page 1. the efficient small businessman gen erally has a better percentage of earnings on sales than big business." H enry H. Hcwiann. e x ec u tiv e nice president, Nation! .Association of Credit Men. The plus factor . . . . "Business men can take advantage of the present lull by looking ahe ad `a t the plus factors in the economic picture' and planning for the upsurge that lies ahead. This is the tim e to accelerate lesearch, eliminate loss items, get costs under control, drive for new markets, improve' production sched uling, review purchasing policies and resist uneconomic wage de mands. This is not 1929. It is only realistic to say that anyone w ho is in the stock m arket today feels poorer than he did a few months ago, but hundreds of thousands of our people are not up to their ears on m argins as they w ere 28 years ago. T here is the F edera l Deposit Insurance Corporation . . . . Our de posits are safe. The factory w orker who is temporarily laid off draw s unemployment compensation . . . . Although I sometimes shake my head in wonder at the uneconomic extremes at which we have pro gressed with the various kinds of subsidy programs . . . . the farmer is at least piotected from the n a t ural hazards that have always sur rounded agriculture . . . "The most important plus factor . . . . is the movement toward easier credit availability and declining in terest rates . . . sensitive commod ity prices have already reached an eight y ea r low, and producers are bringing production into line with dem and at these lower levels in a num ber of commodity markets." Philip M Talbott. President of the U. S. Chamber of Com m erce. Publisher JAM MS E. D U N N E Associate Publisher YEHXOX D. BLANK Editor JAMES E. DUNNE Managing Editor H. LEON SC H E L L Kditni Insurance Medicine EHKDEKIC U. STEAHNS, M I) Associate Editons MANUEL STEVENS PECO Y 11OVA I, Cncnlation Manager JANE, B. DIEU THE INSURANCE INDEX Pi rsident CHAULES D. DUNNE Vice President and Secv. IDA L. DUNNE Nice Piesidenl EltED T. KEIIGU.SON Vier Piesidcnt VEUXON D. BLANk Vier President E. \Y. BEOK Vice President IIAHUY L. BAKTOX Tl easin ei MANUEL STEVENS tssistanl Secielar\ It LEON SOI 1KL1, 2 m a r c h , 3958 T h e fn u n ra n re I N D E X failvdmg INSUIANCt MtDIClUt MARCII, 1958 Voi. XX No. 0 25c per copy Kshiblislicri 1870 I N D E X n> Immmmmer T^c s h o re lin e w ith t h e w o rld Lnious G o ld en G ale B rid g e i the b a ck g ro u n d is B erk e*>. C a lifo rn ia p h o to g r a p h e r Mike R o b e r ts ' o f f e r in g f o r :e I n d e x 's M a rc h c o v e r . T o { .i it is a v e ry b e a u tif u l an d jt rn k in g e x a m p le of j u s t one { th e m a n y th o u s a n d s of j! ngineering a cc o m p l is h m e n ts `.it th e in s u ra n c e in d u s tr y I \s p la y e d a m a jo r ro le in. Insurance Medicine t Editorial 84 J'ledical Digest 8G I 3ook R e v ie w 94 Quotes: 1 C h m in ii'n ls of noted insurance figures Of Many Things 4 Insurant c nates highlights The "World" of Today 22 lain hilcis, Wotltl Insurance Ctnnjtntui iMULIC Honors Top Producers 28 Annual Leatlets Ateanl Ham/tiel Through Referred Lead Prospecting 32 Increase your clients lists Life Section 37 Notes m the field nf life Fire and Casualty Section 47 Featm m g cohi/ rhij/ activities Accent on Selling 64 Case histoiies of sales successes I TUB IN SU R A N C E IN D E X In c lu d in g In s u ra n c e M ccllclnc Is p u b lis h e d m o n th ly b y T H E VSTJRANCE P U B L IS H IN G CO. E d ito ria l, A d v e rtis in g a n d B u sin ess d e p a rtm e n ts, 915 E. te n tu c k y S t , L o u isv ille 4, K y . P . O. B o x 1738. E n te r e d a s s e c o n d c la ss m a t t e r S e p te m b e r T. 1939. a t P o s t O ffic e a t L o u isv ille . K y .. u n d e r th e A c t o f M a rc h 3, 1879. A n n u a l s u b s c rip in r a le s , o n e y e a r. S2 50. S u b sc i ip tlo n s p a y a b le in a d v a n c e : in th e U n ite d S ta te s a n d bsscssions, C uba, M exico. C en tral A m erica (except B ritish H onduras) and South A m erica veept Ih e ( lu ia n a s ) $2 50; In C a n a d a $3.00; e ls e w h e ie '5:1 50. N o lic e o f c h a n g e of a d d re s s -ust he re c eiv ed one m o n th b e fo re c h an g e is to ta k e p lace: b o th old an d n e w ad d resses .-.ould he g iv e n . TIIE INSURANCE INDEX 3 which was called asymptomatic. Yet, when finally conclusive evidence came, the reason was perforation of the appendix or generalized peri tonitis. Suicide in Children and A d olescen ts; Suicide is the fifth m ost frequent cause of death in th e age group 15 to 19 years in th e U. S. Seasonal d is tribution is highest in spring, p a r a l leling th a t of adults. Reasons for suicide among teen-agers include feelings of inferiority, fear of p u n ishment, feelings of guilt, anger, economic difficulties in the family. Twin studies do not point to a hereditary factor. In the age group 10 to 14, 35 to 60 ch ild ren ta k e th e ir lives each year. Suicide among chil d ren u n d e r 10 years of age is r a r e although threats and attempts are frequent. While these threats and attempts do not result in suicide, these children should be carefully examined. In a study of adult sui cides, 75% had made threats of selfdestruction. Paients and friends may tease and ridicule the already u n happy child. His next suicidal at tem pt m ay be successful. Any child who is m arkedly depressed, often in somniac, unstable, and displaying violent temper outbursts should be suspect, and given special attention. Chest injuries"" A uthors report on 365 patien ts with chest injuries in the period from J a n u a r y 1948 th r o u g h A ugust 1954. The ratio of sim ple (closed chest wall) injuries to complex (rib fracture with or without visceral in volvement) injuries has reversed b e tw e en 1923 a n d 1937 to 1940. T he rather persistent mortality rate of *H B ak in S u ic id e U n d e r 20. J . P e d n . 50*749. 1957. **T. \V Jo n es C h est I n ju r ie s A n A n a ly sis o f 3G5 eases N o rth w e st M ed., 50:431. 1957. com plex in ju rie s from 1910 through 1956 was 10 to 24.5%. T he m a le to fem a le ratio w as 3 to 1. Of the 365 patients, 75% su stain ed one or more rib fra c tu re s . T h e com plications in 97.3% w ere due to hemothorax, p n e u m o th o r a x a n d subcu tan e o u s emphysima. Head injury was an addi tional fac to r in m a n y cases a n d was one of th e p r im a r y causes of death in 45% of this series. 32.8% of the in juries w ere due to automobile ac cidents. Falls at home or at work accounted fo r the m a jo rity of the injuries. Yet, the automobile injuries were the cause of 75% of the deaths. A n o ver-all m o r ta lity r a te of 13.9(7 was recorded. Of the patients who died, 61 % h a d e ith e r a h e a d injury or cru sh in ju r y of th e chest. The time interval between m om ent of injury and death ranged from a lew minutes to 29 days. T h e d u r a tio n of hospitali zation averaged 8 days. The greater use an d speed of th e autom obile is prim arily responsible for the increas ing n u m b e r and severity of chest injuries. If th e r e is a com bination of head injuries and crush chest in juries, there is less than a 60" chance of survival. Height, W eight and Essential Hypertension** The accelerated (m alignant) form of h y p e rte n sio n is ch a racterized by the presence of pathological changes indicative of widespread necrotizing arteriolotis. Separation of the ac cele ra ted form from o th e r types was m ade by V o llh a rd and F a h r in 1914, The present study of certain constitu tional factors expects to lead to further differentiation of the acceler ated form of primary hypertension. 30 men an d 30 w o m en w ith primary hypertension of the nonaccelerated *G. A. P e rc ia a n d A. D am on. Height W eight, and T h eir R atio in the A cceletalrJ F o rm of P r im a r y H y p e rte n s io n . A rc h . 3nt M ed. 8 263, 1957. 88 MARCH, 1958 form an d the sa m e n u m b e r w ith the accelerated form w ere selected. All (0 with th e f irs t v a r ie ty w e r e 60 years of age or older, h a d developed hypertension p r io r to age 50, and had no p r e s e n t or past endocrine disorders. All 60 patients w ith ac celerated hypertension gave a his tory of a t le ast 4 y e a rs of e lev a ted blood p re ssu re a n d had p ro te in u ria , retinopathy, and papilledema. P ri mary ren a l d isease w as excluded. Only p a tie n ts b e tw e e n 35 a n d 50 years of age w e r e included. The pondral index (height divided by cube root of w e ig h t) w as r e c o rd e d in men an d w o m en w ith p r im a r y hypertension, with and without the accelerated form, th ere being 30 su b jects in each g ro u p s tu d ie d a t a comparable age with weight meas urements made prior to modification by their disease. T he w o m e n w ith accelerated hypertension were found to have a significantly h ig h e r p o n dral index th a n the w o m en w ith nonaccelerated disease, the former b<ing ta lle r a n d the la tte r h e a v ie r than a control sample of normal omen. T hese resu lts sugge st th a t host factors m a y c o n trib u te to the 'iisceptibility of some persons to the accelerated form of prim ary hyper tension No significant difference in the heig h t-w e ig h t ratio w as a p p a r ent in men, w h e th e r or not th e y had the accelerated form of the disease. Folie D eux1" The term folie deux is generally rcsoived for the appearance of a similar type of psychosis in two or more people living in close associa tion. These m a y be twins, h u sb a n d and wife, siblings, p a r e n t and child, . !c. The d o m in a n t p a r t n e r or one with the s tr o n g e r p ersona lity, dc- clops the psychosis first. T his is *H B e n ja m in S im u lta n e o u s O c c u r e n c e of I\\ch o lic Episodes in M onozygotix Tw ins. \r r h N e u ro l & P s y c h ia t. 2: 197, 1957. usually a paranoid type of psychosis, characterized by persecutory delu sions. The w eaker p a rtn e r soon ac quires the same psychosis. A. Gralnick in 1942 r ev ie w ed 103 cases of folic a deux and the entire English lite r a tu r e prio r to 1942. H e f o u n d that it occurs more frequently in females than in males in a ratio of 4:1. It is especially p r o m in e n t in sister combinations and next com monest in m other - and - d au g h ter pairs. J. G. O a tm a n in 1942 sta le d that in a large maj ority of eases of folie deux, the syndrom e presents itself as a paranoid psychosis, w ith both patients entertaining almost identical systematized, plausible de lusions, but not tile bizarre, primitive beliefs of schizophrenia. A dequate history will reveal th a t one m em ber of the pair exhibited psychotic sy m p toms earlier, if only by a m atter of days. Author presents a report of the simultaneous occurrence of psychotic episodes in a p a ir of 21-year old m o n ozygotic twin girls. Both S later and Shields in 1953 and K a l l m a n n in 1952 and 1953, stressed t h e im p o r ta n c e of blood relationship as a factor p re disposing to psychosis. Occupational and Environmental C a n c e r5' Some of the environm ental c a n cers, such as those elicited by coal tar, arsemcals, and ionizing rad ia tion, display etiologic-specific ep i demiologic and symptomatic patterns in regard to their regional d istrib u tion, population groups affected, e x posure stigmata, pro - cancerous lesions, and site of cancer. Such p a t terns are almost as well defined as those available for some infectious diseases. The target organ of cancer formation may differ for some en vironmental cancers with the route *\V. C H u e p e r N e w e r D e v e lo p m e n ts in O ccupational and E nvironm ental C ancer. A rch . In t. M ed. 3 487, 1957. THE INSURANCE INDEX 89 of introduction of the carcinogen. The great majority of the at present known environmental carcinogens and carcinogenic exposures were dis covered d u rin g th e la st 75 years. Although the total num ber of en vironmental, and particularly occu pational human cancers observed in circumscribed population groups is relatively small, there can be no doubt that the actual num ber of such cancers which have occurred in these restricted populations is con siderably higher because many have not been reported as being of en vironmental origin. The great bulk of worker groups having in some form contact with known occupa tional carcinogens has never been surveyed for the presence and inci dence of occupational cancers. The data on hand suggest that environ mental agents of known and still unknown nature apparently play an important part in the direct or in direct causation of a m ajor portion of hum an cancers involving various organs and tissues. Environmental factoi.s a p p e a r to be ac tive especial) m (lie production of ca nce rs of or gans an d tissues f u rn is h in g the epi dermal and mucosal covers of tissue (cutaneous, respiratory, digestive with w hich the e n v iro n m e n ta l cai em ogens h a v e p r im a r y contact oi which becom e exposed to them dur mg the process of excretion (urinm or in which they may be retaitvd and stored (skin, liver, bone, bonmarrow). During the last century a rapidly increasing num ber of mu recognized, suspected, or potential in d u s try - re la te d carcinogens have been introduced in the hum an en vironment, so that the opportunitic intensities, and sources of hum an ex posure to the agents have risen con siderably. Thus, g ro w in g n u m b e rs oi persons a re becom ing exposed to tinnew carcinogenic constituents. The increasing n u m b e r of d e a th s from cancer demands that adequate meas ures be tak en to keep the n u m b e r of en vironm ental carcinogens an d the degree of e x p o s u re to th e m to 1he practicably attainable minimum Current 1 ileralure E. TotWI, J r . C a n c e r of th e G a llb la d d e r. K e n tu c k y M ed. J., f>r> 419, 1957. 219 patients w h o had been found to have gall stones, during a 5-year period, either refused operation or operation was thought to be unadvisable. It can be exp e cted th a t 13 (6.1%) of those ov er 70 y e a rs of age will develop carcinoma of the gall bladder. W. A. T h o m as, J. <>. Illm iu* a n d K . '1*. 1-eo. R ace and Incidence* of A cute M yocardial In f a r c tio n . A rch . In t. M ed., 3.423, 1957. The incidence of acute myocardial infarction for each decade of life, for each sex, and for each race has been d eterm ine d am ong 17,067 autopsied adults (8003 Negroes an d 9064 w hite persons) from each of tluee widely separated geographic areas (St. Louis, W ashington, D. C., N ew Or leans). The over-all incidence of acute m yocardial in farction is much higher among whites than among Negroes in both of the periods stud ied (1910-1939 an d 1940-1954). The incidence was similar in all three localities. The incidence rose steeply am ong w hites in th e perio d 1940-1954 over the period 1910-1939, b u t this rise did not occur in the Negroes. The incidence in the two races, expressed as a percentage of those who survive to a given age) is not significantly d ifferent in th e a g e -group 20-39, blit is significantly d ifferent betw een the two races in all older age group Among Negroes the over-all inci dence of acute myocardial infarction is sim ilar in the two sexes in each 90 m a r c h , 1958 ptiod studied. Among whites the .hudonee was significantly greater jnong men than among women in the period 1910-1939, b u t th e y w e r e significantly different in the Mod 1940-1954. (. I ( a ju a r d . P a ro x y s m a l T a c h y c a r d ia . C Jin. M*d 8 993, 1957. (fro m B rit.. M. J . 4958: tor.. 1950. The essential feature of paroxys mal tachycardia is a b r u p t onset of the attacks. Attacks starting under age 40 are com m only s u p r a v e n tr ic u lar while a u r ic u la r f lu tte r o r v e n tricular tachycardia are more com mon after age 50. In s u p r a v e n tr ic u la r tachycardia the r a le is b e tw e e n 160 awl 220 and does not v a r y fro m minute to minute. In v en tricu lar tachycardia the rate is w ithin the amo limits b u t less constant. S u p ra wntncular tachycardia occurs often m patients without organic heart diwase. V entricular tachycardia is rate except in patients w ith serious Iv.-irl disease, such as congestive heart failure, recent myocardial in farction, etc. In supraventricular tachycardia, carotid sinus pressure vull either stop or influence t h e ra te . There is no evidence th a t even f r e quently recurrent paroxysms, with a normal heart, will shorten life. f S(nrr. H e a r t D isea se a n d D e a th . C ir c u la tion. Jfi.l, 1957. The statistical conclusion that the tuberculosis mortality rate is falling and the cardiac m ortality ra te is rising depends entirely on d ea th c e r tificates. The diagnosis in tu b e rc u losis is g ene rally correct. T h e a u t h o r asks under w h at conditions establish physicians heart disease as cause of death. While rheumatic, thyroid, and syphilitic heart disease are not being found more frequently than some jeats ago in death certificates, a r teriosclerotic and coronary heart disease are. The author suspects th a t the physician who has not m ade thorough studies on his elderly p a tient, who finds him with a weak pulse and failing heart function prior to death might write in the death certificate "arte rio scle ro tic h e a r t disease" although this statem ent in these eases is confusing. "It is m y strong impression . . . that doctors often diagnose heart disease in eld erly people . . . (as) they do not know what else to call it." Dr. S tarr stresses that the frequency of r e ported deaths from arteriosclerotic heart disease "excites m y suspicion that the data are being contaminated . . . The reported increase in the num ber of deaths from arterioscle rotic heart disease seems to m e dif ficult to interpret with confidence." M . M a k i n . F r ie d r e ic h 's A ta x ia . H u n te r ia n L ecture. Royal College of Surgeons, L o n d o n . 1957 (S co p e W ee k ly . 35:9, 1957). 34 of 37 p atients w h o had s u r g e r y and who had been followed for periods u p to 10 y e a rs r e g a in e d f u ll functional activity. The average age w as ju st o v er 10 years, b u t m a n y of the patients were not treated at the time of the diagnosis. The procedure followed was subtotal arthrodesis w ith correction of deform ity by wedging of resections. The most com mon deformity was symmetrical pes cavus and claw toes. Equinus was present in over half and pcs varus in un d er half of the cases. W. K. Ilnlli dny a n d A. C. W il lia m . T h e T c t r a lofiy o f F a llo t. A rch . In t. M ed., 3:400, 3957. A u th o rs rep o rt on 32 cases. C on trary to widespread belief tlie.se p a tients are not necessarily cyanotic from birth. Onset is quite variable and usually reflects the severity of the malformation. Cyanosis becomes manifest only when the child begins to crawl or walk. Only 50% are syanotie at 5 months of age, and ap proximately 20% may still be cya notic by 2 years. The over-all inci dence of the non-cyanotic tetralogy is of the order of 10%. The prognosis THE IN SU R A N C E IN D EX .91