In this program the Medical Division took advantage of all new facilities and methods that science had developed in the diagnosis and treatment of tuberculosis. Notable in this regard was the routine use of fluoroscopy and X-ray in the examination of employees since 1928. It was long suspected and eventually proved that X- ray procedures were the only effective means of detecting tuberculosis in its early stages. By the time actual symptoms appear the disease is usually well advanced. The long term results of routine fluoroscopy at the home office were extraordinarily good.
Thus, while among applicants for employment the proportion with tuberculosis, active or healed, remained constant in the period since the procedure was begun, the proportion among home office personnel in the life insurance company and out in the life insurance field declined sharply by more than 50 percent in between the early 1930s and the early 1940s. Again, whereas before the inauguration of routine fluoroscopy only 30 percent of the tuberculosis cases discovered among employees were still in the early stage, this proportion had practically doubled by the 1940s, while far advanced cases have declined from 22 percent to 5 percent of the total.
In fact, in that period of time not a single new case of far advanced tuberculosis was found among the many thousands of home office employees. Thus not only were new cases generally less advanced, but they were appreciably fewer in number. Since the chances of complete recovery from the disease were best when patients are brought under early treatment, a greater proportion was successfully treated and the time lost for treatment was markedly reduced. A study conducted around that time showed that, of the patients followed for at least 10 years after discharge from the Mount McGregor Sanatorium; half were at work or still able to work at the end of this period.
Among patients who had been brought under treatment in the early stage of the disease, and whose condition on discharge from the sanatorium was considered satisfactory, the proportion was nearly 80 percent. Among such ex-patients the subsequent mortality was little if any higher than that of their fellow workers, who had a very low mortality. With a steady increase in the number and proportion of older employees, the medical division was alert to their medical needs. It instituted procedures for the detection and care of those presenting early signs of diseases, both physical and mental, which were characteristic of middle and later life.
At the same time it developed a systematic plan for the study of some of these conditions, especially of heart disease and high blood pressure. As a first step in a long range plan the medical division inaugurated, in 1930, a more thorough and searching medical examination for employees reaching or already past age 40. Around the same time, new life insurance policies were being made available, such as no exam term life insurance, for example. These life insurance policies were made more available with the increasing improvements the Metropolitan was making in the public and the insurance company's overall mortality.
This examination, which was repeated at least every year or two, included routine electrocardiographic and X-ray study of the heart. The individual's medical history was also reviewed. It was through careful evaluation of all this information that many instances of early or developing cardiovascular disease were disclosed. The medical observations on these men and women, now numbering more than 2,000, constituted a unique and valuable set of data, and out of their systematic study new guides to the diagnosis of early cardiovascular disease were expected to develop.
