While an investigation was being made into the mortality rates, there was also a review of the laboratory procedures being carried out. For this purpose the medical division called in the foremost experts in the field, Dr. Otto Folin and Dr. Stanley Benedict. These men devised new quantitative tests for glycosuria and albuminuria, which became standard procedure in medicine. In addition, the laboratory refined and improved methods of analysis of various substances in the blood. Dr. Folin developed a method of determining accurately the amount of sugar in a very small quantity of blood.



This method was eventually used in medical laboratories all over the world. Another interesting development was the use of x-ray procedures in solving medical problems of policies such as "life insurance quote without medical." This revolved primarily around the use of the fluoroscope, an x-ray device through which the physician can "see" instantly the internal structures of the body. Fluoroscopy was first taken up by the medical division as an efficient and inexpensive method of detecting early tuberculosis in applicants for employment and in company employees at the home office.

Studies of various abnormalities of the lungs disclosed in these examinations helped the company's doctors to determine their significance, and as a result some abnormalities, such as healed childhood tuberculosis, were proved to have no adverse effect on longevity. Insurance practices were consequently revised in the light of these findings. X-ray films were also extensively used in examinations of the heart and lungs. The determination of the nature and extent of cardiac enlargement by the usual methods of examination was, in some respects, a "rule of thumb" affair.

An x-ray film of the chest, however, yielded more accurate information on the size of the heart and often disclosed other valuable details regarding that organ. Consequently its use, when a heart abnormality was present or suspected, resulted in providing a more accurate and fairer judgment than would otherwise have been possible. Here again observations on home office employees giving different types of life insurance quotes expedited the development of standards for insurance and general use. The investigation of heart impairments had special interest for those concerned with medical selection in the Metropolitan.

In 1899 the company began to insure persons with certain types of heart murmurs, issuing policies in the special class branch to these applicants. As there was no mortality experience to go by, the decision to accept such risks was made on the basis of clinical judgment. In the aggregate, the mortality experience on these heart cases proved to be within the expected limits. Periodic studies proved, however, that some types of heart murmurs were insignificant abnormalities, while others were of such seriousness that persons so impaired were not insurable at all. New procedures that followed for diagnosing heart disease were also useful in insurance medicine.

One of the most important of these was electrocardiography, which was of prime value in detecting diseases of the heart muscle. Prior to the use of this technique in insurance examinations (for life insurance rates and quotes) little distinction could be made with respect to applicants with such disorders. The development of electrocardiography, however, made it possible to identify some cases of serious heart disease that would not ordinarily be picked up by the usual physical examination.

While the normal pattern of the electrocardiogram was defined in broad outlines, there were numerous deviations the nature and significance of which were obscure for many years to follow. In the accumulation of data for the solution of these problems the insurance companies, and particularly the Metropolitan, laid foundations for future scientific advances which would prove of great value not only in insurance medicine but also in general practice.