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of Friendly Societies by English actuaries, particularly the Manchester Unity.

Sickness insurance on a scientific basis can hardly be said to have been developed in the United States." There have, to be sure, been a comparatively small number of sickness and accident companies in operation in this country for several years, and some of the fraternal orders operating in the United States have paid one form or other of sick benefits to their disabled members for many years. With the single notable exception of the Loyal Protective Insurance Company of Boston, which in 1911 compiled and published an exceedingly interesting analysis of its health and accident experience for the ten years, 1895-1904, none of the health (or sickness insurance) companies, or fraternal orders paying sick benefits in this country has ever made public the results of its sickness experience. It may therefore be as truly said in 1914 as Mr. Hoffman observed in 1910, that "sickness insurance on a scientific basis can hardly be said to have been developed in the United States," and in so far as any data of the slightest value for an American comparison of the relative rates of sickness among abstainers and non-abstainers are concerned there is to all intents and purposes an entire vacuum.

The Friendly Societies, and their branches, in Great Britain are numbered by thousands and their aggregate membership runs into the millions, and most of them pay sick benefits to their disabled members. Tabular studies of both the mortality and morbidity experience of a few of the principal Societies have been compiled and published, but most of these tabulations too far antedate the present conditions to be accepted as of any great current value, and the most widely-recognized authority on the subject of the morbidity experience of the Fraternal Societies is the comprehensive actuarial study of the Independent Order of Odd Fellows, Manchester Unity, compiled and published by its Actuary, Alfred W. Watson, in 1903, under the title of “An Account of an Investigation of the Sickness and Mortality Experience of the I. 0. 0. F., Manchester Unity, during the five years, 1893-97.” This colossal work of nearly 500 pages, supplementing Ratcliffe's previous study of the Society's experience from 1866 to 1870, ranks at the head of all works in this particular branch of insurance literature, and the rates of sickness therein laid down for the “whole Society” formed the sickness basis for the calculations under the recent National Insurance Act.

In the Report of the Actuaries in relation to the Scheme of Insurance against Sickness, Disablement, &c., embodied in the National Insurance Bill, 1911,” published in that year, this authoritative statement is made (p. 15):

“There are no general statistics dealing adequately with the rates of sickness in the United Kingdom generally. The combined experience of the Friendly Societies would have been an invaluable guide, but this has not been collated within recent years, if we except the investigation undertaken by the Registry of Friendly Societies, and carried out by the late William Sutton, dealing with the sickness and mortality experience for the years 1876 to 1880, inclusive, which, even at the time of collation, included only a minority of the Societies, and is now out of date.

“The result of an extensive investigation of the experience of the Manchester Unity of Odd Fellows by Mr. A. W. Watson, F.I.A., Actuary to the Society, was published in 1903 and covered the five years 1893 to 1897, dealing only, however, with male lives. Notwithstanding the fact that this experience related only to the various branches of a single affiliated order, it may be considered as fairly representative of the general experience of Friendly Societies. The investigation brought together a larger body of facts than had been before available, and owing to the care and thoroughness which characterized it, we have found the results of great service to us in the present inquiry. An important result of this investigation was to show that a steady increase in the average rate of sickness among

a male lives at all ages had been taking place for many years previously.”

This official statement over the signature of two of the foremost actuaries of the world, Messrs. George F. Hardy and Frank B. Wyatt, both Past Presidents of the Institute of Actuaries, supplementing the well-known lack of any authoritative data on the subject of American morbidity experience, would seem conclusively to establish the fact that no up-to-date sickness experience in any English-speaking country is now available on which the "Monthly Bulletin" of the American Museum of Safety could have worked out any diagram accurately showing "the average amount of time lost by sickness each year” among males in general-let alone, “among moderate drinkers and abstainers."

One of the basic principles of statistical work requires that there shall be a substantial uniformity of groups subjected to analytical comparison, or, in other words, that groups of men in the case of which mortality and morbidity experiences are compared must be of substantially identical age, and in point of location, occupation and other living conditions stand on an approximately common basis. Otherwise, the comparison is practically valueless. In weighing the reliability of the South Australian comparison which obviously furnished the basis for the American Museum of Safety’s “Diagram No. 1," many very serious questions as to the substantial identity of all the material conditions in the case of the two groups of Fraternal Societies in question—with the single exception that the members of one group were total abstainers, whereas the members of the other group were not necessarily so—immediately present themselves.

In the first place, the two branches of the Independent Order of Rechabites, and the Sons of Temperance, in South Australia had a total of but 7,943 male members at the end of 1904, when the third valuation of the Friendly Societies of that country was made by the Public Actuary. Their total membership at the end of 1899, when the previous valuation was dated, was but 6,926, and it thus becomes evident that “Diagram No. 1” of the American Museum of Safety at best has no stronger foundation than a comparison of the five-year sickness experience of less than 7,000 males in far-away South Australia with that of a much larger number of males in other Friendly Societies in which the average age and various other conditions of the male membership very possibly were entirely different. Even the most casual examination of the evidence available at this distance, on the other side of the world, would seem to so indicate.

The official figures of the Chief Registrar of Friendly Societies (of Great Britain) for the year 1910 show that at the end of the year in question the parent Independent Order of Rechabites, Salford Unity, had a total of 320,739 members in England, Scotland, Wales and Ireland, and that in the same territory the Sons of Temperance Friendly Society had a total of 170,755 members. The Chief Registrar's report shows that the membership of these two Societies in the two lower age groups was as follows:

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Societies.

Members

under 16 years. Rechabites

. 100,522 Sons of Temperance

Members,
IC-20 years.

42,930
16,274

Total under 20.

143,452 87,286

71,102

Totals

171,534

59,204

230,738

The above figures indicate that about 45 per cent. of the entire membership of the parent Society of the Rechabites in Great Britain was under 20 years of age, and that more than 51 per cent. of the Sons of Temperance menibership was under that age, or that about 47 per cent. of the home membership of both Societies was under 20 years of age. These figures of course do not necessarily apply to the membership of these abstainer-societies' branches in South Australia, but would at least seem strongly to indicate that the average age of their memberships was materially below those of the memberships of the Ancient Order of Foresters, the Independent Order of Odd Fellows (Manchester Unity), and the Grand United Order of Odd Fellows, comprising Group 2 (non-abstaining societies), with which the comparison of morbidity rates was made. In that event, the rate of sickness would presumably be much lower in the former case.

But the average age of the membership is only one of the many important points on which the conditions would be substantially identical in order to justify any comparison of the morbidity rates. One of the most vital of these points is the occupation of the membership. Occupation is a well-known factor in determining morbidity as well as mortality, and in his authoritative tabulation of the morbidity experience of the Independent Order of Odd Fellows, Manchester Unity, for 1893-1897, Mr. Watson classified the experience at the various ages in four occupational groups. Even at the early age of 30 years, these groups respectively showed morbidity rates of 0.918—1.073–1.388—1.711—thus discovering a discrepancy of 7.93 per 1,000 members at age 30, in the case of the least hazardous and most hazardous classes of occupations. If there were any pronounced differences in the general occupation, as well as in the average ages, of the memberships of the abstaining and non-abstaining societies in South Australia whose sickness experience was compared, radical differences in the showings of the two morbidity experiences might be confidently expected, entirely independent of the fact that one body was, and one was not, limited to total abstainers.

Another condition of recognized importance in comparisons of sickness experience is the location, and the living conditions, of the memberships which are compared. This fact is discussed at considerable length in the exhaustive paper on "Some Statistical Problems Suggested by the Sickness and Mortality Data of Certain Large Friendly Societies” presented before the Royal Statistical Society, of London, on March 18, 1913, by E. C. Snow, M.A., D.Sc., and published in the Journal of the Royal Statistical Society for April, 1913 (Vol. LXXVI), Part V, pp. 445-517. As Dr. Snow there demonstrates by figures for several of the larger Friendly Societies, there are pronounced differences in their respective morbidity experiences not only in the case of members living in (1) metropolitan districts, (2) large towns and (3) country districts, but also even more decided differences in the case of members grouped by counties.

One more, and by no means the least important, of the conditions which govern the sickness experience of the Friendly Societies as recorded in their official returns, is the fact that the various Societies materially differ in the terms and conditions on which they pay sick benefits, providing "waiting periods of different lengths before benefits will be paid, in some cases exempting certain periods from the payment of benefits after prolonged sicknesses, and in many cases prescribing a great variety of conditions. Most, if not all, of these varying conditions figure in the returns for "all durations of sickness,” and, then again, some societies rigidly insist on a physician's certificate of disabling illness in every case, whereas other societies--especially in the country districts—do not so insist. Again, some societies draw no sharp lines between cases of sickness and accidents, but pay so-called sick benefits for any disabling cause, and, of course, if accidents are included with cases of actual sickness the morbidity returns of societies of this class are abnormally swollen.

In short, as Elderton and Fippard's recent work on “The Construction of Mortality and Sickness Tables” puts it, in referring to the rates of sickness in some of the oldest friendly societies, “different methods influence the results to some extent, and too much stress must not be laid on small differences.” Taking into account the many possible material differences between two small groups of friendly societies' sickness experience in far-away South Australia, it would scarcely seem as though the American Museum of Safety had builded on very secure foundations when in “Diagram No. 1” it presented what purported to be an authoritative graphic "comparison of the average amount of time lost by sickness each year among moderate drinkers and abstainers," its sole ground for this pronunciamento, in so far as the figures cited would seem to indicate. being the alleged sickness experience of a little group of total-abstaining societies as contrasted with that of another little group of

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