M ■ ■ ■ -> •' JC1S A; TONOOPF, S, J. PH. C S. ADOLPHUS KNOPF, M. D. ANNIVERSARY TRIBUTE TO GEORGE MARTIN KOBER IN CELEBRATION OF HIS SEVENTIETH BIRTHDAY BY HIS FRIENDS AND ASSOCIATES MARCH 28, 1920 FRANCIS A. TONDORF, S. J., Ph. D. WASHINGTON, D. C. 1920 TABLE OF CONTENTS. PART I. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY. THE GEORGE M. KOBER ANNIVERSARY COMMITTEE I-II BIOGRAPHY OF DR. KOBER IH-VI OBSERVATIONS ON THE NEGRITOS OF THE PHILIPPINE ISLANDS' . Philip Newton, M. D., Assistant Professor of Anatomy, Georgetown University 1-24 THE INDIAN BRAIN. J. J. Keegan, From the Department of Anatomy, University of Nebraska .. 25-62 THE NASO-ORBITO-ALVEOLAR INDEX. A New Craniometric Method including a Description of a Specially Designed Indexo- meter for Estimating it. John Cameron, Professor of Anatomy, Dalhousie University, Halifax, N. S 63-76 ASPECTS OF THE SKULL. HOW SHALL THEY BE REPRE- SENTED? George Grant Maccurdy, Peabody Museum, Yale Uni- versity _ 77-82 MULTIPLE BIRTHS AMONG THE CHINESE. Berthold Laufer, Field Museum of National History, Chicago 83-96 RACE SUICIDE IN THE UNITED STATES. Warren S. Thompson, Cornell University _ 97-146 ANTHROPOMETRY. Ales Hrdlicka, U. S. National Museum 147-174 THE MORTALITY STATISTICS OF INSURED WAGE-EARNERS AND THEIR FAMILIES. Louis 1. Dubli.n, Ph. D., Statiscian; with the Collaboration of Edwin W. Kopf, Assistant Statiscian, and George H. Van Buren, Supervisor Statistical Bureau, Metro- politan Life Insurance Company, New York 175-186 THE NEWEST DISCOVERY OF "ANCIENT" MAN IN THE UNITED STATES. Ales Hrdlicka _ 187-192 INFLUENZA AMONG THE AMERICAN INDIANS. By the Public Health Service 193-194 TUBERCULOSIS AMONG THE NATIONS IN THE WEST INDIES 194-195 SEX DETERMINATION 195 MORTALITY OF INFANTS OF DIFFERENT RACIAL GROUPS 196 CURRENT NOTES 197-198 BIBLIOGRAPHY OF DR. KOBER 199-211 PART II. ANNIVERSARY TRIBUTES. Reprinted from Georgetown College Journal, Kober Anniversary Number, March, 1920. BIOGRAPHY OF DR. KOBER. Francis A. Tondorf, S. J., Ph. D., Head of the Department of Physiology, Georgetown Medical School 217 KOBER AS DEAN. Wilfred M. Barton, M. D., '92, Professor of Therapeutics Georgetown Medical School : 225 KOBER AS THE STUDENTS' FRIEND. John A. Foote, M. D., '06, Associate Professor of Clinical Medicine, Georgetown Medical School 229 AN APPRECIATION. Llewellyn Eliot, M. D., '74 231 TRIBUTE OF THE REV. J. HAVENS RICHARDS, S. J., President of Georgetown University 1888-1898 232 TO DR. KOBER (On the celebration of his Seventieth Anniversary), Verse. Edward F. Mack, A. B., '20 1 ... 236 ADDRESS BEFORE THE GEORGETOWN CLINICAL SOCIETY. James A. Gannon, M. D., '06, Associate Clinical Professor of Surgery, Georgetown Medical School 237 TO A PHYSICIAN. John A. Foote, M. D„ '06 240 A TRIBUTE TO DR. KOBER. From A Pre-Medical Student. (Verse) Thomas E. Mattingly „ ,. 241 WERTH. (A German Poem). Kurt Voelkner 242 EDITORIAL. Joseph R. Mickler, Jr., A. B., '20 243 CONGRATULATIONS FROM THE SOPHOMORE CLASS 244 COMPLIMENTARY DINNER 245 LIST OF GUESTS 249 INTRODUCTORY SPEECH. Francis R. Hagner, M. D., President Medical Society, District of Columbia 252 OPENING ADDRESS OF THE TOASTMASTER. Dr. John A. Foote 252 A TRIBUTE FROM THE MEDICAL SOCIETY. William C. Wood- ward, Health Commissioner of Boston, Mass . 254 PRESENTATION OF A COPY OF THE AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY. Professor William H. Holmes, Head Curator Department of Anthropology U. S. National Museum. Representing the Anthropology Society 261 A TRIBUTE FROM THE CIVIC ORGANIZATIONS. Hon. Henry B. Macfarland, Formerly President of the Board of Commissioners of the District of Columbia 263 A TRIBUTE FROM THE WASHINGTON ACADEMY OF SCIENCES. Dr. Robert S. Woodward, President of the Carnegie Institution of Washington ...... 265 A TRIBUTE FORM THE COSMOS CLUB. Dr. Harvey W. Wiley, Director of Bureau of Foods, Sanitation and Health 267 PRESENTATION OF LOVING CUP. Dr. Charles W. Richardson, Member of the Board of Trustees, American Medical Association, etc., etc 271 RESPONSE by Dr. Kober 272 SOLDIER, SCIENTIST, PHYSICIAN AND PHILANTHROPIST. (A Poem). S. Adolphus Knopf, M. D 277 CONGRATULATORY TELEGRAMS AND LETTERS 279 PART III. A VINDICATION OF VIVISECTION. PREFACE _ 287 LECTURE I.-"A VINDICATION OF ANIMAL EXPERIMEN- TATION." Based upon the work of the Rockefeller Institute for Medical Research in New York City. Bv Simon Flexner, Director, M.. D., Sc. D., LL. D ■ '. 289-301 LECTURE IL-THE LEGAL ASPECTS OF VIVISECTION. By William Creighton Woodward, M. D., LL. M. Health Commis- sioner of Boston, Mass., Professor of Medical Jurisprudence George- town University - 302-309 LECTURE HL-SOME OF THE ETHICAL ASPECTS OF ANI- MAL EXPERIMENTATION. By Wm. H. Arthur, M. D„ F. A. C. S. Late Commandant Army Medical School 310-315 LECTURE IV.-WHAT ANIMAL EXPERIMENTATION HAS DONE FOR GYNECOLOGY AND ABDOMINAL SURGERY. By Thomas S. Cullen, M. D. Professor of Clinical Gynecology, Johns Hopkins Hospital .'. ... 315-324 LECTURE V.-ACHIEVEMENTS OF ANIMAL EXPERIMENTA- TION IN GENERAL SURGERY. By George Tully Vaughan, M. D., LL. D., F. A. S. Professor of Surgery Georgetown University ' 324-331 LECTURE VI.-ACHIEVEMENTS OF THE MEDICAL CORPS OF THE ARMY IN PREVENTIVE MEDICINE. By George B. Foster, Jr., M. D., Dr. P. H. Major Medical Corps, United States Army „ . 331-342 LECTURE VIL-THE LABORATORY WORK OF THE UNITED STATES PUBLIC HEALTH SERVICE. By A. M. Stimson, Surgeon U. S. P. H. S. Assistant Director, Hygienic Laboratory, Washington, D. C ,. '. 342-348 LECTURE VIII-THE ECONOMIC ADVANTAGES DERIVED FROM ANIMAL EXPERIMENTATION. By Ernest Charles Schroeder, M. D., D. V. M. Superintendent Experiment Station United States Bureau of Animal Industry, Bethesda, Md 348-362 LECTURE IX.-THE ACHIEVEMENTS OF DENTAL MEDICINE AND ORAL HYGIENE. By Ralph A. Hamilton, M. D. Prof- essor of Bacteriology and Pathology Georgetown University Medi- cal School .. : 363-368 CONCLUDING REMARKS TO THE COURSE OF LECTURES ON VIVISECTION. By George M. Kober. M. D., LL. D. Dean of the Georgetown University School of Medicine 368-370 MORAL ASPECTS OF VIVISECTION. A D gest of the Statement of Rev. Francis A. Tondorf, S. J., Ph. D. Professor of Physiology, Georgetown University School of Medicine, before the Subcommittee of the Commmittee on the Judiciary of the United States Senate on November 4, 1919 371-372 GENERAL STATEMENT IN PROTEST AGAINST THE ENACT- MENT OF S. 1258; a Bill to Prohibit Experiments upon Living Dogs in the D strict of Columbia, before the same Committee. By George M. Kober, M. D., LL. D ; : 372-377 A PLEA FOR SANITY IN LEGISLATION ON ANIMAL EXPERI- MENTATION (With special reference to the Dog). By Murray Galt Motter,' M. D. Formerly Professor of Physiology George- town University Medical School 378-381 Vol. Ill WASHINGTON, JANUARY-MARCH, 1920 No. 1 AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY Published Quarterly EDITOR ALES HRDLICKA ASSOCIATE EDITORS Professor G. Stanley Hall President, Clark University Dr. E. A. Hooton Peabody Museum, Harvard University Professor George Grant MacCurdy Yale University Dr. Charles B. Davenport Carnegie Institution of Washington Professor Franz Boas Columbia University Dr. Clark Wissler American Museum of Natural History Professor J. Howabd McGregor Columbia University Professor E. V. Cowdry Peking Union Medical College Professor H. H. Donaldson Wistar Institute Dr. William C. Farabee The University Museum of Philadelphia Dr. George M. Kober Dean of Medical Department, Georgetown University Dr. J. H. Kellogg Superintendent, Battle Creek Sanitarium Dr. Berthold Laufer Field Museum of Natural History, Chicago Professor J. C. Merriam National Research Council Professor A. L. Kroeber University of California Professor A. E. Jenks University of Minnesota Sir Francis H. S. Knowles Victoria Museum, Ottawa Annual Subscription Domestic, $5.00 Canada, $5.25, U. S. currency Other Countries, $5.50, U. S. currency All communications and remittances relating to the Journal should be addressed to the Editor, American Journal of Physical Anthropology, U. S. National Museum, Smithsonian Institution, Washington, D. C. Entered as second class matter, June 11,1918, at the Post Office at Washington, D. C., undei the Act of March 3, 1879 SCOPE OF THE AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY I. A. Anthropology in General a. History; Present condition; General B. Research b. Evolution; Man's Origin; Early Man c. Human Ontogeny: Embryology; Childhood; Adolescence; Decline; Death d. Heredity; Eugenics e. Man's Variation: Osteology; Teeth; Soft parts; Body proportions; Races; Physi- ological, Mental f. Demography; Vital and Racial Statistics g. Abnormal Classes; Comparative Human Pathology and Teratology X. Anthropological Problems peculiar to the United States XX. The American Indian II. War Anthropology a. The Peoples at War b. Everything of Anthropological interest connected directly or indirectly with the War III. American Collections a. Status of b. Field work c. Specially important accessions d. Exhibits IV. Anthropometry and Methods in General a. History b. International Agreements c. Instruments d. Directions e. Seriation; Curves; Biometric Methods f. Illustration g. Methods of Excavation, Transportation, Preservation V. Special Communications and Reports VI. Reviews and Annotated Bibliography VII. Notes and Current Anthropological News a. Special lectures; Miscellaneous b. Appointments, Promotions, Changes c. Deaths; Obituaries THE GEORGE M. KOBER ANNIVERSARY COMMITTEE Dr. George M. Kober, Dean of the Medical faculty, Georgetown University, reached the age of 70 years on March 28, 1920. That the day might not pass without some slight testimonial of the admiration and esteem in which he is held by pupils, friends and co-workers in the many fields of his activities, a number of Dr. Kober's associates met on October 24, 1919, and decided to issue an anniversary publi- cation, dedicated to him. This Organization Committee consisted of Dr. George Tully Vaughan, Chairman; Mr. Felix Neumann, Secretary; Mr. John Joy Edson, Treasurer; and General Robert E. Noble, Dr. Charles D. Walcott, Dr. W. M. Barton, Dr. J. W. Fewkes, Prof. W. H. Holmes, Dr. Walter Hough, Dr. L. 0. Howard, Dr. A. Hrdlicka, Mr. Neil M. Judd and Dr. Truman Michelson. Owing to the shortness of the intervening period and to uncertain- ties of publication, it was considered advisable to accept the offer of Dr. Ales Hrdlicka, editor of the American Journal of Physical Anthro- pology, and issue the first quarterly of that Journal for 1920, as the George M. Kober Anniversary Number. Dr. Kober has been an associate editor of the Journal since its inception. Although Dr. Kober's scientific interests include such divergent subjects as Military Medicine, Occupational and Social Diseases, Hygiene, Tuberculosis, Social Welfare, and Physical Anthropology, the specific character of the American Journal of Physical Anthropology limited contributions to those bearing directly upon the latter title. Considering the many distinguished services rendered by Dr. Kober to the advancement of medical science and to the social welfare of the United States, it is significant to note that appreciation of his efforts is not confined to the District of Columbia. The list of names which follows is ample proof that the homage paid Dr. Kober at this time is nation wide. Members of the National Committee and Subscribers to the George M. Kober Anniversary Number: ABEL, DR. JOHN J. Baltimore, Md. ABT, DR. ISAAC B. Chicago, Ill. ACKER, DR. A. E. Jacksonville, Fla. ADAMS, DR. SAMUEL S. Washington, D. C. AGRAMONTE, DR. ARISTIDES Havana, Cuba. ANDERS, JAMES M. Philadelphia, Pa. ANNIVERSARY COMMITTEE ASHFORD, BAILEY K., Col., A. M. C., San Juan, Porto Rico. ASHFORD, DR. F. A., U. S. P. H. S., Fort Stanton, N. M. ASPINWALL, CLARENCE A. Washington, D. C. BALDWIN, DR. E. R. Saranac Lake, N. Y. BALDWIN, WILLIAM H. Washington, D. C. BARIE, DR. GEORGE New York City. BARISCILLO, DR. JOHN J. Asbury Park, N. J. BARKER, DR. LEWELLYS F. Baltimore, Md. BARTON, DR. W. M. Washington, D. C. BEHREND, DR. EDWIN B. Washington, D. C. BELL, DR. ALEXANDER GRAHAM Washington, D. C. BELL, CHARLES J. Washington, D. C. BERLINER, EMILE Washington, D. C. BILLINGS, DR. FRANK Chicago, Ill. BLAKADER, DR. A. D. Montreal, Canada. BLUE, RUPERT, Ass't Surg. Gen., U. S. P. H. S., Washington, D. C. BOARDMAN, MISS MABEL T. Washington,'D. C. BORDEN, DR. WILLIAM CLINE Washington, D. C. BRAISTED, W. C., Surg. Gen., U. S. N., Washington, D. C. BRETT, L. M., Col., U. S. A., Ret., Washington, D. C. BROWNE, D. P. Berkeley, Calif. BROWNLOW, HON. LOUIS Washington, D. C. BRUHL, DR. CHARLES E. Houston, Texas. BRYAN, LEE McK. Washington, D. C. BRYANT, ARTHUR L. Washington, D. C. BUSHNELL, G. E., Col., A. M. C., Concord, Mass. CARMAN, DR. L. D. Washington, D. C. CLARK, APPLETON P. Washington, D. C. COGAN, DR. W. N., U. S. N., Washington, D. C. COLEMAN, DR. WARREN New York City. COLLIER, DR. WILLIAM M. Washington, D. C. CONSTAS, DR. JOHN Washington, D. C. CORRIGAN, DR. GEORGE F. Newark, N. J. COUNCILMAN, DR. WILLIAM T. Boston, Mass. COVILLE, DR. FREDERICK V. Washington, D. C. CRANCH, DR. EDWARD Erie, Pa. CREEDEN, REV. JOHN B. Washington, D. C. CROWDER, C. E., Davis Creek, Calif. CUTLER, ELBRIDGE G. Boston, Mass. DIGGES, DR. J. H. Washington, D. C. EDES, DR. ROBERT T. Reading, Mass. EDSALL, DR. DAVID L. Boston, Mass. EDSON, JOHN JOY Washington,. D. C. EINHORN, DR. MAX New York City. EVANS, DR. W. A. Chicago, Ill. EYNON, WILLIAM JOHN Washington, D. C. FARRAND, DR. LIVINGSTON Washington, D. C. FEWKES, DR. J. WALTER Washington, D. C. FISHER, PROF. IRVING New Haven, Conn. FLEXNER, DR. SIMON New York City. FLY, DR. EDWARD H. National City, Calif. FRANKEL, DR. LEE K. New York City. FROTHINGHAM, DR. LANGDON Boston, Mass. ANNIVERSARY COMMITTEE GANNON, DR. JAMES A. Washington, D. C. GANS, ISAAC Washington, D. C. GAPEN, NELSON, Col., A. M. C., Washington, D. C. GARRISON, F. H., Lt. Col., A. M. C., Washington, D. C. GAYNOR, DR. H. E. Parkersburg, W. Va. GLENN, JOHN H. New York City. GORGAS, W. C., Maj. Gen., U. S. A., New York City. GROSVENOR, GILBERT H. Washington, D. C. GUITERAS, DR. JUAN Havana, Cuba. HABEL, CHARLES Philadelphia, Pa. HABEL, GEORGE M. Berkeley, Calif. HABEL, DR. W. P. H. Fort Lapwai, Idaho. HAMILTON, DR. ALICE Boston, Mass. HARE, DR. HOBART A. Philadelphia, Pa. HAYHURST, DR. EMERY R. Columbus, Ohio. HEKTOEN, DR. LUDVIC Chicago, Ill. HERBST, DR. WILLIAM P. Rochester, Minn. HERMESCH, DR. HARRY R., U. S. N., San Francisco, Calif. HEURICH, CHRISTIAN Washington, D. C. HICKLING, DR. D. PERCY Washington, D. C. HIGGINS, DR. JOHN M. Sayre, Pa. HILKEMEIER, CHARLES Brooklyn, N. Y. HILKEMEIER, GEORGE Brooklyn, N. Y. HODGE, DR. FREDERICK W. New York City. HOFFMAN, DR. FREDERICK L. Newark, N. J. HOLMES, PROF. WILLIAM H. Washington, D. C. HOOVER, DR. C. F. Cleveland, Ohio. HOUGH, DR. WALTER Washington, D. C. HOWARD, DR. LELAND O. Washington, D. C. HRDLICKA, DR. ALES Washington, D. C. HUN, DR. HENRY Albany, N. Y. HYLAND, DR. WILLIAM A. Grand Rapids, Mich. IRELAND, M. W., Sitrg. Gen., U. S. A., Washington, D. C. JACOBS, DR. HENRY BARTON Baltimore, Md. JENNINGS, HENNEN Washington, D. C. JIRKA, DR. I. G. Chicago, Ill. JOHNSON, DR. LOREN B. T. Washington, D. C. JUDD, NEIL M. Washington, D. C. KEEN, DR. WILLIAM W. Philadelphia, Pa. KNOPF, DR. S. ADOLPHUS New York City. KUHN, DR. JOHN F. Oklahoma City, Okla. LAMB, DR. DANIEL S., U. S. A., Ret., Washington, D. C. LARNER, JOHN B. Washington, D. C. LeCOMTE, dr. r. m. Washington, D. C. LEE, DR. FREDERICK S. New York City. LIBMAN, DR. E. New York City. LINS, RICHARD L. Carlisle, Pa. LOEB, DR. LEO St. Louis, Mo. LONGCOPE, DR. W. T. New York City. LOVEJOY, OWEN R. New York City. LYMAN, DR. DAVID RUSSELL New Haven, Conn. MARTIN, DR. CHARLES F. Montreal, Canada. MATAS, DR. RUDOLPH New Orleans, La. McALEER, EDWARD L. Washington, D. C. ANNIVERSARY COMMITTEE McCAW, W. D., Brig. Gen., A. M. C., Washington, D. C. MELTZER, DR. S. J. New York City. MERRITT, HARRY B. Washington, D. C. MICHELSON, DR. TRUMAN Washington, D. C. MOFFITT, DR. HERBERT C. San Francisco, Calif. MORAN, DR. JOHN F. Washington, D. C. MUNCASTER, DR. S._ B. Washington, D. C. MUNSON, EDWARD L., Col., A. M. C., Washington, D. C. MURPHY, DR. F. L. Dunmore, Pa. NEUMANN, FELIX Washington, D. C. NEWTON, DR. J. M. Jarvisburg, N. C. NOBLE, R. E., Brig. Gen., A. M. C., Washington, D. C. O'HARA, DR. J. F. Canton, Ohio. OWEN, W. O., Col., A. M. C., Washington, D. C. PEARSON, DR. WILLIAM M. Des Moines, Iowa. PEREIRA, THOMAS M. Washington, D. C. PFENDER, DR. CHARLES A. Washington, D. C. PRATT, W. S., JR. Washington, D. C. PRUDDEN, DR. T. MITCHELL New York City. PUTZ, DR. WILLIAM EDWARD Chicago, Ill. RAKER, HON. JOHN E., M. C., • Washington, D. C. RANSOME, DR. FREDERICK LESLIE Washington, D. C. REES1DE, FRANK P. Washington, D. C. RICHARDSON, DR. CHARLES W. Washington, D. C. RICHMOND, CHARLES W. Washington, D. C. RIESMAN, DR. DAVID Philadelphia, Pa. ROBERTSON, MISS GEORGIA Washington, D. C. RUDOLPH, HON. CUNO H. Washington, D. C. RUSSELL, F. F., Col., A. M. C., Washington, D. C. SAILER, DR. JOSEPH Philadelphia, Pa. SCHREIBER, DR. HENRY R. Washington, D. C. SCHROEDER, DR. E. C. Bethesda, Md. SEARS, DR. GEORGE G. Boston, Mass. SEWALL, DR. HENRY Denver, Colo. SHANDELLE, REV. H. J., S. J., Washington, D. C. SHATTUCK, DR. FREDERICK C. Boston, Mass. SHAW, DR. C. E. Williamsport, Pa. SHEA, CYRIL E. Washington, D. C. SHOOK, DR. F. M. Oakland, Calif. SKINNER, DR. J. O. Washington, D. C. SMITH, DR. HUGH M. Washington, D. C. SOLLMANN, DR. TORALD H. Cleveland, Ohio. SOLOMON, HARRY C. Boston, Mass. SOWERS, DR. WILLIAM F. M. Washington, D. C. SPIER, GEORGE W. Washington, D. C. STEINER, DR. WALTER R. Hartford, Conn. STERNBERG, MRS. GEORGE M. Washington, D. C. STOCKMAN, DR. FRANK J. Chicago, Ill. STOCKTON, DR. CHARLES G. Buffalo, N. Y. TEWKSBURY, DR. W. D. Washington, D. C. THORNLEY, DR. ROY A. Washington, D. C. TONDORF, REV. F. A., S. J., Washington, D. C. TRASK, DR. JOHN W., U. S. P. H. S., Washington, D. C. UFFORD, DR. WALTER S. Washington, D. C. ANNIVERSARY COMMITTEE UNIVERSITY OF PITTSBURGH Pittsburgh, Pa. VAN SCHAICK, DR. JOHN, JR., Washington, D. C. VAUGHAN, DR. GEORGE TULLY Washington, D. C. VAUGHAN, DR. VICTOR C. Ann Arbor, Mich. VOGEL, THOMAS A. Washington, D. C. WALCOTT, DR. CHARLES D. Washington, D. C. WALKER, DR. REGINALD Washington, D. C. WASHINGTON UNIVERSITY St. Louis, Mo. WELCH, DR. WILLIAM H. Baltimore, Md. WELLS, DR. WALTER A., Washington, D. C. WHIPPLE, PROF. GEORGE H. Boston, Mass. WHITE, DR. WILLIAM CHARLES Pittsburgh, Pa. WILEY, DR. HARVEY W. Washington, D. C. WILLIAMS, DR. FRANCIS H. Boston, Mass. WILLOUGHBY, WILLIAM F. Washington, D. C. WILMER, DR. WILLIAM H. Washington, D. C. WILSON, GEORGE S. Washington, D. C. WILSON, DR. JAMES C. Philadelphia, Pa. WILSON, DR. LOUIS B. Rochester, Minn. WOLF, HON. SIMON Washington, D. C. WOLLENBERG, DR. R. A. C. Detroit, Mich. WOODWARD, DR. ROBERT S. Washington, D. C. WOODWARD, DR. WILLIAM C. Boston, Mass. WURDEMAN, DR. H. V. Seattle, Wash. ZEHNER, HARRY Washington, D. C. ZYCHOWICZ, DR. JOHN F. Scranton, Pa. THIS NUMBER IS PRINTED IN HONOR OF ) THE 70th ANNIVERSARY OF DR. GEORGE M. KOBER Associate Editor of this Journal BY HIS FRIENDS AND ASSOCIATES / MARCH-1920 PRESS OF THE NEW ERA PRINTING COMPANY LANCASTER, PA. BIOGRAPHY OF DR. GEORGE M. KOBER The story of Dr. Kober's life falls into three periods, the period of his Army activities, his period as teacher, practitioner and scientific investigator, and the period of his social activities as philanthropist. Dr. George Martin Kober, the son of Jacob and Dorothea (Behr') Kober, was born at Alsfeld, Hessen-Darmstadt, Germany, on March 28, 1850. He received his early education at the public and grand-ducal Realschule of his native town, and emigrated, at the age of seventeen, from Germany to the United States in 1867. Shortly after his arrival he entered the Hospital Corps of the United States Army at Carlisle Barracks, Penna. In January, 1870, he was appointed hospital steward and ordered to Frank- ford Arsenal, where he remained until September 1871, when he was ordered to the Surgeon General's Office, Washington, D. C. During this period his preceptors were Dr. J. J. B. Wright, U. S. A., and Dr. Robert B. Burns, Philadelphia. In the fall of 1871, he entered the Medical Department of Georgetown University where he came under the instruction of such physicians as Drs. Johnson Eliot, Noble Young, S. C. Busey, Francis A. Ashford and Robert Reyburn, and received his medical degree in March, 1873. The following winter, he was the first graduate from a post graduate course instituted at Columbia Hospital, D. C. In the spring of the year, in opposition to the proposal to establish a German dispensary, he helped to reorganize the "Central Dis- pensary" with a special German-speaking staff. During these three years, he was serving as a hospital steward detailed in a clerical capacity in the Surgeon General's Office, where he rendered valuable aid to Dr. Billings in indexing and classifying titles in German medical periodicals. In July, 1874, he was appointed Acting Assistant Surgeon in the United States Army, remaining on duty in this capacity until November, 1886. During this period, he was Post Surgeon at Alcatraz Island, California, July to November, 1874) post surgeon at Fort McDermit, Nevada, up to July, 1877, during which time he took part in the southeastern Nevada expedition against hostile Indians in the fall of 1875, and in the Nez-Perce expedition (1877); from July to October, 1877, he was in charge of the field hospital at Kamiah on the Clearwater, Idaho; was subsequently post surgeon at camp near Spokane Falls and Fort Coeur d'Alene to November, 1878-1879, Fort Klamath, Oregon, to June, 1880, and Fort Bidwell, California, to November 1886. In post orders No. 104, relieving him from duty at the latter station in November, 1886, the post adjutant states: "In recognition of the long and faithful professional services rendered to the govern- ment during the past twelve years in the field in pursuit of hostile Indians and at various posts, the commanding officer cannot part with him without some expression of his feel- ings of regret, as part of this service was rendered under his immediate command. " His devotion to his professional duties has been warmly recognized not only by this commanding officer, but by others and has stamped him as one of the most skillful sur- geons in the U. S. Army." While at Fort Bidwell, he was also engaged in medical practice among the civilian population, remaining at this station until June, 1887, when he traveled extensively in America and Europe, returning to Fort Bidwell the following year. In the fall of 1889 III IV BIOGRAPHIC SKETCH OF DR. GEORGE M. KOBER he settled again in Washington, D. C., and in 1889 was appointed Professor of State Medicine in Georgetown Medical College. In August, 1890, he was honorary secretary of theSectionof Medical Geography and History in the 10th International Congress. In December, 1890, he returned to Fort Bidwell, where he engaged again in the practice of medicine and where on June 1, 1893, he became once more Attending Surgeon at the post. During his army period, he became keenly interested in the physical anthropology of the North American Indians, which gave him a natural interest in the work of anthropo- logical societies. At the suggestion of Lieut. Colonel George A. Otis, Curator of the Army Medical Museum, he sent to Professor Rudolf Virchow a collection of Indian crania which are described in Virchow's "Crania Ethnica Americana." In the fall of 1893, Dr. Kober returned to Washington where he has since been one of the most prominent physicians in the city. In 1889, he became president of the Medical and Surgical Society of the District of Columbia and has been Dean of the Medical Department of the Georgetown University since 1901. He was also president of the Medical Association of the District of Columbia in 1898, of the Medical Society of the District of Columbia in 1903, of the Association of American Medical Colleges in 1907, of the National Association for the Study and Prevention of Tuberculosis in 1915 and of the Washington Sanitary Improvement Company since 1916. He has been three times president of the Anthropological Society of Washington, in 1906-7,1918-19, and 1919-20. He was president of the section on industrial and occupational hygiene of the 15th International Congress on Hygiene and Demography, chairman of the sub-sec- tion on sociological medicine at the Second Pan-American Scientific Congress {1916} and is an honorary member of the Association of American Physicians and also of the Association of Military Surgeons. Dr. Kober is a member of the advisory council of the American Association for the Advancement of Science, fellow of the American Medical Association, member of the Cosmos Club, Vice President of the Washington Academy of Sciences, Vice President of the Board of Charities and President of the local Social Hygienic Association. During his long and useful life, Dr. Kober has written several medical books and over 240 journal articles in the American periodicals. His first contributions to medicine were an essay on Infantile Paralysis , published in the Pacific Medical Journal in November, 1874, and a small 100-page book on Urinology, reprinted from the Rich- mond and Louisville Medical Journal, 1874, xviii. This was followed by treatises on Milk in Relation to Public Health {1902}, Industrial and Personal Hygiene {1908}, Water Supply {1908}, House Sanitation and in 1916 his ardent labors for the improvement of the hygiene of occupations were brought to a focus in his treatise upon Diseases of Occupation and Vocational Hygiene, which he edited with Dr. William C. Hanson. This treatise is also of considerable interest to anthropology. His contributions to the periodical literature of medicine and related sciences are of the most varied character, covering such themes as the Medical Geography, Diseases and Climate of Surprise and Goose Lake Valleys, California, 1886, the Relation of Soil and Water to Health and Disease {1894-96}, the Place of Military Medicine and Surgery in Ordinary Medical Education {1897}, the Effect of Modern Firearms in War {1899}, the Canteen {1903}, his study of 330 out- breaks of milk-borne diseases {1901}, his long report on butter and butter substitutes {1902}, two notable papers on the progress and. achievements of public hygiene {1897}, and the history of hygiene in the 19th century {1901}. In 1875, he published notes on treatment of chronic dysentery with potassium chlorate lotion and of tubercular adenitis BIOGRAPHIC SKETCH OF DR. GEORGE M. KOBER V with injections of carbolic acid and glycerine. In October 1876, he described an important case of recovery from gunshot injuries of knee joint which had been treated with antiseptic injections of iodine and carbolic add. Dr. Kober was also one of the earliest to emphasize the importance of flies as transmitters of disease (1892) and in his report on typhoid fever in the District of Columbia (1895), he definitely located the fact of fly transmission in connection with a house epidemic of typhoid from box privies. During the last 25 years of his life, Dr. Kober has not been engaged in the actual practice of medicine and has devoted his attention to work in public hygiene, social welfare, and anthropology. His demonstration of the transmission of typhoid fever by flies in a local epidemic, an investigation made at the request of the Health Officer, D. C., was the starting point of these activities. By public addresses and by individual re- searches into the relative merits of sand and mechanical filtering of water, he did much to secure proper legislation and appropriations from Congress in aid of a proper water supply and sewage system for the District of Columbia. His tabulation of 330 milk- borne epidemics (1901), his writings on industrial hygiene, particularity on the effects of diminished atmosphere upon the health of aviators (1916) and his very active labors in aid of securing better housing for the working classes in Washington are all in the same trend. As a member of the Board of Directors of the Associated Charities, he became interested in the removal of slums and the improvement of habitations for people in less than moderate circumstances. Thus he was one of the principal promoters of the Wash- ington Sanitary Housing Companies, organized in 1897 and 190 j, which have provided sanitary homes at reasonable rentals for over 800 wage-earners and their families. This work lead to further improvements in sanitary housing in the District and in other cities and Dr. Kober had the gratification of receiving the award of a gold medal at the Paris International Exposition in 1900 in appreciation of these activities. His report on housing of the laboring classes was published in the same year (1900), and his history of the housing movement in the city of Washington in 1907. Dr. Kober also designed the Tuberculosis Hospital for the District of Columbia, and was awarded a Medal at the Exposition connected with the Sixth International Congress on Tuberculosis, held in Washington, September 28th to October 5th, 1908. In the same year he was also a Member of President Roosevelt's Homes Commission, and in addi- tion to his Monograph on Industrial and Personal Hygiene, prepared a Report on Social Betterment containing among other articles a plea for the prevention of permanent dis- abilities in childhood. Dr. Kober's life has been one of untiring labor, of devotion to duty, of loyalty and gratitude to his adopted country, of many-sided interests, of obstacles triumphantly overcome. The essential trait in his life history has been a sincere interest in the public good. In the city of his adoption he has been identified with almost every movement which has had to do with social hygiene and the well-being of his fellowmen. A public- spirited man in the truest sense, he has been one whose approaches have always been accessible where any enterprise of social moment had to be carried through. People come to him naturally for help of this kind. What he has done has been accomplished not reluctantly or for self-advertisement, but unobtrusively and with a good-natured disre- gard for the demands made upon his time. In anthropology, his chief interests have been in demography, racial pathology, and somatology. His publications give no adequate idea of his interest in these lines; but this has found appreciation in his repeated election to the presidency of the local anthropo- logical society, in addition to which he served as a member of the Organizing Committee VI BIOGRAPHIC SKETCH OF DR. GEORGE M. KOBER of the Nineteenth International Congress of Americanists and as a member of the first Committee on Anthropology of the National Research Council. Besides which he has been one of the Associate Editors of the American Journal of Physical Anthropol- ogy, since the establishment of the Journal. That the beneficent activities of Dr. Kober may be continued far beyond the scriptural span of life is the hope and wish of his many friends. American Journal of Physical Anthropology Volume III JANUARY-MARCH, 1920 Number 1 OBSERVATIONS ON THE NEGRITOS OF THE PHILIPPINE ISLANDS PHILIP NEWTON, M.D. Assistant Professor of Anatomy, Georgetown University FROM THE DIVISION OF PHYSICAL ANTHROPOLOGY, V. S. NATIONAL MUSEUM editor's note. Dr. Newton's work on the Negrito forms a part of the anthropologi- cal investigations carried on in 1912-14 under the writer's direction for the Smithsonian Institution and the Panama-California Exposition (1914-15). A brief note of these investigations was published in the Proceedings of the National Academy of Sciences, 1916, II, 32-37. Their main object was, besides the gathering of original material for the anthropological exhibits of the Exposition (now housed in the San Diego Museum), the initiation of a study of the child among various primitive human groups. Together with the child, however, it was necessary to examine as large series as obtainable of the adults in order to establish suitable basis of comparison, and the present report of Dr. Newton deals with his observations on the adult Negrito. Detailed measurements and data, including those on the 75 Negrito children that could be examined, will be published in the future. Dr. Newton's letter of transmittal of his report seems interesting enough to be included with his article. It follows below. It may only be mentioned in addition that Dr. Newton was selected for the diffi- cult task of a study of the Negritos not only as a medical man and anatomist, but also for his prolonged previous activities in the Philip- pines. 1 Amer. Jour, Phys. Anthrop., Vol. Ill, No. 1 2 PHILIP NEWTON Letter of Transmittal Washington, D. C., October 22, 1912. Dr. Ales Hrdli6ka, Curator, Division of Physical Anthropology, United States National Museum. Sir: I have the honor to report as follows on my trip to the Philippine Islands: I left Washington on May 5, 1912, and arrived at Manila June 4. Returning, I left Manila on September 15, and arrived in Washington October 22,1912. I was in the Philippine Islands 103 days. Of this time 65 days were spent in actual field work. The remaining time was unavoidedly lost in Manila on account of storms and an attack of dengue fever. Measurements: More than one thousand negritos were seen. Of this number, over 400 were measured and carefully observed. Practically all of the pure-bloods that could be found were measured, with about 50 mixed-bloods. These mixed- bloods were mostly a division of the negrito called Bataks, living on the Island of Palawan. They have sometimes been considered a separate strain, but actually represent only another admixture of the negritos with Malay blood. Among the pure-bloods the male adults and near adults numbered 190, the fe- male 83, the children of both sexes 75. The excess of men over women and children is accounted for as follows: The men would frequently travel long distances to meet me when it was impossible for myself to cover their territory. On these occasions very few women and children accompanied them. In addition, the number of children per family among the negritos is surprisingly small. Photographs: Films of any kind are absolute failures for tropical field work. This will be readily understood if it is remembered that a film must be developed within one week from the day it is taken from the tin in the tropics, and that films require a developing bath with a temperature not over 80° F. There was no ice to be had in the field, and the water was always warmer than 80°. On the other hand, it was impossible to get the films to Manila within the week limit. For this reason, almost sixty per cent of the films spoiled. Three hundred pictures were taken. Most of these were taken in the open and in the rain. The best results were ob- tained in Palawan among the Bataks, where ice was obtained within the week limit. Seventy-two good pictures were ruined when my boat was upset in the Cagayan River during a severe storm. Plaster Casts: Sixteen attempts were made to secure casts, but they were all failures. Like the photographs, most of these were made in the open and in the rain. One hundred pounds of the best dental plaster was taken by me from the United States. This was packed in supposedly airtight cans, but when it was opened it had either absorbed moisture, or else absorbed a large quantity in a very few moments, because it had neither the feel nor look that it should have had. A can of plaster was purchased in Manila, but this yielded no better results. I was informed by several physicians that plaster was little used for fracture-casts in the Philippine Islands on account of the great difficulty in keeping it dry. In several cases the plaster was given an hour to set, but the masks always broke when being removed. Casts were made twice as thick as ordinary, but even these were failures. I believe that plaster can be satisfactorily handled only during the dry season when the air is not saturated with moisture. NEGRITOS OF THE PHILIPPINE ISLANDS 3 Skeletal Material: The negrito will not willingly part with the remains of his dead, and this part of the work was very difficult. In addition to the opposition on the part of the negritos, the graves themselves are widely separated and in the most out-of-the-way places. When found they must be opened at night to escape the watchfulness of the negritos. As it rained practically every night this work was done under the most adverse circumstances. Twelve graves were opened-the locations of seven were given by a half-breed-, three were discovered by me on my travels, and two more were located by a Filipino. The locations of seven more graves became known to me, but I could not open them on account of the negritos' watchfulness. Of the twelve graves opened, but one yielded results. From this a skull, part of a femur, and some vertebrse were obtained. This body had been in the ground less than six months. In the case of the other bodies, which had been in the ground from one to six years, the bones were all in the last stages of decay and nothing of value could be saved. This rapid decay is accounted for by me as follows: Many of the mountainous regions have a great deal of lime in their geological makeup; the negrito body is buried only about two feet deep, and without any form of covering, which allows both the surface heat and surface water to attack it very rapidly. Weather: The months of my stay in the Philippines proved, accidentally to be the worst ones of the entire year. It rained every single day and typhoons were numerous. The negritos have no houses, consequently most of the work had to be done in the open. Travel was very difficult during this rainy season, the mud fre- quently measuring from six inches to a foot in depth. Food and Payments: All the food used by me had to be carried with me. Like- wise, to secure the good will of the negritos, I had to feed them. This item of rice for the negritos, with its transportation, was expensive. No cash payments were made, the negritos being satisfied with food, a few beads, red-cloth, and tobacco. Data: The negritos answered freely all questions they could understand. No information as to their number, births and deaths, etc., could be obtained from the Philippine Government for the simple reason that they had none. The negrito has no unit of time, so knew nothing of his age; all ages therefore are approximate only. Expenses: The expenses of the trip were higher than expected. The bad weather greatly increased the cost of travel. The fear of the average Filipino for the negritos' poisoned arrows made guides and porters expensive. The deaths from surra, etc., of large numbers of horses and bulls made their use impossible in many places and very expensive in others. General: Both wooden and metal instruments suffered from the effects of mois- ture. The wooden instruments, plate-holders, camera, etc., were all rendered parti- ally unfit for service, and in the future all such articles should be made of some non- oxidizing metal, if they are to be used in the tropics. Disease: The most common diseases in the Philippines, as observed by me, were malaria, dengue, dhobie's itch, and insect bites. At one time or another I personally experienced each one. I also suffered very much from an attack of maxillary sinu- sitis Which was brought on by the constant exposure to rain and mud. The accompanying report gives the results of my observations. Very respectfully, Philip Newton, M.D. 4 PHILIP NEWTON 'Philippines Outline Map SHOWINQ Distribution of the NEGRITOS NEGRITOS OF THE PHILIPPINE ISLANDS 5 INTRODUCTION During the months of June, July, August, and September, 1912, the writer visited the representative subdivisions of the Negritos in the Philippine Islands. The expedition was under the joint auspices of the Smithsonian Institution and the Pan-American Exposition of San Diego, and under the direction of Dr. A. Hrdlicka. It was sent out for the purpose of making accurate anthropometric studies of the Negritos, and for making physiological and medical observations among them. The measurements and observations are those regularly used in the study of other races by the Division of Physical Anthro- pology of the United States National Museum; the methods of measur- ing were essentially those of the Inter-national Agreements. The investigations were confined as nearly as possible to pure- bloods. The Bataks of Palawan, who are probably all of mixed blood, are placed in a separate series. Subjects showing gross pathological conditions were only noted in the medical observations. The provinces visited were Bataan, Zambales, Pampanga, Tarlac, Cagayan, Isabela, and Palawan. Of these, Bataan was found to have more pure-bloods than any of the other localities. The Negritos of Zambales presented many signs of a more or less recent admixture of outside blood. The Negritos of Cagayan showed also a wide- spread admixture of foreign blood. Among the Negritos or Bataks of Palawan, hardly any were found who approached the pure-blood standard. No objections to the measurements and observations were made by the Negritos after they understood the nature of the work. Owing, however, to the low order of intelligence exhibited in general by these people, various questions were not readily comprehended, so that some parts of the investigation became necessarily restricted. In addition, circumstances did not permit of an exhaustive study of certain physiological and pathological features of the Negrito life. The pure-bloods, regardless of locality, were found to be physically of the same type, so that where uninfluenced by other races the Philip- pine Negrito differs only in language and some minor customs. The introduction of foreign blood rapidly changes these people both physically and mentally; and a contact with other tribes, produces readily marked changes in their habits. 6 PHILIP NEWTON GENERAL ENVIRONMENT Distribution: The Negrito is found on the islands of Luzon, Negros, Mindanao, Palawan, Panay, Alabat, and Tablas. The greatest numbers live on Luzon. This wide distribution, coupled with fact that the Negritos are not travelers (except on their own ranges), and that they do not possess physical qualities that might fit them for invaders, suggest that they were more numerous in these regions in the past and that they prob- ably preceded the other aborigines of the Philippine Islands. Much of the combined area of the Philippines is mountainous, and on those islands where the Negritos live, they are found, for the most part, in the highlands. Whether they were originally mountain people or not is unknown, but if they ever inhabited any of the low- lands, they have long since been crowded out. Quite likely the mountains represent their last stand, where they endeavor as much as possible to live by themselves. Those now found in the lowlands have evidently come there quite recently; they are as a rule dependents on some of the Philippine settlements. Elevation: The elevation of the areas inhabited by the Negritos varies from 500 to 2,000 feet, or more. Their habitations are always found near mountain streams or small rivers. They prefer the wooded parts of the country where they are better secreted. Those not af- fected by outside influences stay in the mountains. Climate: The climate of those parts of the Philippine Islands that are occupied by the Negrito is, notwithstanding the elevation, with the exception of the highest mountains, tropical. In the settlements of the northern half of the Archipelago rains and storms are almost continuous from June to September. From October to February the weather is generally cooler, with little rain. From March to June the weather where they live is hot and dry. Water Supply: The sources of water of the Negritos comprise springs, mountain streams, and small rivers. They make no wells or reservoirs. The drying up of small streams during the hot season affects the Negritos but little, as they are continually moving about. The water is carried from its source to the family shelter in bamboo poles three to seven feet long, from which all septa except the bottom one have been removed. Such a tube is easily carried, and will re- tain the water for several hours. Shorter pieces are used for drinking cups. NEGRITOS OF THE PHILIPPINE ISLANDS 7 The water of the springs and smaller mountain streams is usually clear, but the larger streams and rivers were found muddy. In north- ern Luzon several hot springs were seen, the water of which was charged with mineral substances, including sulphur, and some of these are visited for curative purposes by the Filipinos, but no use is made of them by the Negritos. Flora: The vegetation of the regions occupied by the Negrito is of much variety, but include only a few plants and trees which are made use of by these people. In several places visited by the writer the Negritos were seen to be used by the whites and Filipinos to help fell the trees and get them to the rivers, where they were floated to the mills. Bejuco, or rattan, is cut by the Negritos and used in making their shelters, as well as trade for cloth, knives, and alcoholic drinks. The bamboo is used in making the shelters, and for water vessels and arrows. Bananas, mangos, cocoanuts, and other kinds of tropical fruits, found in many localities, form, with certain edible roots, a large part of the Negrito diet. The Bataks use the bark of the "bago" tree for their breech-cloths. In one place the Negritos knew orchids had a commercial value, and frequently traded two varieties for articles of small cost. Hardly any use is made of plants medicinally by the Negrito. Fauna: The animals of the forests are of importance to the Negritos because they furnish part of their diet. Small deer, wild hogs, wild birds, monkeys, lizards, and other small animals, are all killed and eaten. The methods of killing vary with the amount of outside in- fluence that has affected the particular group of Negritos. In some regions (Bataan and Zambales) nets are used in the deer-hunt. The animals are driven into these and then killed with arrows; but in other regions the use of nets is unknown. In northern Luzon the Negritos use poisoned arrows. Analysis of the poison was impossible in the field, and little information could be obtained from either the Negritos or the Insular Government as to its nature. The symptoms exhibited by a deer when shot with such an arrow resemble those of strychnine poisoning, so that probably the substance is of the nature of curare. Honey bees are abundant in some localities, and the Negritos gather considerable quantities of their product. The bees are smoked out, the wax and honey extracted in a mass and the honey strained through a soiled cloth into bamboo tubes. Insects and Reptiles: In the forests where the Negritos live, mosqui- 8 PHILIP NEWTON ' toes are so numerous during the rainy season that white men visiting these regions must make a continuous fight against the pest. The mosquito bite, however, appears to cause a much lesser reaction in the Negrito than in the white. The Negrito's body, owing to the absence of clothing, offers a large area for mosquito attack, and there is little if any immunity to such attacks, but many bites seem to cause little irritation. A number of varieties of mosquitoes were observed, including the Anopheles and Stegomyia. Fleas are very numerous. So are centipedes. The bite of the latter causes a sharp reaction, but apparently is never dangerous to life. Snakes are not as numerous in the Negrito country as they are in other tropical lands, nevertheless a large number of varieties, some of which are poisonous, have been classified. Several cobras and other snakes were seen by the writer, but no recent deaths among the Negritos from snake bite could be learned of. NEGRITO POPULATION The last census of the Insular Government gives the total number of the Negritos at about 25,000. This number includes many thousands of mixed bloods. Just how many, no one knows. The writer's estimate of the total number of pure-bloods, outside of the unknown territory in northwestern Luzon, would be below 5,000. Accurate figures can scarcely be hoped for, for the reason that the Negritos are ordinarily located in wild, inaccessible regions, over which they are widely scattered in small groups. Nine Negrito districts, with a total estimated population of about 7,000, were visited by the writer. Vital statistics concerning the Negrito, such as the death rate, birth rate, proportion of sexes, etc., were not obtainable from the Insular Government. Personal investigation of these subjects were carried on as far as circumstances permitted, but the possibilities were quite limited. SUBDIVISIONS OF THE NEGRITOS The Negritos, as known from previous writers,1 are subdivided into a number of groups bearing distinct names, but these groups are so far 1 Meyer, A. B. The distribution of the Negritos in the Philippine Islands and elsewhere. 8°, Dresden, 1899. Virchow, Rud. The peopling of the Philippines. An. Rep. Smithsonian Institution, Washington, 1899, 500-526. Reed, Wm. A. Negritos of Zambales. Ethnol. Survey PubL, Manila, 1904. II, Part I, 90 pp., 58 pl. Worcester, Dean C. The non-Christian tribes of northern Luzon. Philippine J. of Sci., Vol. No. 8, Manila, Oct., 1906. NEGRITOS OF THE PHILIPPINE ISLANDS 9 as could be ascertained purely geographical; physically, and in the pure-bloods no marked differences were observed in the different regions. Among the mixed-bloods, the differences depended upon the origin and proportion of the foreign blood. Variations in customs, habits, dress, and language appeared to be due largely to contact and environment. The Aetas of Bataan, Zambales, Tarlac, and Pampanga, inhabit, in scattered bodies, the western mountain range (Zambales Moun- tains) of Luzon, from the Mariveles Mountain, in southern Luzon, as far north as the northern boundary of Tarlac province. A large percentage of the estimated 1,200 Aetas of the Bataan province are of a fairly pure type. They are found in small numbers at varying distances back of the Filipino towns of Mariveles, Bagao, Balanga, Orani, Hermosa, and others. The best types for study were those living farthest away from the Filipino towns, where outside influences were minimum. The foreign blood in the mixed types of Bataan appeared to be mostly Tagalog. The Aetas of Zambales may be reached by traveling north or northwest from Hermosa, in Bataan, from Floridablanca, in Pamp- anga, or from Olongapo, Subig, and Iba, in Zambales. As in Bataan, the Negritos of this province living near Filipino towns showed con- siderably the results of outside influences. The percentage of mixed- bloods was considerably larger- than in Bataan. The foreign blood appeared to be largely Tagalog and Ilokano. The Aetas of the provinces of Pampanga and Tarlac in Luzon were not numerous, and a large percentage of them were plainly of the mixed-blood types. They may be reached by traveling west from Floridablanca in the province of Pampanga, and from Tarlac, in the province of Tarlac. The Attas of Cagayan and Isabela provinces, in Luzon, inhabit the foothills and mountains between the Cagayan and Ablug Rivers, the mountains south of this area between the Kalinga region and the Cagayan River and, in small groups, the country between the Cagayan River and the Sierra Madre Mountains. Little information could be obtained about the western slope of the Sierra Madre. It is believed to be wholly inhabited by Negritos. If such is the case, this region would undoubtedly produce the most characteristic types of the people. In these two groups of Negritos foreign blood appears to have had several sources, including Kalinga, Cagayan, Ilokano, and Ilongot. 10 PHILIP NEWTON The Bataks, all of whom apparently are mixed-bloods, inhabit the mountains of the northern half of the island of Palawan. They were found in small groups by traveling inland from the coast towns of Babuyan, Tinabog, and Tinitian. The whole Batak population is estimated at less than 500 individuals.. They differ from the pure- blood type of Negrito. Their skins are lighter, their hair is wavy or curly rather than wooly, the facial features are less negroid, and the average stature is greater. They resemble the Negrito in the excess of finger-reach over height, low foreheads, thick lips, and rather flat wide noses. Their average stature also, although superior to that of the pure-blood Negrito, is still below that of the neighboring tribes. Their foreign blood appears to have come largely from the Tagbanuas. Several individuals exhibited characteristic Chinese features. PERSONAL ENVIRONMENT Clothing: Negritos uninfluenced by other races dress very scantily; and the absence of sufficient clothing during the cooler months un- doubtedly accounts among them for certain pathological conditions. The men wear a breechcloth only. This is a strip of cloth about six inches wide and four or five feet long. It is wrapped once around the waist, knotted loosely in the back, the two ends brought forward between the thighs and tied in front to the part around the waist. The women wear a short skirt which extends from the waist to a little above the knees. The skirt is a simple piece of cloth of variable width and about five or six feet long. It is wrapped around the waist and hips and tucked in at the waist. The children go naked until about the sixth year, after which they dress like their parents. On Negritos living near the Filipino towns, one can see odd gar- ments of many kinds. They vary from the simple breechcloths to complete multicolored cotton suits with native hats. One of the first changes made by the Negrito women after coming into contact with a higher civilization is the adoption of the "camisa" or waist. With the adoption of this garment, the women assume a certain modesty about exposing their breasts. This delicacy was unknown among the Negritos living far off from Filipino villages, where the women went half nude and readily permitted the chest measurements and photographs to be taken. Shoes, sandals, or other foot-coverings were not observed among the Negritos, even where mixed. Hats or other head-coverings were not used, except among those living in contact with civilization, the heavy, woolly, matted hair affording ample protection. NEGRITOS OF THE PHILIPPINE ISLANDS 11 Hair-dressing and Other Practices: From a hygienic standpoint, the Negrito method of wearing,the hair is very poor. The natural Negrito hair is very thick, black and woolly. It grows usually to a length of from two to five inches, and no attention is given it. As a result it becomes foul, matted, and more or less filled with vermin. The Aetas of Bataan shave in a crude way, with a bolo, a circular area, about two inches in diameter, in the upper occipital region, which reminds one of the tonsura of the Spanish padres. This was observed in both sexes, and the reason for so doing was given as a means of "letting out the heat." The Bataks of Palawan shave the anterior half of the scalp, from a line connecting the external auditory meati. Both sexes are thus treated. No clear explanation of the custom could be obtained. A very common custom observed among the Negritos in the province of Bataan (Luzon) was that of ornamental skin scarring. The opera- tion is performed with sharp bamboo instruments, and begins about the sixth or eight year. Both sexes are ornamented. Small incisions are made through the skin on the forearms, arms, back, and chest; in the female, also on the breasts, abdomen, and thighs. The most common design is that of a series of short parallel lines, converging to a point with another series; or the two series may be parallel. Less common is a design of five short incisions in the form of a star. Several operations are performed in the 'case of large ornamentations. The wounds commonly become infected and heal with the formation of an elevated, light-colored scar. The above custom was observed only in Bataan. In addition, the Negritos of Bataan, in common with those of Zambales, exhibited irregular scars of other origin on their arms and forearms. These scars resulted from burns made by holding embers against the skin. Two explanations of this custom were given: First, it was a means of curing in febrile diseases; and second, it was used as a test of bravery. A widespread custom among the Negrito women is that of per- forating the lobule of the lobe of the ear. This serves for the reception of flowers. It was observed in practically every region visited by the writer. It is made at the seventh or eighth year with a sharp bamboo stick. In young girls it is quite small, but owing to the repeated intro- duction of flowers, it becomes by the time adult life is reached very large. Flowers are the only ornaments used by the full-blood Negritos. Dwellings: These vary from the shelter of a large tree to a crude imitation of the nipa house of the Filipino. The commonest form is 12 PHILIP NEWTON very simple. It is easily constructed and as easily abandoned. Two poles about seven feet long are cut .and inserted into the ground in holes dug with a bolo, about five feet apart. A ridge pole is then tied to the uprights. On -this ridge-pole is balanced a framework filled in beforehand with woven grass. Between the poles and about one and one half feet from the ground is made on short bamboo posts a crude seat or bed; and that is all, except that the top of the hut is adjusted from time to time during the day to meet the change in the sun's rays. More substantial shelters are constructed by the Negritos living near other tribes. The best of them, however, afford little protection against the elements. The only thing that can be said in their favor is that they are well ventilated. Individual shelters are isolated. Groups of from twenty to seventy Negritos, banded together by family or other ties, will construct their shelters at distances varying from two hundred to eight hundred yards from each other. Within a few square miles there may be found several such groups. The different groups are friendly, and there are frequent inter-marriages. Within the Negrito shelter there is no furniture other than the crude bamboo floor or bed. Grass may be spread on this, but there are no blankets. Cooking is done over crudely constructed fireplaces outside of the shelter. Sanitation: Personal necessities are attended to in any convenient spot near the dwelling. During the rainy season the refuse is washed away almost immediately, but during the dry season the decomposing material attracts thousands of flies and other insects, and the growing bad odor causes the inhabitants to make frequent changes of residence. If a Negrito develops a contagious disease, such as smallpox, and it is recognized, food and drink are placed near the patient in the shelter and the rest of the family desert him. After a few days someone returns, and if the patient is still alive, more food and drink are placed by his side. This practice is continued until he recovers or dies. The dead are buried under or near the shelter they have occupied during life, and the rest of the family move to a new location. Among the Negritos unaffected by civilization, the body is placed, without covering or coffin, in a shallow grave, and covered over with dirt. No ceremonies so far as could be learned are observed. Due to the climate the body, including the osseous structures, undergoes a very rapid decay. NEGRITOS OF THE PHILIPPINE ISLANDS 13 Personal Hygiene: The scanty clothes of the Negritos are apparently never washed. Bathing of the body is a very infrequent occurrence. The teeth are never cleaned. Among a few groups the custom of pointing the incisor teeth was observed. It is more common on the males than in the females. It is practiced during advanced adoles- cence; the youngest subject seen with teeth mutilated in this manner was a girl about fifteen years old. A small block is placed against inner surface of the tooth, and the point of the bolo brought sharply against the outer surface. Decay sets in rapidly in these mutilated teeth, other teeth decay also quite readily and after forty years of age the average Negrito has usually a poor denture. The ears and noses of the Negritos of all ages, besides the hair, as mentioned before, are generally likewise very dirty. Experience appears to have taught these people little about taking care of themselves. Year after year exposure during the cold foggy nights of certain seasons induces pulmonary diseases from which many children die. They readily point this condition out as being one of the main causes of death among children, but do nothing at all to improve matters at the next favorable season. Occupations: Strictly speaking, the Negrito uninfluenced by con- tact has no occupation other than hunting game and gathering wild fruit and roots for his subsistence. The men construct shelters, and make their bows and arrows. As for agricultural work, little is done by the average Negrito. Small areas are cleared and planted with rice by those Negritos who have watched other tribes raise crops, but just as frequently as not the family is said to move away from the growing rice before it is ripe, without returning for the harvest. Among Negritos living near the more civilized Filipinos (Tagalogs, Ilokanos, etc.), occupations of a more useful kind are observed, such as farming, lumbering, gathering gums and rattan, portering, and acting as household servants for other races. But this intimacy with semi-civilization does not improve the Negrito either socially or hygienically. He soon acquires a craving for alcohol, while his brother of the far-off mountain regions knows nothing of such bever- ages. He seldom acquires an understanding of the value of his services or of money, as a consequence of which he is much imposed upon. It is not unusual to see petty officials of the Filipino villages getting rich at the expense of the ignorant Negritos. Small Negrito boys were many times seen acting as house-boys for other races. Inquiry elicited the fact that these boys almost in- 14 PHILIP NEWTON variably returned to their natural life shortly after reaching the age of puberty, and that attempts to educate them had failed. However, mixed-breed- Negrito children are more amenable to the restraints of civilization. Food: The principal articles of diet among the wild Negritos, in the main as already indicated, are fruit, edible roots, and the meat of wild animals. The animals are small deer, wild hogs, lizards, monkeys, birds and wild chickens. Honey is sought for and eaten with relish. The vegetable products of the forests include bananas, mangos, cocoanuts, berries, wild camote, and the roots of a few other plants. Rice and fish are eaten when obtainable. Negritos are not fishermen, but they shoot fish in the mountain streams with their arrows, when they see them. The preparation of food is primitive. Meat is usually roasted over a crude fireplace. If a utensil for the purpose is at hand, the meat may be boiled with fruit, rice, or other vegetables. If food is plentiful, the Negrito will have three or four meals a day. If it is scarce, only one meal a day may be eaten. The hours for meals among the wilder groups are very irregular. There is no set time for any one meal during the day. If food is plentiful, as is the case after a deer has been killed, the quantity of food consumed at the next meal will be greater than is ordinarily the case. Under ordinary circumstances the largest meal is eaten during the afternoon, usually an hour or two before sunset. Alcohol and Drug Habits: No alcoholic drinks are manufactured by the wild Negritos and their use is unknown. Those living near villages of other tribes become readily intoxicated. Many will work harder if rewarded with drink than if paid with money. The chewing of betel nuts (the seeds of a palm, Areca catechu) is an almost universal practice among the Negritos. Even those groups living far off from other tribes have this habit, which, however, is not confined to the Negritos. The Negritos living far off acquire the betel nuts by trade with those living nearer trading centers. The Negritos of two regions in the north of Luzon did not use the nut and, as far as the writer could ascertain, did not know of its existence. The physiological effects of the betel-nut chewing habit are not well determined. Smoking is indulged in by men, women, and children when tobacco is available. No tobacco, however, is raised by the Negritos, and its use is very limited in the wilder regions. NEGRITOS OF THE PHILIPPINE ISLANDS 15 GENERAL HABITS OF LIFE, CHARACTER, AND SOCIAL CONDITION! Negritos usually sleep from darkness to dawn. If they are on the march, they sleep wherever darkness overtakes them. Even in the rainy season they will sleep with a tree as their only protection against the elements. Upon arising the Negrito gives no thought to personal cleanliness. When a Negrito enters water it is usually as a means of crossing the stream, or for a relief from the heat. The average Negrito is not industrious, unless it be in the quest for much needed food or in the hunt. Under proper guidance, he will work, but never very strenuously or for a long time. He may be made to build a comparatively large bamboo and grass house for others, but remains perfectly satisfied with a small flimsy shelter for himself and his family. As to amusements, dancing and playing primitive games are common among the children and younger adults. Gambling was not ob- served anywhere. In disposition, the Negritos are cheerful and contented. Their wants are few, and their passions moderate. The moral status of the Negritos living far away from other tribes is good; among the mixed breeds however and with the Negritos living in or around villages of other tribes, it is of low standard. Social Abnormalities. Artificial Abortion: Desire for and love of young children were strong among the Negritos. Artificial abortion was not reported. Accidents causing abortion were reported in three cases. Infanticide: This was unknown. Crime: The Negritos of Bataan were reported to be a very peaceful people. In the North, certain groups are in almost continuous war with the Kalingas. Murder and assault are very infrequent among the unaffected groups, and when they occur they are usually tribal punishment rather than individual differences. Incentive to theft and robbery are wanting among the Negritos because of the absence of articles of value. Suicide: No suicides were reported among the groups visited. REPRODUCTION Marriage: Marriage among both the pure-blood types and the breeds is entered into at an early age. Some degree of mutual attraction is 16 PHILIP NEWTON said to usually exist before the union. Voluntary loss of chastity on the part of the unmarried woman was reported as quite infrequent; but if it occurs it is not regarded as a serious obstacle to future mar- riage. The girl usually exercises the right of acceptance. Among the pure types separation is said to be rather rare. Polyandry was seen in two instances among the Bataks. Polygamy was observed several times during the trip among the mixed types, the man in each case being of enough importance to support two wives. Intermarriage of relatives nearer than first cousins was not learned of. The approximate age of several girls just married, or about to be married, was between fourteen and sixteen. The approximate age of puberty is seemingly about twelve. Sterile Women; Preference of Sex; Gestation. In the series given above, there were ten couples to whom children had not been born two or more years after marriage. Further information along these lines is lacking for the reason that the Negritos did not comprehend the questions. Most of the women questioned appeared to want boys more than girls. Pregnancy does not interfere materially with the daily life of the Negrito women. Even in the last months of gestation these women travel with the rest of the family. No special precautions, such as special diets, avoidance of work, etc., were observed. Morning sick- ness was unknown. Labor: Preparation for childbirth does not occur. When the first pains come on the woman seeks her dwelling or the shelter of a tree. In the intervals between pains she may walk around a few steps, but during the pains she remains lying on the ground. Delivery usually occurs in the kneeling or squatting position. In the larger groups, older women act as assistants. If the family is on the march, another woman and the husband, or the husband alone, assist. In any event, the assistance rendered is very little. The assistant simply catches the child when it is born, and holds it while the mother assumes the dorsal recumbent posture. After a few minutes the cord is tied with a piece of vegetable fiber about three or four inches from the umbilicus, and the cord severed beyond this. A bolo is used in most cases to cut the cord with. Delivery of the placenta follows in a few minutes, the average time for the few cases seen being less than in civilized races. NEGRITOS OF THE PHILIPPINE ISLANDS 17 After delivery the woman remains quiet for three or four hours, but travel is not resumed until the second or third day. No cleansing of either the mother or child is attempted. Fresh green leaves are placed on the stump of the cord, and the child placed to the mother's breast. If a piece of cloth is at hand, the child is wrapped in it, but in many instances the only protection against exposure is the mother's body. Some dystocia was reported in a few instances, but it appears to be rare. One case of what was apparently a transverse presentation was spoken of; the mother and child both perished. A few deaths during the puerperium were mentioned, but ordinarily this period is declared to be free from disease. No change is made in the diet. Twins were not seen, and only reported three times. Histories of triplets or mon- strosities were not obtained. Minor abnormalities were reported in a few cases. Early Attention to the Infant. Nursing and Feeding: No apparatus of any kind is used to carry the infant in. The child as mentioned is placed on the mother's breast immediately after the cord is cut, and remains constantly with the mother until it learns to walk. The flow of milk is usually established promptly, and the child nurses at the breast for twelve or fourteen months. About the sixth month and after the child is given small bits of any kind of food the parents happen to secure for their own subsistence. Clothing for the child is ordinarily restricted to one piece of cloth which is wrapped around the trunk, but in many cases even this slight protection is wanting, and the child goes naked until it is given a breechcloth or a small skirt. VITAL STATISTICS The foregoing paragraphs have touched on the ordinary conditions of life and such of the characteristics of the Negritos of the Philippine Islands as are presumably capable of influencing their physiological functions and health. The environment in which the Negrito originally developed is naturally unknown. Their present environment can hardly be assumed to be their natural one, judging by the traces of their wide- spread distribution, their more or less rapid absorption by other races, and especially by one important physiological difference between them and other races having an analogous environment. This difference in function is that of the small number of children actually born to each family, and the long intervals between births. From the table given below, it will be seen that ninety-three families 18 PHILIP NEWTON had a total of two hundred and eleven children born to them, an average of 2.27 children per family. These families were all of the pure-blood type, and represented widely separated groups of Negritos. No practice of any kind for the prevention of conception could be learned of, nor would the number of abortions and miscarriages account for this restricted number of births. Nursing at the breast is not unduly prolonged, the child being given the regular family diet after the twelfth or fourteenth month, and some of it, of course, much sooner. Family Statistics (931 NEGRITO FAMILIES) Subjects Investigated Total Percentage of Total Born Percentage of Number of Liv- ing and Dead Ratio of Males and Females (Females=100) Total births 211 50.23 Boys 106 Girls 105 49.76 100.95 Total surviving 118 55.92 Boys 60 56.60 50.85 103.44 Girls 58 55.23 49.15 Total died 93 44.07 49.46 Boys 46 43.39 97.87 Girls 47 44.77 50.54 Population by Ages: No figures can be given for this interesting sub- ject. Ages in all cases had to be approximated, as the Negritos know nothing of reckoning time. It was observed by approximation, how- ever, that the number of individuals reaching old age (65 years or over) was remarkably small. Environment accounts for this mortality beyond a doubt. In those individuals approximated to be over forty- five years of age the teeth were, as already mentioned, almost invari- ably decayed to such an extent that mastication was seriously im- paired, and poor mastication leads to malnutrition if continued over a period of years, thus lowering the resistance of the subject to patho- genic influences. With his lowered vitality the subject becomes an easy victim to bronchial or lung disease caused by exposure to the cold damp nights of certain seasons of the year. The mortality for all ages of children was 44 per cent. When com- pared with the mortality among the children in the provincial Filipino 1 Ten of these families had no children born to them, although living together in each case for two years or more. NEGRITOS OF THE PHILIPPINE ISLANDS 19 villages, it will be found that the death rate is smaller among the Negritos than among the Filipinos. Size of Families: The writer's figures given above in the table of children born to ninety-three families are the only ones available. From this limited investigation, it will be seen that the number of living children for ninety-three families was 118, or 1.26 children per family. The greatest number of children born to families of the pure- blood type was five, and the greatest number of living children in one family was three. Among the mixed types, the percentage of children born was greater, as many as nine being reported in each of two families. It is quite apparent from this that the birth rate among the pure- blood types is insufficient to keep up the numerical strength of the people. Proportion of Sexes: Nothing reliable is known about the porportion of sexes. More men than women were seen, as the men are greater travelers. Figures are not available for large numbers, but personal observation indicated that there was no undue proportion of one sex over the other. PHYSIOLOGICAL OBSERVATIONS The details of these observations, as well as those of the anthropo- metric measurements, must be reserved for a future publication. Pulse, Respiration, Temperature: The pulse was found to be some- what more frequent in the Negritos than it is in average whites, the mean in one hundred healthy Negrito men being 76.1, in fifty healthy women 76.3 per minute. This in sitting position and with the in- dividual at rest. The normal in whites is, as well known, about 71 in men and slightly more in women. Respiration, under same con- ditions, averaged 18.05 in the males and 18.3 per minute in the fe- males; temperature (sub lingua), slightly less than 98.6 in the males and slightly more than 98.6 in the females. Among healthy white Americans examined in the same way Dr. Hrdlicka obtains the averages, for respiration, of 17 in men and 18.4 in women, for tempera- ture 98.5 in men and 98.7 in women. The Negritos may thus be said to present a perceptibly more rapid pulse than the whites; a slightly more frequent respiration in the males; and practically the same temperature. Their lack of clothing favors of course heat radiation, though this may be offset more or less through adaptive changes in the skin. 20 PHILIP NEWTON A number of interesting observations were made in connection with these tests. Four young pregnant women gave the pulse of 96, 86, 90, 92; respiration of 20, 22, 23, and 26; and temperatures of 98.8, 98.7, 98.6, and, 98.8. The pulse considerably increased with the respiration moderately so, but temperature quite normal. Fatigued persons, on the other hand, and those hungry, gave invariably lower pulse, respiration as well as temperature. In a group of eighteen males the temperature, taken between five and six o'clock -in the morning, was found in each case to be from one to two and a half degrees below normal. Inquiry developed the fact that the men had been marching all night, and had no food for twelve hours. The temperature was taken again about one hour after a meal and in each case was found to be about the average. Sight lowering of pulse, respiration as well as temperature was also noticed in the older persons. The averages, minima and maxima of the above determinations, in healthy persons, were as follows: Males . Females Average Minimum Maximum Average Minimum Maximum Pulse 76.1 64 88 76.3 66 84 Respiration 18.05 16 20 18.3 16 20 Temperature 98.58 97.8 99.2 98.62 98.2 99.6 Muscular Force: This was determined by obtaining the maximum pressure in each hand with a standard Collin dynamometer. The averages for both sexes was considerably lower than the averages for the white race. The Skin and Its Appendages: The color of the skin in adult Negritos of the pure-blood type was uniformly chocolate brown. Numerous comparisons with Broca's Color Standards showed it to correspond most closely with Nos. 42 and 43. The mucous membranes were hemoglobin red with a bluish tinge. The hair on all parts of the body where it grew was black, with an occasional discoloration due to ex- posure to the sun. Irregularities of pigmentation were frequent. They were due almost entirely to tinea imbricata, except in Bataan, where the practice of ornamental scarring was observed. The skin was ordinarily dirty and unhealthy. Sweating was not more profuse than would be expected in a tropical country. The hair on the head was from two to six inches in length. It was uniformly black, coarse, and woolly. The beard and mustache were generally scant and short. Baldness was observed in the oldest NEGRITOS OF THE PHILIPPINE ISLANDS 21 individuals, but was never pronounced. Grayness was common, but nothing can be said regarding the actual age of its appearance. ANTHROPOMETRY Measurements and special somatic as well as physiological ob- servations were made on 147 full-blood adult men and fifty women, as well as on a series of mixed bloods. The elaboration of this material was interrupted by the war and the final report on the numerous interesting results must' therefore be delayed. A brief abstract of the measurements of the stature and of those of the head is however appended. Stature and Head Measurement of the Negritos (full-bloods) males (147 adults) females (50 adults) Average, Cm. Minimum, Maximum, Cm. Cm. Average, Cm. Minimum, Maximum, Cm. Cm. Stature 147. - 18.- 14.9 12.4 140.2 - 154.3 17. 18.8 13.9 - 15.6 11.6 - 13.1 138. - 17.4 14.5 12 4 129.6 - 146.1 16.1 - 18.4 13.6 - 15.6 11 5 - 12 7 Head: ( Length max [ Breadth max Height1 Indices'. t Cephalic 82.7 68.9 83.3 75.L 83.5 714 85.5 77 8 I Height-Length I Height-Breadth Height-Index2 Face: (a) Height menton- nasion 10.- 17.3 13.55 8.9 - 11.- 15.5 - 18.7 12.4 14.2 74. 78.3 9.4 16.1 13. - 8.4 - 10.4 14.3 - 17.3 12.1 14. - 72.5 80.6 (b) Height menton- crinion (c) Diam. bizygo- matic max. . . . Facial Index, lower a X 100 c Facial Index, total c X 100 & MEDICAL OBSERVATIONS Many agencies capable of affecting the Negrito's health have been mentioned in the preceding paragraphs. Mosquitoes are the most troublesome insects. Their bite does not cause a severe reaction in the Negrito, but during certain seasons these 1 From line connecting the floor of meatus auditor to bregina. 2 Height multiplied by 100, divided by the mean of length and breadth. 22 PHILIP NEWTON insects cause enough irritation to seriously interfere with sleep. Centipedes, fleas, ants, and several species of mites are all the cause of much local irritation. Investigation as to snake-bites revealed nothing among the Negritos, although death from snake-bite was common among the Filipinos. The dry season is naturally the more healthful one. During the rainy season malaria and bronchial diseases are common, the latter causing many deaths among the very young and the aged. Gastro- intestinal diseases are more prevalent during the wet seasons, owing apparently to contamination of the water supply. DISEASES Diseases of the Skin: Tinea Imbricata, a form of body ringworm pro- duced by a trichophyton, and characterized by a concentric arrange- ment of closely set rings of scaling epidermis, is very widespread among the Negritos.' It was observed in all stages of severity, from a few spots to an involvement of the entire surface of the body, with the exception of the palms and soles and the scalp. The disease is communicated by contact, and fostered by uncleanliness. Acne vulgaris was common at the age of puberty and adolescence. Pedic- ulosis capitis and corpus were quite common, especially head lice. Tropical itches of several varieties were observed. Keloid was seen in two cases. Boils were seen several times. General Diseases: Malaria was very widespread among many groups, and less frequent among a few groups far off from other habitations. No blood examinations were made, but from the clinical findings diagnoses of both the benign and the malignant forms were made. The methods of treatment were very primitive and quite ineffectual. The application of hot embers to the naked skin, for the purpose of " drawing out the fever," was frequently tried among certain groups in Bataan and Zambales. Among other groups the "medicine" woman attempted, by means of much vocal noise and many bodily contortions, to draw the fever from the body of the patient to her own body. Deaths from the malignant form of malaria (sestivo-autumnal in- fection) were reported a number of times. In the benign forms, the disease usually runs its course, to reappear the next year. No reli- able statistics were obtained as to the percentage of the Negrito population that suffered from malaria, but during the season of rains when the writer made his studies, the disease was quite prevalent among both sexes and all ages. Judging from the number of mos- NEGRITOS OF THE PHILIPPINE ISLANDS 23 quitoes which included a large percentage of the Anopheles group, the chances for infection were very large. The patients were in no way protected, thus allowing - many more mosquitoes to become in- fected. Quinine was unknown, except to a small group of Negritos who visited the St. Louis Exposition in 1904. Whenever it was possible to do so, the malaria patients were dosed with quinine; frequent moves did not permit of an exhausted study of the results of the treatment, but in many cases the drug had a prompt and bene- ficial effect. Tuberculosis: This disease was diagnosed but twice among the pure- blood type. Both cases were of the pulmonary form, and both pre- sented the characteristic physical signs. One case was a female, approximately twenty years of age, the other a male, approximately twenty-five years of age. Both cases gave histories of contact with Filipinos, among whom the disease is very common. With these exceptions, tuberculosis was not observed. Considering the open- air life of the Negrito, this is as would be anticipated. Leprosy: No case of leprosy among the Negritos was seen, even at the Leper Colony, where more than two thousand lepers were segre- gated. Inquiries indicated that leprosy was unknown in these people. Variola: About ten per cent of the total number of Negritos ex- amined showed the characteristic scars resulting from smallpox. The disease itself was not seen, and information gathered from various sources showed that smallpox had not been epidemic for over four years. In all cases, the infection was at first communicated to those Negritos living near the Filipino towns, and from them to the Negritos living farther away. Systematic vaccination among the more civilized tribes resulted in checking the ravages among them, and secondarily among the Negritos, by removing the source of infection. Dengue: This disease was observed among a few mixed-breeds living near Filipino villages. Gastro-intestinal Diseases. Dysentery: This disease existed in about fifteen per cent of the Negritos. Lack of time and apparatus pre- cluded more than, a cursory examination, and it is likely that many of the diarrhoeal conditions were not true dysentery. The insanitary surroundings and water contaminations already referred to presented numerous opportunities for infection. Typhoid fever and cholera: These two diseases were not seen, and histories as to their occurrence were negative. Diarrhoeal diseases of children: Indiscriminate feeding of young children resulted in many cases of intestinal disorder. Not with- 24 PHILIP NEWTON standing this peculiar diet, the Negrito child was stronger than the average white child of the same age. Green fruit and exposure were causes of intestinal disorders in the older children. Diseases of the Respiratory Tract. Acute coryza: "Catching cold" was more frequent among the children than among the adults. Bron- chitis: During the cold, damp nights of certain seasons acute bronchitis is reported as common among the children and the aged. This disease and pneumonia (lobar) were actually diagnosed in more than thirty patients. The writer was told repeatedly that bronchial diseases were the cause of death among children in most cases. Venereal Diseases. Syphilis: Manifestations of this disease were not seen in any individual of the pure-blood type. Contact with other races was accountable for its presence in a few mixed-breeds. Gonorrhoea: No evidences of this disease were seen. No special examination was made, but the absence of ophthalmia and blindness were taken as indicators. Surgical Conditions. Fractures: Fractures in long bones are treated by rest, the most common result being deformity. Wounds: The only treatment observed was the application of green leaves to the wound. Infections usually occurred, with healing by second intention and the formation of a scar. Cutting Operations: The only operations observed have already been mentioned, i.e., the incisions made for the purpose of ornamental scarring, the perforation of the external ears in females, and the cutting of the umbilical cord. Anomalies and Deformities: Six fingers on one hand were seen in one case. The subject was a young adult male. Congenital absence of the small toe was seen in a male child about twelve years of age. Deformities resulting from fractures have been mentioned. The rachitic deformities so common in the negro race in the United States were not once seen. Spread-toes was a universal condition. In this condition the great toe deviates somewhat towards the median line, and is well developed from constant climbing. The foot of the new-born child is quite normal. I CRITICAL CONSIDERATIONS Racial comparisons and critical considerations of the data obtained on the Negrito through the study of which the above is a partial report, must be postponed until the detailed results of the measurements and observations can be published. This special ethnic group is however of such interest that even the preliminary remarks here given may be of service. THE INDIAN BRAIN J. J. KEEGAN From the Department of Anatomy, University of Nebraska The three Indian brains which are the basis of this study are from the great brain collection of the Division of Physical Anthropology in the United States National Museum, and were called to the writer's attention by Dr. Ales Hrdlicka, Curator of the Division, who was also instrumental in arranging their loan. They consist of two full-blood Tonto Apache, collected many years ago by Dr. Washington Mathews, and one full-blood Teton Sioux, collected by Hrdlicka. With the brain of an Omaha Indian recently reported from the University of Nebraska Medical College1 and a specimen in Johns Hopkins, they are the only brains from this race that have been preserved in this country. And as the difficulty of obtaining full-blood North American Indian brains' for study increases, due to the extensive admixture with other races, it is important that this material be placed upon record. Although the interpretation of cerebral characters has not yet furnished a certain guide to the establishment of mental differences of race, sex or individual, the knowledge of the evolution, structure and function of the cerebral cortex has advanced sufficiently in the last ten years to permit a better comparison of cerebra than was possible at the time of the great monographs of Eberstaller,2 Cunningham3 and Retzius.4 The significance of this later work of functional and histo- logical localization in the establishment of definite relations between areas of cortex and the fissural pattern has not been emphasized by many writers in cerebral anthropology, perhaps due to the still rather incomplete knowledge in the subject and the uncertainty of its applica- tion. But that it has proven of distinct value, furnishes the most rational interpretation of fissures and convolutions and offers the most promise in future investigations, I hope to show by a brief review 1 Keegan, J. J., A plains Indian brain.-J. Comp. Neurol., 1916, xxvi, 403. 2 Das Stirnhirn, 1890. 3 Surface anatomy of the cerebral hemispheres.-Mem. Roy. Irish Acad., 1892, No. 7. 4 Das Menschenhirn, 1896. 25 Ameb. Jour, Phys. Anthrop., Vol. Ill, No. 1. 26 J. J. KEEGAN of the more specific literature and an application to the material which is the subject of this paper. The first conception of the brain as the seat of the mind dates back to 500 b.c. but even as recently as 1800 it was common among the best authorities to attribute a number of the emotions and passions to visceral organs as the heart, the stomach, the liver, etc., or to con- sider the seat of the soul to be localized in the fluid of the cerebral ventricles, an idea which had descended from Herophilus and Galen.1 These irrational ideas at such a late period, when even a considerable knowledge of the detailed anatomy of the brain existed, were due largely to the insensitiveness of the cerebral cortex when exposed and the lack of response to mechanical stimulation. The emphasis upon the gray matter of the cerebral cortex as the seat of all mental activities was first advanced by Gall and Spurzheim2 about a hundred years ago in an elaborate theory or system of cerebral localization. Their conception of the brain as the basis of all mental activity was not controlled by the scientific evidence at hand, but was elaborated by fantastic ideas into a system of subdivis- ion of all regions of the cerebral cortex into localized areas, each of which represented some prominent mental faculty or moral char- acteristic. This system, popularly known as phrenology and existing to-day as a cult of fortune-telling, obtained many followers for a time even among scientific men, but was soon supposedly proven to be fallacious by physiological experimentation on lower animals, and extirpations or destruction of small and large parts of the cerebral hemispheres without any apparent loss of specific functions but rather a diminution of all functions, thus showing the brain to act as a unit or whole and not as separate localized parts or areas. Following this criticism the wave of scientific opinion went to the other extreme and with difficulty entertained any idea of localization of function in the cerebral cortex. But the gradual accumulation of physiological and clinical evidence of a cerebral localization, especially the establish- ment by Broca in 1861 of a localized motor speech center in the inferior frontal gyrus of the left hemisphere, began again to arouse suspicions that there is a type of localization in the cerebral cortex, but related rather to different motor and sensory functions than to higher mental faculties. This renewed interest in the cerebral cortex from the standpoint of functional localization demanded experimental evidence and better 1 Soury, J., Le systeme nerveux central, 1899. 2 Anatomie et physiologie du systene berveux, 1810-12. THE INDIAN BRAIN 27 definition. This was begun by the work of Fritsch and Hitzig1 who, contrary to the previous claims of the non-excitability of the cerebral cortex, obtained definite and fixed motor response from galvanic electric current stimulation in the region of the sulcus cruciatus of the dog's cortex. These experiments were extended and presented in greater detail by Ferrier2 on the dog and lower apes by use of the faradic electric current instead of the galvanic, which elicits greater response and is less depressing to the irritability of the cortex. This first work on the ape established the constancy and homology of the sulcus centralis in its relation to the motor excitable cortex. Beevor and Horsley3 in a similar' series of experiments upon the lower apes subdivided this motor region of cortex into constant areas, each con- nected with definite movements in some part of the body, locating these on both sides of the sulcus centralis and attributing overlapping qualities to them. In later work upon the higher apes they claimed these areas to be more definitely localized, with intervening portions of non-excitable cortex. Grunbaum and Sherrington4 advanced still further the exact localization of the limits of the motor cortex from experiments upon the highest apes, the orang, gorilla and chimpanzee. They found in each of the animals examined that the same order of motor areas was present, with overlapping qualities however, within the precentral convolution and limited rather sharply posteriorly by the floor of the sulcus centralis. Added to these experiments on the ape brain were a few observations from stimulation of this region of the exposed human cerebral cortex, which practically agreed with the findings in the higher apes in the location and the motor areas. This experimental work, however, was limited to the motor cortex as the only excitable portion, with a rapidly decreasing proportionate size from the lower apes to man. The proof of a limited cortical localization of function suggested the possibility of a more general cortical localization. This was supported by numerous clinical ob- servations of specific sensory or psychic defects from localized injury or tumor, the most striking being the long recognized speech or language defects, the loss of power of articulate or written language and loss of auditory or visual memory of language, each existing 1 Elektrische Erregbarkeit des Grosshirns.-Arch. f. Anat. Physiol, u. Wissen. Med., 1870. 2 Functions of the brain, 1876. 3 Phil. Trans., 1890. 4 Physiology of the cerebral cortex of the anthropoid apes.-Proc. Roy. Soc.t 1903, Ixxii, 109. 28 J. J. KEEGAN separately and associated with lesions in a certain region of the cortex. But the difficulty of an exact functional localization, except in the motor region, and the apparently undefined irregularities of the fissures and convolutions, stimulated a search for an internal structural basis for differentiation of cortical areas. Evidence of such a general structural localization was first advanced by Flechsig,1 although the association of the Betz cell area with the motor cortex and the area striata with the visual cortex had long been recognized. Flechsig found that the myelin sheath of the nerve fibers of the cerebral cortex does not develop everywhere simultaneously or to the same degree, but by areas and in a definite order of succession. He claimed that thus there come into existence sharply circumscribed areas differing in the stages of development of their elements; that these fields are constant in their arrangement and repeat themselves in essentially the same position and extent in all individuals of approximately the same age. The number of such localized areas was first placed at forty but later reduced to thirty-six2 (Plate I). Flechsig interpreted that since every area possessed a special anatomical position it also possessed a special functional significance, which for a few of the areas had been proven by experimental and clinical evidence. In a more general way he divided the entire cortex into three regions or zones: primordial zones which myelinate before birth, mainly primary sensory and motor; intermediate which are myelinated in the first month after birth, psycho-sensory or psycho-motor; and terminal zones which are myelinated in the second month after birth, the so-called higher association centers which represent the latest development of the central nervous system and are the most characteristic feature of the higher development of the human brain. The next step towards the proof of a general structural localization in the cerebral cortex, and inferred functional localization, was a complete histological examination of the adult cortex in search for regional differentiation and definite boundary lines of transition from one area to another. This was first completed by Campbell3 in a very important monograph based upon a combined study of fiber disposi- tion and of cell lamination in the entire cerebral cortex of man, ape, dog, cat and pig. On the basis of structural differentiation and func- tional interpretation he succeeded in mapping out about fifteen 1 Gehirn und Seele, 1896. 2 Flechsig, P., Untersuchungsmethoden der Grosshirnrinde.-Arch. f. Anat. u. Physiol., 1905, 337. 3 Localization of cerebral function, 1905. Pl. I. Myelogenetic areas, primordial, intermediate and terminal zones (Flechsig). Pl. II. Histological localization of cerebral functions (Campbell). THE INDIAN BRAIN 31 prominent areas of cortex on the surface of the human cerebrum, which could be homologized with similar areas in the ape and higher mam- malian brains (Plate II). These areas also corresponded in a remark- able manner to the general developmental subdivision of the cortex presented by Flechsig, thus furnishing corroborative evidence of the correctness and reliability of the methods. The almost exact corre- spondence in the ape of the plainly differentiated Betz cell area of cortex with the area of excitable motor cortex defined by Griinbaum and Sherrington furnished proof of the correctness of the interpreta- tion of functional localization from structural differentiation, although the motor** significance of the giant pyramidal cells of Betz had long previously been recognized by Lewis and Clarke.1 The frequent coincidence of area limits with important fissures was especially noted by Campbell and led to the statement that the fields governing the functions we have hitherto succeeded in locating are all deposited in direct relation to some important sulcus, which in one direction at any rate, forms a sharp and perfect boundary. A similar histological survey of the human cerebral cortex was presented by Brodman,2 which represented .the final result of several years of comparative study of the histological localization in the cerebral cortex throughout the entire mammalian class of vertebrates, and in which he delineated fifty-two different cortical areas in the human brain (Plate III). These areas he grouped into eleven regions or principal fields: the postcentral (tactile), the precentral (motor), the frontal (association), the insular, the parietal (association), the temporal (auditory), the occipital (visual), the cingular, retrosplenial, hippocampal, and olfactory, the general agreement of which to the subdivisions of Flechsig and Campbell is very evident. According to Brodman the structural peculiarities characteristic of each area are sharply limited, so that it is fairly easy in serial sections to recognize and fix the limits which mark off each area from the adjoining regions. He also called attention to the significant fact that, while the greater number of the fields thus defined have, as far as is known, no connec- tion with actual physiological functions, some of the areas, and pre- cisely those which are characterized by conspicuously different struc- ture, coincide with or are directly related to the regions whose functions are known from experimental physiological research or clinical observa- tions. Little emphasis, however, was placed upon the significance of 1 Cortical localization of the motor area.-Proc. Roy. Soc., 1878, No. 185. 2 Die Cortexgliederung des Menschen.-J. f. Psychol, u. Neurol., 1908, 231. Pl. III. Histological localization of the cerebral cortex (Brodman). THE INDIAN BRAIN 33 fissures as area boundaries, for in the smaller subdivisions of the less differentiated cortex they often showed no boundary correspondence, although plainly preserving this relation in the more differentiated regions emphasized by Campbell. The most successful attempt to define the significance of the fissures in their variable relation to the cortical areas of the cerebrum is the work of Elliot Smith.1 The significance of this work, or wherein it differed from previous structural localizations, was the identification of area limits in the fresh brain by means of knife section and macro- scopic examination of the cut surface. This permitted a much greater amount of material to be examined and conclusions to be drawn from the general or average relation of area limits to fissures, a feature which is often obscured by individual variations in the small series of hemis- pheres necessitated by the more detailed histological method. The accuracy of this macroscopic delimitation of cortical areas, based upon abrupt changes in the myelo-architecture of the cortex, is sup- ported by the general correspondence of the areas with those estab- lished by the histological method and the coincidence with known functional areas. In agreement with Campbell and Brodman, Smith claimed that the changes in structure between areas occur with the utmost abruptness, which can most easily be seen in the limits of the area striata, making it possible to determine with precision the exact boundaries of each area. His conclusion on the fissural significance was that the vast majority of the furrows on the surface of the hemis- phere present a definite causal relationship to some given cortical area or areas, and on this basis he constructed a new type map of the cerebral cortex with the areas plotted in definite relation to the main fissures as limiting, axial or operculated sulci2 (Plate IV). The application of this method has resulted in a modified phylogenetic interpretation of the occipital sulci and has furnished in the other regions of the hemisphere a diagrammatic representation of fissures in relation to cortical areas, which aids greatly in the identification and comparison of different regions of the cortex (Plate IV). The general trend of all of this work upon cerebral localization and fissural significance, both physiological and structural, has been in a sense a return to the old idea of Gall and Spurzheim of a cortical mozaic, each localized area presumably representing a distinct or modified function. A significant difference, however, of the present 1 A new topographical survey of the human cerebral cortex.-J. Anat. & Physiol., 1907, xli, 237. 2 The central nervous system.-Cunningham's Textb. of Anat., 4th ed., 1914. Pl. IV. Type diagram of cortical area and fissure relation, lateral surface (Smith). 35 THE INDIAN BRAIN conception of cerebral localization is that it is established around a number of primary sensory or motor functions and areas, with ad- joining or surrounding localized differentiation of the primary type cortex, presumably representing an elaboration of this function, psycho-sensory or psycho-motor areas; and finally that it shows a remaining or intervening portion of less differentiated cortex of latest development ontogenetically and phylogenetically, the so-called asso- ciation areas of Flechsig. The extensive comparative work has shown that there is a similar localization of function and structure in all mammals, in fact in the entire vertebrate kingdom, with the difference only that this localization receives its greatest elaboration and differ- entiation in the higher apes and man, the most striking feature being the great increase in size of the association areas. A homology of fissures has been fairly well established from the lowest mammals to man with the significant deduction that the main fissures develop primarily in the regions of differentiation of structure and function, but are frequently separated from this relation by the greater tendency of the fissures to remain stationary, through their closer relation to the underlying central masses of the hemisphere, than the more plastic and remote cortical areas which necessarily make the first response to increase or reduction of function in the evolution of the brain.1 The anthropological significance of these advances in cerebral inter- pretation is the possibility, in fresh and properly preserved material, of a more accurate recognition of cortical areas, their boundaries and functions, a comparison of such areas by measurements and the establishment of racial and intellectual differences by this means. That this is not a hopeless task is well indicated by comparison of the area striata of the occipital region in different races and individuals, from which it has been established that this area is generally more extensive on the lateral surface of the negro brain than the white brain and more extensive in the left hemisphere than in the right.2 The application of such principles, and methods to poorly preserved and hardened material is necessarily very limited, due to lack of history, to shrinkage and distortion. The attempt has been made in this series of Indian brains to apply this increasing knowledge of cortical localization and fissural significance by superposing the cortical 1 Kappers, C. U. A., Cerebral localization and the significance of sulci.-Seven- teenth Internal. Cong. Med., 1913. 2 Smith, G. E., Morphology of the human brain.-Rees. Egypt. Gov't. School of Med., 1904, ii. 36 J. J. KEEGAN plan of Smith1 upon the delineated fissures and intervening gyri of each hemisphere. No claim is made to represent by this method the exact boundary lines of very many cortical areas. The original plan is a small per cent type condition deduced from the study of negro brains, to which it is more applicable. In the more highly developed brain the variation and irregularity of fissure relation to cortical areas increases and it is doubtful if this method of interpretation of cortical areas is sufficiently accurate to permit valuable comparison, since it does not represent the concealed area of cortex which bears the relation of about two to one of the superficial cortex. Yet it dodfe aid in the interpretation of fissures in a uniform manner and on a proper basis and emphasizes the greater importance of the gyri as representing cortical areas. Also it shows at a glance, by comparison with the type figure of Smith, the interpretation of the fissures without con- fusing labels and detailed description. The plan used in the illustrations consisted of the tracing in ink of the fissures, representing by interruption and intervening dash the site of the more prominent submerged bridging gyri, and the plotting of the areas in relation to the fissures which are generally recognized as approximate boundaries. In many regions of irregular fissuration and unbounded transitional lines the borders of the areas were more or less arbitrarily defined and perhaps bear little relation to the exact limits of the areas. This necessity, however, in an at all regularly fissured region formed a relatively small part of any single large area and perhaps does not entirely preclude a remaining com- parative value. The descriptive part of the text is intended only to call attention to those points that may be of interest in identification and comparison, as the detailed disposition of the fissures can be observed from the figures. The difference in size of the brains, due largely to fixation, has been equalized in the figures by reducing all to the same length, which, although not allowing for original undeter- mined differences in size, permits a better regional comparison. Indian Brain No. 1 (Catalogue No. 226552. Plates V to VIII) This brain was from a full-blood Tonto Apache Indian and of the three specimens of this study showed the least distortion from fixation. However, it showed considerable flattening on the superior surface and shrinkage and hardening from fixation in Muller's fluid. The 1 The central nervous system.-Cunningham's Textb. of Anat., 4th ed., 1914. THE INDIAN BRAIN 37 weight of the parts of the brain, with the membranes removed from the cerebral hemispheres, was as follows: Right hemisphere weight 370 gms., length 156 mm. Left hemisphere " 385 " " 156 " Brain-stem " 130 11 Total " 885 " From this is seen the great shrinkage that has taken place, for there is no indication from the fissuration of a below normal brain. The inequality between the two hemispheres has no significance for it could be entirely due to the division of the hemispheres considerably to the left of the midline. The distortion and great shrinkage reduced to the minimum the value of comparative and relative measurements and as the other two brains were in even more unfavorable condition very little attempt has been made to record such measurements. Even in well-preserved specimens much doubt has been cast upon the rationality and practicability of past methods of comparison by the criticisms of Mall1 and Brodman,2 and it would be of very little value to undertake detailed measurement of poorly defined points and distances in this material. The hemispheres present a fairly complex type of fissuration, there being few extensive areas not incised by prominent branches of ad- joining sulci. The complexity, however, and tendency to transverse fissuration does not approach that observed by Bond3 and Schuster4 in the Chinese brain and by Hrdlicka5 in the Eskimo brain. Consider- able asymmetry is noted between the two hemispheres, which will be discussed in more detail under the different regions. LATERAL SURFACE The lateral cerebral fissure is similar in the two hemispheres with prominent upturned posterior extremity. The two anterior rami and the sulcus diagonalis are very distinct and widely separated in the left hemisphere but in the right the place of the sulcus diagonalis is taken by an apparent ascending ramus. This interpretation, however, 1 Anatomical characters of the human brain.-Am. J. Anat., 1909, ix, 1. 2 Neue Forschungsergebnisse der Grosshirnrindenanatomie.-Verh. d. Vers. d. Naturf. u. Arzte in Wien, 1913. 3 Observations on a Chinese brain.-Brain, 1894, xvii. 4 Descriptions of three Chinese brains.-J..Anat. & Physiol., 1908-09, xlii. 5 An Eskimo brain.-Am. Anthropol., 1901. Pl. V. Indian brain No. 1. THE INDIAN BRAIN 39 can hardly be made without deeper examination of the manner of communication with the main fissure, which is impossible in this specimen. The sulcus centralis has an unusual tortuosity in the left hemisphere, with a length of 83 millimeters as compared with 75 millimeters in the right. It crosses the mesial border in the left hemisphere but not in the right. The sulci precentrales, superior and inferior, are superficially con- tinuous in the left hemisphere except for a detached tri-radiate element near the mesial border, Cunningham's1 sulcus precentralis marginalis. This makes a continuous and even boundary for the lower two-thirds of the precentral cortex and quite prominent superior and inferior genua. In the right hemisphere the sulcus is represented by the three separate elements. The gyrus or area precentralis is notably different on the two sides, especially in the inferior region where the sulcus preceritralis inferior is a generally recognized boundary. This suggests a functional difference between the two sides. The sulcus frontalis superior represents excellently the typical dis- position as three diagonal elements, the posterior in communication with the sulcus precentralis superior and the anterior possibly inter- preted as the sulcus frontalis medius in communication with the sulcus fronto-marginalis. Following the cortical plan of Smith, the superior and anterior frontal areas adjust themselves very readily to the type of fissuration, showing the widening and anterior extension of the areas as the mesial border is approached, with the extension of the anterior frontal area between the two posterior elements of the sulcus frontalis superior. The similarity of the fissuration of the superior precentral and superior frontal regions in the two hemispheres is noteworthy. The sulcus frontalis inferior is rather regular in the left hemisphere and completely bounds an inferior frontal area that agrees almost exactly in its fissuration with the type plan. An elevated posterior portion of the area, incised by the prominent sulcus diagonalis and corresponding to the motor speech center, suggests a functional significance. In the right hemisphere the sulcus frontalis inferior is more irregular and unusually high on the frontal surface, especially in the posterior region, thus giving to the inferior frontal area a greater superficial extent than in the left hemisphere. But comparison of superficial extent in this region is especially liable to be fallacious on 1 Surface anatomy of the cerebral hemispheres.-Roy. Irish Acad., 1892. Pl. VI. Indian brain No. 1. THE INDIAN BRAIN 41 account of the large per cent of cortex concealed in the superior wall of the lateral cerebral fissure, which could not be examined in this specimen. The sulcus frontalis medius, on the basis of the interpretation of the three elements of the sulcus frontalis superior, is represented only by irregular transverse branches or elements. The sulcus postcentralis in both hemispheres lacks fully two centi- meters of reaching the lateral cerebral fissure and is compensated by an unusually large sulcus subcentralis posterior. In the left hemis- phere it forms a large curve concentric with the prominent superior genu of the sulcus centralis at a distance of ten to fifteen millimeters. The course is much straighter in the right hemisphere and at a distance of only five to seven millimeters from the sulcus centralis, thus making a striking difference in the width of the gyrus or area postcentralis in this region. Since the fissures are rather constant boundaries to this cortical area the great difference between the two hemispheres must have a functional significance, possibly associated with right-sidedness in the body as the greater cortical area occurs in the left hemisphere. The sulcus interparietalis and the sulcus paroccipitalis are quite irregular in the left hemisphere but rather typical in the right. This irregularity may be associated with the posterior convexity of the sulcus postcentralis. It consists of an anterior extension of the sulcus paroccipitalis to within three millimeters of the sulcus postcentralis, with very little indication of either an anterior or a posterior bifurca- tion. In the right hemisphere the inferior extension of the anterior extremity of the sulcus interparietalis and the prominent arcuate form of the sulcus paroccipitalis are noteworthy. The superior parietal area presents no points permitting comparison. The sulcus lunatus is not typical in either hemisphere, the type of fissuration corresponding more to the sulcus occipitalis lateralis formed by a migration of the superior half of the sulcus lunatus to a position nearly in line with the sulcus prelunatus and a lengthening of the sulcus prelunatus. It is difficult to judge which approaches nearer to the arcuate form of sulcus lunatus but the more lateral extent of the sulcus postcalcarinus and consequently the area striata in the left hemisphere would indicate the more typical condition. The sulcus temporalis superior is a recognized boundary for the acoustico-psychic cortex. The independence of the sulcus temporalis polaris (transversus) and the sulcus angularis (ascending ramus) is evident in both hemispheres. The superior temporal gyrus is narrower Pl. VII. Indian brain No. 1. THE INDIAN BRAIN 43 than usual in its superficial extent. It shows here, as in most brains, a tendency to a posterior communication with the visual cortex by bridging or superficial gyri. Flechsig1 shows a narrow intervening area of cortex in this region that myelinates earlier than the parietal and temporal association areas and Smith2 a strip of differentiated cortex. The same condition is illustrated by a special strip of cortex along the superior wall of the interparietal sulcus connecting between the somatic sensory and visual areas and suggests a remnant of an earlier more direct connection between these primary sensory centers. The location of the audito-sensory cortex, which just appears upon the superficial surface of the gyrus temporalis superior, can rather constantly be determined by a small branch of the lateral cerebral fissure which represents a continuation of the sulcus dividing the two transverse temporal gyri of Heschl. The audito-psychic area is defined below by the sulcus temporalis superior, anteriorly by the line of the inferior extremity of the sulcus centralis and posteriorly by the bifurcation of the lateral cerebral fissure. The remaining cortex of the lateral cerebral surface, the inferior parietal and the middle and inferior temporal areas, are those repre- senting in myelogenesis and supposedly function the latest develop- ment in the evolution of the cerebral cortex, excepting the frontal region which takes an intermediate position between the parietal and temporal. The outline of the inferior parietal area is fairly well defined by the boundaries of surrounding more primitive areas. The anterior boundary is formed by the sulcus postcentralis and the sulcus subcentralis posterior and the superior by the sulcus interparietalis and the sulcus paroccipitalis. The inferior limit is the lateral cerebral fissure and a rather constant but irregular series of communications between the lateral cerebral, the superior and middle temporal, the anterior and lateral occipital fissures. The posterior boundary is typically the sulcus occipitalis anterior but the irregularity of this sulcus often results in uncertainty of definition. The typical fissura- tion of this inferior parietal area is well illustrated in the left hemisphere of this brain, the area being divided into anterior and posterior parts by a prominent descending branch of the sulcus interparietalis. This branch, according to the maps of Smith, Brodman and Flechsig marks a line of cortical differentiation. Cole3 has called attention to these 1 Untersuchungsmethoden der Grosshirnrinde.-Arch. f. Anat. & Physiol., 1905. 2 A new topographical survey of the human cerebral cortex. J. Anat. & Physiol., 1907, xli, 237. 3 On some morphological aspects of microcephalic idiocy.-J. Anat. & Physiol., 1910, xliv. Pl. VIII. Indian brain No. 1. THE INDIAN BRAIN 45 areas, claiming a predominance of growth in the anterior to be more characteristic of the ape brain, and the opposite in the highly developed human brain. Comparison of the two hemispheres shows very plainly the greater posterior representation in the right, interpreting the descending branch of the sulcus interparietalis as the dividing line. The boundaries and fissuration of the frontal and temporal association regions are not definite enough to permit comparison. MESIAL SURFACE The sulcus centralis does not extend to the mesial surface in the right hemisphere and consequently the extent of the motor area in the paracentral area is not well defined. Campbell1 calls attention to a more or less horizontal curved sulcus paracentralis, suggested as the possible homologue of the sulcus cruciatus of lower mammals, which is frequently the inferior and posterior boundary of the motor area in this region. Smith2 shows this element as a boundary and both are agreed that the motor cortex does not reach the sulcus cinguli. In the left hemisphere the boundaries are somewhat better indicated. The posterior part of the sulcus cinguli, bounding the paracentral lobule, is typical in the left hemisphere but fails to incise the superior border of the hemisphere in the right, bifurcating on the mesial surface. The anterior part of the sulcus cinguli is also radically different in the two hemispheres, but the correct interpretation of this part is often difficult on account of the frequent compensatory relation it bears to the sulcus frontalis marginalis. The areas plotted in this region are of doubtful significance. The lobulus precuneus in the left hemisphere is rather typically divided into two regions of cortex by the horizontal sulcus subparietalis. The posterior part of the sulcus is lacking in the right hemisphere. The superior part of the lobule belongs to the superior parietal type of cortex, the inferior to the cingulate. The calcarine fissure and the fossa parieto-occipitalis could not be examined in their depth, hence the prominence of bridging gyri could not be determined. In both hemispheres there is an unusual extent of the incisura parieto-occipitalis on the lateral surface but no com- munication with the sulcus paroccipitalis. In the left hemisphere the gyrus intercuneatus, which separates the three elements of the fossa, is almost superficial at the border of the hemisphere. 1 Localization of cerebral function, 1905. 2 The central nervous' system.-Cunningham's Textb. of Anat., 1914. 46 J. J. KEEGAN The postcalcarine sulcus terminates in a prominent polar bifurca- tion in the left hemisphere, more lateral and more typical than in the right, thus denoting a greater lateral extent of the area, striata in the left hemisphere, a condition which may be considered normal in most brains. The area striata, although not delimited by section, could be plotted with a fair degree of accuracy due to its rather con- stant relation to the posterior bifurcation of the sulcus postcalcarinus and the general coincidence of its boundary on the mesial surface with shallow superior and inferior limiting sulci of the , cuneus and gyrus lingualis and with frequent superior and inferior polar occipital sulci. The fissura rhinalis is entirely independent of the sulcus collateralis in both hemispheres, forming a boldly curved lateral boundary to the piriform area and communicating with the incisura rhinalis of the lateral cerebral fossa. The sulcus collateralis approaches the foetal type with its short anterior extremity and irregular posterior portion. Indian Brain No. II {Catalogue No. 22655^. Plates IX to XI) This second specimen of a full-blood Tonto Apache Indian brain also was hardened in Muller's fluid outside of the cranial cavity and had suffered so much distortion and shrinkage that measurements would be of practically no value. However, the following weights are given to show the extreme shrinkage that must have taken place: Right hemisphere weight 337 gms., length 149 mm. Left hemisphere " 335 " " 149 " Brain-stem " 125 " " Total " 797 " The hemispheres presented a simpler type of fissuration with broader and more regular gyri than Brain No. I, notwithstanding the smaller size of the brain. This difference is perhaps emphasized to some extent in the figures by the equalization of the longitudinal measure- ments. The width of the gyri in the central region is especially noticeable. LATERAL SURFACE The lateral cerebral fissure is rather short in both hemispheres with a more pronounced upturned extremity in the right. The anterior limbs are of the "V" or beginning " Y" type with the ramus Pl. IX. Indian brain No. 2. 48 J. J. KEEGAN horizontalis placed rather low, almost upon the orbital surface. An unusual condition in both hemispheres is a communication with all three vertical central fissures through the intermediation of the sub- central elements. The superficial extension of the sulcus dividing the two transverse temporal gyri of Heschl is very evident in both hemispheres. The sulcus centralis communicates with the lateral cerebral fissure in both hemispheres through the sulcus subcentralis anterior. It extends typically to the mesial surface on both sides, with a much straighter course than in Brain No. I. The superior genu again is more pronounced in the left hemisphere. The sulci precentrales are separated in the right but are in shallow communication in the left hemisphere. They are rather typical of Cunningham's description, including the sulcus precentralis marginalis on the left side. The gyrus precentralis, corresponding to the area precentralis in the lower two-thirds, is of about uniform width through- out, only slightly expanded in the region of the superior genu. The general size appears proportionately larger than usual with a distinct enlargement of the lower part in the left hemisphere due to the anterior convexity of the sulcus precentralis inferior. The sulcus frontalis superior has an unusual position and course in the left hemisphere, receding slightly from the mesial border towards the frontal pole, thus resulting in a rather wide anterior frontal area and narrow middle frontal area. The definition of this sulcus as a boundary line is uncertain, however. On the right side the more typical oblique arrangement of elements is found. The sulcus frontalis inferior is continuous in the left hemisphere from the sulcus precentralis inferior to the orbital border. In the right it is much shorter although bearing the same relation to the ascending rami of the lateral fissure. The left inferior frontal area consequently is well defined but the right is lacking in an anterior superior boundary. The left ascending ramus of the lateral cerebral fissure is situated much farther anterior than the right, thus leaving a wide posterior inferior frontal area on this side which is incised by a sulcus diagonalis and descending branch of the sulcus frontalis inferior. The sulcus postcentralis is continuous in both hemispheres from the lateral cerebral fissure to a shallow communication with the sulcus centralis near the mesial border. The gyrus postcentralis, corre- sponding in boundaries to the area postcentralis, is of greater extent in the left hemisphere but not to the degree noted in Brain No. I. Pl. X. Indian brain No. 2. 50 J. J. KEEGAN The sulcus interparietalis is similar on the two sides but situated more lateral on the left. The descending branch is quite prominent, more so in the left where it appears to compensate for the short lateral cerebral fissure. The sulcus paroccipitalis is typical in the right but irregular in the left hemisphere on account of the lateral deflection of its posterior part. On both sides is to be noted the communication with the incisura parieto-occipitalis. The sulcus lunatus is represented in both hemispheres in a stage of transition to the sulcus occipitalis lateralis by the conversion of the sulcus prelunatus and the superior half of the sulcus lunatus into a longitudinal fissure parallel to the lateral border of the hemisphere. Very little difference between the two sides can be detected but judg- ment is complicated by a partial destruction of this region of cortex in the left hemisphere, thus leaving the more easily defined sulcus lunatus in the right hemisphere. This is contradicted, however, by the more lateral extension of the sulcus postcalcarinus in the left hemisphere, which predicates a greater lateral extent of the area striata and more typical sulcus lunatus. The limits of the area striata plotted on this basis, about a centimeter distant from the sulcus post- calcarinus and related to superior and inferior polar occipital sulci, is more restricted to the mesial surface than in Brain No. I. The limits of the area peristriata are approximated to the sulcus paroccipitalis, the inferior limb of its posterior bifurcation, the sulcus prelunatus and the sulcus occipitalis inferior. The sulcus temporalis superior has a distinct arcuate form limiting the audito-psychic area, more pronounced in the right hemisphere. This increased size of the area, combined with the prominent incising transverse temporal sulcus of Heschl,' suggests a greater functional significance than usual. The sulcus angularis is quite well developed but situated more posterior in the right hemisphere. The inferior parietal cortex has very well defined boundaries and a distinct division into anterior and posterior areas by the prominent descending branch of the sulcus interparietalis. The entire' area appears more extensive in the right hemisphere. The two subdivisions are of nearly equal size in the left hemisphere, the posterior being incised by the sulcus angularis and limited by a typical sulcus occipi- talis anterior. In the right hemisphere the posterior area is distinctly the larger, denoted by the more anterior position of the sulcus angularis and the presence of a sulcus intermedins, posterior to this sulcus. Pl. XI. Indian brain No. 2. 52 J. J. KEEGAN MESIAL SURFACE The sulcus centralis is seen on the mesial surface in both hemis- pheres and the motor area is very easily plotted in relation to this termination and a somewhat horizontal sulcus paracentralis. The lobulus is completely bounded by a typical posterior element of the sulcus cinguli which incises the border of the hemisphere just posterior to the sulcus centralis. The anterior two-thirds of the sulcus cinguli is more regular than in Brain No. I and the areas of this region can be plotted very easily in correspondence with the type plan. The lobulus precuneus presents a striking difference of size and fissuration in the two hemispheres, the right being narrow and the left unusually wide. This increased width is associated with an accessory sulcus in the posterior region, which deeply incises the superior or mesial border of the hemisphere to communicate with the sulcus paroccipitalis. This sulcus can only be interpreted as a com- pletely separated sulcus limitans precunei of the fossa parieto-occipi- talis, a very rare condition. The calcarine and parieto-occipitalis complex of fissures could not be examined in their depth, consequently a doubtful interpretation is necessary. The superficial communication of the left sulcus cal- carinus with the fossa parieto-occipitalis is located fully twice as far from the splenium of the corpus callosum as in the right hemisphere, which condition must be associated with the independent sulcus limitans precunei interpreted in the lobulus precunei. The analogous sulcus in the right hemisphere also communicates with the sulcus paroccipitalis but is here incorporated within the fossa parieto- occipitalis. The sulcus postcalcarinus extends just to the occipital pole in the right hemisphere and slightly beyond in the left, but the latter termina- tion is partially destroyed by an injury to the cortex in this region. The area striata boundaries are fairly well indicated by shallow limiting sulci in the cuneus and lingual gyrus and a very distinct sulcus occipi- talis polaris superior in the right hemisphere arching around the bifurcation of the sulcus postcalcarinus. The fissura rhinalis represents an advanced type of development with complete separation of the posterior part from the incisura rhinalis and a full communication with the sulcus collateralis. THE INDIAN BRAIN 53 Indian Brain No. Ill (.Catalogue No. 228483. Plates XII to XIV; Fig. 1) This brain was from a full-blood Teton Sioux Indian and formalde- hyde fixation permitted the walls of the fissures to be separated and examined. However, it was the most distorted of the three specimens and in addition was injured by a deep incision in the lateral surface of both hemispheres, extending from the incisura parieto-occipitalis across the parietal and temporal cortex to the anterior part of the lateral cerebral fissure. The weight of the brain was nearer normal than the preceding two as is seen from the following figures: Right hemisphere weight 545 gms., length 166 mm. Left hemisphere " 543 " " 173 " Brain-stem " 140 " Total " 1,228 " Practically nothing can be judged from the weight concerning the original or relative size of this brain. The type of fissuration has a peculiar angular appearance due to late fixation in the membranes and flattening of the surface of the gyri. This irregular appearance, however, certainly has a structural basis in the lower central region. The complexity of the fissuration in the plotted figures does not appear greater than normal. LATERAL SURFACE The lateral cerebral fissure presents nothing unusual except a considerable irregularity in the region of the ascending ramus of the right hemisphere, where there is a communication with a prominent descending branch of the sulcus frontalis inferior. The sulcus centralis hardly reaches the mesial border in either hemisphere, although compression in this region has made the exact line of the border difficult to determine. The superior and inferior genua are accentuated, perhaps due to the flattening of the surface. A communication with the sulcus precentralis is noted in the right hemisphere. The sulcus precentralis superior is completely separated from the sulcus precentralis inferior in both hemispheres and has an unusual length and course, extending below into the gyrus precentralis and terminating in a transverse bifurcation. The sulcus precentralis inferior is rather distant from the sulcus centralis, especially in the Pl. XII. Indian brain No. 3. THE INDIAN BRAIN 55 right hemisphere, thus giving rise to a wide area precentralis in this region. The sulcus frontalis superior has the typical oblique element dis- position on both sides, fitting well with the antero-mesial extension of the cortical areas in this region. The sulcus frontalis inferior in the right hemisphere extends from the sulcus precentralis inferior to a very prominent anterior bifurcation or sulcus radiatus, but in the left hemisphere is separated from this transverse part by a narrow gyrus. A prominent descending branch incises the posterior part of the inferior frontal gyrus on both sides, but takes origin in the right hemisphere from the communication with the sulcus precentralis inferior and communicates with the ascending ramus of the lateral cerebral fissure and with the sulcus diagonalis. The posterior part of the inferior frontal area is smaller in the right hemisphere. The pars triangularis is incised by the sulcus radiatus in both cases. The sulcus postcentralis resembles that of Brain No. I by terminating a considerable distance from the lateral cerebral fissure and being com- pensated by the sulcus subcentralis posterior. The width of the area postcentralis is about equal in both hemispheres. The sulcus interparietalis communicates with the sulcus paroccipi- talis in the right hemisphere but not in the left. The descending branch is of doubtful identity in both, possibly in communication with the sulcus angularis on the right side and as a short independent branch on the left. The sulcus paroccipitalis, although interrupted by the deep cut in the lateral of the hemispheres, can be interpreted of rather typical form on both sides, the greatest variation being the long arcuate medial limb of the posterior bifurcation in the right. The sulcus lunatus is completely converted into the sulcus occipitalis lateralis. A small arcuate sulcus near the occipital pole in the left hemisphere is interpreted, on account of its close relation to the poster- ior extremity of the sulcus postcalcarinus, as a lateral limiting sulcus for the area striata, not the sulcus lunatus but a combination of shallow elements which frequently mark the limits of the area striata. The mesial termination of the right sulcus postcalcarinus and the extension of the sulcus occipitalis lateralis nearer to the occipital pole in this hemisphere indicate a smaller lateral extent of the area striata than in the left. The sulcus and gyrus temporalis superior were extensively destroyed Pl. XIII. Indian brain No. 3. THE INDIAN BRAIN 57 in both hemispheres by the deep cut in this region of the lateral surface. In the right hemisphere a continuous sulcus is interpreted, extending from the temporal pole to a communication with the sulcus interparietalis through the intermediation of the sulcus angularis and the descending branch of the sulcus interparietalis. In the left hemisphere the sulcus angularis is situated more posterior and an accessory sulcus lies between it and the termination of the lateral cerebral fissure. This suggests the greater growth in the anterior parietal cortex of the left hemisphere. MESIAL SURFACE The left paracentral lobule contains a horizontal element inter- preted as the inferior and posterior boundary of the motor cortex. The right is less definite. The posterior part of the sulcus cinguli forms a complete posterior and inferior boundary for the lobule on both sides, deeply incising the superior border of the hemisphere and arching around the posterior extremity of the sulcus centralis. The anterior two-thirds of the sulcus cinguli appears in the position of the sulcus frontalis marginalis in the right hemisphere and is incomplete in the left, thus confusing the interpretation of the areas in this region. The lobulus precuneus is rather typically fissured in both hemis- pheres. The postero-superior angle is incised by the sulcus limitans precunei of the fossa parieto-occipitalis. The fossa parieto-occipitalis is very deep and partly destroyed by the cut in the lateral surface. In the left there is a wide separation of the three elements of the fossa, the sulcus limitans precunei, the sulcus incisura, and the sulcus paracalcarinus, resulting in an extension of the first into the lobulus precuneus, an entirely superficial lateral position of the second, and a deep incision of the border of the hemisphere by the sulcps paracalcarinus. Thus it may be said that the gyrus intercuneatus is superficial. In the right hemisphere this region, although injured to a greater extent, gave indication of a deeper position of the elements and separating gyrus intercuneatus, with the incisura appearing bifurcated on the lateral surface. The sulcus calcarinus has a deep communication with the fossa parieto-occipitalis in both hemispheres, but an almost superficial bridging gyrus cuneo-lingualis anterior separates it from the sulcus postcalcarinus. A rather long anterior extension in shallow communi- cation with the hippocampal fissure may be due in part to the artificial compression of the lingual gyrus. Pl. XIV. Indian brain No. III. 59 THE INDIAN BRAIN The sulcus postcalcarinus is rather short and situated nearer the superior border of the hemisphere than usual, but this may be due largely to the distortion of the brain. The posterior bridging gyrus cuneo-lingualis is present but less prominent than the anterior. The posterior termination or bifurcation is situated fully a centimeter more lateral in the left hemisphere than in the right. This agrees Fig. 1. Indian brain No. 3, occipital surface. with the usual condition and denotes a more lateral extent of the area striata on the left side. The superior and inferior limiting sulci of the area striata are not indicated very definitely, the tendency being more towards a transverse disposition of these shallow elements. The superior and inferior polar occipital sulci, bounding the area striata at the borders of the hemisphere, are both very distinct in the left hemisphere. The fissura rhinalis approaches the primitive type, having an appre- ciable communication with the incisura rhinalis and a tendency to separation from the irregular deflected anterior extremity of the sulcus collateralis. 60 J. J, KEEGAN Summary The study of these three full-blood Indian brains permits little to be said from the standpoint of structural or racial differentiation, partly due to the imperfect preservation and small series but chiefly due to the fact that few exact points for comparison have been estab- lished in cerebral anthropology. It is safe to state, however, that in these Indian brains there is no discernible difference from the average brain of the white race. An observation perhaps also noteworthy is that in none of the brains is there a very close approach to the complex type of fissuration noted in the Chinese and Eskimo brain or in the most complex type of brain of the white race. But in none of the brains does the lateral extent of the sulcus postcalcarinus and related area striata and sulcus lunatus approach the typical condition fre- quently found in the negro brain. The nearest resemblance to this condition is found in the left hemisphere of Brain No. I where a prominent polar bifurcation of the sulcus postcalcarinus is present. Associated with this more primitive condition in this brain is the foetal or more primitive type of the fissura rhinalis in both hemispheres and the superficial gyrus intercuneatus in the left hemisphere. Per- haps next in advance stands Brain No. Ill with its intermediate type of fissura rhinalis, the prominent bridging gyrus cuneo-lingualis anterior in both hemispheres, and the superficial gyrus intercuneatus in the left hemisphere. Brain No. II, although characterized by rather wide and regular gyri, is farthest removed from the low type cerebrum by the numerous communication of fissures usually inde- pendent and by the complete fusion of the posterior part of the fissura rhinalis with the sulcus collateralis. From an analysis of the literature on cerebral localization and fissural significance and from the study of the negro, Indian and white brain from the standpoint of cerebral anthropology, a few conclusions concerning the trend of work in this field and the possibilities for future investigations may be added. Detailed measurements on the cerebral surface have not established constant racial, sexual or mental differences, perhaps because of their fewness as yet in number, and because the possibility of error in the definition and selection of the landmarks is in some cases greater than the probable differences of race, sex or mentality. Further, such differences may be represented largely through finer organization of the inner structure of the cortex. The most valuable indications of degree of differentiation have been found in connection with the extent and type of cortical area differen- THE INDIAN BRAIN 61 tiation, to which the fissures play a secondary role but often furnish superficial evidence through their recognized relation to cortical areas. The most important example of this is found in the occipital region where the position and type of the sulcus lunatus bears a direct relation to the lateral extent of the area striata and is found more typical in the negro brain and especially in the left hemisphere. From this it is concluded that future possibility rests in the application of a better knowledge of area definition and extent in the comparison of brains and individual hemispheres. Three methods of attack of these prob- lems are open: first is the comparison in the embryo of the early appearance of cortical elevations as the beginnings of area differentia- tions; second, a closer study of the development of the fissures in relation to cortical area differentiation to prove or disprove a large part of the suppositional significance of fissures; and third, a com- parison by exact measurements, particularly of surface measurements of the more primitive and more differentiated cortical areas, with the remainder of the cortex representing the elaboration and association of these primary functions. Bibliography Beevor (C. E.), and Horsley, V.-Phil. Trans., 1890. Bond (M.)-Observations on a Chinese brain.-Brain, 1894, xvii, 37. Brodman (K.)-Die Cortexgliederung des Menschen.-J. f. Psychol. & Neurol., 1908, x, 231. Neue Forschungsergebnisse der Grosshirnrindenanatomie mit besonderer Beriicksichtigung anthropologischer Fragen.-Verh. d. 85 Vers. d. Naturf. & Arzte in Wien, 1913. Campbell (A. W.)-Histological studies on the localization of cerebral function.-4°, London,1905. Cole (S. J.)-On some morphological aspects of microcephalic idiocy.-J. Anat. & Physiol., 1910, xliv, 315. Cunningham (D. J.)-Contribution to the surface anatomy of the cerebral hemis- pheres.-Mem. Roy. Irish Acad., No. 7, 4°, Dublin, 1892. Eberstaller (O.)-Das Stirnhirn.-8°, Wien & Leipzig, 1890. Ferrier (D.)-Functions of the brain.-8°, London, 1876. Flechsig (P.)-Gehirn und Seele.-4°, Leipzig, 1896. Developmental localization of the cerebral cortex in the human subject. -Brit. Lancet, 1901, n, 1027. Einige Bemerkungen uber die Untersuchungsmethoden der Grosshirnrinde, inbesondere des Menschen.-Arch. f. Anat. & Physiol., 1905, 337. Fritsch (G.) '& Hitzig, E.-Ueber die elektrische Erregbarkeit des Grosshirns.- Arch. f. Anat. Physiol. & Wissen. Med., 1870. Gall (F. J.) & G. Spurzheim.-Anatomie et physiologic du systeme nerveux.-4°, Paris, 1810-12. Griinbaum (O.) & C. S. Sherrington.-Observations on the physiology of the cerebral cortex of the anthropoid apes.-Proc. Roy. Soc., 1903, lxxii, 109. 62 J. J. KEEGAN Hrdlicka (A.)-An Eskimo Brain. Amer. Anthropol., 1901, m, 454-500; also 8°, N. Y., 1901. Kappers (C. U. A.)-Cerebral localization and the significance of sulci.-Seventeenth Intern. Cong. Med., 1913. Keegan (J. J.)-A study of a Plains Indian brain.-J. Comp. Neurol., 1916, xxvi, 403. Lewis (B.) & H. Clarke.-The cortical localization of the motor area of the brain.- Proc. Roy. Soc., 1878, No. 185. Mall (F. P.)-On several anatomical characters of the human brain, said to vary according to race and sex.-Am. J. Anat., 1909, xx, 1. Poynter (C. W. M.) & Keegan (J. J.)--The American Negro brain.-J. Comp. Neurol., 1915, xxv. Retzius (G.)- Das Menschenhirn. 4°, Stockholm, 1896. Schuster (E. H. J.)-Descriptions of three Chinese brains.-J. Anat. & Physiol., 1908-09, xlii, 59. Smith (G. E.)-Studies in the morphology of the human brain with special reference to that of the Egyptians.-Rees. Egypt. Gov't Sch. *of Med., Cairo, 1904, n. A new topographical survey of the human cerebral cortex.-J. Anat. & Physiol., xli, 237. The central nervous system.-Cunningham's Textb. of Anat., 4th ed., 1914. THE NASO-ORBITO-ALVEOLAR INDEX A New Craniometric Method, Including a Description of a Specially Designed Indexometer for Estimating it John Cameron Professor of Anatomy, Dalhousie University, Halifax, N. S. The author has been engaged for some time on a comparative study of measurements of the facial portion of the skull, and after some ex- perimenting has been able to secure results that appear worthy of being placed on record. He made a preliminary communication on the subject to the Royal Society of Canada in May, 1919, and since then was privileged to study the collection of crania in the Royal College of Surgeons Museum, London, England, during the summer of 1919, thanks to the kindness and courtesy of Dr. Arthur Keith. These investigations inspired the production of a specially designed indexometer, the description of which is now published for the first time. I can find no evidence of this "naso-orbito-alveolar" method having been previously utilized in craniometry. All the investigations recorded in this memoir were conducted on adult male crania, the reason for this being that the orbital contours were found to vary with age and sex throughout all the racial types, where this comparison could be made. As the lower orbital margins were utilized for one of the horizontal planes in the research, it was therefore found essential to confine the study to one sex. As soon as a representative collection of female racial types can be secured, it is intended to carry out an independent investigation on these, along lines similar to those followed in this research. Crania of the following races were examined: European, Ancient Egyptian, Hindoo, Chinese, Eskimo, Polynesian, North American Indian, Ancient Inca, Patagonian, African negro, Melanesian, aborigi- nal Tasmanian, and aboriginal Australian. I was also enabled, through the courtesy of the Bureau of American Ethnology, to utilize the photographic reproductions of the Muniz collection of ancient Inca crania in the 16th Annual Report of the Bureau of American Ethnology, and the plates in Hrdlicka's memoir on the Lenape In- dians (Bull. 62, Bur. Amer. Ethn.). Amer. Jour. Phys. Anthrop., Vol. Ill, No. 1. 63 64 JOHN CAMERON Several of the well-known types of fossil Hominidae were also utilized in this research. I have never had the privilege of studying the actual specimens in the case of the Obercassel Cro-magnon man, the "old man" of Cro-magnon, the LaChapelle cranium or the Grimaldi re- mains, though I have frequently seen the Gibraltar Skull in the Royal College of Surgeons Museum. I was, however, enabled to apply my method to photographic reproductions of these taken from the works of Bonnet,1 Boule2 and Verneau3 and from the plates illustrating Hrdlicka's memoir on types of fossil Hominidae. ("The Most Ancient Skeletal Remains of Man," 2 ed., 8°. Smiths. Inst., 1916.) The naso-orbito-alveolar index may be calculated in two ways: (1) by drawing certain lines on photographs of the skulls, or (2) by using the author's specially designed indexometer (Fig. 1). In regard to the photographic method, it was essential that the orientation of the skulls should be exactly the same, in all cases, and it was found most convenient to use the Frankfort plane. One im- portant point to be noted was that the relative levels of the camera and the skull had to be the same for each series of crania. The simplest way to ensure this was by focusing the midpoint between the nasion and the akanthion (point of nasal spine) on to the intersection of diagonal lines drawn on the ground glass screen of the camera. Hori- zontal lines were then drawn through the following four points on each photograph-the nasion, the lower orbital margins, the akanthion and the alveolar point. Two vertical lines were then drawn along the outer margins of the nasal aperture. It will be noted that three of the cranial points chosen possess a fair degree of positional constancy, and it may be further observed that the plan makes full use of the re- markably constant and trustworthy nasal index. It may be mentioned here that in the case of the LaChapelle skull a small piece of bone is absent from the region of the nasion, thus rendering the localization of this point only approximate. The horizontal line drawn through the lower borders of the orbits does not possess so high a degree of constancy as the others. Moreover, it was found that in some of the skulls the lower orbital margins were not on the same horizontal plane, in which case the mean of these was taken. When these lines were drawn in the manner indicated, the result was an elongated rectangle, with the long sides placed vertically, and subdivided into three subsidiary rectangular areas (see the illustra- 1 Die Naturwissenschaften, 1914, Heft. 27. 2 Ext. Annal. Paloeont., VI, VII and VIII. 3 Les Grottes de Grimaldi. Monaco, 1906. THE NASO-ORBITO-ALVEOLAR INDEX 65 tive figs.). It will, therefore, be recognized that the index is really composite in character, for one can calculate the relationship of the width to the height of the complete rectangle, or to the height of each of the subsidiary rectangles, and this is the plan that has been adopted. It is to be particularly noted that all the measurements recorded were made on the photographic reproductions. It is essential that this fact should be mentioned, as it is obvious that in a very prog- nathous skull the nasion-alveolar point height would be decidedly less than the total aggregate of the nasion-akanthion and the akan- thion-alveolar heights. In compiling the indices it was decided to follow the plan of estimating the nasal index. The nasal width, which formed the foundation of the whole scheme, was therefore multiplied by 100, the result being then divided by the height of each rectangle in turn. The second method of estimating the naso-orbito-alveolar index is by means of the author's specially designed Indexometer, of which a brief description will now be given. It possesses the merit of being readily made at home and of being easily applied. All that is required is the possession of two long and four shorter pieces of thin, stout wire, which are arranged in the manner shown in Fig. 1. At each inter- section a thinner piece of wire is twisted lightly round both, but sufficiently firm to make the apparatus hold together and yet permit of the horizontal pieces of wire being moved up or down, and the verti- cal pieces in a lateral direction. I am endeavouring to make arrange- ments with a scientific instrument maker to manufacture a suitable model of the indexometer which will possess a double sliding joint of the close fitting tubular type at each intersection of the wires. Mode of Application.-The indexometer is placed against the skull so that the uppermost bar rests against the nasion and the lowermost bar against the'"alveolar point. The lower ends of the upright wires of course rest upon the table and they require to be slid towards or away from each other, until each lies exactly anterior to the outer border of the nasal aperture. The intermediate horizontal bars are then moved up or down as the case may be until they lie exactly anterior to the lower orbital margins and the akanthion respectively. It is of course clear that the uppermost and lowermost bars are the only ones that are in actual contact with the skull. A little practice enables one to become proficient in the application of the indexometer. The relation of the nasal width to the height of the complete rectangle or to the height of each of the subsidiary rectangles can then be readily estimated, as explained previously. 66 JOHN CAMERON On investigating the results yielded by this composite index in the male crania of the various racial types enumerated above, it was ascer- tained that it divided races into two great groups. The first group comprised the European, ancient Egyptian, Hindoo, Chinese, Eskimo, Polynesian, North American Indian, ancient Inca and Patagonian Nasio/v Lowest t Qrbttol. M_aKqi_HS_ /! A(WT#/<w djLVEOLai? ? 'Po i ait Fig. 1. A sketch of the author's naso-orbito-alveolar Indexometer. It consists of two vertical and four horizontal pieces of stout wire with a double sliding joint at the eight intersections, so as to admit of the horizontal pieces of wire being moved up or down and the vertical pieces in a lateral direction. For its mode of applica- tion see the text. THE NASO-ORBITO-ALVEOLAR INDEX 67 racial types, while the second group, which might be termed the negro group, included the African negro, aboriginal Australian, aborigi- nal Tasmanian and Melanesian racial types. In the first group the height of the uppermost rectangle was always greater than its width, its index being therefore well under 100, while the two lower rectangles approximated closely to the outlines of squares, their in- dices being somewhere in the neighbourhood of 100, sometimes above £ lift of? a n. Fig. 2. Represents European and Ancient Egyptian types of skull. It is to be noted how closely the relative proportions of the three horizontal dotted areas of the facial skeleton correspond to each other in these two racial types. It is to be observed further that the two lower rectangles in each case are approximately squares, while the uppermost rectangle is elongated vertically. and in other cases below. Moreover, the index for the complete rect- angle, that is to say, the relation of the nasal width to the nasion- alveolar height, was as a rule under 40. In the Eskimo skull in my collection this index was found to be as low as 31.6 owing to the con- traction of the nasal width. In the second or Negro group, on the other hand, the upper two rectangles approximated to the outlines of squares, their indices being somewhere round 100, while the lowermost rectangle, owing to the great reduction in its height due to the prognathism in these races, exhibited an index of at least 192.5 (African negro), indicating of course that the nasal width was practically twice the height of the 68 JOHN CAMERON lowermost rectangle. In an aboriginal Australian cranium the index for this rectangle was as high as 252.5. Moreover, the index for the complete rectangle in these races was always well over 40, that is to say, the nasal width was in all cases more than 40 per cent of the naso- alveolar height. In an aboriginal Australian skull it was as high as 50.7 per cent. It is therefore manifest that this index demarcated races into two definite groups,1 the appearance exhibited by the various rectangles being illustrated in Figs. 2, 3, 4 and 5. In Fig. 2 European and ancient Egyptain types of skull have been placed side by side in order to demonstrate how closely the relative proportions of the three horizontal areas of the facial skeleton corre- spond in these two racial types. Note further that the two lower rectangles in each case are approximately squares, with indices there- fore in the vicinity of 100, while the uppermost rectangle is elongated vertically, with an index well under 100 in both crania. The writer has previously referred more than once2 to the high type of index that is exhibited in some ancient Egyptian skulls, and is therefore not surprised to find that the naso-orbito-alveolar index consistently follows these, and brings the two racial types into some degree of approximation. I have placed the Mongolian, Polynesian and Eskimo types to- gether in Fig. 3. It will be observed once more that the relative pro- portions of the three horizontal areas of the face and the outlines of the three rectangles correspond more or less closely to those in Fig. 2, except in the case of the Chinese cranium. I utilized the latter deliberately as an example of variation, since two other skulls of this race that I examined showed relative proportions of the three rect- angles that conformed to the European-Asiatic type. This variation is due to the varying levels of the lower orbital margins which would of course affect the relative proportions of the uppermost and inter- mediate rectangles. The degree of variation of the naso-orbito- alveolar index cannot of course be fully worked out until a large series of crania has been examined. In the meantime I will have to rest satisfied with the demonstration and mode of application of the index. I had difficulty in deciding where to place the Eskimo skull in the illustrative Figs, for this paper. As he has some Mongolian attributes, 1 The zone of demarcation between these groups would become greatly reduced in an extensive series of crania. 2 Manchester University Museum Publication, No. 68, 1910; also Trans. Nova Scotian Inst. Sd., XIV, Pt. 1, 1916. THE NASO-ORBITO-ALVEOLAR INDEX 69 I placed him with the Chinese and Polynesian crania. Owing to his contracted nasal aperture, however, he occupies a definitely isolated plane, and I have therefore installed him in the upper part of Fig. 3 by himself. cski)no Chi m Si. Sandwich Sslanden- Fig. 3. Shows Chinese, Polynesian and Eskimo types of skull. The rectangles of the Eskimo and Polynesian types of crania correspond more or less to those de- picted in Fig. 2. The Chinese cranium has been utilized to demonstrate the fact that the naso-orbito-alveolar index has a considerable range of variation. 70 JOHN CAMERON Representatives of three aboriginal races of the Western Hemisphere have been chosen for Fig. 4, which demonstrates that the relative proportions both of the three horizontal dotted areas of the facial Pa ta yonia n Jn. di art J^nca Fig. 4. Representation of the crania of three aboriginal races of the Western Hemisphere. There is a certain degree of correspondence in the relative heights of the three rectangles, which makes them conform more or less to the European- Asiatic type. The nasion-alveolar height of the Patagonian skull is an unusual feature, though apparently not a definite character of this race. THE NASO-ORBITO-ALVEOLAR INDEX 71 fay Ro Qloxicjinal fliisfkalmn ulotlicTinal fas man tan fTlelanssia/z Fig. 5. Shows that African negro, aboriginal Tasmanian, aboriginal Australian and Melanesian types of skulls give corresponding results when studied by means of this index. The two upper rectangles are approximately squares, while the lower- most show an extreme degree of reduction of their heights, due of course to the prog- nathism in these races. These crania thus display a marked contrast to those of the Euro-Asiatic type. 72 JOHN CAMERON skeleton and of the three rectangles conform more or less to the general European-Asiatic form, or what might be termed the Eurasiatic type. I was much struck by the amount of the nasion-alveolar point height in the Patagonian skull. An examination of this cranial group in the Royal College of Surgeons Museum, however, demonstrated the fact that this did not appear to be a characteristic racial feature. The inter-racial range of variation in the relative sizes of the three rectangles was such that the Eurasiatic races, the Polynesians and the aborigines of the Western Hemisphere were practically on the same level. Thus it appears as if the Eurasiatic types could be linked by this craniometric method with both the American Aborigines and the Polynesians. In a previous communication1 the writer has referred to the fact that the crania of the aborigines of the Western Hemisphere betray some Mongoloid affinities, and a link with the yellow-brown Mongol of Asia is also provided by the Polynesians of the Pacific. In reference to this fact it is important to quote Hrdlicka's remarks on p. 183 of Bulletin No. 52 of the Bureau of American Ethnology2: "This general American type is more or less related to that of the yellow-brown peoples, wherever these are found without decided ad- mixture with other strains. These yellow-brown people, including the American, represent one great stream of humanity." Fig. 5 demonstrates the fact that the naso-orbito-alveolar index placed the African negro, the aboriginal Tasmanian, the aboriginal Australian and the Melanesian on the same plane. It is interesting to note how the uppermost and intermediate rectangles approximate in all four cases to the outlines of squares, and are therefore about equal in size, their indices being somewhere in the vicinity of 100. The great feature of Fig. 5 is, however, the great reduction in the height of the lowermost rectangle, due, as previously explained, to the high degree of prognathism in these races. The index for it was there- fore about 200 or even much more (192.5 in the African negro, 199.9 in the aboriginal Tasmanian, 234.5 in the Melanesian and as high as 252.5 in an aboriginal Australian), indicating of course that its height was about one half its breadth-in some cases much less. THE CRANIA OF FOSSIL HOMINID® On comparing Fig. 5 with Fig. 6, it is evident that the cranium of the Grimaldi youth exhibited fairly consistently the characteristics of 1 Trans. Nova Scotian Instil. Sci., Vol. XV, Pt. 1, 1919. 2 Early Man in South America, 8°, 1912. See also his "Genesis of The American Indian," Proc. XIX Intern. Cong. Amer., Wash., 1917. THE NASO-ORBITO-ALVEOLAR INDEX 73 \ J - I zn / (£ Rin ci I di youtk (yleRccissfl CHo^a^j-icn Chahtlle. Q\cah cfe/dnQL'MonstcRt Fig. 6. Tracings of the Grimaldi skull (Verneau), the Obercassel skull (Bonnet), and the La Chapelle cranium (Boule). The Grimaldi skull shows the Negro type index. In the Obercassel specimen the index conforms fairly with that of the Euro-Asiatic type. The Cro-Magnon race represents the only example of fossil Hominidse amongst those examined that could with safety be placed in the Eurasiatic category. In the La Chapelle skull it will be observed that the three rectangles are quite different from those of the racial types represented in Figs. 2 to 5. 74 JOHN CAMERON the negro naso-orbito-alveolar index. He could therefore be definitely placed in his appropriate racial position. The indices for the upper- most and intermediate rectangles of his skull were approximately 100, while that for his lowermost rectangle was found to be as high as 233.3-that is to say, practically the same as that for the modern Melanesian skull cited in the preceding paragraph. The skulls of the Obercassel Cro-magnon man (Fig. 66) and of the "old man" of Cro-magnon, were the only cranial types of fossil Hominidse amongst those examined that could be safely placed in the Eurasiatic category. A study of Fig. 66 will demonstrate the fact that the relative proportions of the three horizontal dotted areas of the Obercassel facial skeleton conform niore or less to those of the general European-Asiatic type, while the indices for the three rect- angles likewise consistently follow this result. The application of the naso-orbito-alveolar index to the La Chapelle and Gibralter crania, representing Neanderthal-Mousterian man, provided some interesting results. The great nasal width of these two crania seemed at first sight to render them comparable, to those of the modern negro type, but the height of the lowermost rectangle in both instances at once negatived this impression (Fig. 6c). On examining this figure it will be noted that the three horizontal dotted areas of the La Chapelle skull were almost equal in height, which rendered it quite different from the modern European-Asiatic type or the modern negro type., Moreover the three rectangles were also quite different from those of the modern racial types, for all three were approximately equal in size and were transversely elongated owing to the great nasal width. It is thus clear that the Neanderthal- Mousterian type of skull is one that does not exist at the present day. ENUMERATION OF THE VARIOUS MODES OF APPLICATION OF THE NASO- ORBITO-ALVEOLAR INDEX 1. Calculate the relation of the nasal width to the height of the complete rectangle, that is to say, the relation of the nasal width to the nasion-alveolar height. 2. Calculate the relation of the nasal width to the height of each of the three subsidiary rectangles. 3. Calculate the relation of the square area of the three subsidiary rectangles to each other. For this investigation the crania would all have to be photographed to the same scale of reduction. 4. The relative proportions of the three horizontal areas of the THE NASO-ORBITO-ALVEOLAR INDEX 25 kirn o 75 Fig. 7. The naso-orbito-alveolar method is seen to divide races into two distinct groups. The skulls were all reduced to the same size approximately. flit Io. nts/an i 1 The A /I loRiji nctl TetSfodnian ft or?A Amt/ticn/v Indian Chint st d IroRiyinnl Ausf^lidn J/i n doo Cine ith/' Cjjpiittn ^Ricah /VtjRo ftlodtRn t^Ro^nn. 76 JOHN CAMERON facial skeleton mapped out in Figs. 2 to 6 could be studied. This investigation might be regarded as accessory to the estimation of the naso-orbito-alveolar index, and so far as I have been enabled to de- termine, promises to provide a new and fruitful field of research. In concluding this paper which is to be regarded entirely as a pre- liminary announcement owing to the comparatively small series of crania examined, and the vast issues that have been introduced, I wish to emphasize the fact that all the conclusions arrived at have been based entirely on this one "naso-orbito-alveolar" craniometric method. It is quite obvious that one cannot depend upon it alone as a means of classifying mankind. Still, its value as a further means of studying the cranium appears to present certain possibilities. Another reason for this publication is that it may stimulate further study of the comparatively neglected norma frontalis of the skull. ASPECTS OF THE SKULL: HOW SHALL THEY BE REPRE- SENTED? GEORGE GRANT MACCURDY Peabody Museum, Yale University One of the chief handicaps of physical anthropology has been hither- to lack of unity in mode of procedure. This is particularly true of anthropometry and osteometry. In order that the records of each observer may be readily made use of by every other observer, it is imperative that series of measures be uniform and be taken in uniform ways. Many authors have contributed to our knowledge of these subjects. Under the leadership of Broca, the French developed a method that has had a very wide influence. In the so-called Frankfort Agreement, German anthropologists took an important step in the direction of unification. It remained, however, for the International Congress of Prehistoric Anthropology and Archeology held at Monaco in 1906 to place the matter of unification on an international basis. At Monaco the International Commission agreed upon twenty- four measures of the cranium, eight of the lower jaw, and twenty- one of the head. At the next session of the Congress held in Geneva in 1912, a reconstituted International Commission agreed upon forty- nine additional measures of the living subject. It also adopted a technique for the reconstruction of the height by the aid of the long bones; and passed a resolution that for the graphic representation of skulls, anthropologists employ the horizontal plane either of Broca or of the Frankfort Agreement. There remain for consideration at some future Congress measures of the skeleton in general, exclusive of the cranium and lower jaw. There is another matter which it seems to me might well engage the attention of some future international commission; namely, an agreement as to what attitudes to give the skull in representing its. five aspects: norma frontalis, lateralis, occipitalis, verticalis, and basilaris. For the front view of the cranium there is but one logical attitude; namely, the vertex up. With this there is already universal agree- 77 Amer. Jour. Phys. Anthrop., Vol. Ill, No. 1. 78 GEORGE GRANT MACCURDY ment in practice. The same may be said of the rear or occipital aspect. For the lateral aspect, while the rule of vertex up is universally followed, the skull may be and is made to face to the left or to the right-to show either its left side, or its right side. Would it not be well to agree as to which of these two attitudes is preferable? The writer proposes that the left side be chosen for two reasons. In the first place, in paired measures it is already the rule to take the measures on the left side; in the second place, by making the skull face to the left is to follow the rule of the printed page, which one reads from left to right; and finally this position gives us a more natural position of the teeth. Exceptions to this proposed rule might justly be claimed in cases where one wished to present some special feature which occured on the right side only. The problem of choosing the correct attitude for the top or verti- cal view is still more complicated. There are four possible attitudes: face up, face down, face to the left, and face to the right. In all four positions the vertical axis would of course be at right angles to whichever of the two horizontal planes one might select. Since to all intents and purposes, the skull has bilateral symmetry, both sides should be given an equal chance for self-expression. This can be accomplished only by preserving the bilateral integrity of the figure; in other words, by placing the face either up or down. Is there a choice between these two attitudes? Most certainly there is. The face is the front and should be first. The position of the first is at the top not at the bottom. Therefore, in the norma verticalis of the cranium, the face should be at the top. There are, moreover, two other valid reasons for selecting this atti- tude. It brings the right side of the skull on the right side of the page and the left side on the left. In the second place, the cranium gives the appearance of being in more nearly stable equilibrium when resting on the occipital bone than when resting on the nose, the alveolar margin, or even on the brow ridge. The correct attitude for the norma verticalis then is face up. What do we find in actual practice? Authors have made use of all four possible attitudes at random, sometimes employing more than one attitude in the same work. As a rule, however, after choos- ing a given attitude, the author sticks to it throughout the publication. Thus Broca (Instructions Craniologiques), R. Virchow (Crania Ethnica Americana), de Quatrefages and Hamy (Crania Ethnica), Topinard, ASPECTS OF THE SKULL 79 Sir William Flower (J. A. I., X, 157, 1880), Harrison Allen, Martin, and Hrdlicka, to mention only a few authors, place the face down. On the other hand, in at least certain works of Sir William Turner (Challenger Reports), W. L. H. Duckworth (Anthropology and Morphology), Eugene Pittard (Crania Helvetica), Rivet, E. A. Spitzka, and A. Keith the face-up attitude of the vertical aspect is chosen. These two lists are sufficiently long to show the need for unification. Once the attitude for the norma verticalis is agreed upon, it should not be difficult to unite upon the correct attitude for the basal aspect of the cranium; for if the face-up attitude is correct in the one case, it must be also in the other case. Here again the practice has been as divergent as it was in respect to the vertical aspect. Those who choose the face-up attitude for the latter are generally consistent and place the norma basilaris face up also, and vice versa. On the other hand, some authors are not even consistent, but alternate be- tween the two attitudes. Having fixed upon the face-up attitude for both the vertical and basal aspects of the cranium, it follows naturally that in illustrating crania sectioned transversely the same attitude should be employed, no matter whether one is viewing the floor or the vault of the endo- cranium. Here again in practice there is both inconsistency and diversity. For example, for the vertical and basal aspects of the cranium as a whole, Broca turns the face down (incorrect), but in his illustration of the floor of the endocranium the face is turned up (correct). In the Handatlas of His and Spalteholz, the face is turned up (correct) in the figure of the floor of the endocranium, while in that of the vault of the endocranium it is turned down (incorrect and inconsistent). In this work both the norma verticalis and the norma basilaris of the entire cranium are correct (face up). It often happens that a basal view (hard palate) of the upper jaw alone is wanted. In such a case, there should be no hesitancy in selecting the same attitude it would have if attached to the cranium; namely, the face-up attitude, which happens to be the one suggesting the more stable equilibrium. Notwithstanding, some authors do just the opposite thing, especially those who are in the habit of turn- ing the cranium face down. What is true of the upper maxilla is likewise true of the lower jaw. It should be represented in the same position it would have if in natural contact with the cranium. It should rest on the condyles and angles 80 GEORGE GRANT MACCURDY with the chin (symphysis) up for both the basal and the alveolar as- pect. With its lateral aspect, chin to the left would take precedence over chin to the right. That which is good form for the brain case is also good form for The Five Aspects of a Skull from the Rhone Valley, Switzerland. Hori- zontal plane of Broca. (After Eugene Pittard.) ASPECTS OF THE SKULL 81 the brain. It should be allowed to assume the same attitudes it would have if kept unmolested in the cranium. For the skull as well as the brain, or even the dissected head, a simple rule of procedure may be expressed as follows: Vertex up, face to the left, face or front up. If this rule is a good one for anthropologists to follow, there is no valid reason why it should not be followed likewise by zoologists and paleontologists, especially where the requirements are similar to those in man. In respect to the rest of the skeleton, the same general rule should hold. If so, then there is need of unification of practice both past and present. In so far at least as the genus Homo is concerned, this would mean that segments of the skeleton or disarticulated bones should be repre» sented in the attitude they would have if articulated, that is to say, in their normal position in life. The clavicle would thus be represented in a horizontal position, limb bones in a vertical position. If any other than a superior-surface-up attitude is required for a vertebra, for ex- ample, it should be represented with the anterior aspect up and the posterior aspect down, no matter whether the view be from above or from below. Or if a segment including vertebra, ribs, and sternal junction be represented, the ventral or front portion should be up and the dorsal down. When it comes to the hands and feet, valid arguments may be adduced for two opposite attitudes. It might be well, therefore, to employ each under given conditions. When the hand or foot bones are shown in connection with the lower arm or leg bones, let the phalanges point downward. This would be in conformity with a previously formulated general rule. On the other hand, if the arti- culated bones of the foot alone be shown, let it be with the toes up and the heel down, both for the sole aspect and the reverse. This would be following the rule that the front should take precedence over the back. The same attitude might well be chosen for the articu- lated bones of the hand alone; since this would be in conformity with the attitude selected for the articulated foot bones and would have the added advantage of making it possible for an observer to orient his own hand with the figures on the printed page, thus immensely facilitating comparison and observation. MULTIPLE BIRTHS AMONG THE CHINESE BERTHOLD LAUFER Field Museum of Natural History, Chicago INTRODUCTION The Chinese Annals contain not only records of human events, but also of unusual natural phenomena which left a deep impression upon the minds of the contemporaries. In the early days of historiography, when occurrences were chronicled day by day and year by year, the two categories of human and natural events were noted indiscrimi- nately, merely in the chronological succession as they happened. In the introduction to the Shu king we read, for instance, "The king's uncle, the prince of T'ang, found ahead of grain, two stalks in different plots of ground growing into one ear, and presented it to the king." In the Bamboo Annals (Chu shu ki nien) this feature is still more conspicuous: solar eclipses, meteoric falls, earthquakes, droughts, ex- traordinary phenomena in the growth of trees, appearance of a fung- hwang (so-called phcenix), rain of particles of earth, unusual thunder- storms, and other phenomena are there on record, being interspersed with the record of imperial and military affairs. Beginning from the Annals of the Former Han Dynasty (Ts^ien Han shu), a novel depart- ure from the old practice was instituted in as much as the natural events were detached from the general narrative to be relegated to a special section, entitled "Records relating to the Five Elements" (Wu hing chi). The majority of official annals has adopted this practice. These chapters contain most interesting information, not for the historian, but for the scientist, and therefore merit close study. They give detailed lists, with exact reference to date and place, of great catastrophes, such as famines, droughts, locust-pests, inunda- tions, hail-storms, landslides, earthquakes, conflagrations, excessive cold, electric storms in the winter, etc., abnormal phenomena and monstrosities in domestic animals and human beings, cases of insanity, abnormal customs and practises, etc. It is to this department of records that we owe our principal information on a subject which has not yet been discussed,-the frequency of multiple births among the Chinese. Ames. Johb. Phys. Anthbop., Vol. Ill, No. 1. 83 84 BERTHOLD LAUFER In ancient times, under the Chou dynasty, the officer presiding over the people (se min) was obliged to keep a register of the population. All individuals were recorded from the age when the teeth appear. A separate count was taken of males and females; every year, the number of births was added, while the number of dead was taken off the register (cf. E. Biot, Le Tcheou-li, Vol. II, p. 353). We cannot but regret that documents of this character have not survived. No allusion to twins or other plural births is made at that period. The chapters Wu hing chi of the two Han Annals contain no records of multiple births. The Wei shu gives a single case of a quadruplet birth. Triplets, but only two cases, are first recorded in the Books of the Tang Dynasty, and there is a long list of them under the follow- ing Sung dynasty. There is one case of triplets of early date, not on record in the Annals, but in the Sou shen ki, written by Yu Pao in the early part of the fourth century, who reports that "in a.d. 243 there was a woman who gave birth to three sons." I have not embodied this case in my statistical review of the matter, as the work in question is a Taoist book of marvels, and as the extant edition presents merely a retrospective make-up (cf. Wylie, Notes on Chinese Literature, p. 192). z While triplet and quadruplet births are mentioned in the Annals with comparative frequency, they hardly trouble about twins, save a few cases of united twins. This omission may indicate one of two possibilities: either twin-births were too common to attract much attention, or were too rare to be worthy of notice. This alternative cannot be decided without a solid foundation of statistical material, which unfortunately we do not have. At the outset I am not dis- posed to assume, on a merely empirical basis, a high degree of fecundity of the Chinese woman or a relative frequency of twins; for it is a common experience of our time that personal opinions and impressions along this line are seldom, if ever, upheld by the results of statistical research. Restraint in this case is the more commendable, as in regard to twin-births in Annam we have the following observation of Dr. A.-T. Mondiere ("Monographic de la femme annamite," M emoires de la Societe d'anthropologic, II, 1875, p. 474): "Les grossesses doubles sont excessivement rares chez la femme annamite. Sur les 153174 naissances que j'ai relevees sur les cahiers des villages de toute la Cochinchine de 1872 a 1877 inclus, je n'ai trouve que 15 accouche- ments de jumeaux. Soit 1 sur 10211 naissances. De plus, un arrondissement particulier, celui de Bentre, semble avoir ce privilege, MULTIPLE BIRTHS AMONG THE CHINESE 85 car sur 15 accouchements gemellaires il en a 9 a lui seul, c'est-a-dire 60 pour 100. Les six autres arrondissements (sur 19) qui en ont presenter Bien-hoa, Chau-Doc, Saigon, Soctrang, Tan-an, Tay-ninh, n'en ont eu chacun qu'un seul cas, en ces six annees. D'apres ce que les autorites cambodgiennes m'ont declare, les jumeaux seraient plus frequents chez eux, et d'une fagon assez sensible, mais ils n'ont pu me fournir de chiffre exact." A real investigation of the problem in question is impossible for the present, as we lack any vital statistics for the Chinese Republic. Nevertheless I venture to hope that the facts and observations given below will be of some interest to anthropologists. In order to critically balance the data furnished by the Chinese Annals, it would be indis- pensable to have reliable birth statistics for China, to know the birth- rate for the different provinces, and to depend on good records showing the total number of plural births for at least a decade. In default of such material in the mother-country I anticipated to receive at least some data from those countries outside of China with a large Chinese population, although it must be taken into account that social and economic conditions of the Chinese abroad are different and that, above all, Chinese emigrants hardly ever take their families along, but intermarry, when settled, with women of other nationalities. I have not yet been able to obtain relevant statistics from the British, French and Dutch colonies; but what I have found thus far is not very encouraging. The Birth Statistics for the Registration Area of the United States for 1915 (Washington, 1917) give a total of 74 births (33 males and 41 females) among the Chinese for that year, but nought else. According to a communication of Dr. William H. Davis, chief statistician in the Bureau of Census, Washington, D. C., there were, in the years 1915-17^ 309 births among the Chinese in the registration area for births in the United States (California not being admitted to the registration area is not included), only one pair of twins appearing in this total. The State of California gives in its vital statistics only the number of births and deaths of its Chinese populace, without touching the question of plural births. In 1916 there were 425 births (compared with 727 cases of death); in 1917, 419 births (compared with 818 cases of death) among the Chinese of California (Twenty- Fifth Biennial Report of the State Board of Health of California for the Fiscal Years from July 1, 1916, to June 30, 1918, Sacramento, 1918, pp. 201, 203, 205, 207, 224). The statistics of Mexico contain merely 86 BERTHOLD LAUFER the number of Chinese living in the various provinces, the total, as taken in the third and last census of 1910, being 13,118 men and 85 women = 13,203 (Estados Unidos Mexicanos, Boletin de la Direction General de Estadistica, Num. 5, p. 37, Mexico, 1914), but no tables of births. A literal translation of all cases of triplet and quadruplet births, as they are chronicled in the Annals, has been prepared by me. In every case, the exact date, the name of the family, the social status of the father, and the place where he lived are given; also the distribution of sex in each birth is indicated. As this material would be unin- telligible without the use of Chinese characters, it is here omitted. Readers interested in this phase of the work may be referred to the New China Review of Shanghai, in which the complete article will be published. For some of the bibliographical references mentioned on the following pages I am under obligation to Dr. A. Hrdlicka, Curator of Physical Anthropology in the U. S. National Museum of Washing- ton. UNITED TWINS The Chinese Annals have preserved a few cases of twins grown together at birth. In this case, the question naturally is of twins produced from a single ovum. In the fourth year of the period Kien-hing (a.d. 316), under the Emperor Min of the Tsin dynasty, a woman of the family Hu, when she was at the age of twenty-five, the wife of Jen Kiao, a minor official (clerk) in the district of Sin-ts'ai (prefecture of Ju-ning, Ho- nan), gave birth to female twins grown together in the region of the abdomen and the heart, but separated above the breast and beneath the navel.-Sung shu, Ch. 34, p. 28. In a.d. 487 (under the Emperor Wu of the Ts'i dynasty), the wife of Wu Hiu, one of the people of Tung-ts'ien in Wu-hing (now Hu-chou fu, Che-kiang) gave birth to male twins grown together below the chest down to above the navel.-Nan Ts^i shu, Ch. 19, p. 16b. In the fourth month of the third year of the period Yi-fung (a.d. 678), King-chou (Kan-su) presented the Court with two infants the hearts of which were connected, but each with a separate body. Formerly it had happened that the wife, nee Wu, of Hu Wan-nien, a soldier of the guard in the district Shun-ku (Kan-su), gave birth to twins, a male and a female, whose breasts were connected, but who, for the rest, had individual bodies; when separated, both died. At a subsequent birth it was thus again. The twins were boys, and were MULTIPLE BIRTHS AMONG THE CHINESE 87 brought up. In the above mentioned year they had reached the age of four years, and were presented to the Court.-T'ang shu, Ch. 36, p. 21. In a.d. 1610, the wife of Li Yi-ch'en of Fan-ki (in Tai-chou, Shan-si), nee Niu, brought forth two girls with their heads and faces grown together, but with separate arms and legs.-Shan-si t'ung chi ("Gazet- teer of Shan-si Province"). Two Chinese twins grown together, born in 1887, were shown by Barnum and Bailey in 1902, and at that time were still unseparated and well. Cf, R. Virchow, Xiphodymie (Z. Ethn., 1891, pp. 366-370). The modern Gazetteers occasionally record the birth of twins, not, however, on account of any special interest attached to the fact itself, but merely in order to emphasize the interest in the vitality of twins (cf. W. A. Macnaughton, The Longevity of Twins, Caledon. M. J., X, pp. 127-129, Glasgow, 1915). The following examples from the Gazetteer of Hwa-yang (Hwa-yang hien chi, Ch. 43, p. 4) will suffice to illustrate this feature. The wife of Chu Ch'ang-hwa, nee Lin, had 14 sons, among these 2 pairs of twins, who did not die prematurely, but are still alive. The wife of Chung Se-kin, nee Tsou, had 9 sons, among these one pair of twins still alive. The wife of Chung Chao-k'in, nee Chang, had 9 sons, among these one pair 6f twins still alive. The wife of Li Ch'ao-kung, nee Lin, had 8 sons, among these one pair of twins still alive. TRIPLETS Following is a summary of the Chinese data. For the period of the T'ang dynasty (a.d. 618-906) only two cases of a triplet birth are on record in the Annals. In a.d. 775 a woman of the family Chang gave birth to one male and two females, and in a.d. 905 triplets (males) were born by the wife of P'eng Wen, one of the people of Ju-yin in Ying-chou (Ngan-hwi or An-hwi Province). For the Sung period the data of triplet births are fuller than for any other dynasty. From a.d. 960 down to a.d. 1150 we have a total of 110 cases, listed with exact dates, family and place names, father's social status, and sex distribution in each triplet birth. For the time from a.d. 1023 to 1126 no list of names is given, but merely a statistical record which covers several reign-periods of emperors. It is here reproduced in tabular form. 88 BERTHOLD LAUFER Records of Multiple Births in China, 1023-1126 Period Years Quadruplets (Males) Quadruplets (3 Males, 1 Female) Triplets (Males) Triplets (2 Males, 1 Female) Total 1023-68 46 2 44 1 47 1068-83 15 1 1 84 86 1084-99 16 2 - 18 - 1 21 1100-26....... 27 1 - 19 20 Total 104 6 1 165 2 174 Quadruplets total 7 Triplets total 167 While the preceding cases are not recorded in the way of vital statistics, but solely as unusual events, the above table conveys the impression of embracing a fairly accurate register of all multiple births (save twin births), which took place within the span of a century. The proportion of quadruplet to triplet births in this period is 1: 23.86. The total of triplet births on record during the Sung epoch, accordingly, is 110 + 167 = 277. The total of quadruplet births during the same period is 7 (as shown by the above table) + 7 (recorded in the following section) = 14. The proportion of quadruplet to triplet births for the entire period of the Sung is 1:19.78; while the proportion for the entire period of Chinese history here considered (473-1643) is 1:10.8. This calculation is based on a total of 324 triplets and 30 quadruplets. There are no multiple births on record in the chapter Wu King chi of the Kin shi. The Yuan shi (Chs. 50-51), covering the period from 1260 to 1367, contains only 15 cases of triplets (all males), recorded under the years 1261, 1265, 1273, 1285, 1291, 1297, 1300, 1327, 1328, 1335, and 1363. In the years 1273, 1297, 1335, and 1363, two cases are listed for each year; and it is of especial interest that in two in- stances we have two cases of triplets in the same family, the interval between the two being in either case given as three years. According to Dr. Puech, to whom we owe excellent studies on the causes of multiple births, the more children a woman has had at close intervals, the more she will be inclined toward these physiological anomalies. Three women admitted in the St. Petersburg Midwives' Institute between 1845-59 in their fifteenth pregnancy had triplets, and each had triplets three times in succession (J. M. Duncan, Fecundity, p. 71). For the period of the Ming dynasty (1368-1643) we lack official records; but the section jen i of the Ku shu tsi cKeng gives a list of 30 cases of triplet births, extracted from the provincial and local Gazet- teers, and covering a period from 1404 to 1626. In 1413, 1515, and MULTIPLE BIRTHS AMONG THE CHINESE 89 1520, two cases are recorded in each year. In view of the fact that this material is extracted from a number of scattered books, it cannot lay claim to completeness; the figure 30 is certainly much removed from reality, but even if multiplied by 3 or 4, it is left far behind the total of the Sung period. On the whole, the impression prevails that the number of multiple births has steadily been on the decrease from the days of the Sung. This would agree with an anthropological theory to the effect that the phenomenon of multiple births in man represents a survival of or reversal to his former animal state and that with the advance of civilization the number of such births is liable to decline. There is a correct biological viewpoint in this hypothesis, but it does not account for all facts connected with the phenomenon, and, above all, conflicts with given data and statistics. It is not brought out by the vital statistics of any European country that the frequency of plural births is on the decline; on the contrary, in France, for instance, it is surprisingly high (see below). Further, if that theory were correct, we should naturally anticipate to find the greatest number of multiple births among primitive tribes, which for all we know is not the case. Hardly a century has elapsed that records of plural births have been taken in Europe, and this period is too short to allow us to indulge in much speculation on the subject. According to the Statutes of the Manchu Dynasty, it was decreed in 1663 that in the case of a triplet birth or a twin birth of a boy and a girl, if it should occur among the people of the Eight Banners, a special report should be submitted to the Board of Rites; if it should occur in the provinces, the governor of such province should report to the Board, of Rites, which would have to forward it to the Board of Finance, the latter to grant a premium of five piculs of rice and ten pieces of cloth. In 1674 it was ordered that a special report should be made solely in the case of male triplets, but not in the case of twins or female triplets. In 1684 an edict ordained that in the case of male triplets the Board of Rites and the Board of Finance should submit a joined report to the Throne, and that rewards should be authorized in accordance with law. This benevolent attitude toward the energetic propagators of the race was not an innovation of the Manchu, but a heritage of the Ming; for under the Ming we are fre- quently informed of special grants of food, cloth, and even paper money, made to these involuntary heroes from public funds. It may hence be inferred that under the Manchu regime a register of male triplets was kept, and presumably is still preserved in the 90 BERTHOLD LAUFER archives of Peking. If it should ever be published, the fact must be borne in mind that female triplets were not officially reported. Meanwhile we are thrown back for that period on the local and provincial Gazetteers, which in the chapter on untoward or abnormal events sometimes record cases of plural births. To cite a few instances of this kind in the period of the Manchu dynasty,-the Gazetteer of Ju-chou in Ho-nan (quoted above) enumer- ates four cases (all males), which occurred in 1770, 1785, 1824, and 1833. In 1797 a triplet birth occurred in Hwa-yang (prefecture of Ch'eng-tu, Se-ch'wan); the case was reported to the throne, and by imperial favor, a picul of rice was granted to the father, Yang Kwo-yii (Hm yang hien chi, Ch. 43, p. 3). The Gazetteer of Mong-chou (prefecture of Hwai-k'ing, Ho-nan) cites only two cases for the years 1682 and 1736. Most Gazetteers which I have looked up are dis- appointing: thus the Gazetteer of Shen-si Province {Shensi Hung chi) contains only two cases of triplets, recorded for the years 1470 and 1729. In the Gazetteer of the Prefecture of Sung-kiang, three cases of triplets are recorded between 1367 and 1640 (according to D. J. Macgowan, Cosmical Phenomena Observed in the Neighborhood of Shanghai, Journal China Branch R. As. Soc., II, 1860, p. 74). The data of the Chinese certainly are defective, and cannot entirely satisfy the anthropologist. We miss, for instance, data concerning the ages of mother and father and order of birth in triplet deliveries {rang chronologique de I'accouchement of the French statisticians). Above all, we should desire information as to the vitality and fecundity of the offspring. What the Chinese may boast of, however, is the fact that they possess lists of plural births for periods of the past when nothing of the kind was ever attempted in any country of Europe. In the vital statistics of France, plural births have been recorded only from 1858; and in no country of Europe did they receive any attention before the nineteenth century (in Berlin from 1825). The sum of 277 triplet births for the Sung and 324 for the time from the T'ang to the Ming inclusive may seem a high figure to the uninitiated; in fact, however, it is strikingly low. During the four years 1907-1910 there was in France a total of 327 triplet births; 91, 93, 68, 75 in the respective years, making a mean average of 81.75 per year (Statistique general de la France, Statistique du mouvement de la population, Paris, 1912, p. 56). There were, accordingly, more triplet births in France during those four years than in China in the MULTIPLE BIRTHS AMONG THE CHINESE 91 course of many centuries. Or, to cite another example, in the period 1835-47, there were in Bavaria 1,050 triplet, 56,062 twin, and 3,413,763 normal births. The frequency of triplets varies in different years and in different countries. In 1855, triplets were produced in Scotland by 11 mothers out of 92,300 births; that is, one in 8,391. Triplet births in Scotland from 1855 to 1901, a period of 47 years, numbered 644, and averaged 116 per million confinements (C. J. Lewis and J. N. Lewis, Natality and Fecundity, p.62). I do not go any further into the question of the frequency of triplets in Europe and the proportion of triplets to twin and normal births, as the Chinese data are not com- parable, and as figures of total births are lacking for the Sung period. Judging from our experience, it must be stated, however, that the Chinese data can hardly be complete; but there is no way of correcting or adjusting the figures, which we are simply compelled to take for what they are worth. The reader should not forget that the material furnished by the Chinese Annals is not intended as statistics, but merely as a record of extraordinary events in human life. In order to give a certain perspective to the number of multiple births, some data concerning the population may follow here. According to the calcu- lations of E. Biot ("Memoire sur la population de la Chine," Journal asiatique, 1836, p. 461), the population of China under the Sung totaled 43,388,380 in the year 1021, and rose to 100,095,250 in 1102; again in 1223, it amounted to only 63,354,005 (in consequence of the loss of northern China to the Kin). These figures, in all probability, are too high; for they are estimated on the number of families given in the Chinese records, the assumption being made that the mean average of the number of individuals in a family is 5, which, in my opinion, is too high a figure. The total number of triplets recorded for the T'ang and Sung periods is 279. The distribution of sex in this number is as follows: 273 all males, that is, 97.8 per cent; 4 consisting of 2 males and 1 female, that is 1.4 per cent; 1 consisting of 1 male and 2 females, that is, 0.04 per cent; and only one consisting of 3 females (0.04 per cent). Again, the 15 triplet births of the Yuan dynasty and the 30 of the Ming are all males exclusively. The above percentages perhaps give an approxi- mate clew to the actual frequency of sex in triplet births, as far as China is concerned. C. J. Lewis and J. Norman Lewis (Natality and Fecundity, p. 61, London, 1906), who base their remarkable study on the birth registers of Scotland for the year 1855, during which year there were 11 triplet 92 BERTHOLD LAUFER births in that country (3 males, 5; 3 females, 3; 2 males and 1 female, 3), offer the following conclusion in regard to the distribution of the sexes: "There is a strong probability that in any given occurrence of triplets the children will all be of the same sex, either all males or all females. If the same ratio held in other nations and in other years, it would amount to a law of triplet production that in over 70 per cent of cases the newly-born children are all of the same sex." In the period from 1858 to 1865, there were in France 1,005 triplet and 4 quadruplet births; among the former, there were 280 entirely males, 218 entirely females, 256 consisting of 1 male and 2 females, and 251 consisting of 2 males and 1 female. The number of twin births during the same period amounted to 83,279; of these 28,056 were two males, 26,310 two females, and 29,363 consisting of one male and one female (A. Puech, Annales d'hygiene publique, XLI, 1874). Of the 277 triplets recorded for the Sung period, the social standing of the fathers is given in only 110 cases, while the remaining 167 cases are merely recorded as chronological-statistical events. Among the 110 cases, the social status of the fathers is distributed as follows: Rural population Field-laborers 85 1 Percentage 76.7 1.1 Workmen 1 1.1 Soldiers 22 20.0 Petty officials 1 1.1 Total 110 100.0 In the Yuan period, 14 common people and 1 soldier share in the 15 cases of triplets placed on record. In the Ming period, 28 common people and 2 soldiers assume responsibility for 30 cases of triplets recorded. It will thus be seen that the bourgeoisie, inclusive of officials, gentry, and merchants, has no share in these records. Peasants and laborers, of course, formed the majority of the populace; but there is no reason why triplet births, if they had occurred in the upper classes, should not have been reported or recorded. In arranging our data according to families, we arrive at the result that the members of the families Li, Wang, Chang, and Liu, take the uppermost rank. The male Li reach the score with 163 + l4, while two female Li figure with 24; in the years 986 and 996 respectively we have two male Li participating in triplets. The record of the Wang is 133 + 24 (plus one female Wang I3); the Chang follow with 93 + 24, plus two female Chang (23), and the Liu with 93 + I4, two MULTIPLE BIRTHS AMONG THE CHINESE 93 members of this family being conspicuous in the same year (1016). This does not mean, of course, that these four families are more prolific than others, but is merely the index of the fact that they are the most numerous and the most widely spread. The share of the members of the Yang family is expressed by the figure 63, that of the Chao by 53 (plus one female Chao I3), that of the Cheng by 43 (plus one female Cheng I4). The Fung, Sie, and Sil have a 33 to their credit; the Wei reach the mark 23 + I4, the Kwo I3 + I4, while the Chu, Hou, Kao, Mong, and Tung, can only boast of 23 each. All other families are represented but once. These figures certainly have a mere relative value, and do not allow of any far-reaching inferences. It is assumed by anthropologists that the tendency to multiple births is frequently hereditary, both in the male and female line, more frequently in the former than in the latter; and there is no doubt that heredity is a potent cause in the perpetuation of plural births. In the case of triplets and to a still higher degree of quadruplets the hereditary tendency is particularly striking. Quadruplets often issue from parents who were multiples themselves. Female twins often give birth to twins. During the 61 years covering our records 1-109 (= 1093), the frigh- water mark is reached in the year 991 with 93, and there is only this one year that offers such a record. There are two years (998 and 1015) with 73, two years (995 and 996) with 53, 4 years (982, 983, 1014, and 1016) with 43, 8 years with 33, and 11 years with 23. In the remaining years there is but l3 or 03. In the Yuan period we have four years with 23. QUADRUPLETS There is a total of 30 on record, the first in a.d. 473, the last an a.d. 1608, a span of 1,136 years. In this total of 30, 4 quadruplets fall to the lot of a single woman. Twenty-five out of the number of 30, that is 5/6 or 83.33 per cent, consist of males exclusively. The remaining 5 are distributed as follows: 3 cases consisting of 3 males and 1 female (10 per cent), 1 case being 2 males and 2 females (3.33 per cent) and 1 case being 4 females (3.33 per cent). In 1907 two quadruplet births in France produced 5 males and 3 females; in 1908 there was one quadruplet birth of 4 boys; in 1909 three quadruplet births produced 10 boys and 2 girls; and in 1910, there was one quadruplet birth of 2 males and 2 females (Statistique du mouvement de la population, p. 56). 94 BERTHOLD LAUFER For 7 cases no personal data are on record; in a single case of the Ming period the father's social status is not indicated. In the remain- ing 22 cases we find 2 soldiers, 1 falconer, and 19 common people, in all probability, farmers. Again, we accordingly meet here with the same social status of the parents as in the case of triplets. As to the relative proportion of quadruplet to triplet births, see above, p. 50. Pliny (VII, 3, § 33) records the example of a quadruplet birth of two males and two females toward the end of the reign of Augustus and ascribed to Fausta, a Plebeian woman of Ostia (Fausta quaedam e plebe Ostise). QUINTUPLETS It is striking and worthy of especial mention that the Chinese Annals do not record a single example of a quintuplet birth; at least I have failed in tracing any. Both Aristotle and Pliny were convinced of such an occurrence. Aristotle (Historia animalium, transl. of D'Arcy W. Thompson, p. 584b) states: "Some animals produce one and some produce many at a birth, but the human species does sometimes the one and sometimes the other. As a general rule and among most nations the women bear one child at a birth; but fre- quently and in many lands they bear twins, as for instance in Egypt especially. Sometimes women bring forth three and even four chil- dren, and especially in certain parts of the world. The largest number ever brought forth is'five, and such an occurrence has been witnessed on several occasions. There was once upon a time a certain woman who had twenty children at four births; each time she had five, and most of them grew up." Pliny (VII, 3, § 33) has it that in the Peloponnesus a woman was delivered of five children at a birth four successive times, and that the greater part of these survived (Reperitur et in Peloponneso quinos quater enixa, maioremque partem ex omni eius vixisse partu),-perhaps the same event alluded to by Aristotle. Nijhoff, in his interesting study " Vijflinggeboorten" (Groningen, 1904, 4°) has fully described and figured a case which came under his notice. He further reviews from literary records 29 more cases of quintuplet births, one of which only seems to be of doubtful authen- ticity. Cf. also S. Shishido, The Birth of Five Infants at One Parturi- tion (Iji Shinbun, Tokyo, 1901, pp. 433-438). SEXTUPLETS In regard to sextuplet birth, I have found only two cases on record. According to the Gazetteer of Chi-li Province (Ki fu Cung chi), it was MULTIPLE BIRTHS AMONG THE CHINESE 95 in 1574 that a woman of the people of Fei-hiang (in Kwang-p'ing fu, Chi-li) brought forth six children at one birth. The name of the woman and the husband is not given. The other case is reported in the Su K'ien shu (Ch. 5, p. 8), a record of Kwei-chou Province, written by Chang Chu in 1805. In a certain village of western Kwei-chou a woman, nee Wang, gave birth to six sons at one time, both children and mother being well. The author, however, had this merely from hearsay. Nijhoff (p. 66) reports the case of a sextuplet birth in a peasant family at Castagnola near Lugano (Italy) in 1888 (4 males, 2 females, who were alive at the time of birth, but died in a few seconds) and another from Alburi on the Gold Coast in Africa after Dr. H. Vortisch of the Basle Mission. In the latter case a Negro woman is said to have been delivered of 5 boys and 1 girl, who for lack of care died shortly; the woman stated that it was her fifth deliverance, at the second she had twins, at the third quadruplets, and at the fourth triplets. An Italian woman, who in the fifth month of pregnancy miscarried, expelled six foetuses; the truthfulness of this report is generally conceded (J. Parvin, Science and Art of Obstetrics, 3d ed., p. 161). Other cases of sextuplet delivery are described in the Boston Medical and Surgical Journal, XXXV, 2, 1847, and by J. W. Kerf and H. Cookman (Med. Pres, and Circ., LXXV, p. 537, London, 1903: five boys and one girl). Cf. also Shishido, Examination of the Records of More than Five Infants at a Birth (Iji Shinbun, Tokyo, 1901, pp. 1897-1901). SEPTUPLETS The Gazetteer of Chi-li Province (Ki fu Cung chi) has it on record that in 1527 a woman, nee Ch'en, of Ho-kien (Chi-li), was delivered of seven girls at one birth, but that none of them survived. According to Trogus, there was a case of seven children at one birth in Egypt (Et in Aegypto septenos uno utero simul gigni auctor est Trogus, Pliny, VII, 3, § 33). Cases of septuple! birth are mentioned by Roy (Couches avec 7 foetus, in Revue medicale frangaise et etrangere, Paris, 1877, I, p. 225); cf. also R. C., Multiple Pregnancy with a Vengeance (Med. Rec., LXIII, p. 267, New York, 1903). It is reported in verse on a tombstone of Hameln that on January 9, 1600, two boys and five girls were born to Thiele Roemer and Anna Breyers. The tombstone is adorned with a sculptured scene which shows six babes in swaddling-clothes on a pillow, while the lucky (?) father holds the seventh on his arm toward the Savior. Nijhoff 96 BERTHOLD LAUFER (p. 71-72), who has reproduced the tombstone, holds that the question is here of a veritable fact, as at that time no mockery was made of religious subjects. I am far from sharing this opinion. It is well known that the Germans have displayed a great deal of fun and humor on their epitaphs, collections of which have been made. The tomb- stone itself does not suffice to bear out the historicity of the case. It would be necessary to trace it in the parish-register, death-lists, or any other documents in the archives of the town of Hameln; but this evidence, as far as I know, has not yet come forward. A case of eight children at a birth, as far as I know, is nowhere on record, but the following curious passage occurs in the book "Cos- mographie de Levant" (p. 114, Lyon, 1554) by F. Andre Thevet d'Angoulesme: "Non seulement ce pais abonde en fruits, et herbes: mais aussi en fleurs odoriferentes, Les femmes y sont tant fecondes, qu'elles engendrent communement trois, et quatre, et bien souvent huit enfans: et encores qu'ils naissent au huitieme mois, ils vivent: ce qu'aucuns attribuent a la bonte du Nil: Outreplus elles surengen- droient, (comme Pline raconte d'une femme d'Alexandrie) ce qui n'est pas tant signe de merveille, que argument de fecondite." Thevet is doubtless influenced by the passage of Pliny, and is somewhat in- clined toward exaggerations. I doubt very much that a case of octoplets has ever come under his actual experience: his statement is generalized, but no reference is made to a specific case^ The preceding article discloses the fact that a department of vital statistics, either in connection with the Government or as a private enterprise, is urgently required for China. The motive which princi- pally guided me in writing this notice was to demonstrate by a concrete example the necessity of founding such an institution. It goes without saying that a statistical research into the population of China would mean a considerable advance of our knowledge, from which the econ- omists and sociologists gll the world over might learn and benefit, and that the Chinese would yield the most fruitful material for all problems of heredity and eugenics. It is particularly genealogical research that could be carried on in China with most promising results. Another problem which is much on my heart is that of longevity and the average duration of a generation among the Chinese and Japanese; and if nothing interferes, I hope to make a small contribution to this question in the near future. RACE SUICIDE IN THE UNITED STATES WARREN S. THOMPSON Cornell University The question of the relative rates of increase of the population of old native stock and of that of immigrant stocks is one which has attracted the attention of anthropologists and students of our population move- ments for half a century or more. Studies of population movements in New England made more than fifty years ago showed that the birth rate among the people of native stock had been falling steadily since 1800, and that the Irish immigrants and their descendants were rapidly supplanting the old native stock. More recent data show that the same process is still going on, only now it is the French Canadians, the Italians, the Slavs and the Jews that are supplanting both the old native stock and the earlier immigrants of Nordic stock from the British Isles, the Scandinavian countries and Germany. Before we can proceed to a discussion of the questions involved in this process of substitution, we must examine the facts of population increase in various parts of the United States, in order to ascertain how far it is true that the old native American stock and the earlier immigrants are rapidly dying out and being supplanted by newer immigrants. EVIDENCES OF RACE SUICIDE The Registration Report of Maine for 1910 showed that the three counties in that state having the highest percentages of native stock had the lowest birth rates and also that the death rate exceeded the birth rate, while in the state as a whole the birth rate exceeded the death rate by 4.55 persons per 1,000. The Registration Reports also show that for some years past the number of marriages among the foreign born in Maine has been about 29 per cent of all marriages, while the children born to foreign born parents constitute about 40 per cent of all children born. A comparison of Auburn, a city of about 16,000 inhabitants of predominantly native stock, with Lewis- ton, a city of about 27,500, having a large French Canadian element, shows that in 1915 the former had a birth rate of 17.4 and the latter Amer. Jour. Phys. Anthrop., Vol. Ill, No. 1. 97 98 WARREN S. THOMPSON a rate of 27.3. The death rate is somewhat higher in Lewiston than in Auburn, but when allowance is made for this fact the former has a rate of natural increase more than twice as large as the latter-10.5 and 4.6 respectively. In a study made several years ago, Kuczynski1 found that the mar- riage rate was much higher among the foreign born in Massachusetts than among the native born, and also that the birth rate of the former was much higher than that of the latter. According to his calculations the birth rate was 63 per 1,000 native-born "female adults," and 124 per 1000 foreign-born "female adults," during the fifteen-year period 1'883-1897. He also pointed out that according to the state census of 1885, 20.18 per cent of the native-born married women had no children, while only 13.27 per cent of the foreign-born married women were childless. This same census showed, too, that the average number of children born to a native married woman was 2.69, while the average number born to a foreign married woman was 4.53. Numerous other studies confirm the general belief that in the north- eastern states the native population is being supplanted by the foreign- born population and their descendants. Hoffman2 says: "Engleman, as the result of his analysis of New England genealogies, shows that while in 1800 the average number of children was 6.1, it had decreased to 4.6 by 1830, to 3.3 by 1860, 2.5 by 1872, and for the upper classes of Boston to 1.8 by 1900." In a footnote on page 678 of this same article Mr. Hoffman states that an original investigation into the facts of American ancestry from published genealogies shows that the average number of children per family in the period 1700-1750 was about seven; 1800-1850 about five; 1850-1900 less than three. To confirm the conclusions justified by the facts found in genealogies he also gives data from the Rhode Island State Census of 1905 showing: (1) That only 71.6 per cent of the native women 15-45 years of age were married, while 82.5 per cent of the foreign women in the same group were married; (2) that the average number of children born to a native white woman was 2.06, while to a foreign white woman it was 3.35 (twenty years earlier the figures were 3.49 and 5.38 respectively); (3) that the proportion of native married women with one child was 23.4 per cent, while that of foreign married women was 16.4 per cent; (4) that only 19.8 per cent of the native married women had more than three children, while 38.7 per cent of the foreign married women 1 Kuczynski (R. R.)-Quart. J. Econom., 1901, XVI, 1-36, 141-186. 2 Hoffman (Frederick L.)-Decline in the Birth Rate. N. Am. Rev., 1909, CLXXXIX, 675-687. RACE SUICIDE IN THE UNITED STATES 99 belonged to this class; and (5) that at the age of 25, 39.0 per cent and at the age of 30, 29.1 per cent of the native married women were childless, while for foreign married women at the same ages the per- centages were 25.6 and 15.9 respectively. A study made by the registrar of vital statistics for Michigan1 on the "fecundity of marriage by nativity" in that state, shows that, for the twqnty-year period ending with 1894 the number of children born per marriage where the mother was native was 3.2, and that where the mother was foreign both it was 5.6. The Registrar con- cludes that Michigan is rapidly following Massachusetts and other eastern states in its population movement and that within a short time its native population will be submerged by immigrants and their descendants. He quotes the following from the State Census as being in entire agreement with the conclusions he would draw from his own study of birth rates among the native-born and foreign-born classes: "Of the 53,228 children tabulated, the parents and grandparents of 10,880 were all native, and the parents and grandparents of 20,080 were all foreign-born. The former number is 1.20 per cent of the native inhabitants with native parents, and the latter is 3.72 per cent of the foreign-born with foreign-born parents. The latter number is 1.85 times the former." A recent investigation of the size of the families of the graduates of eight eastern women's colleges and one co-educational institution,2 shows that the average number of children born to those who have children in 2.1. This figure is somewhat too low because it includes many of the graduates of recent years who have been married but a short time and who, therefore, are not through child-bearing. The average number of children born to graduates in classes prior to 1880 who have married and have had children is 2.9; to those in classes between 1880 and 1890, 2.8 children; and to those in classes between 1890 and 1900, 2.6 children. Inasmuch as it is not safe to assume that the graduates between 1890 and 1900 who were married and had had children were through child-bearing in 1915, when the investiga- tion was made, we shall probably not make a very grave error if we assume that their final average will be approximately the same as that of the graduates between 1880 and 1890-viz., 2.8. This same investigation shows that of the graduates prior to 1880 only 80.7 per cent of those married had had children; of those in 1 Twenty-eighth Registration Report, Michigan, 1894. 2 Van Kleeck (Mary),-J. Ass. Colleg. Alum., May, 1918. 100 WARREN S. THOMPSON classes between 1880 and 1890 only 77.7 per cent; and of those in classes between 1890 and 1900 only 78.3 per cent. Thus we see that the graduates of these colleges who marry and raise families have scarcely enough children to replace themselves and their husbands in the next generation, to say nothing of the 20-22 per cent who marry and have no children and the 40-50 per cent who do not marry. If we take for granted that there is a bachelor for every unmanned woman among college graduates the situation might be expressed as follows: Out of each 1,000 men and women belonging to this class 400 do not marry, of the 600 married couples 120 are childless, leaving 480 who have children with a total of 1,344 children born to them, of whom approximately 1,150 live to reach the average age of college graduates. A few of these will die before they reach the customary age of marriage. It is, therefore, a conservative estimate to say of this class as a whole, that deaths are to births as 2000 : 1100, or 20 : 11.1 It is very clear that this class is not sustaining itself and that the conclusions arrived at by the studies cited above certainly hold true for this particular group of the native population. An investigation made by the Immigration Commission several years ago still further confirms the general belief that the native population is being rapidly supplanted by the immigrant stocks. In this investigation it was found that in Rhode Island the average number of children born to native white women of native parentage, married ten to nineteen years, was 2.5, while the average number born to white women of foreign parentage, married ten to nineteen years, was 4.5; for Cleveland the figures were 2.4 and 4.3; for Minneapolis 2.4 and 3.8; for certain rural counties in Ohio 3.4 and 4.5; and for certain rural counties in Minnesota 3.4 and 5.2, respectively. After one has examined a number of studies such as those referred to above, he is likely to feel that it is only a matter of a few decades (with immigrants coming as rapidly as they were before the war) until the older stocks, Celtic, Teutonic and Scandinavian as well as Anglo-Saxon, will be supplanted by the newer Latin, Slavic and Hebrew stocks. The evidence submitted is seemingly overwhelming. It will be noticed, however, that most of the data upon which these studies are based have been gathered from the northeastern states-largely 1 The death rate used in the above calculation is the extremely low one found by this study to exist in this class-viz., that only 13.0 per cent of the children of graduates prior to 1880 had died by 1915. RACE SUICIDE IN THE UNITED STATES 101 from New England. The question naturally arises, therefore, whether the population movements of this section of the country are typical of those taking place elsewhere. It seems to the writer that the probabilities are against this being the case. The social and industrial conditions in the northeast are so entirely different from those in most other sections that it would be strange if the population movements there were the same in nature and extent as they are in other parts of the nation. The northeast is a relatively densely settled area in which manufacturing and commerce are the predominant interests, while agriculture is the predominant interest in most of the other states. Again, the population of the northeast is much more heterogeneous than that of most other sections. Not only did the northeast retain its due share of immigrants before 1890 but it has retained most of those who have come in since that time, for the newer stocks which occasion so much concern to most writers on race suicide are to be found mostly in the northeast and a few large cities along the Great Lakes. Since this is the case it becomes necessary, in order to study popula- tion movements, to classify our population not only on the basis of state of residence but also on the basis of type of work done. For this purpose I have adopted the Census classification of urban and rural. I believe that if we can measure the relative rates of increase in these groups as well as in the different states we can arrive at a more accurate, notion of population movements in our country. If we had good statistics of births and deaths for all states and their minor civil divisions, we could tell what the natural increase is in cities, counties and even townships, as well as in the state as a whole. By using the data of the Federal Census in connection with data from the vital statistics of the states, we could compare the rate of growth in political units having populations chiefly composed of different stocks. Unfortunately only a few states have comprehensive birth statistics and these must be used with many reservations. For one thing, there is good reason to believe that the data for the rural districts are more defective than those for the cities, so that a comparison between the rates of growth in these two classes on the basis of pub- lished vital statistics is fraught with danger. In addition to this difficulty all places having less than 10,000 people are classed as rural in the federal reports on births, while only those having less than 2,500 are so classed in the decennial census. Furthermore, the birth rates and death rates for intercensal years are based on estimates of popula- 102 WARREN S. THOMPSON tion and are liable to a considerable error with regard to an.? particular city, county or state. Lastly, the age and sex distribution in different areas are so unlike that crude birth rates and death rates tell us but very little regarding the fecundity of women in these different areas. In view of these facts the writer has prepared some tables from data given in the Federal Census of 1910 which he believes will show the most significant population movements in the United States better than such birth statistics as we now have. The general method used in the preparation of these tables-that of showing the proportion of children at certain ages to women of child- bearing age-is one which Professor Wilcox has made familiar to all those interested in our population problems. It is not claimed that these tables show us the exact rates of increase in the urban and rural populations of the different states, but merely that they will enable us to determine with fair accuracy what groups are contributing most children to the next generation. This is all we need to do in a dis- cussion of race suicide in the United States. For the phrase race suicide has never been used by those conversant with population facts to refer to a low rate of natural increase, but rather to the fact that the children contributed by one nation or class to the next generation were relatively fewer than those contributed by another nation or class. The natural consequence of such a situation is that the nation or class with a low child-contributing rate is supplanted sooner or later by a nation or class with a higher child-contributing rate. In the United States the serious question is, whether the people from northern and western Europe-British, Scandinavian and Teu- tonic-are being supplanted by those from southern and eastern Europe-Mediterranean, Slavic, and Hebrew-and not whether the natural increase of the nation as a whole is sufficiently high. There seems to be little doubt that the rate of natural increase for the nation as a whole (i.e., annual excess of births over deaths per 1,000 of the population) is as high as that of most civilized countries. RACE SUICIDE IN THE UNITED STATES 103 Table I-Showing the Proportion of Children to Women in the United States, the Geographic Divisions and the States: also the Proportion of Women and of the Native Born of Native Parents in the Total Popu- lation of these Different Areas Geographic Area No. Children Under 5 Yrs. per 1,000 Women 15-44 Yrs. No. Children 5-9 Yrs. per 1,000 Women 15-44 Yrs. Percent of Total Population Comprised by Women 15-44 Yrs. Percent of Totai Population Native Born of Native Parents United States: whites Urban 382 341 25 4 41 9 Rural 603 555 21.2 64.1 New England States: Urban 384 345 25 7 33 9 Rural 458 437 20.4 69.8 Maine : Urban 388 359 24 3 55 1 Rural 493 458 20.2 78.9 New Hampshire: Urban 385 353 24 7 41 0 Rural 428 409 20.3 71.5 Vermont: Urban 392 370 24 1 54 3 Rural 489 472 20.0 73.6 Massachusetts : Urban 376 336 26 2 30 8 Rural 412 399 21.3 58.6 Rhode Island: Urban 390 349 25 7 28 2 Rural 428 396 21.0 66.2 Connecticut : Urban 405 363 25 2 33 1 Rural 450 441 20'3 56.4 Middle Atlantic States: Urban 402 351 26 2 34 4 Rural 518 477 21.2 67.0 New York: Urban 379 332 26 9 27 2 Rural 420 407 21.2 66.1 New Jersey: Urban 420 374 25 8 33 6 Rural 440 382 22.4 58.7 Pennsylvania : Urban 433 373 25.4 45.8 Rural 599 534 20.9 69.2 East North Central States : Urban 382 340 25 9 41 7 Rural 523 506 21.3 66.5 Ohio: Urban 370 324 26 1 51 0 Rural 500 478 21.4 79.6 Indiana : Urban 361 335 25 7 67 8 Rural 503 493 21.7 87.0 Michigan: Urban 395 347 25.6 35.5 Rural 535 513 20.7 50.8 104 WARREN S. THOMPSON Table I-{Continued) Geographic Area No. Children Under 5 Yrs. per 1,000 Women 15-44 Yrs. No. Children 5-9 Yrs. per 1,000 Women 15-44 Yrs. Percent of Total Population Comprised by Women 15-44 Yrs. Percent of Total Population Native Born of Native Parents Illinois : Urban 388 342 26.1 32.3 Rural 529 507 21.8 68.4 Wisconsin: Urban 398 369 25.4 28.5 Rural 562 557 20.8 35.9 West North Central States : Urban 344 317 26.4 51.2 Rural 582 548 21.3 58.5 Minnesota: Urban ' 353 319 26.1 29.2 Rural 598 602 20.3 26.7 Iowa: Urban 335 325 25.9 58.2 Rural 526 508 21.8 58.8 Missouri: Urban 328 303 27.2 55.0 Rural 583 549 21.6 85.5 North Dakota: Urban 384 325 26.9 37.7 Rural 716 607 20.6 27.0 South Dakota: Urban 355 326 25.9 51.5 Rural 618 563 21.2 40.6 Nebraska: Urban 361 321 26.3 51.8 Rural 581 534 21.7 54.6 Kansas : Urban 367 339 25.7 70.3 Rural 567 525 21.5 71.8 South Atlantic States: Urban 393 354 26.4 54.2 Rural 678 604 21.5 62.2 Delaware : Urban 401 344 25.1 52.9 Rural 447 455 21.8 72.7 Maryland: Urban 366 348 26.4 50.7 Rural 516 505 22.2 67.9 District of Columbia: White 299 279 27.4 50.4 Virginia: Urban 390 353 26.5 59.4 Rural 646 599 21.6 65.7 West Virginia: Urban 410 359 26.3 74.8 Rural 703 615 21.0 87.8 North Carolina: Urban 465 395 26.3 61.2 Rural 716 620 21.4 68.4 RACE SUICIDE IN THE UNITED STATES 105 Table I-{Continued) Geographic Area No. Children Under 5 Yrs. per 1,000 Women 15-44 Yrs. No. Children 5-9 Yrs. per 1,000 Women 15-44 Yrs. Percent of Total Population Comprised by Women 15-44 Yrs. Percent of Total Population Native Born of Native Parents South Carolina: Urban 441 379 26.2 49.6 Rural 702 603 21.9 42.7 Georgia: Urban 418 372 26.6 52.4 Rural 727 639 21.4 53.5 Florida: Urban A 437 387 25.7 37.1 Rural 683 607 21.1 54.8 East South Central States: Urban 378 349 26.7 54.4 Rural 696 619 21.6 67.2 Kentucky : Urban 340 325 27.0 58.2 Rural 669 609 21.6 88.8 Tennessee : Urban 366 335 27.2 57.2 Rural 671 599 21.9 80.4 Alabama : Urban , 453 398 26.0 49.8 Rural 752 651 21.3 56.2 Mississippi : Urban 427 390 26.1 46.7 Rural 727 641 21.5 41.5 West South Central States : Urban 405 384 26.0 58.4 Rural 729 658 21.2 67.7 Arkansas : Urban 396 371 26.5 61.0 Rural 754 653 21.2 69.5 Louisiana: Urban 391 385 26.2 43.8 Rural 765 699 21.0 48.2 Oklahoma: Urban 421 379 25.5 76.0 Rural 735 658 21.0 79.8 Texas : Urban 405 388 26.1 59.5 Rural 708 21.3 69.1 Mountain States: Urban 382 350 25.5 51.9 Rural 641 564 19.9 57.8 Montana: Urban 378 340 24.7 40.3 Rural 570 505 18.7 44.7 Idaho: Urban 375 347 24.4 62 7 Rural. .* 674 598 19.9 62.5 Wyoming: Urban 396 348 22.6 51.7 Rural 629 528 18.2 56.8 106 WARREN S. THOMPSON Table I-(Continued) Geographic Area No. Children Under 5 Yrs. per 1,000 Women 15-44 Yrs. No. Children 5-9 Yrs. per 1,000 Women 15-44 Yrs. Percent of Total Population Comprised by Women 15-44 Yrs. Percent of Total Population Native Born of Native Parents Colorado: Urban 321 307 26.9 56.9 Rural 593 525 20.6 62.1 New Mexico: Urban 425 409 26.2 74.0 Rural 679 609 20.8 78.8 Arizona: Urban 439 385 24.5 42.1 Rural Utah: 634 545 19.4 39.6 Urban 515 445 24.3 42.5 Rural 792 693 19.9 48.9 Nevada: Urban 290 279 25.6 49.8 Rural . 425 366 18.6 41.8 Pacific States: Urban 301 271 25.7 46.9 Rural 509 480 19.9 54.8 Washington: Urban 335 303 24.6 48.7 Rural 566 529 19.6 54.2 Oregon: Urban 288 263 25.5 55.4 Rural 524 507 20.0 67.5 California : Urban 290 261 26.2 44.4 Rural 469 439 20.0 50.0 THE PROPORTION OF CHILDREN IN THE RURAL AND URBAN POPULATION The above data throw considerable light on the child-producing rates of women in the rural and urban populations of the United States and its constituent parts. In the United States as a whole the white women1 of child-bearing- ages in the rural districts had 221 more children under five years of age to each 1,000 than the women of the urban districts-i.e., each 1,000 rural women 15-44 years of age had about 58 per cent more children under 5 living at the time of the census than the women in the urban districts. The actual numbers of women and children in these two classes are well worth giving. There were 10,382,634 women in this age group in the urban districts having 3,966,957 chil- dren under 5,. while there were only 8,877,985 women in the same age group in the rural districts but they had 5,355,957 children under 5. Although there were only 85.5 per cent as many women in the 1 The discussion will refer only to the white population unless negroes should be specifically mentioned. Table I gives data for white population only. RACE SUICIDE IN THE UNITED STATES 107 rural districts as in the urban yet they had 35 per cent more children. If the women in the urban districts had had as many living children under 5, per 1,000, as the women in the rural districts they would have had a total of about 6,261,000 instead of only 3,966,957. Not only in the United States, as a whole, was the proportion of children to women larger in the rural districts than in the urban districts, but this was also true for every state in the Union. In the New England states the difference was not large-a little over 19 per cent-and in Massachusetts it was only 9.6 per cent. In some states, however, the difference was over 80 per cent-86.5 per cent in North Dakota and 83.3 per cent in Tennessee. THE URBAN POPULATION In the urban population the proportion of children is generally between 300 and 400 to 1,000 women of between 15 and 44 years. In a few states of the northeast, in most of the southern states and in a few of the mountain states it exceeds 400. In only one state-Utah- does it exceed 500, while in two states only-California and Oregon-and the District of Columbia, is the proportion of children less than 300. In spite of several exceptions, I believe one is justified in making the following general statement regarding the proportion of children in the urban population of the different states: Those states in which the white population is mostly of the older stock-the southern states-have the largest proportion of children; those states having a considerable percentage of newer immigrants in their population-mainly in the northeast-have the second largest proportion of children; next come those states in which older immi- grants predominate-e.g., Wisconsin and Michigan-and lastly those states in which old native stock and the older immigrants seem to be pretty nearly equal in numbers. In view of these facts there can be no doubt that the newer immi- grants who live chiefly in the cities of the northeast and in those of the Great Lakes region are contributing by far the largest increment to our urban population year by year by an excess of births over deaths. THE RURAL POPULATION In sharp contrast to the great uniformity in proportion of children to women in the urban population is the wide variation in the propor- tion of children in the rural population-from 412 in Massachusetts to 108 WARREN S. THOMPSON 792 in Utah. In general, the proportion is smallest in those states of the northeast where agriculture is of least importance and greatest in the south and southwest where agriculture occupies the attention of almost the entire white population. The states in the middle west and west have, as a rule, a larger proportion of children than the states of the northeast but a smaller proportion than those of the south and south- west, and in most of these states the proportion of the population engaged in agriculture is greater than in the states of the northeast but smaller than in the states of the south and southwest. The full significance of the relatively high proportion of children in the rural population becomes clear when we consider this fact in connection with the data in the fourth column of Table I. In prac- tically every state the rural population contains a much greater proportion of native born of native parents than the urban population. Of the rural white population over three-fourths is native born of native parentage, while only about four-ninths of the urban white population belongs to this class. Furthermore, the one-fourth of the rural population which is of foreign stock is composed chiefly of Teutonic, Scandinavian, Irish and English immigrants and their chil- dren, so that the bulk of our rural population is of the same general strain. In view of the facts adduced above there seems no good reason to fear that race suicide is taking place in the whole of the United States. The older native stock is not yielding its place to the newer immigrants except in the cities of the northeast. It is the rural population ap- parently which is destined to supplant the city population. Although the newer immigrant women who live very largely in the cities have a higher birth rate than the native women with whom they come into competition, yet they do not have as high a birth rate as the rural women. Moreover, they soon succumb to the influences of the city environment so that their birth rate becomes lower. In the investiga- tion of the Immigration Commission in Rhode Island it was found that of white women of foreign parentage under 45 years of age and married 10-19 years, 7.2 per cent of the first generation had no children and 10.5 per cent of the second generation, while in rural Minnesota the percentages were 2.6 and 2.8 respectively. The average number of children born to women of these groups in Rhode Island was 4.7 in the first generation and 3.9 in the second generation, while in rural Minnesota the averages were 5.5 and 4.7 respectively. This same investigation also showed that the percentage of childlessness among 109 RACE SUICIDE IN THE UNITED STATES the immigrant women of certain cities, married 10-19 years, was greater than among the native women, married the same length of time, in certain country districts. Table II-Showing Number of Children under 5 Years of Age per 1,000 Married, Widowed or Divorced White Women 15-44 Years of Age; also Percentage of these Women are of All Women of these Ages in the Urban and Rural Populations of the United States and its Geographic Divisions. Census 1910 Geographic Area Percentage Married, Widowed or Divorced Women 15-44 are to all Women 15-44 Number of Children Under 5 to 1,000 Married, Widowed or Divorced Women Urban Rural Urban Rural United States 57.8 64.6 660 933 New England 53.9 63.8 714 718 Middle Atlantic 56.7 62.7 709 827 East North Central 59.2 63.2 645 828 West North Central 57.4 62.0 599 937 South Atlantic 58.4 63.7 672 1066 East South Central. . . 59.8 66.5 632 1047 West South Central 63.9 69.5 633 1050 Mountain 63.6 70.6 601 907 Pacific 61.6 67.6 489 754 It may be argued against the position taken here that the reason the proportion of children is higher in the country than in the city, is because the percentage of women of child-bearing ages in the total population is much smaller in the rural districts than in the cities (see column 3 of Table I), and also that the percentage of married women is higher in the rural districts than in the cities (columns 1 and 2 of Table II). These facts cannot be disputed but they do not prove that country women do not raise more children than city women. They merely point to two of the reasons why the proportion of children to women is larger in the country than in the city. Table II, columns 3 and 4, shows that when allowance is made for the fact that the percentage of women is smaller in the rural districts than in the cities and also for the fact that more of them marry, the proportion of chil- dren to women is still much larger in the rural districts. In the United States as a whole l,t)00 married women between 15-44 years,- living in the country, have 41.3 per cent more children under 5 than 1,000 city women. In New England alone there is practically no difference in the number of children per 1,000 married women 15-44 in the rural and urban districts. In the Middle Atlantic States the difference is 16.6 per cent, in the East North Central States it is 28.4 110 WARREN S. THOMPSON per cent, while in all other sections it is over 50 per cent. The married women of the urban districts constituted 51.1 per cent of all married women but they had only 42.5 per cent of the children under 5. Thus we see that the facts regarding the proportion of children to married womefi also support the conclusions drawn from Table I. It is the women in the rural districts who are raising the greater part of the children of the next generation, and these women are largely of the same basic stock as that by which the nation was originally constituted. The facts regarding where the children of the United States are found show beyond question that so far as race suicide is a fact it is confined to certain classes of the urban population, and to the rural population of a few states where urban industrial life is so predominant that its influence is strongly felt even in the rural districts. It is due to the fact most people have only studied the movements of population in a few states where urban industrial life is almost universal that there is such widespread misapprehension of the real situation. I would not be understood to overlook the likelihood that the older stocks in this country may be supplanted by the newer immigrants. But, in my judgment, this will not come about by the immigrant mother raising more children than the mother of older stock (so long as the newer immigrant women live in cities and the women of older stocks live in the country), but rather by there being more women of these newer stocks than of the older stocks-i.e., immigration may be so large as to swamp the older stocks. The influx of people from other countries is, in many respects, a separate problem from that of race suicide and will only be touched upon in this paper where necessary. DIFFERENCES IN DEATH RATES IN THE URBAN AND RURAL POPULATION The following table gives in very brief form the best data available regarding the differences in the death rates of the urban and rural population:1 This table shows that the death rates for both sexes are consider- ably higher in the city than in the country. There is one exception. Women at the age of 20 have a slightly lower death rate in the city than in the country. Moreover, there is no doubt whatever that these 1 All places having under 8,000 population in 1900 and under 10,000 population in 1910 are considered rural. As will be pointed out below this method of determining urban and rural tends to exaggerate the death rate in the rural population. These data are compiled from "United States Life Tables" published by the Bureau of Census, 1916. 111 RACE SUICIDE IN THE UNITED STATES data understate the difference in death rates because the population of all places having between 2,500 and 10,000 is included with the rural population and in the northeast such places are usually manu- facturing towns. In these small manufacturing towns the living conditions are often as bad or even worse than they are in the large cities and so including these towns with the rural districts would undoubtedly raise the death rates of the latter. Number of Deaths per Annum per 1000 Persons Living at Different Ages: Original Registration States:1 1910 (Whites Only) Males Females Urban Rural • Urban Rural Under 1 year of age 133.80 103.26 111.23 84.97 During tenth year 2.88 2.17 2.52 1.88 During twentieth year 4.49 4.31 3.82 3.97 During thirtieth year 6.83 5.33 6.08 5.44 During fortieth year 11.61 6.90 8.58 6.53 During fiftieth year 18.34 10.24 13.74 9.43 During sixtieth year 36.07 21.19 28.65 18.72 During seventieth year 69.42 48.79 59.16 45.12 Some studies of infant mortality made by the U. S. Children's Bureau show beyond question that the death rate of infants under 1 year is much smaller in the open country than in cities. In Water- bury, Conn., the infant mortality rate (the number of children dying during the first year of life per 1,000 born alive) was found to be 122.7; in Saginaw, Mich., it was 84.6; in Brockton, Mass., it was 96.7; in Johnstown, Pa., it was 134.0; and in Manchester, N. H., it was 165.0. In a rural district in Montana the infant mortality rate (approximate) was found to be 71; in a rural district in Kansas it was 40; in a low land rural district in North Carolina it was 48.1 for the whites and 64.4 for the negroes. The North Carolina report says:2 "A comparison of the findings of these rural surveys with the findings of infant mortality studies in cities and towns, tends to con- firm the impression that rural conditions are distinctly more favorable than urban conditions to infant life." All of the mortality reports issued by the Census Bureau confirm this view. In Massachusetts 1 The original registration states are chiefly in the northeast. 2 Rural Children in Selected Counties of North Carolina, Children's Bureau Pub. No. 33, 1918, 37. 112 WARREN S. THOMPSON the infant mortality rate for the "Registration Cities" was 102, while in the rural part of the registration area of Massachusetts it was 92.1 But this is not a fair comparison, because many people who are living under urban conditions are included with the rural population. A fairer comparison will be between the rate of the registration cities and that of the rural area in those states where the rural area includes the largest proportion of population really living in the open country. In the cities of the registration area in 1915 the infant mortality rate for white children was 102, in the rural part of Michigan it was 78, while in the rural parts of Minnesota (the most representative agri- cultural state in the registration area) it was only 67. Although, as was mentioned above, the incompleteness of the registration of births (the Children's Bureau has found over 10 per cent of the births un- registered in all of the cities where it has made investigations) renders these rates highly inaccurate, yet they are of value for purposes of com- parison,2 and when considered in conjunction with the other data given above, show beyond doubt that the chances of a baby living through the first year are from 50 per cent to 100 per cent greater in the country than in the city. The studies of the U. S. Children's Bureau also show that the infant mortality rate of children born to foreign mothers is generally much greater than of those born to native mothers. In Saginaw, Mich., the infant mortality rate of children born to native mothers was 70.5, while of those born to foreign mothers it was 127.6; for Waterbury, Conn., the rates were 97.9 and 134.8 respectively; for Johnstown, Pa., 104.3 and 171.3; for Manchester, N. H., 128.1 and 183.5; and for Brockton, Mass., 101.5 and 92.0. Brockton is the only city in which the infant mortality rate among the children of natives was higher than among the children of foreigners. Of this situation the report on infant mortality in Brockton says: "Few, if any, New England manufacturing cities have shown similar results." 3 In the study of the families of the graduates of women's colleges referred to above it was found that the infant mortality rate was only 45. 1 The rural part of the registration area includes all places of less than 10,000 inhabitants as well as the open country. 2 If the situation in Kansas is at all typical of that in other states the com- parison between infant mortality rates in the city and country on the basis of registra- tion reports is in favor of the city for it was found that unregistered births were much more common in the country than in towns. 3 Infant Mortality: Results of a Field Study in Brockton, Mass., Children's Bureau Pub. No. 37, 1919, 56. RACE SUICIDE IN THE UNITED STATES 113 The facts given above justify the conclusion that in the United States, as a whole, the infant mortality rate of children of native mothers is not more than 55 to 65 per cent of that of children of foreign mothers. Reasons for a Larger Proportion of Children to Women in the Rural Districts than in the Urban Districts The reasons which explain the fact that there is a larger proportion of children to women in the country than in the city are of two kinds: (1) those which explain the lower death rate in the country, and (2) those which explain the larger average number of children born to country women. REASONS FOR A LOWER DEATH RATE IN THE COUNTRY The investigations of the U. S. Children's Bureau enable us to say with considerable certainty why the infant mortality rate is lower in the country than in the city. One of the chief causes of death among infants is found to be gastric and intestinal diseases. These diseases can be avoided to a large extent by proper feeding. The following quotation shows that country babies fare better than city babies in this respect:1 "If the feeding history of these country babies in Kansas is compared with that of the city babies of native mothers in Johnstown, Pa., and Manchester, N. H.- the first two cities where this study was made by the Children's Bureau-and in Akron, Ohio, the larger of the cities of the Middle West, we find that exclusive breast feeding is much more common through the first nine months in this Kansas county than in any of these (with the exception of the last three months in Akron), and, conversely, that artificial feeding is even more markedly absent. Since breast feeding, especially in the early months, is proved and acknowledged to be an im- portant factor in protecting a baby's chance of life, this fact of the unusual prevalence of breast feeding probably accounts, in part at least, for the low death rate among this group of country babies." Quotations might be made from other reports to the same effect but there is no need to accumulate evidence on this point. Another class of important causes of death among infants is diseases of early infancy and malformations which include premature birth, congenital debility, injuries at birth, etc. In Waterbury, 31.6 per cent of all infant deaths were due to conditions existing before the birth of the child or to injury and accident at birth; of those that 1 Maternity and Infant Care in a Rural County in Kansas. Children's Bureau Pub. No. 26, 1917, 42. 114 WARREN S. THOMPSON died under two weeks, 72.7 per cent dies from these causes. It has been proved conclusively that many deaths from these causes are preventable if the mother has good prenatal care and the services of a skilled obstetrician during confinement; and the investigations of the Children's Bureau show that rural mothers generally have better care than mothers among the poorer classes in our cities. The social and economic causes which underlie these and other medical causes of infant deaths cannot be discussed here. Suffice it to say that poor housing, low wages, work of the mother outside of the home, ignorance, etc., all contribute to a high infant death rate and that their influence is felt more among the workers of our cities than in the open country. Out-of-door life of country people is an important cause of their lower death rate. We have no way of measuring the influence of this factor on the health of people; but the results of the physical examina- tions for the first draft show that those states which are most typically agricultural had a larger percentage of physically qualified men than those states which are most typically industrial and commercial. In Kansas 77.22 per cent of those examined were physically qualified; in Nebraksa 79.85 per cent; in South Dakota 85.87 per cent; and in Iowa 77.82 per cent. These are all typically agricultural states in which the city population is relatively small, so that boys from the farms constituted a very large percentage of all those examined. On the other hand, in Massachusetts only 64.52 per cent of those examined were physically qualified; in Connecticut 53.70 per cent; in New York 69.47 per cent; and in Pennsylvania 53.33 per cent. These states are largely urban, most of the people , being engaged in manufacturing, commerce and mining. The writer believes that much of this difference is due to the greater healthfulness of the outdoor life of country people. He is well aware that the country home and its surroundings are often subject to criticism from the standpoint of health. In spite of deficiencies, however, he believes that the average country home is a more healthful place to live than the average home of a working class family in the city, and that the better class of country homes are more healthful than the better class of city homes. At its worst the country has no counterpart of tenement life in the big cities and shanty life in mining camps and mill towns; at its best the country has homes superior in healthfulness to the homes of the wealthy. The proof of this latter statement is to be found in the fact that wealthy city people actually spend a great deal of their time away from their city homes out in the country. RACE SUICIDE IN THE UNITED STATES 115 Another reason for the lower death rate in the country is the fact that people there are closer to a pure food supply. Country people still prepare for themselves much of what they eat. They kill their own poultry, pork, and veal to a large extent. They can much of the fruit and vegetables they use during the winter besides having an abundance of fresh vegetables'during the season. Many kinds of fruits and vegetables can be stored so that they are available, prac- tically fresh, during a large part of the year. It may seem to many that our present system of distribution makes it possible for the city dweller to have just as good a quality of fresh food as the farmer and that, therefore, the difference in kind of food used by these groups is not an important cause of difference in death rates. It is true that it is possible for the city dweller to have just as good a quality of food as the farmer, but as a matter of fact only the well-to-do secure the best quality. Fresh, wholesome food in sufficient amount is beyond the means of the majority of city dwellers. If one doubts this let him read the reports of city health commissioners and of the physicians employed by school boards to make examinations of the children; or, let him spend a few hours in the more densely populated parts of any moderate-sized or large city and watch the poor buying their food. Another phase of this situation in the city is that those who have the means to secure an abundance of the best food are usually those who lead more or less sedentary lives. These people, as a rule, do not take enough exercise to use up their food and get rid of waste matter. The farmer, on the other hand, may eat very heartily but his active life renders him less likely to suffer from over-eating. The writer has often been impressed with the fact that in the cities one sees large numbers of soft flabby men while in the open country one seldom sees such a man, the farmers being generally lean and hard. The relative security of the farmer's position is another reason for a lower death rate in the country. He is not harrassed by the un- certainty of his job and income, as a great proportion of the salaried and wage-earning classes in the city. He does not need to fear that some machine will be invented to take his job, nor that he will be turned off in hard times because of lack of work. There is no danger that his industry will move away from him, forcing him to take up some new work or spend all of his savings in moving his family to a new home, nor do strikes and lock-outs affect the farmer in any appre- ciable degree. Furthermore, the farmer does not have to compete with an ever renewed supply of immigrant laborers having a lower 116 WARREN S. THOMPSON standard of living. This does not mean that the farmer does not have his "hard luck" just as the city laborer does, but that is not likely to force him into such dire straits as it does the latter. If crops are a failure the whole neighborhood feels it, but no farmer is likely to lose his position as a farmer because of that. He receives a temporary set-back but he is in little danger of being forced to rely on public charity to see him through. As a result of this greater security of life the farmer should be, and it is reasonable to believe is, less subject to worry than the city man, and that worry affects health is unquestionable. Country people are also less affected by accident and occupational diseases than city people. One proof of this is found in the fact that it is the practise of companies selling insurance to the working classes in cities to charge them a much higher premium than they do farmers and those in other occupations. Of a total of 1,222 fatal industrial accidents reported to the Canadian Department 'of Labor during 1918 only 36 or 2.9 per cent were in agriculture. In 1917 the per- centage was 3.2. About two-fifths of the male population in Canada is engaged in agriculture. If further proof is needed that accidents are a cause of higher death rates in the city than in the country it may be found in almost every volume of the Monthly Labor Review. In the mptal mines in 1916 there were 3.62 fatal accidents per 1,000 of 300-day workers; in 1917, 4.44; while there were 250.64 accidents all told in 1916 per 1,000 of 300-day workers; and 240.97 in 1917. Coal mining is even more deadly (4.25 fatalities per 1,000 of 300-day workers in 1917) while train service, steel work and quarrying take from 2 to 4 per 1,000 of 300-day workers each year. The fatal accidents in industry, however, do not contribute so largely to the general death rate of city workers as the lesser accidents whose effects are not directly felt. Even with compensation from the employer, the city worker's family is more likely to become destitute when his wages cease than is the farmer's when he suffers injury. The farmer has more resources to fall back upon. His family is still an economic unit, in which each member, from a very early age, can contribute something to the welfare of the whole, while in the city this is not the case. In a pinch, the farmer boy, with the help of his mother and sisters, can keep things going while the father is unable to work. And if the farmer's family is unable to get along without aid the neighbors will usually see them through. Friendly aid of his neighbors has saved many a farmer from the worry of wondering how RACE SUICIDE IN THE UNITED STATES 117 he was going to care for his family during the ensuing winter. It is almost impossible for people who are neighbors in the modern industrial community to render one another sufficient aid, as country neighbors do, even if they were disposed to do so. Still another cause of the lower death rate in the country is what may be called the lower tension of competition in the rural districts. This manifests itself in a variety of ways. Among men engaged in brain work (executives of all kinds and professional men) there is an intense competition for preferment. Most of these men are animated by the desire to "make good." There is, generally, a position just ahead for which they are striving. Usually there are several com- petitors for each job so that a man must be continually on the alert. There is no place where he can stop and relax, for if he does some one will step ahead of him and get the coveted prize. Besides most men in these groups have a real struggle to make their incomes cover the standard of living which they feel is essential to their success. ' Among laboring men there is a somewhat similar process going on. There is the never-ending conflict of the skilled artisan with the machine designed to do his work; there is the constant change in methods and processes to which the man who has become settled in his habits finds it difficult to adjust himself; there is the competition between the skilled and unskilled worker as new machines are invented; there is the competition between native worker and the immigrant with a low standard of living; and, finally, there is the competition between men and women. All this struggle to keep one's place is almost un- known in the country. The farmer may become old-fashioned and work with inferior stock and tools but yet he can hold on and make a fair living. He has little need to fear some younger man or some immigrant can crowd him out if he does not care to go. And yet in many farming communities there is enough competition to keep the farmer truly progressive. Another way in which the keener competition in the city manifests itself is in the attitude of women towards dress and home equipment. The continuous incitement to dress well and to vie with one's neighbors to which most of the better classes of city women are subject is very largely lacking in the country. In the city the success of the husband and the social position of the family are judged very largely by the outward show its members make. So "good dressing" and the like are indulged in not merely for the satisfaction of personal vanity, but also because they are the assertion of the right to and the means 118 WARREN S. THOMPSON of attaining a definite social position in the community. It is almost inevitable that this should* be so where neighbors and friends only know one another superficially. The country woman, on the other hand, does not need to assert her claims to a social position for the family by means of dress and other externals. Her neighbors know whether her husband owns his farm and whether he lends or borrows money. She cannot impress her neighbors with outward show. In addition, the security of her position and, in many cases, the substantial prosperity of the family, render her more or less indifferent to the outward show of things. In view of these differences in living conditions in the country and the city the writer believes that the former is more favorable to health and that it will remain so for a prolonged time if not perma- nently. The eugenic and anthropological value of this is self-evident. Reasons Explaining the Larger Average Number of Children Born to Country Women The reasons explaining the larger average number of children born to country mothers are of two classes: (1) biological; (2) social or psychological. BIOLOGICAL CAUSES Herbert Spencer believed that as civilization increased the repro- ductive capacity of the human species decreased. If this were true one might explain the whole difference between the city and the country, as regards the size of families, by saying that the city has a higher civilization than the country and consequently the reproductive capacity of its inhabitants is lower. But Spencer's dictum is not yet accepted by biologists. No definite proof has yet been discovered that the inherent reproductive capacity of man is affected adversely by the more complicated social environment of the city as compared with the country. What appears to the writer to be the nearest approach to proof of Spencer's position-the fact that many women cannot conceive although physicians can discover no definite cause of this inability-is generally explained, by the physicians themselves, as due to the fact that these women probably use all their vitality in some other way. It is supposed that excessive fatigue and nervous debility may so reduce a woman's vitality that the organs of reproduc- tion will not function properly. The point of importance here is that inability to reproduce is due to some individual pathological RACE SUICIDE IN THE UNITED STATES 119 condition and not to any decline in racial capacity as Spencer supposed. There are a large number of specific reasons why reproduction is impossible to some people. There are women who have malformations of the genital organs that render conception impossible. Of practically the same effect as malformations are accidents and pathological condi- tions of various kinds which create a mechanical or chemical obstruc- tion in the path of the spermatozoon so that it cannot reach the egg. In men temporary impotency may result from certain practices designed to prevent conception. If such practices are continued too long permanent sterility may possibly result. There is much dis- agreement among experts regarding the general effects of birth restric- tion upon the health and vitality of people who practice it. As I read both sides of the discussion I am convinced that those who believe birth control leads to the physical deterioration of the race are thinking primarily of the use of abortifacients; while those who contend that birth control does not harm the health of those who practice it are thinking of the use of methods which prevent concep- tion. So far as I am able to judge from the evidence both are nearly right. Abortion and the use of crude methods of preventing concep- tion lead to dire results while the use of the better methods of pre- venting conception probably have few or no harmful effects. The combined effects of the causes enumerated above in lowering the birth rate are, however, less than those of venereal diseases. There is much difference of opinion among doctors as to what proportion of sterile marriages are sterile because one or both parties are suffering from venereal disease. There seems to be no doubt, however, that the effects of venereal diseases on the birth rate are even greater than their effects in causing sterility. , This is the case because syphilis does not generally render conception impossible but renders it unlikely that a healthy or normal child will be born, while gonorrhoea spreads to the more remote genital organs of the woman, rendering her sterile. Dr. Prince A. Morrow states that "in private practice the mortality of infants born of syphilitic mothers is from 60 to 65 per cent. In hospital practice it is elevated to 84 or 86 per cent." Other investi- gators give even higher percentages. Certain it is that a syphilitic mother has very little chance of having any of her children live, to say nothing of having them grow into normal boys and girls. Syphilis is deadly to the race; and gonorrhoea is scarcely less so because it produces such a high percentage of sterility. About one marriage in every eight is sterile and many physicians believe that 120 WARREN S. THOMPSON most of these are due to gonorrhoea. Even those who estimate the percentage conservatively, believe that 40 to 50 per cent of these sterile marriages are caused by gonorrhoeal infection. Dr. Morrow says: "Abstraction made of every other possible factor of sterility and minimizing gonorrhoea as a predisposing agent to the lowest possible degree, yet there must remain a vast contingent of sterile marriages which are caused directly and solely by gonorrhoeal infec- tion." Thus it is not unlikely that about five or six marriages in every hundred are sterile as a result of venereal diseases, and several more in each hundred may produce only a single child before sterility sets in or abortion and stillbirths ensue and thus reduce the birth rate. The question now arises as to the relative importance of these different biological causes in the rural districts and in the city. Un- fortunately we have no definite data on this subject. In regard to malformations of and accidents to the genital organs resulting in sterility there would seem to be little difference between the country and the city. But the writer believes that all the other causes listed above operate more strongly to reduce the birth rate in the city than in the country. General nervous debility is more often a result of the tense urban life than of the slower and more placid rural life. Practices designed to prevent conception are far more widespread in the city than in the country. Lastly, but of greatest importance, venereal diseases are more common in the city than in the country. Just how much more common we may be able to tell when the complete reports of the Provost Marshal General for the period of the war are issued. In an indirect way the data on sterility of women collected by the Immigration Commission confirm ..this opinion. The percen- tage of women, married 10-19 years, bearing no children, was found to be about three times as great in the cities as in the rural districts. This was true of women of foreign parentage as well as of women of native parentage. If complete sterility of married women is generally involuntary, as many physicians believe to be the case, we are certainly justified in concluding that these biological causes are much more important factors in reducing the birth rate in the city than they are in the country. SOCIAL OR PSYCHOLOGICAL CAUSES When all due allowance is made for the fact that the death rate is higher in the city than in the country, and also for the fact that biological causes operate more strongly to reduce the birth rate in the RACE SUICIDE IN THE UNITED STATES 121 city than in the country, we must seek still farther to find the most important causes of the larger proportion of children in the rural districts. In the writer's judgment the social forces operating in a community are the most important causes determining the birth rate. They are the forces moulding and shaping the attitude of mind. They determine the aims and purposes of the men and women of the community. In order to understand these forces which underlie the attitude of people towards the rearing of children, it will be necessary to divide the population into several classes. I have divided the city population into four classes on the basis of family incomes because I believe that the different social conditions for these four classes lead to different attitudes towards bearing and rearing children. Consequently the extent of voluntary control of the size of the family varies in these different classes. These four classes are: (1) The poor, those having an income of less than $1,000 to $1,200 a year. The class is composed chiefly of unskilled workers; (2) The comfortable, those having an income of from $1,200 to $2,200. Most skilled workers belong to this class, also many people engaged in mercantile and commercial pursuits; (3) The well-to-do, those having incomes ranging from $2,200 to $6,000 or $7,000. Most professional men and men in executive posi- tions in industry and commerce belong to this class; (4) The wealthy, those with incomes of $7,000 or over. Capitalists and those on the road to become capitalists belong to this class. (These income limits are purely arbitrary and not too much importance should be attached to them. Obviously, many people belong to more than one class during their lives.) The rural population will be treated as a single separate class. THE INFLUENCE OF RELIGION ON POPULATION GROWTH Before proceeding to a study of the forces operative in these dif- ferent economic classes it will be well to inquire briefly into the in- fluence of religion upon the birth rate, inasmuch as religion knows no class lines. Protestantism has concerned itself but little with this matter and its influence is practically negligible. Protestant churches may not sanction birth control but the subject is rarely discussed by their ministers either in public or in private and the opinions of the ministers, if expressed, would have but little influence. The over- whelming majority of Protestant people consider such matters as their private affairs and would brook no meddling by the clergy. In 122 WARREN S. THOMPSON the Roman Catholic church, on the other hand, if one can put credence in common reports, the priests frequently exhort their parishioners (chiefly in private) to use no means to restrict the size of their families. How closely this advice is followed it is impossible to tell. Even a comparison between the size of families of Catholics and Protestants would not enable us to draw any definite conclusions. It is altogether likely that Catholics, as a group, have larger families than Protestants but it does not follow that their religion is the cause. A large propor- tion of the Catholics in America belong to the poorer classes (recent immigrants) and this rather than their religion may be the cause of large families. After some years of observation I am inclined to believe that as Catholics pass into the upper classes the size of their families is determined by the same social forces as are operative among other members of these classes and that well-to-do Catholics do not have larger families than the well-to-do among the Protestants. The Jews, like the Catholics, are generally supposed to be greatly influenced by their religion to raise large families. Again my observation leads me to believe that it is the economic and social status of the individual Jew rather than any general religious attitude that determines the size of the family. In my judgment, therefore, in the United States religion is not a very important factor in determining the birth rate. It serves only to assure some of those who would have large families anyway that they are doing what is pleasing to the Lord. THE POOR CLASS In the first class there is but little voluntary limitation of the size of the family. The two most important reasons why this is the case, are: (1) The people in this class do not know how to limit their families, (2) they do not care a great deal about limiting them, because they do not feel the burden of a fairly large family as keenly as people in the higher classes. There can be no doubt that the poor would practice voluntary limitation of families much more than they do if they knew how. But as yet the laws forbidding the dissemination of such knowledge are quite successfully enforced against the poor. (In my judgment this is the only class of the population which the laws prevent from securing this knowledge and they bid fair to become ineffective even against them in a short time.) They have only been effective this long because this class depends largely upon free agencies for such medical attention and nursing as it secures, and because the members RACE SUICIDE IN THE UNITED STATES 123 have no personal friends among doctors, nurses and others, who might tell them how to limit their families. I believe, however, that even if the poor knew how to limit their families as generally as members of other classes, they would not put their knowledge into practice to the same extent. It is the customary thing among the poor to look forward to the economic aid of the child as soon as he or she can be put to work. In the sweating industries mere babies often add their pittance to the family income by "helping mother" with her work. Even where child-labor laws and school laws are well enforced, the parents can count on the aid of the children as soon as they are fourteen or fifteen years old. Not only does the child of poor parents cease to be a direct burden upon the parents very early, but there are usually several years in which it contributes more than its "keep" to the family income. Thus a family of four or five children may render the parents substantial aid for ten or fifteen years or even longer. The parents very generally expect to get back the cost of the child before it strikes out for itself and they usually succeed. It may seem to many people that this attitude towards children is exceptional and is not a very important factor making for large families. I feel certain, however, that this attitude towards children is very general among poor people. The parents themselves were brought up to expect to go to work as soon as they were able and they expect the same of their children. The experience of those who have to do with the enforcement of child-labor laws shows that people in the poorer classes want their children to leave school and go to work at a very early age and that the children are quite willing to do so. This is the usual attitude of poor people the world over. Hard conditions of life and simple forms of work make it necessary and possible for children while yet very young to help their parents and it is customary for them to do so. Old-world ideas brought over by the immigrants also work in the same direction. The peasant economy of Europe has a place for the labor of the child and only too often the immigrants see no reason why the child should not go to work as young in this country as he would in the old country. Many times the child begins to assist the parents at their work long before it is permitted to work regularly. It can do this quite easily, because both men and women do unskilled work. When the time comes that the child can leave school, it finds comparatively little difficulty in getting the same kind of a job as father or mother or a similar one. Children whose mothers work at home in the sweated 124 WARREN S. THOMPSON trades can acquire all of the skill needed to do any of the work by the time they can leave school. When the boys are too big to work at the sweated trades they are able to go to the wharves with their fathers or do rough labor on construction work or any other of a thousand jobs which require no special preparation. I would not imply that boys and girls in this class always do the same kind of work as their parents, but I do believe that the great majority of them do work of the same general nature. I should say that the boy whose father is a longshoreman and who himself becomes a deliveryman is staying in the same general class as his father. Similarly the boy who does the unskilled labor in a new subway is following in the steps of his father who is the janitor of a tenement. We are too apt to forget that only a small proportion of children can ever rise from the general class into which they are born. I have many times been amazed at the utter lack of ambition among the children of unskilled laborers. But when one canvasses the situation carefully, one finds nothing in this attitude of children to cause surprise. They have been' brought up to expect to go to work at an early age, their parents never tried to instil into them the desire to better their lot. They have attended schools where no mention was ever made of occupations open to them, or if occupations of different kinds were brought to their attention, no efforts were made to inspire in them a desire to get into better occupations than those of their parents, and they have not been prepared to enter such occupations if the desire for them was implanted. In a word, every- thing in the life of the child of the poorer classes tends to press it into the mode of life of its parents while almost nothing urges it to a different mode of life. There are forces at work now, however, which seem to me to be bringing about a change in the attitude of parents in this class towards their children, and also to be breaking down the passive acceptance by children of the role chosen for them by their parents. More stringent child labor laws, better enforced, are making the children dependent upon their parents for a longer time and thus rendering it less economically advantageous for them to have relatively large families. Going hand in hand with the movement to prevent too early work among children is the movement for vocational guidance and occupational training. In so far as these movements arouse ambition in the children of the poorer classes and supply the training to help them realize their ambitions, we may expect to see them RACE SUICIDE IN THE UNITED STATES 125 become less and less an economic asset to their families. As this takes place, there is not the least doubt but that the birth rate will fall. It may well be that the effects of these movements on the birth rate in this class will not be very marked in this generation, but they will be in the next. Those who have themselves risen from the poor class will want to maintain .their new standards and give their children at least as good a start as they themselves had, and those who wanted to rise, but were unable, will hope that by having only a fair-sized family they can give their children such advantages that they can rise. Thus the effects of better education and a longer period of childhood and preparation are certain to bring about a reduction of the birth rate. It is not likely, so far as I can see, that the poorer classes will ever have as low a birth rate as the other classes. There will always be those who must do the unskilled work of the community and their children will, for the most part, take their places with the minimum of preparation allowed by law. Under such conditions the children of this class will naturally cease to be an expense to the family sooner than the children of the higher classes, and they will be able to add something to the family income for several years before striking out for themselves. Thus in spite of greatly improved conditions children will always be more valuable economically to the poorer classes in the city than to the other classes. Another reason why I do not believe that the birth rate of the poor class will ever fall as low as that of the higher classes is that the poor class will always contain a greater proportion of improvident ne'er-do- wells than the other classes. People who never look to the future, who make no plans for their own lives, who care little what becomes of their children, will always have large families. No matter how widely the knowledge of birth control may be disseminated people who are shiftless, improvident and perhaps sub-normal will never restrict the size of their families to any appreciable degree. In this class marriages take place at an earlier age than in the other classes. The unskilled laborer reaches the age of full earning power by the time he is twenty years old and will draw his highest wages between that time and the age of forty-five. This means that he can reason- ably expect to care for a family at a much earlier age than the men of most other classes. The woman of this class, therefore, marries relatively early and has more years in which to bear children than the woman of any other class in the city population. Divorce, too, is less 126 WARREN S. THOMPSON frequent in this class than in the others. This adds to the average length of the child-bearing period of the woman of the poor class. In spite of the fact that all these things tend to keep the birth rate of this class high its rate of natural increase is not so high as might be supposed for its death rate is high, as has been shown above. THE COMFORTABLE CLASS In the second class, voluntary limitation of the family is widely practiced, though it is by no means universal. There are many people in this class who look upon their children in much the same way as those in the first class. In so far as this is the case, there is no need to dwell upon the motives at work. But there are also many influenced by motives that lead to the desire for a small family. The skilled laborer who believes in the restriction of output and in the limitation of union membership can readily see the advantages in limiting the size of his family. If it is a good thing, from his stand- point, to control the amount of labor available for doing certain kinds of work then it is a good thing not to raise more children than he can find places for in his own trade or other trades of the same grade. A great many skilled mechanics have small families for no other reason than that they believe this the most effective method of restricting the amount of labor and therefore of raising wages. Many other people in this class raise small families because they hope to be able, thereby, to give their children better opportunities to rise into the higher classes. Many and many a family can be found among skilled laborers and clerical workers putting forth its utmost efforts to give at least one of the children a better start than its father had. In such cases, the child instead of becoming an economic asset at fourteen or fifteen years of age becomes an increas- ingly heavy economic burden in the years after he leaves the common school. Not only is the child a charge for a much longer period, but in the degree that the parents are successful in launching him upon his career in a higher class, they must expect to forego any return on their investment, for it takes so long to attain even a moderate degree of financial success in these higher classes that parents seldom live to see their children achieve it. Of equal effect with ambition for one's children in causing restriction of the size of the family is ambition for oneself. There are many men in this class who feel that children would be a hindrance to them in attaining a higher position. There are also many women who have RACE SUICIDE IN THE UNITED STATES 127 social ambitions or who desire to continue their work outside the home after marriage. In either case children are not wanted and voluntary limitation of the family is practiced. Since, however, personal ambi- tion, incompatible with the raising of a fair-sized family, is much more common in the third class than in this, I shall not discuss it further here. The lack of training for women in homemaking, which is so prevalent among all classes of city women, perhaps, shows its effects most markedly in this class. The girls usually leave school after they have finished the grades or early in their high-school course and work for several years in factories, stores or offices before they are married. The work they do is very largely unskilled and requires little thought or close attention. In many factories they repeat a single simple process over again and again until it becomes purely mechanical. In the stores only a few ever learn more than the simple mechanical parts of salesmanship. Even in offices as stenographers and filing clerks, their work is but little less mechanical than in factories and stores. In any event the work of the girl who expects only to work until she gets married very seldom offers much opportunity for her to develop responsibility, self-reliance or foresight. Instead of pre- paring girls for homemakers, such work as they do induces careless habits and an indifferent attitude towards -work of all kinds which is demoralizing in the extreme. These girls never learn to regard work as the normal and proper condition of life. They do not know what it means to find work interesting and to put the best of themselves into it. They rather come to regard work as a necessary evil to be endured for a given length of time daily either because they must work to live or because they need the money to have a good time outside of working hours. The girls are not primarily to blame that they so regard their work. The organization of our industrial system is such that most girls never get a chance to do work that is interesting to them nor do they ever have their attention called to the opportunities for self-expression in their work. It is not the least surprising, therefore, that these girls have never developed the qualities which make a successful and happy wife and mother. Such qualities as patience, economy, foresight, good taste and adaptability-essentials to a happy life under all conditions-are not to be acquired with the taking of the marriage vows; they must be developed slowly through the years. In my judgment the work of these girls not only does little to help them develop such qualities, but often actually aids in developing other 128 WARREN S. THOMPSON traits of character which unfit them for home life, e.g., carelessness, shirking, selfishness, irresponsibility and vulgarity. The woman who looks upon her daily life in the home as she looked upon her day's work in the factory or store before she was married is quite certain to find little there which will compensate her for raising a family. When this attitude towards the home exists, when all the good things of life are thought to lie outside of the daily routine of home life, family limitation will be practiced if the woman knows how. Although the birth rate in this class is considerably lower than in the first class I believe that the rate of natural increase is not much different, for the death rate is also lower. But it may well be that in recent years with the improvement of the public health agencies administering to the poor the rate of natural increase of the poor has come to exceed that of this class Unfortunately we have no very conclusive evidence on this point. THE WELL-TO-DO CLASS In the third class voluntary restriction of the size of the family is almost universal. In addition, late marriages and celibacy contribute to a very low birth rate. The motives leading to late marriage and celibacy do not need much special attention because they are the same, in general, as those leading to the rearing of small families among those who are married. It may be that the ease and comfort in which both bachelor men and women can live in the cities are motives which of themselves lead many to forego marriage, but I believe that ambition in various forms is the most potent motive leading to celibacy, as it is to family restriction. Most professional and managerial positions offer abundant oppor- tunities for advancement to capable, wide-awake, energetic, men and women. Honor and wealth are the rewards of diligence in these positions. The ambitious young man who goes into business hopes soon to leave the well-to-do class and join the wealthy as do many who go into the professions. There are many others in the professions who do not care to leave this class, but rather who are ambitious to gain recognition through scholarly or artistic work, which is more dear to them than wealth. In either case-in seeking honor or wealth, or both-personal ambition is the dominating motive in life and has a great deal of influence upon the size of the family raised. The young man in business who sees vistas ahead in which he may exert power through wealth has little time or inclination to give himself RACE SUICIDE IN THE UNITED STATES 129 to his family. He may be quite willing to meet the expenses of a relatively large family; but he is so immersed in his work that he is likely to forget to be human. He probably expects his wife to shoulder the entire burden of worry and care at home, so that he will not be distracted from his work. The wife soon becomes weary of bearing her burden alone and is ready to take measures to prevent it from becoming greater. So it is that the ambition of the father lies at the basis of family restriction in many cases. Again the father may feel that he needs all the money he can pos- sibly save to further his business plans and so takes means to prevent the coming of children. He often feels also that he will be hampered in his freedom of movement by even a fair-sized family. Then there is always the element of chance in business, and a man may not be willing to give hostages to fortune until he can be reasonably sure that he can redeem them. In the professions the situation is much the same, with the exception that the goal is more often recognition of some kind than mere wealth. Better than wealth to a lawyer may be the appointment to the Supreme Bench, better than wealth to a physician may be the discovery of some new means of aiding mankind, better than wealth to the engineer may be the successful completion of some public work, e.g., a Panama Canal, better than wealth to the scholar may be the writing of an essay which will inspire good thoughts and noble ambitions in his fellows. But the way to success in the pro- fessions is slow and laborious, and even a moderate-sized family may make the ascent much slower and more difficult. There are also numerous cases in this class in which the man marries so that he may increase his acquaintance among men who may be of help to him through the social activities of his wife. Many such marriages are childless, while many more have only a single child. It is quite likely, however, that only a small proportion of the women who. spend much of their time and energy in social life do so with the object of furthering their husbands' interests; most of them have social ambitions of their own. The care and expense of even a single child will seriously curtail the social activities of a woman of this class and so, many times, children are sacrificed to social ambitions. Children tie a woman to the home rather closely for a good many years if she gives them a true mother's care. They are also expensive. No doubt the woman in this class very often has to make a choice between another child and some cherished object which will further her social ambitions. An automobile, a new home, new furniture or 130 WARREN S. THOMPSON more expensive clothes will each and all enhance one's social position and keep one before the attention of one's friends, while another child will withdraw one from their attention for a considerable time and make it more difficult to appear so well in their eyes. Only too often the temptation of the easy and immediately pleasant way out over- comes them and they shirk the real duty of a woman. Like the mistrained or untrained of the lower classes, women of this class who "go in for" social life see no satisfaction to be derived from the daily routine of the home. The dearest objects in life lie elsewhere. Nowhere among their friends and acquaintances do they encounter any disapprobation of the frivolous, meaningless lives they are leading, for tliey are all of a feather. If it is to women of this type that the charge of parasitism, so often heard now-a-days, refers, it is very largely justified. Again there are many women in this class who want a "career." They want to be independent economically and socially. Some of these women do not marry, but more of them do marry, although relatively late. Of those who do marry, many regard their work essential to the highest self-respect and self-development and therefore find no place in their lives for the bearing and raising of children. Happily there is a reaction, in late years, from the extreme type of feminism prevalent about a generation ago, which taught that for a woman to be dependent on a man for support was disgraceful and not to be tolerated by any woman of strong character. But by no means are all the women of this class of the type that would prefer not to have children. The majority, without doubt, are women who find a satisfying existence in simple home life. But even such women do not desire large families, for they find the raising of children in the city a task of ever-increasing difficulty. The results of a recent investigation will show the correctness of these statements. The Delineator for October, 1919, published the results of a question- naire sent to the graduating classes of a number of women's colleges. To the question: If you follow a professional or business career, would you attempt marriage and motherhood in addition, if you met the right man? 235 replied, yes, 302 replied, no, and 26 said they would attempt marriage but not motherhood. To the question: Provided you could not have both marriage and a business or pro- fessional career, which would you sacrifice? 522 replied they would sacrifice a career, 51 that they would sacrifice marriage and 22 were undecided. To the question: How many children do you want? RACE SUICIDE IN THE UNITED STATES 131 the replies were: None-10; One-4; Two-76; Three-163; Four -179; Five-55; More than five-63. As I have watched the child life of the cities, especially among this class of people, I have often wondered that they tried to raise children at all. Children are not wanted in most apartment houses in desirable sections of the city, nor will single houses be rented to families with children if those without can be secured. Open places for play, close at hand, are generally lacking, while a private yard where one's children hold undisputed sway is almost unknown. Thus the naturally venturesome spirit of youth has no place in which to express itself in ways useful to the child and not troublesome to others. On the other hand, the opportunities to get into mischief seem to be unlimited. Our cities today seem to be organized for the repression of the natural life of the child rather than to encourage its normal expression. Don't! Don't! You must not! Get out of the way! What are you doing here? are apparent everywhere, while, Come on! Take part! Enjoy yourself! Here is a place for you! are scarcely visible anywhere. Because of these conditions it is not unlikely that, in this class where standards of living are high and income not sufficient to permit of much help in the home, one child causes more work and worry than several in the lower classes. But aside from the care and expense of raising children while they are comparatively young, parents in this class generally have to provide for their children for a much longer period than those in the lower classes. At the age the child of the poorer classes begins to be self-supporting the child in this class begins to make greater demands upon the economic resources of its parents. Prevision and foresight are well developed in these people and consequently they make definite plans, so that their resources will meet their own needs and provide a good start in life for their children. Expenses during high school, college, technical school and possibly even for a year or two while getting a foothold in some profession, generally strain the family resources to the limit when the family is small. Therefore a large family is not desired. ' The desire for travel is another motive often leading to the restric- tion of the size of the family in this class. It needs no argument to show that children make travel more difficult both from the standpoint of expense and from that of leisure. Each child born increases the normal expenses of the family and makes it more difficult for the parents to take their children with them or to leave them behind 132 WARREN S. THOMPSON when they travel. Thus with the growth of the family the likelihood of being able to travel decreases. Therefore, where there is a strong desire to travel, a "trip" very often is chosen as the alternative to another child. The desire to attain culture is also a motive leading to family restriction in many cases. A certain amount of leisure and freedom from harassing care are necessary to the development of a cultured personality. A large family of children or even a moderate-sized family is apt to make the work and the worry of maintaining class standards so difficult that one will have little energy or inclination for anything beyond the daily routine. The realization that this is likely to take place causes many people to raise only one or two children. They feel that the sacrifice of self-development involved in rearing more is too great. We have no very extensive data bearing on the birth rate and death rate in this class, but such data as we have seem to justify the conclusion that there is no natural increase. My own belief is that this class does not produce enough children to keep up its numbers, but we must await further investigations before we can be positive on this point. THE WEALTHY CLASS There is no sharp line dividing the fourth class from the third either in regard to the motives leading to family restriction or the rate of natural increase. Family limitation is almost universal in the fourth class and ambition, in one form or another, and love of ease are the most powerful motives leading to it. This class is quite small, comprising not more than a few hundred thousand families (judging from the federal income tax returns). The great majority of the men belonging to it are men having incomes near the lower limit. Most of these men hope very soon to increase their incomes and are struggling desperately to rise. Nowhere in our population is the competition more strenuous than between men who have attained some measure of success and whose appetite for it is, therefore, insatiable. These men are "climbers" in their lines and very often their wives are social "climbers." Thus the chief interests of both husband and wife lie outside the home and children are re- garded as a burden. Such people have no real home life and do not care enough for it to stop scrambling for position. The husband only too often thinks of his wife as the means to a larger acquaintance RACE SUICIDE IN THE UNITED STATES 133 among people who may be able to help him along and the wife regards the husband and home merely as necessary incidents to respectability. The result is that their families almost never comprise more than two children and very often none at all. These "climbers" have neither accumulated wealth nor do they have very assured positions in society. They have therefore nothing definite to bequeath to their children. They have no pride of family urging them to leave descendants to carry on the family name and traditions; they have no definite position in the community, which they can be assured of transmitting to their children. These people are themselves adrift, they know not whither they are bound, and many of them feel, in their more serious moments, that life is so un- certain and there is so little worth while to be got out of it that they will save trouble all around if they have no children. On the other hand, among the wealthy, whose position is assured, there is a certain amount of pride in one's family, leading them to rear children to carry on the family name and fortune. They have not only wealth but a much-coveted position in the community which they can command for their descendants. This portion of the wealthy class probably more nearly reproduces itself than the "climbing" portion. Undoubtedly the sheltered lives of ease and luxury led by many girls in the wealthy class and even by some in the well-to-do class disincline them to undergo the hardships of bearing and rearing a family. To a girl who has been brought up in the belief that her own whims and desires are of prime importance and that all values are to be judged by these pampered inclinations it is often inconceivable that she should deliberately do anything to bring herself pain and work and worry and probably even deprivation of some customary luxuries. Such girls brought up apart from the stern realities of life are not cap- able of judging values aright. They know little of the feelings and values which grow up naturally when men and women struggle side by side, help to bear one another's burdens, share sorrows as well as joys and, above all, live close to the great streams of simple, work-a-day humanity. Women whose only passion is for ease and luxury lose touch with humanity and substitute for true human values those of a small and highly institutionalized class. It is especially unfortunate that the women of this class do not rear moderate-sized families, because they are so widely imitated by the women in other classes. 134 WARREN S. THOMPSON THE REASONS FOR THE HIGH BIRTH RATE IN THE COUNTRY There is no need of dividing the rural population into classes in order to study the causes of the relatively high birth rate in the country. The great majority of people living in the country have incomes (counting what they use directly from the land) about the same as those in the comfortable class in the city. There are some people in the rural population who are really poor and there are a few who belong to the well-to-do and wealthy classes but these two extremes (not taking the negroes into account) comprise only a very small proportion of the whole. For this reason and also because I believe that all classes of people in the country, in spite of considerable differences in their incomes, think in much the way same regarding the size of their families, I shall speak of the farmer and non-farming rural population as belonging to a single class. The women raised in the country have been trained to be home- makers. The changes which have been referred to above as unfitting many city girls to become good homemakers have not affected the country to any great extent. The country girl learns to help her mother about the home almost as soon as she can walk. There are numberless little tasks that she can do before and after school hours. If she happens to be an older child she gets training in caring for the younger children. She learns to make butter, care for the chickens, and to raise a garden as well as to cook and keep house. She never lacks for work about the home during vacations and after she has finished the country school. She grows up with the idea that her place in the world is to be a wife and mother. She never learns that the world offers almost numberless opportunities to women to do things outside the home. When the time comes for her to marry she knows what is expected of her and she is trained to the task. The country woman who keeps house and does the work usually connected with housekeeping on the farm never needs to feel that she may be an economic hindrance to her husband as many city women must. She knows, as her husband too often does not, that she is helping to make the farm pay. Her garden and chickens and butter and her daily economies constitute a positive contribution to the welfare of the family greater, in all probability, than that of many city women who work outside the home. A farm is commonly a partnership affair on its producing side, but as in most other industries the "boss" is able to distribute the product according to his desires rather than in accordance with the principles of justice. RACE SUICIDE IN THE UNITED STATES 135 The fact that the woman is such a direct economic asset on the farm probably accounts for the greater proportion of married women in the country and the earlier marriages there. Both of these things help to keep the birth rate in the country relatively high. Children, too, are generally of economic value on the farm earlier than they are in the city. There are many kinds of tasks both for boys and girls on the farm which do not injure their health but which help to keep the work going smoothly. The bringing in of fuel, the care of calves and colts and pigs, errands to and from the fields, the assistance with the garden, all can be done by boys and girls, without injury to health, outside of school hours and during vacations. Be- sides the boy can even help with the field work by the time he is ten or twelve and be all the better for it, so long as he does little but drive a team hitched to light machinery. He can also help with the lighter parts of the heavier chores-the care of horses and cattle. The girl in addition to her chores outside the house can be of use to her mother in the house in a hundred ways and if not overworked will in no way be injured. I am fully aware that many country children are over- worked and underplayed, but I do not believe that such a state of affairs is at all general. If it is, however, it only goes to prove that country people find children more economically valuable than I have supposed they are, therefore, more willing to have good-sized families. In the country both boys and girls work at home by the side of their parents. Because of this they very soon learn that both father and mother are working for the same ends and that they are helping their parents to attain these ends. There is thus developed a unity of interest in the family in the country which is very often lacking in the family in the city. Because of this close personal contact between parents and children while at work, there is less danger that the morals of the country children will be corrupted. I would not be understood to say that, morally, all is as it should be in the country- far from it-but there is less chance that the average country boy will become utterly good-for-nothing than that the city boy will. I am quite convinced that the fact parents and children spend much time working together in the country has a wholesome influence on the children in teaching them habits of steady application and thrift, while the fact that parents and children are together so little in the city has, in general, a demoralizing effect. This brings it about that parents 'in the country have less reason to fear for the future of their children and are therefore more willing to raise good-sized families. 136 WARREN S. THOMPSON Another way in which the unity of interest is developed in the family in the country is through the discussion of family affairs in the home. Most of the things of a local nature that the farmer and his wife are interested in can be discussed with profit before the children. From the time the children are ten or eleven years old they can understand something of the problems of farm management and household management and they are also interested in what is going on in the neighborhood. In fact, the children very often have something to contribute that is of interest to the parents. Thus the whole family grows up within the same circle of interests and every member feels that he is included in any discussion or conversation that may arise. How different is the situation in the city! The business man comes home from the office or store with weighty matters on his mind and he finds it impossible to relieve himself by talking to the whole family, or even to his wife, because the thing absorbing his attention is highly technical. He finds his wife and children talking about neighborhood or school matters of which he knows little or nothing. So the family instead of being brought into closer unity by a mutual understanding of one another's interests is divided and the members may feel rather indifferent towards one another. Modern city life seems to me to have an increasing tendency to diversify the interests of the members of the family rather than to centralize them as rural life does. Country life, therefore, makes it easier to keep alive personal interest in human beings than city life does. Definite personal interests- interest in wife and children, interest in school and church, interest in neighbors-take up a goodly share of the farmer's thought. He does not become engrossed with entirely impersonal matters as the city man is apt to. He must deal directly and humanly with people at almost every turn, while the city man deals more and more with things directly and people only indirectly and technically. But even if the farmer becomes engrossed with things, e.g., the extension of his acres, he yet hopes that he will have the children to help him till these new acres and to whom he can leave them, so that after all it is a family interest he is looking out for. I am quite certain that the more human and personal nature of the life of country people as com- pared with that of city people makes them willing to raise larger families. Another reason for large families in the country is that it is easier to raise a good-sized family there than in the city aside from the fact RACE SUICIDE IN THE UNITED STATES 137 country children early become an economic asset. The "barefoot boy with cheek of tan" is to be seen wherever one goes in the open country and usually his little sister is with him. The clothes may be soiled, the faces and hands dirty, but it is usually the "clean dirt" of the open country-the mud from the creek, the dust from the road or the stain of fruit and berries-not the foul slime from the gutter which one sees on the children in the poorer parts of our cities. The country child always has a big playground at hand. In this playground are wagons and buggies, cultivators and plows, machinery and tools, cattle and horses, all of which call for careful attention and invite to manipulation. Many are the months and even years which the child can spend in playing with things which he will later want to use in his work. If the children are not in the farm yard at play the mother may be quite sure that they are safe wherever they are. Besides, she knows all the neighbors' children and knows whether or not they are good companions. The dressing of the children for school so that they will look respec- table is not the trying task it often is in the city. Cleanliness and comfort are the two chief standards of respectability and they may be attained quite easily in the country. Colored dresses for the girls, with big aprons; overalls and blue shirts for the boys, with black stockings and heavy shoes for both, are sufficient for their require- ments, and, for my own part, I think they look very well. Furthermore, country children do not have the continual entice- ments to spend money that the city children have. They do not see the gaudy display of toys and candies in the store windows on their way to and from school and, recently, the brilliant-colored lithographs of the "movies." If the country boy wants a sled he probably makes one, thus saving money and learning something useful. Country children learn to amuse themselves rather than to ask papa for money to pay to be amused and this can not fail to relieve the country mother of much worry, because while amusing themselves around the home they are not very likely to get into serious mischief. We must all agree, I think, that it costs less, in money, in work, and in worry, to rear a child in the country than in the city, and for this reason country people are more willing to rear them. Moreover, the relatively secure economic position of the farmer makes him and his wife more willing to raise a good-sized family. The industrious farmer, either renter or owner, is practically certain 138 WARREN S. THOMPSON of a fair living. Panics and hard times do not affect him as they do the industrial worker. Dissatisfaction of the capitalist manufacturers over a new tariff schedule does not throw the farmer out of a job nor render his living precarious, as it may the city worker. In fact the farmer is more or less immune from the most of disturbing conditions connected with modern industry. Of course, he occasionally loses a crop. But now-a-days when the farmer raises a number of different crops he very seldom has a total failure in all of them. For these reasons a farmer does not need to worry whether he will be able to feed and clothe his family, as many men in the city do. He can be practically certain that he will be able to meet the ordinary exigencies of life without a great deal of hardship to himself and his family. Because of this feeling of security of position the farmer has less reason than the city man to feel that he is giving irredeemable hostages to fortune when he has a large family. We have seen that in the city many people limit their families because they feel that they can not otherwise give their children the best opportunities. This motive to family limitation has very little influence in the country. The farmer generally regards his duty to the child as fulfilled if he allows him to complete the country school. He is quite sure that the boy who amounts to anything can shift for himself if he has a common-school education and has learned habits of steady application. In the environment of the country most farmers come to believe that the schooling which was good enough for them is good enough for their children. Only a few make plans for the better education of their children which involve saving and preparing years ahead. This is not because the farmer does not want his boy and girl to have as good opportunities as other boys and girls, but rather because the only opportunities he knows about are on the land and he does not see how an expensive education can help the boy to raise better crops. The average farmer little realizes how many opportunities are open to the young man with a good education which are closed to the one with only a common-school training because he does not realize the growing complexity of modern life. Therefore the farmer finds no reason to limit his family in the hope that he may thereby be able to give the smaller number of children an expensive training for their life work. In the past, too, the farmer has known that there were good oppor- tunities farther west if his family was too big to settle on the home place, and so he felt little anxiety over the future of his children. RACE SUICIDE IN THE UNITED STATES 139 Even when the boy prefers to go to the city rather than to go west the farmer feels little doubt about his ability to compete with the city boy. He firmly believes that his boy can take care of himself wher- ever he may go. He also knows that the boy who works at home until he is twenty or more years of age owes him little economically for his "keep" and he does not feel that either his situation or the future of the boy would be much changed by rearing a smaller family. THE OUTLOOK FOR THE FUTURE In the opinion of the writer there is little danger that the newer immigrants will supplant the older stocks by any natural process of population growth. If they supplant the older stocks it will be because adequate restrictions are not placed upon their entrance into this country. The future racial constitution of this country can be deter- mined by prompt adoption of simple legislative enactments for this purpose. If, however, nothing is done and matters are allowed to proceed as in the past, the situation may soon be beyond control. Should the time come when our whole population of Nordic stock is subjected to the same severe competition with immigrants as our city population has been for some time past, no amount of legislative action or exhortation will prevent the rather rapid conquest of the United States by peoples from southern and eastern Europe. General Walker long ago pointed out the fact that our population growth, as a nation, had been influenced very little by immigration. He believed that the competition of immigrants with older stocks so reduced the birth rate of the latter that the immigrants just about made up the loss. There can be no question that the opportunities which people see for themselves and their children to gain a good living determine the size of families to quite an extent. Since native men and women have seen less and less opportunity as competition with immigrants increased, and even a moderate amount of ambition has led them to restrict the size of their families until the older stocks in our cities are dying out. Ambition of country people has been more moderate than that of city people and the opportunities they coveted for their children have not been subject to the same competition from other groups and so the native stock on the farms has gone on increas- ing at a good rate. At present most of our large cities are peopled by stocks different from the prevailing stock of the open country. The city people are an amorphous mass of humanity whose purposes and aims are not 140 WARREN S. THOMPSON understood by country people. Nor are the farmers understood by the mass of city dwellers. These groups are mutually suspicious. They have no common historical background and few common aims and purposes. The suspicion and distrust of one another feeds upon social differences and mutual lack of understanding. Just how much of this suspicion and distrust is due to racial differences and how much to the natural antagonism of agricultural and commercial and manu- facturing interests, I shall not attempt to say. I believe, however, that the different racial elements in these groups make mutual under- standing more difficult and may lead to some rather serious conse- quences when both groups become better organized. If immigrants are allowed to .come practically without restriction, as before the war, the racial differences between these groups will become still more marked and the possibility of misunderstandings' thereby increased. THE EUGENIC SITUATION From the standpoint of eugenics the effects of our present popula- tion movements merit careful consideration. Is it eugenically desir- able that our population should continue to increase most rapidly in the country and in the poorer classes in the city, while the well-to-do and wealthy classes increase very slowly if at all? In what ways, if any, is this process leading to a survival of the unfit? Our rural population, as a whole, is of good eugenic value. The people are hardy, energetic and of good habits. Their hereditary capacities are in general good and sound. Their average of ability is high. I am well aware that there are many biologically degenerate families and neighborhoods in the country but they form only a very small proportion of the total rural population. Aside from these biologically inferior people, who should be prevented from propagating their kind, the relatively rapid rate of increase of the rural population is eugenically desirable because it adds a large increment of good stock to our population year by year. Certainly, so long as the increase of our population comes most largely from the country we need have no fear that the quality of the stock is deteriorating. The poorer classes in the cities are also of good stock although, in my opinion, they contain a slightly larger percentage of hereditary degenerates than the rural population. Poverty is not, as so many are accustomed to think, prima facie proof of inferiority. In most cases it is a result of lack of opportunity rather than of lack of ability. In the very nature of the case, however, the percentage of thqse who RACE SUICIDE IN THE UNITED STATES 141 lack ability is larger among the poor than among other classes. The indolent, the incompetent and the good-for-nothing drift into the poor class as naturally as a stone sinks to the bottom of the pond. The question of the mental capacity of our recent immigrants who belong chiefly to this class is one which I cannot discuss here. I wish to say, however, that no convincing proof has ever been offered to show that they are essentially inferior to the older stocks. Moreover, I have never found a person knowing any group of them well who does not believe that they are of sound stock and of good average capacity. It seems to me, then, that this class, as a whole, may be said to be of good heredity and that we need not fear deterioration of our popula- tion because of its relatively rapid increase. It should not be forgotten, however, that there is a certain small percentage in this class that is biologically unfit. The people in this small group constitute a menace not only to the standards of the poor class, but also to the well-being of the whole community and conse- quently should be treated as wards of the state and should be segre- gated so that they cannot propagate. The real hereditary degenerates of the nation are found chiefly in the rural population and in the poorer class in the city. So far as can be judged from numerous special studies these unfit are increasing at a rather rapid rate, although not as rapidly as the normal members of these classes. Year by year the number of incompetents who cannot be raised to normal conditions of living by the improvement of their environment is increasing. Thus we find a steady absolute, if not relative, growth of the lowest stratum of the population. Contrast this with the situation found at the other extreme-among the well- to-do and the wealthy. In the upper economic classes there is no natural increase of popula- tion, but in all probability a decrease from year to year. It was shown above that the graduates of women's colleges were only rearing about enough children to replace themselves, to say nothing of their husbands. There is very good reason to believe that this is true of the upper economic classes as a whole. These classes contain a high average of ability. Most men who belong to them have risen from a lower economic class. They have proved by their rise that they have more of certain kinds of ability, on the average, than other members of the classes from which they rose who had equal oppor- tunities. They have shown adaptability, energy and initiative above the mean. 142 WARREN S. THOMPSON It may be objected that many are born into these classes and there is no proof that they have more than average ability. The latest developments in our knowledge of heredity show us that the hereditary qualities of people pass from generation to generation with but little change. The cases of the children of the wealthy who do not amount to anything furnish no proof that they do not have good capacities. They merely prove that their training, perhaps their health, and the environmental influences by which they have been surrounded, were bad and unwholesome. I recall reading in Montaigne the opinion that princes usually learned nothing well except the management of horses. He explained this as due to the fact that the people about them always flattered them and gave way to their caprices and re- quired nothing thorough of them, while horses made no distinction between princes and commons and consequently they were forced to learn the management of horses thoroughly. The children of our upper classes are much like princes. They are seldom subjected to adequate discipline and it is rather a wonder that so many of them turn out well than that many are utterly useless. I think there can be no serious doubt of the fact that the members of the upper classes, whether they have risen into them through their own efforts or were born into them, have a somewhat better heredity than the average of the population. It should be remembered that we are considering the average of ability in these upper classes, for there are no doubt in them indi- viduals of very ordinary capacities and some few who are biologically degenerate. There are those who become members of these classes by the merest chance, having no merit of their own entitling them to distinction of any sort. Then there are those whose financial success is due to certain qualities-callousness, ruthlessness, indomitable ambition for wealth, selfishness, greed and brute force-who should not, in the interest of the general welfare, be in positions of importance and power. But in spite of the presence of many people in the upper classes who are of very ordinary capacity I believe that the average of ability in these classes is somewhat higher than in other classes. If this is true, then it is a very serious matter that these classes do not reproduce themselves. One objection often raised to a democratic country is that the breaking down of class lines is likely to lead to the depletion of the best stocks. It would seem that this is now happening in the United States. We pride ourselves on the fact that people with initiative, energy, ambition, imagination and good minds can rise RACE SUICIDE IN THE UNITED STATES 143 from the most humble conditions to positions of wealth and influence in the upper classes. This very ease of rising tends to extinguish much of our best ability in a single generation. A man from the poor class, with no family traditions to uphold, and therefore, with no concern for the future of his own family, struggles to rise. He suc- ceeds in attaining wealth or prominence or both. He has not more than three children at most and often none. His family soon dies out and his ability is lost to the nation. This process is going on with great rapidity at the present time and in my judgment is the most serious phase of race suicide. However large the supply of excellent ability in the lower classes from which the upper classes may draw, this process of obtaining leaders cannot go on indefinitely without weakening the nation. In view of what has been pointed out above I would take issue with those who believe that the rate of increase of the nation, as a whole, is hot sufficiently large-who believe that a more rapid rate of popula- tion growth is all that is needed to prove that our people still possess the vigor of their ancestors. There is no doubt in my mind that our population is increasing as fast as it can be provided with the means of maintaining a good standard of living. It is a serious matter, how- ever, that the lowest class, the biologically unfit, is steadily increasing while the better stocks are dying out. If the upper classes were to raise fair-sized families-four or five children-the national birth rate would be raised but slightly and yet the good capacities and abilities of these people would be saved to the nation. There is little doubt, moreover, that if the children of these classes were raised in fair-sized families they would get better training and discipline for life than they now do. What can be done to encourage the upper classes to raise fair-sized families? Certainly nothing can be done by legislation. Birth con- trol has come to stay and bounties for large families will only be accepted by the improvident-the very class which should not be encouraged to raise a numerous progeny. A general hue and cry about our low birth rate will be of no effect. The problem is one of developing standards of life in the upper classes which are not incompatible with the raising of a family of four or five children. This will involve a simplification of present standards. There is neither time nor energy for good home life and all of the external activities now engaged in by people of these classes. The raising of a family of moderate size involves a choice of a home life 144 WARREN S. THOMPSON with much unobtrusive sacrifice in preference to a life with a large amount of personal gratification and a minimum of responsibility to others. Certainly the choice of the former requires some fortitude when one belongs to a class where the latter is regarded as the only normal life. If any great change is to be wrought in the habits of the upper classes it must come from the examples set by those who believe that life is a serious matter and should not be frittered away in doing solely those things which make for their common personal gratification. If any considerable number of wealthy people so conducted their home life and their business affairs that other members of the upper classes were convinced of their serious moral purpose, they would imitate them and we should have little need to deplore the dying out of our better stock. Along with the return to a more simple life we need to develop a just pride of family. We probably cannot go very far in this direction until we are more mature. A family must have back of it some genera- tions of solid achievement and a well-developed tradition before pride in it will be a powerful motive leading to the rearing of children. A young people living in an age when all things seem transitory will have little of the better sort of family pride. Such as we have is often arrogant and is scarcely more than snobbishness. This has led many earnest people to feel that concern about one's family-past or future- is undemocratic. But we shall probably never get the best out of the people in our upper classes-biologically through their children and socially in direction of national development-until they do develop a just pride in family. So long as one is thinking merely of himself and the swath he can cut in the present generation his best energies are quite likely to be directed to the accumulation of the tangible evidences of his success and to the display of these in a conspicuous manner. In such a scheme of life children are more or less of a nuisance and consequently are shunned. If, after the present standards of the upper classes have undergone a simplification and a just pride in family has developed, there should prove to be any considerable number of people in them who will not participate seriously both in the life of their own day and in that of the future, through the raising of children, it is perhaps just as well that they should die out. Certainly such people will be failures in a larger social sense as well as biologically and they probably would have nothing to contribute to the progress of mankind. One may look upon the dying out of those who worship the God Mammon as RACE SUICIDE IN THE UNITED STATES 145 nature's kindly provision for ridding the world of the over-ambitious, egotistic elements who have missed the true goal of living. SUMMARY A study of the population movements in the United States shows that the older stocks (Teutonic) are dying out in many places and are being supplanted by the newer immigrants. In Massachusetts, Rhode Island and other states in the northeast this process of substitu- tion has already gone very far. In some classes, e.g., graduates of women's colleges, deaths are almost twice as numerous as births. A comprehensive view of the situation throughout the nation shows that it is chiefly in the cities the old stocks are not holding their own. City life seems to be unfavorable to the raising of even moderate-sized families among all except the poor. In the rural districts, on the other hand, children are numerous and the rate of natural increase is much in excess of that of the urban districts. If it were not for immigration a few generations would find most of our city people tracing their descent back to the rural population of today. This would, no doubt, greatly simplify our population problems of the future for the rural population of today is largely of old (Nordic) stock. The rural population has a higher rate of increase than the city population, (1) because it has a lower death rate, and (2) because, on the average, the women give birth to more children. The death rate is lower in the country because of its generally superior health condi- tions. The families of country people are larger than those of city people both because they want more children, consequently practicing birth control less, and because involuntary restriction is a less im- portant factor in the country. If one divides the city population into four classes: the poor, the comfortable, the well-to-do, and the wealthy, he will find that the last two classes almost universally limit the size of their families voluntarily where involuntary sterility, due to venereal diseases and other biological causes, does not render this unnecessary. In the comfortable class voluntary restriction is quite common but in the poor class it is little practiced. Thus race suicide becomes a problem in eugenics and anthropology. Is it desirable to have our natural population increase come chiefly from the rural districts and the poor class in the cities? Although the vast majority of people in these classes are biologically sound yet 146 WARREN S. THOMPSON most of the biological degenerates in our population also belong to these two classes and at present they are propagating almost as rapidly as the sound stock. The upper classes-well-to-do and wealthy- probably do not propagate themselves, to say nothing of adding to the population. These classes contain much of the best ability in our population. To have them die without leaving fair-sized families is a serious matter. It means that much of the superior ability of the nation is used up in each generation. Able men and women rise into these classes and fail to propagate, thus eliminating their superior qualities from the population. If this process continues for any length of time it is bound to be harmful to the nation. The only chance of changing the attitude of the upper classes towards raising children lies in changing their standards of living. They must live more simply. Ambition, love of ease and love of luxury must be moderated and humanized before the members of these classes will be willing to raise fair-sized families. A just pride of family must also be developed among the people in these classes so that they will feel they have something worth passing on to the next generation. The subject of the effects of these conditions on the physical standards of the American people will demand future attention^ ANTHROPOMETRY ALES HRDLICKA E.-Osteometry Anthropometry of the skeletal parts (outside of the skull) is a fertile and fascinating field in which much as yet remains to be exploited and even explored. It is, moreover, a large field, which few workers may hope to cover in its entirety. Every bone of the body presents sexual, racial and individual variations, many of which remain to be thoroughly studied; and some of these features, according to indica- tions, possess a very considerable phylogenetic and racial importance. Investigations on the skeleton are for the most part of a more recent date than those on the skull or those on the living, and have been largely the work of anatomists. Descriptive observations, such as those on the sexual characteristics of the pelvis, or those on the perforated humerus, pilasteric femur, platycnaemic tibia, etc., preceded and accompanied measurements. The first serious attempt at osteometry was made essentially in France, and the first system of measurements was developed by Broca and his pupils in Paris.1 Since the early seventies a whole series of valuable contributions to the subject of bone study and osteometry have been made,2 and 1 See Broca (P.)-Sur les proportions, relatives du bras, de l'avant bras et de la clavicule chez les Nigres et les Europeens. Bull. Soc. d'Anthrop. Paris, 1862, III, 162-172; ibid., 1867, 2 ser., II, 641-653. Hamy (T.)-Recherches sur les propor- tions du bras et d'avant-bras aux differents ages de la vie. Rev. d'Anthrop. Paris, 1872, 79. Topinard (P.)-Elements d'Anthropologic Generate, 8°, Paris, 1885. 2 Bello y Rodriguez (S.)-Le femur et le tibia. These, Paris, 1909. Biimuller (J.)-Das menschliche Femur. Phil. Diss., Munchen, 1899. Bertaux (T. A.)-• L'humerus et le femur consideres dans les especes, dans les races humains, selon le sexe et selon l'age. These, Lille, 1891. Fischer (E.)-Die Variationen an Radius und Ulna des Menschen. Z.f. Morph. & Anthrop., 1906, IX, 147. Lehmann-Nitsche (R.)-Ueber die langen Knochen der sudbayerischen Reihengraberbevolkerung. Phil. Diss., Munchen; and Beitr. z. Anthrop., & Urgesch. Bayerns, 1894, XI, H. 3 & 4. Livon (M.)-De 1'omoplate. These Med., Paris, 1879. Hrdlicka (Ales)- Physical Anthropology of the Lenape or Delawares, and of the eastern Indians in General. Bull. 62, Bur. Am. Ethnol., Wash., 1916. Pfitzner (W.)-Beitrage zur Kenntniss des menschlichen Extremitatens-skeletes. Morphol. Arb., 1892, I, 516; 1893, II, 93. Rollet (E.)-La mensuration des os longs des membres. These med., Amer. Jour. Phys. Anthrop., Vol. Ill, No. 1. 147 148 ALES HRDLICKA much work in this line, particularly in the United States, is as yet un- published. The repeated discoveries of skeletal remains of early man have in particular stimulated research in this direction. Not- withstanding all this, however, we are still far from a satisfactory grasp of the evidence which the bones embody. The reasons are, in the first place, that the gathering of skeletal material has always lagged behind that of the skulls, so that even today most anthropologi- cal collections are relatively poor in that respect, which hinders com- prehensive and conclusive investigations. Besides this, the bones of the skeleton present many features and correlations the study of which demands large series of specimens, and in many cases also the presence of all the important constituents of the skeleton or the bones of the two sides of the body, conditions which are realizable with difficulty even among the Whites, not to speak of other peoples. The field will long remain, therefore, one of a very considerable importance, and no pains should be spared to develop the technique of osteological ex- amination. The scheme here presented rests on the same principles as those presented before for anthropometry and craniometry. It utilizes the most useful procedures of other scholars, supplements these where extensive individual experience warrants, leaves aside every- thing superfluous or of value only in special studies, and aims at the utmost simplicity. INSTRUMENTS The matter of osteometric instruments has already to some extent been dealt with in the section on Craniometry (Vol. II, 1919, p. 50). The essentials are few. They are the Broca's osteometric board (pl. 1), the small compas glissiere and for a few measurements also the large sliding compass; but other instruments may be needed for special investigations. Lyon, 1889; Intern. Monatschr. & Anat., 1889, VI, 345. Soularue (M.)-Recherches sur les dimensions des os et les proportions squeletiques de 1'homme. Bull. Soc. d'Anthrop. Paris, 1899, Ser. 4, X, 328. Turner (Sir Wm.)-Report on the human crania and other bones of the skeletons collected during the voyage of H. M. S. Challenger, 1873-6: II-The bones of the skeleton. Challenger Reports, Zook, 1886, Pt. XLVII. Verneau (R.)-Le bassin dans les sexes et dans les races. These Med., Paris, 1875. Volkov (Th.)-Variations squelettiques du pied ches les primates et dans les races humaines. Bull. Soc. d'Anthrop. Paris, 1903, Ser. 5, IV, 622; 1904, V, 1, 201. Waldeyer (W.)-Das Becken. Bonn, 1899. Wetzel (G.)-Volumen und Gewicht des Knochens als Massstab fUr den phylogenetischen Entwicklungsgrad. Arch. f. Entw. d. Organismen. 1910, XXX, 507-537. ANTHROPOMETRY 149 Pl. 1. Osteometric board with block; goniometer (translucent); leather ring, for support of skulls while being measured and examined. 150 ALES HRDLICKA The osteometric board is too well known to need special description ; but for the original accessory square the writer uses a block of light wood (see pl. 1), which offers certain advantages. The block is 9.5 cm. high and 4.5 cm. thick, while its length equals the breadth of the board. For description of instruments used on special occasions the student should consult the original sources.1 BLANKS The matter of blanks in osteometry presents some difficulties on account of the many distinct bones each of which requires its own blank. An outline of a blank such as used for general purposes by the writer will be given separately with each bone. Such blanks may be made by the student himself, and their scope may be enlarged as demanded by the needs of the occasion. As they are they represent what invariably we should know of each of the bones. observations: typical bone variants in form Before proceeding to the measurements, attention should be given to the important subject of bone variations in shape. Each of the long bones, and also the scapulae, first rib, etc., present a variety of forms which are reducible to definite types, and the fre- quency of these types differs from race to race. In the remainder of the skeletal parts similar variations occur, but they are less classifiable. The whole subject is of very considerable anthropological, phylo- as well as ontogenetic, importance. In the long bones the part that varies most in form is the shaft; in the scapula it is in the contour of the bone.2 Bones of less conse- quence will be considered on other occasions. 1 Besides the Memoirs of Broca and the textbooks of Topinard and Martin, see: Emmons (A. B.)-A study in the variations of the female pelvis. Biometrica, 1913, IX, 34-57. Garson (G.)-Pelvimetry. J. Anat. & Physiol., 1882, XVI, 106-134. Frassetto (F.)-Lezioni di anthropologia, 1911-1913. Hepburn (D.)-A new osteo- metric board. J. Anat. & Physiol., 1899, XXXIV, 111. Matthews (W.)-An apparatus for determining the angle of torsion of the humerus. J. Anat. & Physiol., 1887, XXI, 536-8. Russell (F.)-A new instrument for measuring torsion. Am. Nat., 1901, XXV, 299. 2 For original reports on this subject see Hrdlicka (Ales)-Study of the normal tibia. Am. Anthrop. 1898, XI, 307-312; Proc. Ass. Am. Anat., 11 Sess., Wash. 1899, 61-66. A further contribution to the study of the tibia, relative to its shapes. Proc. Ass. Am. Anat., XII & XIII Ses. Wash. 1900, 12-13.-Typical forms of shaft of long bones. Proc. Ass. Am. Anat., XIV Sess., Wash. 1901, 55-60. Also Bull. 62, Bur. Am. Ethnol., Wash. 1916. Consult also: Manouvrier (L.)-La platycnemie ANTHROPOMETRY 151 Long Bones: The form of the shaft of the long bones is best differenti- ated at or near the middle of the bones, in adult individuals. Variation in these shapes is greatest in the Whites. There are considerable racial and other group differences in the relative fre- quency of the different types of the shaft of the various bones; no one type, however, occurs exclusively or is completely absent in any of the human groups now existing. Some of the shapes are common to the anthropoid apes, and others occur far back in the animal kingdom. The bones of the lower extremity show more numerous and better defined differentiations of form than those of the upper extremity. Of the individual long bones, the fibula presents the greatest variety of shapes; then follow in the order named, the tibia, femur, humerus, ulna, and radius. Perfect representations of the various types of each bone are found whenever large collections are examined, but the less perfect and less clearly distinguishable types are always more common. Besides there is always a considerable percentage of bones which present intermediary or indefinite, and a small proportion which show com- bined forms. The form of shaft common to all the long bones in man is the pris- matic (No. 1). The outline of the cross-section of a shaft of this type approaches the equilateral triangle. This type is also common in apes, and more or less modified in lower mammals. The base of the prism is formed in the tibia, fibula, and humerus by the posterior surface; in the femur by the anterior surface; in the ulna by the in- ternal, and in the radius by the external surface of the bone. In whites this type of shaft is most frequent in the humerus and tibia. In the fibula it is more or less modified by the narrow anterior surface of the bone. The nearest modifications of type 1 are types of shaft Nos. 2 and 4. Type 2 occurs principally in the tibia, fibula and humerus; and is characterized by the obliquity of the posterior surface of the bone. The outline of the cross-section is a lateral triangle, a half lozenge (more or less). Type 4 occurs in all the long bones, and is charac- chez 1'homme et chez les singes. Bull. Soc. d'Anthrop. Paris, 1887, Ser. 3, X, 128.-■ M^moire sur la platycnemie chez 1'homme et chez les anthropoids. Mem. & Bull. Soc. d'Anthrop. Paris, 1888, Ser. 2, III, 469.-Etude sur les variations morphologiques du corps de femur dans 1'espece humaine. Bull. Soc. d'Anthrop. Paris, Ser. 4, IV, III; Rev. d'Ecole d'Anthrop. Paris, 1893, III, 389. And Graves (Wm. W.)-The scaphoid scapula. Med. Record, May 21, 1910; Wien. klin. Woch., 1912, XXV, No. 6; J. Cutan. Dis., etc., April, 1913; and others on same subject. 152 ALES HRDLICKA ANTHROPOMETRY 153 terized by the presence of a distinct additional surface on the shaft. The formation of the surface differs in the various bones. In the tibia the additional surface results from a division into two, by a vertical ridge, of the posterior surface; in the femur it is the anterior, in the radius the external, and in the ulna the posterior surface, which occasionally, through the influence of a vertical ridge, shows a forma- tion of a distinct additional plane; in the humerus, finally, a new, anterior surface results occasionally by the broadening out of the anterior border of the bone. The cross section of the shaft in these cases differs from lozenge shape (more or less) to a more even quad- rangle. A special class of modifications of the form of the shaft is that where one or more surfaces of the bone show a pronounced concavity. We find such types (3, 3a, 3b,) particularly in the fibula, but also in the tibia, ulna and radius. In the fibula the concavity affects es- pecially the external, but also the internal, and occasionally both the external and internal, and even the posterior surfaces; in tibia the character is observed on the external, and in the ulna and radius mainly on the anterior, flexor, surface. Types 5, 6, e and r, are widely differing forms of the shaft of some of the long bones; all these types have, nevertheless, two features in common, and that is an indistinctness or complete absence of one or more of the borders of the bone, with marked convexity of two or all the surfaces. Type 5 occurs occasionally in the tibia and frequently in the radius. It is marked by the convexity of the posterior tibial and external radial surface, and by indistinctness of the internal and sometimes also the external border in the tibia and the anterior and posterior borders in the radius. In both bones, but particularly in the tibia, this type of form represents a deficiency in the differentiation of the bone. Type No. 6 occurs in the tibia, femur and humerus. The shaft is plano-convex. Types e (elliptical) and r (round, cylindrical) are found in the femur. The condition of flatness in long bones occurs quite independently of the shape otherwise of these shafts. Flatness is not only found in the tibia, but also in the fibula (lateral), in the femur (antero-posterior of whole shaft, and, independently, antero-posterior of the upper part of the shaft, below the minor trochanter), and in the humerus (lateral). The flat femur (whole shaft) occurs almost exclusively in whites and independently of the flatness of other long bones. It is a 154 ALES HRDLICKA ANTHROPOMETRY 155 rare and possibly abnormal condition. A flat tibia is often accom- panied by a flat fibula, and not seldom also by a platymeric (flat in upper part) femur. The scapula presents three main shapes or types, namely, the triangular or wedge-shaped; the bi-concave, with its axillary and especially vertebral border concave (the "scaphoid" scapula of Graves); and the convex, with its vertebral border markedly convex. Causes.-The shape of the bones is influenced by heredity, stage of development, sex, muscular activity, size of body, and pathological conditions. Heredity: There are reasons to believe that certain types of bones run in families; and essentially through differences in heredity there are marked differences in the relative frequency of occurrence of the various types in different races. Stage of life: During fetal life and early childhood, the shapes of bones are fewer in number, and do not always correspond to the shapes the bones will eventually have in the adult. Differentiation advances with age and the shape of a bone is probably not fully stabilized, particularly as to fluting, before advanced adult life. Sex: The male bones show on the whole a greater differentiation of shapes than the females; also, some types of form are more common in one sex than in the other. Most, if not all these differences, may, however, be due to differences in muscular activities. Race: The modern cultured Whites show more variation in shape of bones than the Indians, and the Indians more than the Negro or Negrito. The causes appear to be partly hereditary and partly occupational. Muscular activity: Muscular peculiarities and muscular activites of the individual exercise a potent influence in modifying the shape of the bones. Size of the body: The largest and the smallest bones of any variety show in general less differentiation than the average; and weak bones show more uniformity than the strongly developed. Pathological: Very prolonged undernourishment or vitiated state of blood during fetal life or childhood may undoubtedly affect the general development as well as the shape differentiation of bones; but no proof exists that special pathological states are responsible for any special form-types of individual bones. The sum of the observations points to the fact that the principal causes of the various shapes of the shafts of the long and bodies of 156 ALES HRDLICKA other bones must be sought for, first, in original differences in the attachment of the various muscles on the shafts; and second, in an unequal development and work of the individual muscles during child- hood and adolescence. The original differences in attachment, some of which can be clearly seen on the bones, are in all probability partly hereditary, partly early acquired conditions. The manner in which the differently attached or differently developed muscles affect the shape of bone must of course be largely if not entirely mechanical. ADDITIONAL OBSERVATIONS In addition to shape, the bones of the skeleton offer an array of highly interesting points for observation, and many of these, as already mentioned, are of phylogenetic importance. Of these, the main ones will be included in the blanks to be given. MEASUREMENTS Blank: Humerus Tribe Locality Observer Right Left Cat. No. Sex Age Length Max. At Middle : Observations : Diam. Major (a) Diam. Minor (b) Index Shape of Shaft1 Perforation of Septum2 Supra- condylar Processes3 Special Patho- logical - 1 Type 1 = prismatic; 2, 2a = lateral prismatic (2 = posterior surface facing backward and inward; 2a = posterior surface facing backward and outward); 4 = quadrilateral (anterior border broadened out to a distinct fourth surface); 6 = plano-convex; i = intermediary or indistinct. 2 pp = pin point; sm = small; m = medium; I = large. When double or multi- ple, state so. 3 None (-); rough trace = r. h; ridge: slight, medium, pronounced (r. sl-m-pr}', tubercle: slight, or medium (tb. sl-m); process: 1/3, 1/2, 2/3, etc., complete (pr. 1/3, 1/2, 2/3, etc.). Notes.-The length is taken on the osteometric board. Apply head to the vertical, take hold of bone by left hand, apply block to distal extremity, and raising bone slightly, move up and down as well as from side to side until maximum length is determined. ANTHROPOMETRY 157 Diameter major at middle.-C. g. Determine mid-point of shaft on osteometric board and mark with pencil. Diameter minor at middle.-Apply fixed branch of sliding compass to the antero-lateral surface at middle and take measurement. Radius Tribe Locality Observer Right Left Cat. No. Sex Age Length Max. Shape1 Anomalies Pathological Radio- Humeral Index2 Note: Maximum length is taken in same way as that of the humerus. Ulna Tribe Locality Observer Right Left Cat. No. Sex Age Length Max. Shape3 Anomalies Pathological • Note: Maximum length is taken in same way as that of the humerus. 11 = prismatic; 2 = flexor surface concave (fluted); 5 = external surface con- vex, borders indistinct. 2 Length of Radius X 100 Length of Humerus 31 = prismatic, 2 = flexor surface concave (fluted); 4 = quadrilateral (posterior) surface divided into two, so that the shaft presents four distinct surfaces, borders and angles. 158 ALES HRDLICKA Femur Tribe Locality Observer Right Cat. No. Sex Age Length Bicondylar Length Max. Humero- femoral Index1 At Middle: Diam. Antero- Posterior Maxim. Diam. Lateral Index2 - {Continued') Left At Upper Flattening: Observations: Diam. Lateral Maxim. Diam. Antero- posterior Minim. Index3 Shape of Shaft4 Third Condyle5 Llnea Aspera6 Anomalies Patho- logical Notes: The bicondylar length of the femur is taken by adjusting both condyles to the vertical part of the osteometric board and applying the block to the other extremity. The length maximum of the femur is measured in the same way as the maximum length of other bones (see under Humerus). The antero-posterior diameter at middle (middle of shaft determined and marked beforehand) is the diameter maximum. The lateral diameter at middle is taken so that the linea-aspera reposes on the stem of the sliding compass midway between the two branches of the same while these are applied to the bone. 1 Length of Humerus X 100 Bicondylar length of femur 2 Diam. lat. X 100. Diam. ant.-post. 3 Diam. minium X 100. Diam. maxim. 4 Type 1 = prismatic; 4 = quadrilateral (anterior surface divided by a vertical ridge in two); r = cylindrical (juvenile); e = elliptical; pc = plano-convex. = ridge; o. t. = oblong tuberosity; r. t. = round tuberosity; d = depression; All: slight, moderate, or pronounced. 6 si., mod., pron. 159 ANTHROPOMETRY In plano-convex and related femora the shaft is so deformed and the linea-aspera so displaced, that the measurement of the diameters is impractical and should be omitted. Circumference of the shaft at middle as taken by some observers and contrasted with the length of the bone gives data of some value for sexual identification; but the same may be done with the mean of the two diameters. Tibia Tribe Locality . Observer Right Cat. No. Sex Age Length (Less Spine) Length Maxim. . Tibio-temo- ral Index1 At Middle: Diam. Antero- posterior Max. (a) Diam. Lateral (&) Index {Continued) Left Observations: Pathological: Shape2 Peculiarities Curvature Exostoses Other 1 Notes: To take the ordinary length of the tibia introduce the spine into the orifice provided for this purpose in the vertical part of the osteometric board, apply outer parts of the condyles to the vertical outside of the orifice, let body of the bone repose on the horizontal part of the board, and apply block to the most distant point (mal- leolus). i T X 100 Bicond. I. of femur 2 Type 1 = prismatic; 2 = lateral prismatic; 3 = external surface concave (fluted); 4 = posterior surface divided in two; 5 = posterior surface convex, in- ternal border indistinct; 6 = plano-convex (gorilloid). 160 ALES HRDLICKA It is also useful to take the maximum length of the tibia. This is secured by placing the spine within the orifice as with the previous measurement, applying the most prominent point of the condyles to the vertical, taking hold of the body by the left hand and moving the bone from side to side as well as slightly upward and downward, while holding the block applied to the malleolus, until the maximum length is determined. Fibula Tribe Locality Observer Right Left Cat. No. Sex Age Length Max. Shape1 Anomalies Pathological Scapula Tribe Locality Observer Right Cat. No. Sex Age Height Total (a) Height Infra- spinous (6) Breadth (c) Index:7 Total Index: Inferior3 Type4 - Notes: The total height of the scapula is obtained by measuring in a straight line the distance from the superior to the inferior angle. 11 = Ordinary quadrilateral, approaching prismatic; anterior surface nearly absent to moderate; posterior surface facing directly backward or nearly so. 2 = Lateral prismatic; posterior surface facing backward and inward; medial surface much less in area than lateral; anterior surface narrow to broad. 2a = relation between medial and lateral surface reversed, the latter being the narrower. 3 = medial surface fluted; 4 = lateral surface differentiated into two surfaces; 5 = lateral surface fluted; 6 = both medial and lateral surfaces fluted; 9 = all three surfaces deeply fluted. 2 c X 100 a 3 c x 100 b 4 Type: 1 = triangular; 3 = biconcave ("scaphoid"), axillary and vertebral borders concave; 6 = convex, vertebral border convex. ANTHROPOMETRY 161 Scapula (Continued') Observations: Shape of Su- perior Border1 Notch2 Vertebral Border3 Axillary Border* Anomalies Pathological • Left The infraspinous height is the height from the inferior angle to a point at which the spine transects the vertebral border of the bone. To determine this point hold scapula in left hand with dorsal surface up in such a way that the eye can follow the prolongation of the spine to the axillary border. Mark the mid point of the juncture of the spine with the border (and not the lower or upper limit). The breadth of the scapula (c) is the diameter from the middle of the outer (dorsal) border of the glenoid cavity to the point where the spine intersects the vertebral border. (Broca, P. -Sur les indices de lon- gueur de 1'omoplate chez 1'homme, les singes et dans la serie des mammiferes. Bull. Soc. d'Anthrop., 1878, Ser. 3, I, 66.)5 Sternum6 Tribe Locality Observer Cat. No Sex Age Total Length (Less Xiphoid) («) Length of Man- ubrium (m) Manubrial Index ^mXlOO^ Great- est Breadth of Body (&) Sternal Index PH Maxi- mum Thick- ness of Body Nur of Fa nber Rib rets I. Anoma- lies Re- marks 11 = horizontal, at right angle, or near, with coracoid; 2 = moderate obliquity upwards, angle 55-80; 3 = pronounced obliquity, angle near 45; 4 = semiquadrate; 5 = semicircular; 6 = wavy. 21 = none; 2 = slight; 3 = moderate; 4 = nearly a foramen; 5 = foramen. 31 = straight; 2 = concave; 3 = convex: slightly-moderately-pronouncedly. 41 = straight; 2 = teres process slight; 3 = moderate; 4 = pronounced. 5 Were it not for the amount of work done with this breadth, it would be preferable to take that from the slight depression or roughness in the middle of the glenoid fossa to the spine-point, for the borders of the fossa ar'e liable to some irregularities of development, besides which the mid-glenoid point is the more suitable in measure- ments of scapulae of various animals. 6 Consult: Anthony (R.)-Notes sur la morphogenie du Sternum chez mammiferes. 162 ALES HRDLICKA Notes: The length of the sternum as well as that of the manubrium is best measured on the osteometric board; the breadth and thickness of the bone are measured with the sliding compass. The thickness of the body should be measured between the facets for the ribs. Among the anomalies are to be observed especially the foramen or defect in the lower part of the bone, and the occurence of episternals. The relative proportions of the manubrium and body of the sternum show sexual as well as group differences; and the same may be said in regard to the fusion of the manubrium with the body of the bone. Clavicles1 Tribe Locality Observer Right Left Cat. No. Sex Age Length Maximum Conoid Tuberosity Strength2 Curvature3 Anomalies Notes: The length of the clavicle is best determined on the osteometric board, but may also be measured by the small or the large sliding compass. The comparison of the length of the clavicle with the length of the humerus (claviculo-humeral index) is useful as an indication of the relative development of the thorax. The acromial extremity may in rare cases be separated; a few other anomalies may also occur. Bull. Soc. d'Anthrop. Paris, 1901, II, 19-43. Dwight (Thos.)-The Sternum as an index of sex, height and age. J. Anat. & Physiol., 1890, XXIV, 527-535. Krause (W.)-Ueber das weibliche Sternum. Intern. Monatsschr. f. Anat. & Physiol., 1897, XIV, 21-32. Parker (W. J.)-Structure and development of the Shoulder Girdle and Sternum in the Vertebrates. Roy. Soc. Publ., Lond., 1868. Paterson (A. M.)-The human sternum. Liverpool, 1904; also Brit. Med. J., 1902, II; and J. Anat. & Physiol., 1900, XXXV, Pt. 1. 1 Consult Pasteau (E.)-Recherches sur les proportions de la Clavicule. These med., Paris, 1879; also Parsons (F. G.)-On the proportions and characteristics of the modern English Claricle. J. Anat., Lond., 1916, LI, 71-93. 2 SI = slender; m = medium.; str = strong; mas = massive. 3 SI = slight; m = medium; pron = pronounced. ANTHROPOMETRY 163 Ribs1 Tribe Locality ' Observer Cat. NO. Sex Age Number Present Anomalies Fractures and Pathological 1st Rib Shape.2 Remarks R. L. Notes: In skeletal material obtained from older graves the ribs are seldom all present and in good condition; nevertheless their examina- tion should not be neglected. Cervical, supernumerary, bifid, bici- pital and fused ribs are of special interest; and other anomalies may occur. The first rib deserves special attention, particularly as to its shape. The development of the scalene tubercle may also be noted on the first rib. Spine3 Tribe Locality Observer Atlas: Other Cervical:. Dorsal: Lumbar: Cat No. Sex. Age Anoma- lies Re- marks Num- ber Anoma- lies ■ Re- marks Num- ber Anoma- lies Re- marks Num- ber Anoma- lies Re- marks 1 Bardeen (Ch. R.)-Costo-vertebral variation in Man. Anat. Anz., 1900, XVIII, 377-382. Hrdlicka (Ales)-Contribution to the Osteology of Ribs, Proc. Ass. Am. Anat., XIV Sess., Wash., 1901, 61-68. Tredgold (A. F.)-Variations of Ribs in the Primates with especial reference to the number of sternal Ribs in Man. J. Anat. & Physiol., 1897, XXXI, 288-302. 21 = curved (semilunar); 2 = monoangular or pistol-shaped (nearly straight neck, with nearly straight body); 3 = biangular (distinct angle in body, besides that between neck and body). 3 Consult: Anderson (R. J.)-Observations on the diameters of human vertebrae in different regions. J. Anat. & Physiol., London, 1883, XVII, 341-4. Bardeen (Chas. R.)-Numerical Vertebral Variation in the Human Adult and Embryo; Anat. Anz., 1904, XXV, 497-519. Cunningham (D. J.)-Lumbar Curve in Man and the Apes. Dublin, 1886. Dubreuil-Chambardel (L.)-Variations sexuelles de 1'Atlas. Bull. & Mem. d'Anthrop., Paris, 1907, VIII, 399-404. Dwight (Thomas)- 164 ALES HRDLICKA Notes: Various measurements and many detailed observations are possible on the spine and its different constituents. As to measure- ments, the most interesting are the relative lengths of the cervical, dorsal and lumbar parts of the spine compared with the total length of the three. The length of these parts is best taken by the small and large sliding compasses, between the mid points anteriorly of the upper and lower border of the body of the first and last vertebra of each segment, with the bones held in a close and natural apposition. The atlas should receive special attention, for it is subject to many independent variations, particularly in respect to blood vessel foramina and canals. The lowest part of the dorsal and the uppermost as well as lower- most parts of the lumbar segment, are also of special interest, the former on account of occasional numerical variation, the latter on account of occasional separation of neural arch, a presence of a sacral element with more or less assimilation, etc. The minor anomalies of the spine and its constituents should be reserved for special study. Sacrum, Pelvic Bones, Pelvis Tribe Locality Observer Cat. No. Sex Age Sacrum: Height Maxim.1 Breadth Maxim. Sacral Index2 Number of Segments Curva- ture3 Curvature Begins at4 Special Description of the Human Spines showing numerical variation. Mem. Boston Soc. Nat. Hist., 1901, 237-312, also, Anat. Anz., 1901, XIX, 332, 337-347; and Anat. Anz., 1906, XXVIII, 33-40, 96-102. Hrdlicka (Ales)-The atlas of Monte Hermoso. In Bull. 52, Bur. Am. Ethnol., Wash. 1912, 364-9. Papillault (G.)-Variations numeriques des vertebres lombaires chez 1'homme. Bull. Soc. d'Anthrop., Paris, 1898, IX, 198-222. Ranke (J.)-Zur Anthropologie der Halswirbelsaule. Sitz, math. phys. Cl. bayer. Akad. Wiss., 1895, XXV, 1-23. Ravenel (M.)-Die Maas- verhaltnisse der Wirbelsaule and des Riickenmarkes beim Menschen. Dwang. Dissert., Leipzig, 1877, 1-27. Regalia (C. E.)-Sulla causa generale delle anomalie numeriche del rachide. Arch. p. Antrop. & Etn., 1895, XXV, 149-219. Rosenberg (E.)-Ueber die Entwicklung der Wirbelsaule. Gegenbaur's Morphol. Jahrb., Leipzig, 1875,1, 1-111. Soularue (G. Martial)-Etude des proportions de la colonne vertebrale chez 1'homme et chez la femme. Bull. Soc. d'Anthrop. Paris, 1900, Ser. 5, I, 132-147. Zoja (G.)-Sulle varieta dell'atlante. Bol. sci., 1881, Nos. 1 & 2, repr. 24 pp., Also C. R. R. 1st. Lomb., Cl. Sc. mat. & nat., 1881, XIV, 269-296. ANTHROPOMETRY 165 {Continued') Sacrum, Pelvic Bones, Pelvis Ossa Innomlnata Pelvis: Height Maxim. Breadth Maxim. Mean Index5 Special Features Breadth Maxim.6 Total Index7 Superior Strait: Breadth Maxim. Diameter Antero- posterior Maxim.8 Pelvic Index Re- marks Right Left Right Left Notes: In measuring the height of the sacrum use sliding compass, and apply points of instrument to middle of promontory and middle of anterior-inferior border of the fifth sacral vertebra. For general comparative purposes measure only sacra with five segments. In measuring breadth apply stem of compass to the upper surface of the body of the first sacral vertebra and measure the greatest expanse of the lateral masses of the bone. The height of the ossa innominata is best measured on the osteo- metric board. Apply ischium to the vertical part of the board, hold bone with left hand, apply block to iliac border with right hand and move bone up and down and from side to side until maximum measurement is obtained. The breadth of the ossa innominata is best measured by the sliding compass. It is the distance between the anterior and posterior superior spines. For measuring the pelvis as a whole articulate the bones, hold with both hands, invert, and secure breadth maximum of ilia on the osteo- 1 Long branch of sliding compass applied ventrally, in median line, to anterior border of lower end and to promontory. 2 Breadth X 100 , Height 3 Slight, moderate, pronounced. 4 Name segment (from above). 6 Mean breadth X 100 . mean height 6 Pelvis held together with bones in natural position; the bread this the bi-iliac maximum, and can be taken handily on the osteometic board, or by a second person with the large sliding compass. 7 Breadth X 100 . mean height of ossa innominata 8 From promontory of the sacrum to the nearest point on the ventral border of the pubic bones. 166 ALES HRDLICKA metric board. With the help of a pelviphore (such as that of Emmons) the taking of this measurement and of those of the brim becomes a simple matter. To measure the diameters of the superior strait or brim of the pelvis without a pelviphore, hold pelvis in left hand, and use small sliding com- pass. The antero-posterior diameter is that between the mid point on the promontory of the sacrum and the nearest point on the ventral borders of the pubic articulation. The lateral diameter is the maxi- mum transverse diameter of the brim. A natural slight separation of the pubic bones should be retained during all measurements. Short Bones Patella.1 Tribe Locality Observer Right Left Cat. No. Sex Age Height Maxim. Breadth Maxim. Thickness Maxim. Breadth-Height Index (BX 100) 11 Patellar Mod- ule (H+B+T) 3 Vastus Notch2 Notes: All the measurements to be taken with the small sliding compass. In measuring the height and breadth of the bone, move the latter slightly from side to side between the branches of the compass until the maximum measurement is determined. The height is taken by applying the fixed branch to the anterior surface of the bone and bringing the movable branch posteriorly over its thickest parts. The vastus notch shows interesting variations. Consult: Corner (E. M.)-Varieties and structure of the Patella of Man. J. Anat. & Physiol., 1900, XXXIV, XXVII-XXVIII; also Ten Kate (H.)-Rotule. Rev. Mus. La Plata, 1896, VII, 12-16; and Bull. 62, Bur. Amer. Ethnol., Wash. 1916. 2-'none; si = slight; m = moderate; 1 = large. ANTHROPOMETRY 167 Calcaneus1 Tribe Locality Observer Right Left Cat. No. Sex Age Length | Maxim. Breadth | Minim. Height of | Body Breadth- Length Index (B X 100) L Breadth- Height Index (B x 10C) H Height- Length Index (H X 100) L Module (L + B + JT) 3 Articular Facets for Astragalus Anomalies Remarks Notes: All measurements to be taken with the small sliding compass. The taking of the maximum length will be self-evident. To secure the breadth, the branches of the compass should be applied to the sides of the bone in the region of the minimum thickness of its body. The most practicable height of the calcaneus is obtained by moving the bone from side to side between the branches of the compass, which are applied to what is seen to be the greatest constriction of the body (approximately its middle). As to visual observations oh the Os calcis, the greatest interest attaches probably to the number and conformation of the articular facets for the astragalus. These facets may be two in number, an- terior and posterior. But the anterior facet may be divided into two by a ridge; or it may be replaced by two facets, anterior and median, completely separated by a narrow to moderately broad groove or space; or, finally, in place of the single oblong anterior facet there may be a small to rudimentary anterior and a medium-sized median facet, separated by a broad and deep notch. An additional point of some interest is the development of the peroneal spine. 1 See Bull. 62, Bur. Amer. Ethnol., Wash., 1916. 168 ALES HRDLICKA Astragalus1 Tribe Locality Observer Right Left Cat. No. Sex Age Length Maxim. Breadth Maxim. Height Maxim. Breadth- Length Index (BX 100) L Height- Length Index (HX ICO) L Module (L+B + H) Facets for Calcaneus2 II Special 3 Notes: For length maximum, apply stem of sliding compass to lowest (most prominent) parts of the medial surface on the bone. The maximum breadth is taken by applying the fixed branch of the sliding compass to the lowest (most prominent) parts on the medial surface of the bone. The maximum height of the astragalus is best taken on the osteo- metric plane, on which the bone is placed so that all the three lowest points of its inferior surface touch the vertical part, while the block is applied to the most prominent part of the bone from the opposite direction. . A comparative study of the calcaneus facets on the talus with the corresponding facets on the latter bone, is of considerable interest, and shows some racial variations. Scaphoid3 Tribe Locality Observer Right Left Cat. No. Sex Age Breadth Maxim. Height Maxim. Stout- ness Maxim. Height- Breadth Index (HX 100) B Stoutness- Breadth Index (SX 100) B Facet for Cuboid4 Facet for Talus, Form6 Tuber- osity6 Addi- tional 1 See Bull. 62, Bur. Am. Ethnol., Wash,, 1916. 21 = one facet not divided by any ridge; 2 = one facet divided into two by a ridge; 3 = two distinct facets, but slightly connected or completely apart. 3 See Bull. 62, Bur. Am. Ethnol., Wash., 1916. 4 Present or absent. 6 Pf = pyriform; q - quadrilateral; i = intermediary or indefinite. 6 p = pointed; bl = blunt (markedly); sq = squarish. ANTHROPOMETRY 169 Notes: The maximum breadth of the bone is taken by the small sliding compass and is measured from the extremity of the tuberosity ad maximum. To take the maximum height of the bone use the large sliding com- pass with broad branches; hold instrument vertically, lay bone on movable branch on its talus facet, raise the branch until the bone touches the under surface of the fixed branch and read measurement. To measure the stoutness use same instrument as for height. Lay bone on the movable branch of the compass on its dorsal or superior surface, let it assume a natural position, and raise the branch until the most prominent part of the plantar surface of the bone touches the under surface of the fixed branch. Cuboid1 Tribe Locality Observer Right Left Cat. No. Sex Age Length Maxim. Breadth Maxim. Thick- ness Maxim. Breadth- Length Index CBX1OO) L Thickness- Length Index (TX100) L Module 3 Facet for Cunei- form2 Facet for 1 Talus3 Addi- tional - Notes: The maximum length of the bone is measured with the small sliding compass, between the most prominent point on the superior and inferior borders of the distal or metatarsal facet of the bone and the point at the inferior medial angle (calcanean process). The maximum breadth is obtained with the cuboid resting on its medial surface in such a position as it naturally assumes. This and the next measurement are best taken by the large sliding compass with broad branches. The maximum thickness is taken with the cuboid resting on its anterior surface in such position as it naturally assumes. 1 See Bull. 62, Bur. Am. Ethnol., Wash., 1916. 2 s = single; r = divided in two by a well marked ridge; 3 = double (connected or not). 3 Present or absent. 170 ALES HRDLICKA Internal Cuneiform1 Tribe Locality Observer Right Left Cat. No. Sex Age Height Maxim. Breadth Minim. Breadth-Height Index (^X 100) H Metatarsal Facet2 Additional Note: Measurements taken with sliding compass. Height maxi- mum is secured by applying the fixed branch of the compass to the most prominent parts of the inferior surface of the bone and bringing the other branch into apposition. The minimum breadth, in the middle of the bone, is obtained by applying the fixed branch of the compass so that it rests on both lips of the scaphoid facet, and bringing the other branch into apposition with the bone. It is the only practicable breadth in all specimens. External cuneiform: Note frequency of absence of facet for fourth metatarsal, also for second metatarsal. Middle Cuneiform: Note character of central ligamentous depression and canal running downward from this. Bones of the Hand3 Tribe Locality Observer Right Left Cat. No. Sex Age Bones of Carpus: Metacarpals: Metacarpo- Humeral Index1 Phalanges: Number Obser- vations Number Re- marks Length Max. of 1st Meta- carpal Number Re- marks 1 See Bull. 62, Bur. Am. Ethnol., Wash., 1916. 2 Single or double. 3 See Bull. 62, Bur. Am. Ethnol., Wash., 1916. 4 Max. length of 1st metacarpel X 100 . Max. length of humerus ANTHROPOMETRY 171 Bones of the Foot1 Tribe Locality Observer Right Left Cat. No. Sex Age Metatarsals: Re- marks Phlanges: Number Obser- vations 1st Metatarsal: Hallux Fe- mur Index3 Num- ber Re- marks Length Maxim. Pollux-Hal- lux Index2 ESTIMATION OF STATURE FROM PARTS OF THE SKELETON4 The International Agreement of Geneva stipulates that: "For the reconstruction of the stature with the aid of the long bones, the maxi- mum length shall be measured in all cases save in those of the femur which is to be measured in the oblique position, and the tibia which is also be to measured in the oblique position, the spine being excluded." Under these conditions and until something more serviceable may be provided, the student is advised to use Manouvrier's tables, which are here reproduced. These tables apply* only to bones of adults; and a proper sexual identification is in each case of the greatest importance. All the long bones present should be measured and the mean length of each pair used for the approximations in the table, the mean of the total of approximations giving the stature. 1 See Bull. 62, Bur, Am. Ethnol., Wash. 1916. 2 Max. length of 1st metacarpal X 100. Max. length of 1st metatarsal 3 Max. length of 1st metarsal X 100 . Bicondylar length of femur ' • 4 Dwight (Thos.)-Methods of estimating the height from parts of the skeleton. Med. Rec., Sept. 8, 1894. (Gives data for estimating stature also from length of sternum and that of the spine.) Manouvrier (L.)- Determination de la taille d'apres les os longs. Rev. Ec. d'Anthrop. Paris, 1892, II, 227.-La determination de la taille d'apres les grands os des membres. Mem. Soc. d'Anthrop., Paris, 1893, Ser. 2, IV, 347-411. Pearson (K.)-On the reconstruction of the stature of prehistoric races. Philos. Trans. R. Soc., London, 1899 (Mathematical); CXCII, Ser. A, 169-244. Rollet (E.)-La mensuration des os longs des membres. These med., Lyon, 1899 (Similar to Manouvrier). Topinard (P.)-De la restitution de la taille par les os longs. Rev. d'Anthrop., Paris, 1885, VIII, 134.-Procede des mensuration des os longs dans le but de reconstitues la taille. Bull. Soc. d'Anthrop., Paris, 1885, VIII, 73-83. Also Elements d'Anthropologic generate (used maximum lengths throughout). Older data unreliable and lack precision of methods. 172 ALES HRDLICKA The final estimate will be the more reliable the larger the series of subjects involved. In single individuals the error, as Dwight has shown, may be very considerable, particularly in tall males (1 up to 11.9 cm.).1 Percentage of Stature 17.7 1S.1 to 18.5 18.6 to 19 19.1 to 19.5 19.6 to 20 20.1 to 20.5 2C.6 to 21 21.1 to 21.6 Percent of Bones Males Females 1.4 11.7 12.2 24.3 20.7 27.1 31.7 21.6 18.3 9 9.8 3.7 7.3 1.1 Manouvrier's Tables Showing the Correspondence of Bone Lengths among Themselves and with Stature Males Humerus Radius Ulna Stature Femur Tibia ■ Fibula cm. cm. cm. cm. cm. cm. cm. 295 213 227 1,530 392 319 318 298 216 231 1,552 398 324 323 302 219 235 1,571 404 330 328 306 222 239 1,590 410 335 333 309 225 243 1,605 416 340 338 313 229 246 1,625 422 346 344 316 232 249 1,634 428 351 349 320 236 253 1,644 434 357 353 324 239 257 1,654 440 ' 362 358 328 243 260 1,666 446 368 363 332 246 263 1,677 453 373 368 336 249 266 1,686 460 378 373 340 252 270 1,697 467 383 378 344 255 273 1,716 475 389 383 348 258 276 1,730 482 394 388 352 261 280 1,754 490 400 393 356 264 283 1,767 497 405 398 360 ' 267 287 1,785 504 410 403 364 270 290 1,812 512 415 408 368 273 293 1,830 519 420 413 Mean Coefficients for bones shorter than those shown in the Table: 5.25 7.11 6.66 3.92 4.80 4.82 Mean Coefficients for bones longer than those shown in the Table: 4.93 6.70 6.26 3.53 4.32 4.37 To determine from this table the stature of the living, add 2 mm. to each length; take the mean of the resulting statures, and subtract 2 mm. from the final height thus obtained.2 1 The author obtained the following correspondences between the humerus and stature in 354 male and 82 female dissecting room individuals, Whites, 22-25 years of age, and where both humeri could be measured. 2 Dwight found that a large proportion of the errors with the Manouvrier tables was due to this subtraction, and advocates that this recommendation be not followed. It should be stated by the author whether it was or was not followed. ANTHROPOMETRY 173 Manouvrier's Tables Showing the Correspondence of Bone Lengths among Themselves and with Stature-Continued Females Humerus Radius Ulna Stature Femur Tibia Fibula cm. cm. cm. cm. cm. cm. cm. 263 193 203 1,400 363 284 283 266 195 206 1,420 368 289 288 270 197 209 1,440 373 294 293 273 199 212 1,455 378 299 298 276 201 215 1,470 383 304 303 279 203 217 1,488 388 309 307 282 205 219 1,497 393 314 311 285 207 222 1,513 398 319 316 289 209 225 1,528 403 324 320 292 211 228 1,543 408 329 325 297 214 231 1,556 415 334 330 302 218 235 1,568 422 340 336 307 222 239 1,582 429 346 341 313 226 243 1,595 436 352 346 318 230 247 1,612 443 358 351 324 234 251 1,630 450 364 356 329 238 254 1,650 457 370 361 334 242 258 1,670 4Q4 376 366 339 246 261 1,692 471 382 371 344 250 264 1,715 478 388 376 Mean Coefficients for bones shorter than those shown in the Table: 5.41 7.44 7.00 3.87 4.85 4.88 Mean Coefficients for bones longer than those shown in the Table: 4.98 7.00 6.49 3.58 4.42 4.52 SPECIAL COMMUNICATIONS AND REPORTS THE MORTALITY STATISTICS OF INSURED WAGE- EARNERS AND THEIR FAMILIES LOUIS I. DUBLIN, Ph.D., Statistician, with the collaboration of EDWIN W. KOPF, Assistant Statistician, and GEORGE H. VAN BUREN, Supervisor, Statistical Bureau 1. DATA ON THE RACE AND SEX RATIO OF MORTALITY AMONG WAGE-EARNERS Students of anthropology will be interested in the above mentioned work, a recent publication on the mortality statistics of a group of more than ten million wage-earners dispersed over the United States and Canada. From these data, it will be possible to make deeper inquiries than have been possible from data hitherto available, into the influence of urban working-class environment upon mortality at the various divisional periods of life, and comparatively for the sexes; and on the relative mortality of the negro and Caucasian groups of the wage-working population. The authors have throughout the work distinguished the white and colored races, according to sex, in all of the tables, whether relating to the total mortality or to the important diseases. They have also shown comparisons of the data for white wage-earners, by sex, with those of the population of the Registration Area in the United States. It will be recalled that until this volume was issued there had been accessible no such display of detailed public health statistics relating specifically to wage-earners and to members of their families. The published statistics of mortality issued by the municipal, state and federal offices, cover the entire population and give no clue to the mortality situation among the wage-earning masses of the country. The health statistics of the negro, compiled from similar population sources, have been more or less unsatisfactory because of the lack of required detail as to sex, age and diseases causing death. Students of the health of races have long desired mortality statistics of groups comparably situated as regards urban environment and otherwise. In the present work, there is as much detail of tabulation for the white as Amer. Jour. Phys. Anthrop., Vol. Ill, No. 1. 175 176 SPECIAL COMMUNICATIONS AND REPORTS for the negro groups. Anthropologists may have confidence in these figures of mortality according to race, first, because they are founded upon an accurate knowledge of the number of lives exposed to risk, and second, because the processes of gathering, editing and compiling the facts of mortality were carried on with the utmost concern for accuracy. The report covers the six years from 1911 to 1916. There were more than 635,000 deaths tabulated, of which more than four fifths (82 per cent) were those of white persons, and 18 per cent of negroes. But only 12.5 per cent, of the lives exposed to risk were negroes. The higher mortality rate of negroes becomes apparent at once from this simple comparison of the racial make-up of the exposure and of the deaths. In terms of the actual death rate, the negro group showed an excess life-loss of 56 per cent. Considered according to sex, negro males showed an excess of nearly one half (49 per cent) and negro females an excess of slightly more than three fifths (62 per cent) over the rates for the corresponding sexes among the Caucasian groups. Anthropologists will perhaps be interested in following this ratio between the mortality figures of white and colored persons through the several age-divisions of life. From the published data this can be done not only for the total mortality, but also for any of the important diseases and conditions. The findings on the relative mortality of whites and negroes, and of males and females, in this work may be discussed first, with respect to age, and then for the important diseases and conditions causing death. 2. EXCESS OF MORTALITY AMONG NEGROES (a) Males Considering the excess mortality among negroes over that for white persons, according to age, properly distinguishing sex, we find that whereas the negroes show for all ages one and over1 an excess of 49 per cent among males, this ratio of excess mortality varies con- siderably at the several age divisions of life. Thus, in early childhood, in the period one to four years, there was an excess of 72 per cent. Between 5 and 9 years of age this excess was 49 per cent. There was a sharp increase in this ratio to a maximum of 150 per cent for colored males at 15 to 19 years of age. After age 20 this ratio tends to de- 1 No infants under 1 are included in this insurance mortality experience. SPECIAL COMMUNICATIONS AND REPORTS 177 crease until in old age there is very little difference shown in these figures between the mortality of insured male white and negro wage- earners. The data are given on page 16 of the book. (6) Females The readers of this journal will be interested in the analysis ac- cording to age, of the mortality among colored females in excess of that among white females. Between 15 and 19 years this group of negro females showed an excess of 217 per cent over the mortality of white females. After having risen to this point of maximum excess, the ratio declines gradually with age, but is higher than the excess for negro males at every age period. The reasons for the unfavorable showing of colored females, especially in the age period of early adoles- cence, 15 to 19 years, are not apparent from superficial examination of the figures at hand. The data suggest detailed inquiry by students of the comparative health of races. Enough material is given through- out the book for the several diseases and conditions to justify refined analysis of the figures. 3. EXCESS OF MORTALITY AMONG MALES (a) White Persons Among white persons the mortality of males, at all ages one and over, exceeded that of females by 14 per cent and among colored persons by 4 per cent. The mortality rates of the two sexes among white lives tended to approximate each other only in the ages 10 to 19 years, but at all other age periods in this present mortality experi- ence the curves of mortality among white males and females showed a decided excess among males. The maximum excess of mortality among white males is reached in the age period 35 to 44 years, after a series of sharp increments in this ratio at the earlier ages. (6) Colored Persons The group of insured colored lives shows few of the characteristics of the sex-ratio of mortality that are found among the Caucasions. These figures emphasize the caution that inquiries into the sex-ratio of mortality by age must take into account the factor of race. Thus, between 5 and 25 years of age the death rate from all causes among colored males is very much below that of colored females. The age period 25 to 34 years, begins to show an excess of male mortality 178 SPECIAL COMMUNICATIONS AND REPORTS (15 per cent), and this rises to a maximum figure of 19 per cent in the age group 35 to 44 years. In the ages between 45 and 75 years of age the excess of mortality among colored males varies but little from a figure of 15 per cent. It will be seen from this brief consideration of the mortality from all causes of death that no general conclusions on the comparative vitality of males and females, of white and colored persons can be drawn without considering the make-up of the mortality according to diseases and conditions. Before passing to such a detailed discussion, however, we would direct the reader's attention to the characteristics of the two sets of curves given on pages 17 and 19 of this book. On the first mentioned page the authors have shown a chart illustrating by age the mortality from all causes of death of white males and colored males, respectively. The curve of white males is "J" shaped, or concave throughout, but that for colored males shows a convex tendency between central age 12.5 and 30 years of age. The curves on page 19 of the book show the usual "J" shaped curve of mortality for white females, but the colored female group shows a pronounced departure from the "J" conformation between central ages 12.5 and 30 years, more so than for colored males. Among the group of insured colored persons, tuber- culosis seems to be responsible for most of the convex tendency of the mortality curve between central ages 12.5 and 30 years. In addition, among colored females the very high death rate from diseases and conditions connected with child-bearing and the gravid state con- tribute to the hump in the curve for that group at the early adult ages. 4. IMPORTANT ASPECTS OF WAGE-EARNERS MORTALITY ACCORDING TO DISEASES CAUSING DEATH A short abstract table is given below showing the mortality from principal causes of death among this group of insured wage-earners. Death Rates per 100,000 Exposed. Principal Causes of Death among Wage- Earners. By Color and Sex Cause of Death Total White Colored Male Female Male Female All causes of death 1,181 1,182 1,040 1,763 1,689 Tuberculosis-total 205 212 147 430 385 Tuberculosis of the lungs 186 194 132 391 349 Organic diseases of the heart 140 126 137 191 202 SPECIAL COMMUNICATIONS AND REPORTS 179 Death Rates per 100,000 Exposed. Principal Causes of Death among Wage- Earners. By Color and Sex.-Continued. Cause of Death Total White Colored Male Female Male Female Pneumonia-total 108 112 92 179 131 Bronchopneumonia 30 30 29 38 34 Pneumonia-lobar and undefined . . 78 83 63 142 97 Bright's disease 97 97 88 139 121 External causes of death1 94 147 45 184 58 Accidents , 73 116 36 121 39 Suicides.... 12 20 7 10 5 Homicides 7 5 2 52 14 War deaths 2 5 Cancer 70 50 88 31 88 Cerebral hemorrhage, apoplexy 68 60 70 77 97 Four communicable diseases of child- hood: Measles 9 11 9 5 5 Scarlet fever 9 11 9 3 2 Whooping cough 6 5 6 9 9 Diphtheria and croup 24 30 24 10 9 Diarrhea and enteritis 26 28 25 26 28 Puerperal state: 19 33 49 Puerperal septicemia 8 14 23 Puerperal albuminuria and con- vulsions 5 9 12 Typhoid fever 17 16 13 36 34' Diabetes.. . 14 11 19 10 11 Appendicitis 12 13 10 14 13 Pellagra 4 2 4 6 21 Malaria 4 2 2 18 22 5. TUBERCULOSIS It can be seen very readily from the foregoing table that tuberculosis is still the chief cause of death among wage-earners. The group of organic diseases of the heart is next in importance in the number of deaths, followed by pneumonia-all forms. In the Registration Area of the United States, 1917, on the other hand, organic diseases of the heart is the first group of causes of death followed by pneumonia- all forms, and then by tuberculosis-all forms. Prior to 1915 tubercu- losis had been the chief cause of death in the general population, but with the continued downward progress of the tuberculosis rate, or- ganic diseases of the heart assumed the place of first importance. Since then, the rate for organic diseases of the heart has been higher than that for tuberculosis-all forms. In 1915 and 1916, organic diseases of the heart, tuberculosis and pneumonia were the three ranking causes of death in the general population, but in 1917 pneu_ 1 Includes war deaths not shown in above table. 180 SPECIAL COMMUNICATIONS AND REPORTS' monia displaced tuberculosis as the second cause of death. For the group of insured wage-earners, however, there is still such a gap be- tween the tuberculosis curve and that for organic diseases of the heart that it will be some time before the order of the first three im- portant causes is disturbed, barring years of excessive pneumonia pre- valence such as in 1918. The group of colored males showed the highest rate from tuberculosis (430), with colored females next in order (385) followed by white males (212), then by white females (147). • These differences in the tuberculosis death rates of the four-chief race and sex groups require much detailed examination before con- clusions can be drawn. There are, first of all, differences in the age distribution of the several groups and in the types of tuberculosis curves when drawn with respect to age. On page 50 of the book, the authors show two sets of curves for tuberculosis of the lungs. Due reflection upon these curves emphasizes the need for extreme caution in comparing the crude tuberculosis death rates of the several color and sex groups or classes when the data are not displayed for age. It will be seen that the curve for white males is of the middle adult age type with its peak at central age 40. That for colored males is, no doubt, a compound of curves of an early-adult and a middle- adult age type. There is a sharp rise from childhood to a high rate in the age period 20 to 24 years. This figure is maintained practically until central age 40 after which there is a more or less precipitate drop. The curve for white females covers by far the least area, reaches a maximum at central age 30 but resembles no one type of tuberculosis curve. The outline of the curve for colored females, on the other hand, is frankly that of very early adult, perhaps more properly, late adolescent type, with its maximum point at central age 22.5 years, with very sharp descending limbs on both sides of the maximum. The authors suggest that the figures for the age incidence of tubercu- losis of the lungs may not represent a single disease entity, but that perhaps all of the curves are compounded of constituents, each repre- senting a certain type of the disease in relation to race, economic status, and other causative factors. There may even be a variety of infecting organisms which may help to account for the differences in the two races at the various age groups. In the text the authors have simply stated their findings with respect to the incidence of tuberculosis mortality in the several race groups and by sex and age, but admit that it is extremely difficult to say why tuberculosis mortality of the negro is higher than that of the SPECIAL COMMUNICATIONS AND REPORTS 181 white group, and among males higher than among females. Whether these differences reflect truly the influence of race, or of sex, or whether the explanation lies in environment (sanitation, economic status, occupation, etc.) it is impossible to say. So very much depends upon clinical evidence of the type and characteristics of the disease and upon one's success in evaluating the several factors of inheritance, opportunity for infection, the virulence of the invading and compli- cating organisms and the important facts of environment such as hous- ing, nutrition, medical care during the incipient state and a host of other important facts. Physical anthropology has before it one of its greatest tasks in showing what bodily measurements are associated in tuberculosis with the several race and sex groups, considered by age, which display such widely different types of mortality curves for a single disease. Among white male wage-earners, the authors found a lower rate from tuberculosis of the lungs under age 15, and after that age a higher rate than among males in the general population. This was also true for white females in wage earners' families, with the excep- tion of the ages beyond age 65 years. 6. TENDENCY OF TUBERCULOSIS MORTALITY IN THE WHITE AND COLORED RACES The course of the tuberculosis death rate has been consistently downward during the six years covered by this report and there is no reason to expect any slackening in the tendency toward decline. In 1911, the rate for tuberculosis of the lungs was 203,; in 1916, 173 per 100,000 exposed. This represents a decline of 15 per cent. In other words, for every seven deaths from tuberculosis of the lungs in 1911 there was, to correspond, in 1916 only six deaths. This is indeed a satisfactory showing and reflects not only the work of the entire tuber- culosis movement but also every other effort toward the improvement of the public health, especially the advancement of the welfare of children. 7. TUBERCULOSIS IN THE NEGRO Unfortunately, this downward tendency of the tuberculosis death rate of the Industrial Department reflects only the very favorable experience of the group of white lives. Among colored males, there has been a distinct increase in the death rate for tuberculosis of the lungs over the period covered by this report. In 1911 the rate was 182 SPECIAL COMMUNICATIONS AND REPORTS 379 and in 1916, 387 per 100,000. In 1915 a very high rate of 400 per 100,000 was reached for colored males. Although the situation is not so grave among colored females, still, there is no evidence from the statistics of six years that there has been any substantial decline in the rate for tuberculosis of the lungs among this group. It would be conservative to say that the rate for this disease among colored females is practically stationary but that among colored males it has increased at an alarming rate. These sanitary statistics show, for recent years, what has been emphasized by students of negro mortality for the past twenty or more years, namely, that the increasing urbaniza- tion of the negro is, and will be for some time to come, productive of high mortality from tuberculosis of the lungs. It is not possible to say, at the present time, whether there is any prospect of checking the increase in the tuberculosis death rate among colored males be- cause of the elimination of individuals unable to survive under the conditions of urban negro life. Students of the health of the several races of mankind, would do well to observe the trend of the tubercu- losis death rate of negroes in cities, especially in relation to changes in the age or other outstanding characteristics of the disease. 8. ORGANIC DISEASES OF THE HEART So far as we may place confidence at present in any statistics of this group of causes of death, the death rate seems to be very much higher among the negroes than among the insured white group. Organic diseases of the heart, however, ^showed a higher death rate among females of both race groups than among males. From an inspection of the graphic chart given on page 67 of the book, it will be seen that this higher mortality among females of both race groups occurred under 25 years of age. Among white males, after 25 years of age, the death rates for organic diseases of the heart are greater than for white females. It should be noted that up to 54 years among colored females (with one exception, between 25 and 34 years), the death rate for this group of diseases is higher than among colored males. After 55 years of age, the death rate for colored males is the higher. There seems to be a greater proportionate excess of the death rates of this group of diseases for colored females above white females, than there is for the rates for colored males over those of white males. This will be seen also from the chart given on page 67. By age periods, the mortality from organic diseases of the heart are much higher among wage earners than among the general popu- lation. SPECIAL COMMUNICATIONS AND REPORTS 183 The evidence from table 31 is that there seems to be a stationary- death rate from this group of organic diseases of the heart. This may be contrasted with the apparently increasing death rate in the Regis- tration Area for deaths in the United States. 9. PNEUMONIA Diseases caused by acute infections of the respiratory tract have assumed an increasingly menacing place among the causes of mortality. The public health records of important cities of the United States show that the only bacteria-caused disease in the entire category of such diseases, which had higher death rates in these recent years than 30 or 40 years ago, is the pneumonia-bronchitis-influenza group. The statistics given by the authors in Chapter VI will be a small contribu- tion to the historical study of respiratory infections. It should be borne in mind that pneumonia is the most important, numerically, of the acute infectious diseases. It kills every year more people than die of such communicable diseases as measles, scarlet fever, diphtheria, whooping cough and acute poliomyelitis combined. Somehow or other, until the great outbreak of so-called influenza in the fall of 1918, the general public paid but little attention to respiratory disease mortality. The interest aroused in real preventive measures by the pandemic should be maintained and some solution sought to the riddle of mortality from the group of diseases resulting from respira- tory infections. Reverting to the statistics of insured wage-earners, the death rate from pneumonia, lobar and undefined, was considerably higher among colored persons than among white persons. This applies to both sexes. The most striking differences between the mortality of the two race groups from pneumonia-lobar and undefined, occurred between central age 17.5 and 52.5 years. It is shown on the chart on page 75, that there is a slight convexity in the curve for pneumonia-lobar and undefined between central ages 12.5 and 30 years, for both colored males and colored females. Whether this hump in the curve is due to the inclusion of deaths from tuberculous pneumonitis, is doubtful. The volume also gives a discussion of mortality from bronchopneu- monia. The graph on page 81 shows that the broncho-pneumonia mortality curve according to ages is "U" shaped and not " J" shaped, as for pneumonia-lobar and undefined. If the statistics for the ages under one year were available, a still higher point would have been shown on the graph for bronchopneumonia, but unfortunately such 184 SPECIAL COMMUNICATIONS AND REPORTS data were not eft hand in the insurance records. The data for both forms of pneumonia, taken in conjunction with those for influenza, should afford students of the influenza pandemic a considerable amount of material for study. After 25 years of age, the pneumonia rate is much higher among wage earners than among the general population. 10. OTHER DISEASES AND CONDITIONS In this abstract a considerable amount of text has been given on the three important groups of causes of death in this experience for wage-earners. In concluding this summary it may be well to comment, briefly, upon the chief facts reported by the atuthors for the other leading causes of death. (a) bright's disease The cause of death next in numerical importance was Bright's Disease. As the authors point out on page 87, there is still too much uncertainly in the statistics of Bright's disease, and in fact for the other cardiovascular-renal diseases, that they did not draw any final conclusions on the relative incidence of Bright's disease in the several color, sex and age groups. The statistics, however, are sufficiently good to warrant presentation in detailed tabular form, having in mind always the inherent deficiencies in such statistics of organic diseases. The discussion on page 87, at the beginning of Chapter VII, outlines the reasons why Bright's disease mortality statistics should be viewed with more than ordinary caution. The Bright's disease death rate among both colored males and females, was very much higher than the rates prevailing among white males and white females. These differences are much more pronounced after 35 years of age than earlier in life. The mortality of both groups is, for nearly all age periods, higher among males than among females. (6) EXTERNAL VIOLENCE Mortality from accidental and other external causes of death was high. Accidents, including unspecified violence, showed a death rate of 73 per 100,000, suicides a rate of 12, homicides a rate of 7, and war deaths a rate of 2 per 100,000. These mortality rates were higher at most age groups among the group of white insured wage-earners than in the corresponding sex classes of the United States Registration Area for deaths. The figures of accident mortality in the United SPECIAL COMMUNICATIONS AND REPORTS 185 States compare very unfavorably with those available for the countries in Europe before the War. Thus, in the year 1913, the fatal acci- dent rate of England and Wales for the age period 35 to 44 years among males, was 62 per 100,000. In the Registration Area of the United States, the rate for males at these ages was 140, and among insured white males, 154 per 100,000. It was pointed out, further, that when the fatal accidents for these three areas were classified according to means of injury, i.e., falls, burns, drowning, steam rail- road accidents, etc., the figures for the United States were much above those for England and Wales. The table on page 101 shows that falls were the most frequent of the specified forms of violence, with accidental drowning next in importance and followed by burns, steam railroad accidents and injuries and automobile accidents and injuries. The authors indicate that the death rate from automobile accidents and injuries was progressively on the increase throughout the period under observation and showed that the automobile is a growing menace to the lives of children of the run-about age. Homicide is an important cause among negroes. It is next to tuberculosis and pneumonia, the chief cause of death among colored males at the period 25 to 34 years. (c) CANCER The chapter on cancer statistics is interesting because it presents among other things, a table showing the incidence of the disease in three different economic strata. The authors show, that age being considered, the cancer death rate is higher among the wage earning groups of the population than among those better situated in an eco- nomic sense. Furthermore, another important fact brought out in the text is that no real increase in the cancer death rate can be de- tected from the statistics of insured wage-earners. Students of the cancer problem will profit from a detailed examination of this chapter. It should be noted that the Journal of Cancer Research for July, 1919, gives the tabular and text material of this chapter in full. (d) DISEASES OF THE MATERNAL STATE The chapter on diseases and conditions associated with the maternal state will also be interesting, especially those that show the possible effect upon maternal mortality of a comprehensive programme of nursing in the puerperal state. The authors show that there was a 186 SPECIAL COMMUNICATIONS AND REPORTS decline of 10.7 per cent in the death rate from puerperal diseases and conditions among insured white women in the six years as compared with the practically stationary death rates among women in the Registration Area of the United States. (e) TYPHOID FEVER Typhoid fever, a disease which is practically an index of the sani- tary intelligence of a community, shows a decline of 43 per cent during the six years covered by this mortality experience for all of the color or sex classes or groups. Rather complete statistics are given for the age and sex incidence of the disease. (/) OTHER DISEASES The statistics for diabetes will be of exceedingly great interest to anthropologists because they show that the death rate is higher among wage-earners than among the general population. It has been thought that'diabetes was more frequent, and perhaps caused more mortality, among the better situated classes of the community. The age distribution of deaths from diabetes is also of interest. This is shown by the statistics contained on page 229 of the volume. Stu- dents interested in the mortality from pellagra and malaria, two diseases found at present very largely in the South, will find complete tables according to color, sex and age and single calendar years in Chapter XVI. Enough has been given in the way of an abstract to show that this volume contains a great mass of material instructive to students of public health and of the health problems of races. The Metropolitan Life Insurance Company has made it a policy to distribute this volume to research students, to reference libraries and to members of the medical profession interested in data of this kind. While the supply lasts, the Company will continue to give this work to qualified per- sons who wish to use these data in the furtherance of the study of anthropological, biological and public health problems. SPECIAL COMMUNICATIONS AND REPORTS 187 THE NEWEST DISCOVERY OF "ANCIENT" MAN IN THE UNITED STATES On July 21, 1919, the Smithsonian Institution received the following letter from a reputable physician: Zanesville, Ohio, July 19, 1919. Smithsonian Institution, Washington, D. C. Dear Sirs: I write you in regard«to a highly important anthropological find made six miles from our city at Gilbert Station within the past week by excavators of the Glacial Sand Company of this city in the glacial drift at that point and at a depth of thirty- two feet below the surface and in a gravel strata. The find was a skeleton of prehistoric man and measurement was made at once of the length of the body and it measured six feet. The bones crumbled to dust very promptly excepting the skull, which was brought to this city and which I examined today. The measurements of the skull were from glabella to the spinal foramen, fourteen inches; circumference around the forehead (hat band measure), fourteen inches; from tip of mastoid to tip of mastoid, over top of head, fourteen and one-half inches. This was an adult as shown from type of body and the fact that the sutures of the skull were grown together. The temporal bone was missing on one side and the lower jaw was missing. There was a shallow frontal sinus and ethmoidal sphenoidal cells were present, also mastoid cells. The petrous part of the temporal bone was about the same shape as in modern skull and semi-circular canals were in same posi- tion as in any skull, showing that the lower jaw could not have been that of an ape. There was a hole in the occipital region which was made delicately and evidently with a chisel, like the skulls shown in government reports and books of anthropology published some years ago. Whether this hole was made for surgical purposes to extract arrow-head or whether to let out the evil spirit, I do not know. The skull of the body was facing the east. No signs of syphilis on skull. I write you at once so that you can immediately come to Zanesville to examine this skull, should you so desire, before it crumbles to dust, as this undoubtedly is a great find. It is in possession of Mr. Henry Buerhaus of the Glacial Sand Company, 17 Richard Block, Zanesville, Ohio. Very truly yours, , M.D. P.S. This skull must far antedate Glacial period. I have sent a copy of above to Curator O. Mills, Columbus, Ohio. As the Department of Anthropology of the U. S. National Museum,, in cooperation with the Bureau of Ethnology, have made it their aim now for many years to carefully examine into every find of this nature made in the United States that seems to be of some importance, and as the above letter was received from a medical man who evidently had some knowledge of anthropology, a telegram was sent to Professor 188 SPECIAL COMMUNICATIONS AND REPORTS W. C. Mills, of the Ohio Archaeological and Historical Society request- ing him to visit Zanesville, examine the remains, and report at once on the results of this examination. Professor Mills, however, was in the field, and there was no response to the telegram. Efforts were therefore made to have a competent geologist examine the site, which resulted in a visit to the same by Professor Leroy Patton, of the Muskingum College. In addition, the writer sent the following note to our informer at Zanesville: July 26, 1919 Dear Dr. : This letter should reach you on Monday. If so, kindly telegraph at once, Government Business Collect, brief information on the following points: (1) Are the specimens about which you so kindly notified us still available for examination; (2) has any scientific man been there to see them or the site, or is one expected; (3) does the find still appear important enough to you to warrant my coming to Zanesville; (4) has anything else been found besides the skeletal remains you mentioned in your letter? Should the case warrant it, I will reach Zanesville on Tuesday evening. Very truly yours, A. Hrdlibka, Curator, Div. Physical Anthropology i Shortly after, the following letter was received from Professor Mills: Flint Ridge Camp, Thursday, July 24, 1919 Prof. W. H. Holmes, U. S. National Museum. Dear Prof .Holmes: I have your telegram which was forwarded to me here at Flint Ridge, and in a few moments I started for Zanesville, 20 miles to the east. I found Mr. Buerhaus at his office and he turned over the skull in question and I boxed same and forwarded by express and I hope you will receive the package in due time. Mr.' Buerhaus presents same to the Museum and I hope you will acknowledge receipt and give him your opinion concerning the skull. My own opinion is that the skull is adult female (Indian), found in a deposit of river gravel. I did not have time to visit the place but if the skull proves other I will gladly go and inspect the entire region although I have been along the river many times and feel assured in my own mind concerning the location. I have a number of men at work opening the old quarries and felt compelled to return at the earliest time possible. Very truly yours, W. C. Mills The skull came promptly, and after examination the following report on it was sent to the donor: SPECIAL COMMUNICATIONS AND REPORTS 189 July 30, 1919 Mr. A. H. Buerhaus, Glacial Sand and Gravel Co., Zanesville, Ohio. Dear Sir: According to your wish I herewith submit a brief report on the human skull which you had the kindness to send us last week: The skull is that of an adult female subject, probably Indian; but the possibility of it being White cannot be excluded. The specimen is so damaged that very little besides this can be said about it. The hole in the back part is not due to an operation, but evidently to an abrasion. The specimen shows no signs whatever of antiquity. Should any other human remains be found in the work under your direction, kindly preserve the bones for us. Very truly yours, A. Hrdlicka, Curator, Div. Physical Anthropology Meanwhile, a telegram and several notes were received from our original informer to the effect that the find had upon critical examina- tion by Professors Mills and Patton lost much of its importance; and a few days later the following detailed report on the find was received from Prof. Patton: ON THE HUMAN REMAINS IN PLEISTOCENE DEPOSITS AT GILBERT, OHIO On the nineteenth of July of this year announcement was made through the medium of the public press of the finding of a skeleton of a human being near Zanesville, Ohio, in deposits which were said to prove the remains to be of Pleistocene or earlier age. Immediately upon reading the press reports the writer, recognizing the possible importance of the matter, went at once to Gilbert where the skeleton had been discovered and made as thorough an investigation of the circumstances as possible. It was learned that the skeleton had been found in the pit of the Glacial Sand and Gravel Company several weeks previous. After being removed to the office of Mr. Henry Buerhaus, treasurer of the company, at Zanesville, it attracted the attention of some persons interested in geology and anthropology in an amateur way and also other persons interested in news with the result that considerable publicity was given to the matter and the find was heralded as proving the existence of man. in this region in glacial or pre-glacial times. The skeleton was found by Mr. Cleve Hunter, foreman of company at Gilbert works. Mr. Hunter went over the ground carefully with 190 SPECIAL COMMUNICATIONS AND REPORTS the writer and gave a complete and detailed account of the circum- stances under which the remains were found. The writer desires to state that he found Mr. Hunter an intelligent man, thoroughly honest and straightforward and interested only in giving the facts as he knew them. The Glacial Sand and Gravel Company is obtaining material at this place from a terrace of sand and gravel in the valley of the Muskingum River on the east side of the river one eighth of a mile north of the Pennsylvania R. R. station at Gilbert. The top of this Terrace is 773 feet A.T., the river at this place being 700 feet A.T. The material of the terrace consists of alternating layers of sand and gravel, the sand exhibiting marked cross-bedding practically through- out the whole of the exposure. The terrace is a part of the deposits described by Leverett as a valley train, probably of Wisconsin age.1 Sand and gravel is removed from the terrace by means of a steam shovel which is located at the base of the terrace. Operations have exposed the face of the terrace for a distance of two or three hundred yards and as excavations are made down to water level a vertical face of about seventy-five feet is exposed. Sand and gravel have been taken from this terrace for a number of years, this deposit having been worked by several different firms. The base of the terrace at this place is now considerably further east from the river than formerly as a result of these operations. The material of the terrace stands up in steep faces in some places in the exposure and in others slumps down to the angle of repose. Fourteen feet from the top of the exposure there is a rather persistent layer of sandy clay which stands up better than the rest of the material and forms miniature terraces in many places. The sand and gravel slumping down from above lodge on this shelf and the material piles up at an angle of repose. About five feet above the clay stratum there is a layer of dark carbonaceous material. This is also persistent and is seen throughout the exposure. Mr. Hunter stated that the remains were found above the clay stratum and at an elevation lower than that of the line of carbonaceous material. Asked to point out a situation which resembled as nearly as possible the situation in which the remains were found he unhesitat- ingly indicated one of the miniature terraces described above and said that he first saw the skull protruding from the loose sand and gravel Leverett, Frank, Monograph XLI, U. S. Geol. Sur., "Glacial Formations and Drainage Features of the Erie and Ohio River Basins," p. 157. SPECIAL COMMUNICATIONS AND REPORTS 191 piled up on the ledge. It should be noted here that according to Mr. Hunter's testimony that although he recalls the location of the remains with reference to the clay stratum and the layer of carbonaceous material, that the material above the clay stratum was not in place over the remains when they were found. The skeleton was lying roughly parallel to the edge of the ledge when found. Underneath, between it and the clay stratum was perhaps a foot of material. Whether this was the original material deposited on top of the clay stratum or material which had fallen from above could not be deter- mined. It seemed clear, however, from Mr. Hunter's testimony that the material which covered the skeleton was loose material which had fallen from above. This point was made especially clear upon the writer's request to have a geology hammer placed in a deposit of the kind which would show as nearly as possible the conditions under which the skeleton was found. He directed that the hammer be placed in what was unmistakably loose material which had slumped down from above. The writer inquired into the possibility of part of the skeleton being on the ledge with none of the original material being in place over it and part being in the undisturbed stratified material of the face of the exposure. Nothing can be proved as to this, however, as Mr. Hunter cannot state whether it was necessary to dig into any of the undisturbed stratified material as he did not take critical notice of condition. It seems clear, however, from Mr. Hunter's testimony that at least a greater part of the skeleton was found in loose material and there is no evidence to prove that it was not wholly in this kind of material. The position of the skeleton when found in the material above this clay stratum would make its location about thirteen feet below the top of the exposure. Allowing for about two feet of stripping which has taken place the maximum depth from the original surface to the place where the skeleton was found would be not more than fifteen feet. This is an unusual but not a prohibitive depth for interment and there is no evidence here to prove that the remains were not interred in these deposits at this depth. It seems to the writer more probable, however, that the remains were interred at a less depth than this and that together with the material in which they were interred they had slumped down from above and lodged on the ledge on which they were found. The theory of the interment of these remains is further strengthened by several other circumstances. Mrs. Pamelia White, owner of the 192 SPECIAL COMMUNICATIONS AND REPORTS land in question and who has lived here for over forty years, says that when she first came to this place that there were, upon the site where the remains were found, a few stones rudely shaped like tombstones and set in the ground after the manner of placing tombstones. There were some marks on the stones but, either because the characters were nearly obliterated by time or because they were characters the sig- nificance of which was not known, nothing could be learned from them. Nothing was known concerning the history of these stones or whether anyone was buried there. The stones were subsequently removed and their existence all but forgotten. The probability of several people being buried here is further strengthened by the fact that other bones have been found in the pit, although the case under discussion is the only instance of the finding of a nearly complete skeleton. However, irrespective of the suggestion of a possible burying ground at this place, there seems to be no geological evidence in this case that the remains were deposited in the fluvio-glacial at the time this material was laid down since it is not proved that the remains were found in undisturbed material and overlain by undisturbed fluvio- glacial deposits. On the other hand all of the circumstances point to other and more probable solutions. The writer does not base any of his conclusions upon an examination of the remains themselves, having confined his investigations wholly to the geological conditions under which the remains were found. Immediately upon the conclusion of his investigations the writer sent a brief report to the state geologist and also issued a statement to the press to the effect that there is no geological evidence whatever that these remains are of Pleistocene or earlier age. The whole affair is obviously the result of the misguided enthusiasm of some amateur scientific investigators and clever press agent co- operation on the part of over-zealous newspaper writers. Department of Geology, Leroy Patton Muskingum College As a finishing touch to the history of the Zanesville find may be quoted a part of the last letter received from Dr. , which reads thus: "The first article in our local paper (The Signal) was written by a local reporter (you did not see that article) in which it stated the skeleton was found in Glacial drift and was probably 20,000 years old. This was surmise of reporter or owner of sand bank. After the appearance of that article I examined the skull and measured it. It was so small and the report coming from the man who dug the skeleton out SPECIAL COMMUNICATIONS AND REPORTS 193 that the body was 6 feet long made me surmise that the skeleton must have been something unusual with such a very small skull to a six foot body. Also, the first report was that the body was 30 feet below surface." The case represents a fortunate occurrence of the usual initial exaggeration by newspapers and non-experts, with a prompt, sober, scientific examination of conditions. Had some less qualified persons become interested in the find before Professors Patton and Mills could reach the site another item might easily have been added to the already long list of ambiguous examples by which a geological antiquity of man in America is supported. A. H. INFLUENZA AMONG THE AMERICAN INDIANS By the Public Health Service The following tables were compiled by the Public Health Service from data furnished by the Commissioner of Indian Affairs. They Cases of Influenza among Indians, Oct. 1, 1918, to June 30, 1919 State Population Cases Minors Adults Total Cases per 1,000 Pop- ulation Arizona 45,707 9,390 7,847 17,237 377.1 California 16,416 2,010 2,388 4,398 267.9 Colorado 1'222 333 157 490 401.0 Florida 585 20 46 66 112.8 Idaho 4,208 243 407 650 154.5 Iowa 356 90 35 125 351.1 Kansas 2,275 625 235 860 378.0 Michigan 1,097 25 25 50 45.6 Minnesota 12,003 1,311 741 2,052 171.0 Mississippi 1,253 '217 432 649 518.0 Montana 12'079 1,111 1,021 2,132 176.5 Nebraska 2,834 470 391 861 303.8 N evada UI,190 848 2,746 3,594 321.2 New Mexico 22,005 5,410 5,561 10,971 498.6 New York 5,982 400 400 800 133.7 North Carolina 2,343 409 372 781 333.3 North Dakota 9,216 1,631 718 2,349 254.9 Oklahoma 118,227 6,530 8,697 15^227 128.8 Oregon 4,355 '661 '436 1,097 251.9 South Dakota 23,890 4,595 3,964 8,559 358.3 Utah 1,704 201 281 482 282.9 Washington 10,315 824 1,197 2,021 195.9 Wisconsin 9,696 1,601 1,109 2,710 279.5 Wyoming 1,696 1 15 16 9.4 Total 320,654 38,956 39,221 78,177 243.8 1 Includes estimate of 3,000 unenrolled Indians in Nevada and 5,000 in California belonging to the Reno Agency. 194 SPECIAL COMMUNICATIONS AND REPORTS show the number of cases of influenza reported among Indians on reser- vations in the United States, and deaths due to the disease; also morbidity, mortality, and case fatality rates.-Publ. Health Rep's, Oct. 17, 1919. Confirmation of reports that the native Indian population of Bristol Bay, Alaska, virtually was wiped out by an epidemic of influenza has been brought to San Francisco with the return of the United States cruiser Marblehead from a relief expedition to the north. According to Lieut. W. R. Leahy, senior medical officer of the ex- pedition, 95 per cent of a population of more than 900 persons had died by the time the expedition reached Bristol Bay. State Deaths Minors Adults Total Deaths per 1,000 Population Fatalities per 100 Cases Arizona 1,027 921 1,948 42.6 11.3 California '123 133 256 15.6 5.8 ' Colorado 35 24 59 48.2 12.0 Florida 3 7 10 17.1 15.1 Idaho 21 54 75 17.8 11.5 Iowa 5 4 9 25.3 7.2 Kansas 13 7 20 8.8 2.3 Michigan 1 1 2 1.8 4.0 Minnesota 65 57 122 10.2 5.9 Mississippi 18 43 61 48.7 9.4 Montana 59 80 139 11.5 6.5 Nebraska 26 34 60 21.2 6.9 Nevada 52 219 271 24.2 7.5 New Mexico 635 610 1,245 56.6 11.3 New York 40 40 80 13.4 10.0 North Carolina 25 12 37 15.8 4.7 North Dakota 48 72 120 13.0 5.1 Oklahoma 330 531 861 7.3 5.7 Oregon 45 49 94 21.6 8.6 South Dakota 365 390 755 31.6 8.8 Utah 25 52 77 45.1 15.9 Washington 89 83 172 16.7 8.5 Wisconsin 71 87 158 16.3 5.8 Wyoming 0 1 1 .6 6.3 Total 3,121 3,511 6,632 20.7 8.5 Deaths from influenza among Indians, October 1, 1918, to June 30, 1919 Tuberculosis among the Natives in the West Indies The death-rate from tuberculosis among the colored population in some of the West Indian islands has in the past been exceedingly high. The persistent efforts of the white residents in Trinidad, Tobago, the Guianas and elsewhere, and especially the organized SPECIAL COMMUNICATIONS AND REPORTS 195 campaign of the Association for Prevention and Treatment of Tuber- culosis, have reduced this mortality by nearly 50 per cent since 1905; nevertheless the death-rate from the disease is still far too high, being- in Trinidad little short of 30 per 1000. It has been definitely es- tablished however that the West Indian native, if treated on rational lines in the early stages of the disease, seems to be quite as capable of recovery as is the British patient.-Brit. Med. J., May 31, 1919, 683. Sex Determination In an effort to test the correctness of Dawson's theory that sex is determined by the supplying ovary, males being produced by fertiliza- tion of an ovum from the left ovary, Dr. John J. Murray, Jr., has gone over the records of 17,500 deliveries which occurred in the Obstretric Clinic of the Johns Hopkins Hospital between September, 1896, and March, 1918. (Johns Hopkins Hospital Bulletin, December, 1918, pp. 275-281.) There were 75 cases (70 women, five of them having two pregnancies), in which the location of the corpus luteum was determined by Caesarean section, by laparotomy, or by post mortem, and in which there was no doubt as to the sex of the child. Murray found that "male and female children result in about equal numbers from the fertilization of ova from either ovary" and that consequently Dawson's theory is proved to be incorrect. He con- cludes that "the causation of sex is probably not due to any factor in the unfertilized ovum"; that "the 'chromosome theory' must be considered the only explanation of sex at present acceptable"; and that "the sex of an unborn child cannot be foretold, nor can either sex be produced at will, by any rules known at present."-Eugenical News, June, 1919. It may be. recalled in this connection that similar results were in 1911 obtained experimentally by Dean on albino rats: Dean (H. K.)-The effects of semi-spaying and semi-castration on the sex ratio of the albino rat.-J. Exp. Zool., May, 1911, X, 381-392. Heredity in Twins Professor Kristine Bonnevie has published as Contribution No. 2 from the University (of Christiana) Institute for Investigation in Heredity a paper entitled "On Tvillingsfodslers Arvelighet," or "On the Inheritance of Twin Births." A certain rural family shows about three times the normal proportion of twin births in a population of 196 SPECIAL COMMUNICATIONS AND REPORTS about 5,000 individuals. In the special "twin branches," the pro- portion of multiple births rises to 7.7 per cent, or six times the average. The author concludes that among younger mothers, below 30 years, 1- and 2-egg twins are about equally numerous, while the twins borne by older mothers are practically all from 2 eggs. The proportion of 2-egg twins to 1-egg twins in the family is about 4: 1, and it is in double egg twin births that inheritance is most clearly shown. Out of 88 twin-producing mothers, 67 (the best known) are without ex- ception shown to descend from twin families through both parents or through the one parent who is known. "The hereditary nature of the disposition for double-egg twin births is thus proved without doubt. Its types of heredity seem, further, to be that of a recessive character, demanding for its manifestation that the twin mother should receive her disposition in a double dose through both her parents. The twins seem, among their brothers and sisters, not to be predis- posed to twinning."-Eugenical News, Nov., 1919. Mortality of Infants of Different Racial Groups In the New England Medical Gazette, vol. 52, page 366, Dr. F. H. MacCarthy gives the following table of death rates of infants under one year per thousand births from the three principal causes of in- fant mortality grouped according to nationality of mothers. Causes of Death u. s. Canada Ireland Italy Russia and Poland Congenital debility 36.37 30.00 26.08 13.00 20.00 Gastro-enteritis 20.60 14.63 16.56 19.58 15.78 Pneumonia 13.09 15.29 12.83 29.53 19.62 CURRENT NOTES The Anthropological Society of St. Louis.-On January 2, there has been organized in St. Louis The Anthropological Society of St. Louis. The membership of the Society consists essentially of the local anatom- ists and prominent medical men interested in anthropological research; but its interests will comprise the whole field of anthropology. Pro- fessor R. J. Terry has been elected the first President of the Society. Mr. George G. Heye, director of the Museum of the American Indian, Heye Foundation, announces that the department of physical anthropology, which had to be closed during the period of the war, has again resumed active work under the direction of the same staff, namely, Dr. James B. Clemens and Dr. Bruno Oetteking. The department has now separate housing accommodations at 11 St. Nicholas Place, corner of 150th Street, which suits its present needs. Dr. Hrdlicka left Washington early in January for the Far East, in the interests of his studies on the origin of the American Indian, and in those of anthropological work in China and Hawaii. He expects to be back in June. The Journal will meanwhile be in the hands of Dr. Gerrit S. Miller, curator of the Division of Mammals, U. S. National Museum. As the Journal was going to press it became known that the XX International Congress of Americanists, which was to have met at Rio de Janeiro in June of this year, has been indefinitely postponed. The reason given is that the unsettled world conditions prevent European representatives from attending. It has been intimated that the next Congress will meet in 1922. Dr. A. A. Mendes Correa, formerly assistant of the faculty of science of the University of Oporto where he was teaching anthropology since 1912, has been some time ago proposed by the faculty for the vacant place of ordinary professor. A faculty of letters having been lately founded in the University, Dr. Mendes Correa was named ordinary professor of the new faculty for the group of geographical sciences which include anthropology. From the daily press we learn that Dr. and Mrs. Gustaf Dolinder, the former a leading Swedish scientist, sailed for South America early in January. They expect to remain one year, engaged in general ethnographic and archeological investigations; considerable attention will later be devoted to the Indian tribes of the Magdalen River region. Amer. Jour. Phys. Anthrop., Vol. Ill, No. 1. 197 198 CURRENT NOTES Dr. Franz Boas late in December tendered his resignation as one of the representatives of the American Anthropological Association on the Committee of Anthropology and Psychology of the National Re- search Council. Ludwig Stieda.^-Belated German periodicals bring the an- nouncement of the death of Dr. L. S. Stieda, emeritus professor of anatomy at the Konigsberg University. He died in 1918, in his eighty-second year. Physical anthropology owes a debt to Professor Stieda for his lifelong interest in the science, and for his very useful annual reviews of Russian anthropological literature, published period- ically for many years in the Archiv fur Anthropologic. Richard Lynch Garner SR-Professor Garner, who was widely known through his investigations among the anthropoid apes, died suddenly at Chattanooga, Tennessee, on January 23, 1920. He was an indefati- gable worker, and has contributed greatly to our knowledge of the life and habits of the apes. Horatio C. Wood SR-Science reports the death, on January 3, of Horatio C. Wood, M. D., LL. D., emeritus professor of materia medica, pharmacy and general therapeutics in the University of Pennsylvania Medical School. Notes from the Far East Dr. J. G. Andersson, of the Chinese Geological Survey, has loaned a number of human skeletons from Chihli Province excavations to the anthropological department of the Peking Union Medical College; Dr. E. H. Tang, president of the Government Special Medical School in Peking, has also loaned his valuable series of Chihli Province crania to the anthropological department of the college. Pere Florent De Preter, of the Belgian Mission at Chin-Chow, who has been decorated by the Chinese government for his ethnological work in Manchuria, has recently visited Peking. Arrangements for the despatch of an expedition by the department of anthropology, P. U. M. C., to investigate the cave burials in the vicinity of Chin-Chow have been greatly facilitated by Pere De Preter's cordial cooperation. Mr. Roy C. Andrews, of the American Museum of Natural History, has obtained a number of human crania from the vicinity of Urga. Mr. Andrews experienced the greatest difficulty in collecting and transporting this material owing to the present unsettled condition of that part of Mongolia. BIBLIOGRAPHY OF GEORGE M. KOBER, M.D., LL.D. Dean and Professor of Hygiene, School of Medicine, Georgetown University, Washington, D. C. 1874 Infantile paralysis. Pacific Med. and Surg. Jour., San Francisco, 1874, xvi, 261-273. Urinology and its practical application, etc. In: Richmond and Louisville M. J., Louisville, 1874, xvin, 229-256, 2 pl.; 357-387, pl.; tables; 469-490; 580-609. 1875 Chronic dysentery treated with injections of chlorate of potassa. Am. Med. Weekly, Louisville, 1875, in, 241-242. Adenitis treated with injections of carbolic acid and glycerine. Am. Med. Weekly, Louisville, 1875, in, 241. Muriate of ammonia in neuralgia. Am. Med. Weekly, Louisville, 1875, in, 242. Incontinence of urine treated with chloral hydrate and belladonna. A. Med. Weekly, Louisville, 1875, in, 243. Tincture of iron and digitalis in dropsy. Am. Med. Weekly, Louisville, 1875, in, 243. 1876 Report of a case of gunshot wound of the knee joint and right hand treated with antiseptic injections of iodine and carbolic acid. Am. J. M. Sc., Phila., 1876, n.s., lxxii, 427-431. 1877 Die Kriegs-Chirurgie der letzten 150 Jahre in Preussen. A review of Prof. E. Gurlt's oration. Am. J. M. Sc., Phila., 1877, n.s., lxxiv, 226-227. 1878 Analysis of the Medical and Surgical History of the War of the Rebellion 1861-1865; part 2, volume 2; being the Second Surgical Volume. Washington, D. C., 1876, 4°, 1024, xvi pages. Militararzt, 1878, xxvin, 21-23; xxix, 6-8; 126- 127; 141-145; 150-152; 157-158; 165-166; 173-176. (In this review, the reviewer placed himself on the side of the innovators and vigorously combated the objections of Prof. Ashhurst, Hamilton and others to enterorrhaphy without visceral protrusion.) 1881 Die Gelenk-Resectionen nach Schussverletzungen; ihre Geschichte, Statistik, End- Resultate, von Prof. E. Gurlt. Berlin, 1879, 1333 pp. Review in: Am. J. M. Sc., Phila., 1881, n.s., lxxxi, 457-461. 1885 Report on the topography, botany, climatology and diseases of Surprise and Goose Lake Valleys. 31 p. 8°. Repr. from: Report of State Board of Health of 199 Amer. Jour. Phys. Anthrop., Vol. Ill, No. 1. 200 BIBLIOGRAPHY; GEORGE M. KOBER California, Sacramento, 1885, ix. (See editorials: Med. Rec., N. Y., Nov. 11 and Dec. 13, 1886.) 1889 Lectures on hygiene. 48 p. 8°. Repr. from: South. Clinic, Richmond, 1889. 1890 The etiology and prevention of tuberculosis. 8 p. 8°. Sacramento, 1890. Repr. from: Report of State Board of Health of California, Sacramento, 1890, xi. A contribution to the etiology of typhoid fever. 7 p. 8°. Berlin, L. Schumacher, 1891. Repr. from: Verhandl. d. X. Internal. Med. Congr., 1890, Berlin, 1891, v. Referat fiber eine von H. Remondino, San Diego, eingesandte Arbeit: Ueber Meteor- ologie und Klima des sudlichen Californien in Bezug auf Leben und Gesundheit. Deutsche med. Zeitung, Berl., 1890, 724. 1891 Syphilis and prostitution. Virginia Med. Month., Richmond, 1891, xvin, 85-89. 1892 The etiology and prevention of infectious diseases. 18 p. 8°. Richmond, 1892. Repr. from: Virginia Med. Month., Richmond, 1892-1893, xix. , 1893 Laparotomy for wounds of the peritoneal cavity. Med. Rec., N. Y., Jan. 21, 1893. The etiology, distribution and prevention of land and ship cholera. 6 p. 8°. Repr. from: Proc. State San. Convent., Sacramento, 1893, I. Also: Virginia Med. Month., Richmond, 1893-4, xx, 133-152. 1894 A plea for the prevention of tuberculosis. 12 p. 8°. Repr. from: Proc. State San. Convent., Sacramento, 1894, n. A study of soil in relation to health and disease. 29 p. 8°. Richmond, 1894. Repr. from: Virginia Med. Month., Richmond, 1894-5, xxi. A study of water in relation to health and disease. 37 p. 8°. Repr. from: Rep. State Bd. Health Calif., Sacramento, 1894, xm. 1895 Impure milk in relation to infantile mortality. 15 p. 8°. Repr. from: J. Am. M. Ass., Chicago, 1895, xxv. A plea for vaccination. 16 p. 8°. Repr. from: Virginia Med. Month., Richmond, 1895-96, xxn. Max Bartel: Die Medicin der Naturvblker, ethnologische Beitrage zur Urgeschichte der Medicin. Leipzig, 1893. (A review, with a condensation of the subject matter on primitive, minor and major surgery.) Repr. from: Virginia Med. Month., Richmond, 1895-96, xxn. BIBLIOGRAPHY, GEORGE M. KOBER 201 Report of the prevalence of typhoid fever in the District of Columbia. Report of the Health Officer of District of Columbia, 1895, 254-292. Also: Abstracts of Sanitary Reports of the Marine Hospital Service, December, 1895, 1157-1203. Also: Editorials Med. Rec., N. Y., Feb. 22, 1896, 267. Morbific and infectious milk (with S. C. Busey). Report of the Health Officer of District of Columbia, 1895, 299-378. Also: Public Health Reports, Feb. 14, 1896, 118-131. Also: Editorials J. Am. M. Ass., Chicago, March 7, 1896, 487; Med. Rec., N. Y., Apr. 18, 1896, 557; Am. Med.-Surg. Bull., N. Y., May 23, 1896, 694. 1896 A study of milk in relation to health and disease. 51 p. 8°. Sacramento, 1896. Repr. from: The 14th Biennial Report State Board of Health. Opium habit in the District of Columbia. U. S. 54th Congress, 2d Session. Senate Document 174, January 21, 1897. Report of the Editorial Committee of the Medical Society of the District of Columbia. Trans. Med. Soc. Dist. Col., 1896, 3. Trachoma (Discussion). Trans. Med. Soc. Dist. Col., 1896, 11. Milk bacteria (Discussion). Trans. Med. Soc. Dist. Col., 1896, 99. Diphtheria (Discussion). Trans. Med. Soc. Dist. Col., 1896, 111. Skin diseases (Discussion). Trans. Med. Soc. Dist. Col., 1896, 120. 1897 Relations of water supply and sewers to the health of cities with special reference to the City of Washington. Tublic Health Reports, Wash., 1897, xn, 197-200. The place of military medicine and surgery in the medical college curriculum. Repr. from: Proc. Ass. Mil. Surgeons, U. S., Carlisle, Pa., 1897, vii. Predisposition and immunity. 7 p. 8°. New York, 1897. Repr. from: Pract. Med., N. Y., 1897, viii. Prevention of puerperal fever. 16 p. 8°. Richmond, 1897. Repr. from: Virginia M. Semi-Month., Richmond, 1897, I. The progress and achievements of hygiene. (Address before the Anthropological Society of Washington.) 12 p. 8°. Repr. from: Science, N. Y., 1897, n.s., vi. Syphilis (Discussion). Trans. Med. Soc. Dist. Coil., 1897, 9. Scurvy and rickets in children (Discussion). Trans. Med. Soc. Dist. Col., 1897, 27. Bubonic plague (Discussion). Trans. Med. Soc. Dist. Col., 1897, 56-57. Malarial diseases in the District of Columbia (Discussion). Trans. Med. Soc. Dist. Col., 1897, 73-75. Neurasthenia (Discussion). Trans. Med. Soc. Dist. Col., 1897, 207. 1898 Higher medical education and a plea for better training of the volunteer medical officer. 5 p. 8°. Repr. from: Virginia M. Semi-Month., Richmond, 1898, in. Water supply and sewage disposal in the District of Columbia. U. S. 55th Congress, 2d Session. Senate Document 183, February, 1898, 16-25. Pollution of rivers. U. S. 55th Congress. 2d Session. Senate Document 194, March, 1898, 32-40. Arthritis deformans (Discussion). Trans. Med. Soc. Dist. Col., 1898, 14. 202 BIBLIOGRAPHY, GEORGE M. KOBER Typhoid fever (Discussion). Trans. Med. Soc. Dist. Col., 1898, 47-54. Gangrene of eyelids (Discussion). Trans. Med. Soc. Dist. Col., 1898, 109. Hydrophobia (Discussion). Trans. Med. Soc. Dist. Col., 1898, 113. Malarial fever (Discussion). Trans. Med. Soc. Dist. Col., 1898, 117. Expectorants (Discussion). Trans. Med. Soc. Dist. Col., 1898, 120. Ruptured spleen (Discussion). Trans. Med. Soc. Dist. Col., 1898, 163. 1899 Many of the causes of so called school diseases found in the home. U. S. 55th Con- gress, 3d Session. Senate Document 65, February, 1899, 40-43. Sarcoma of the testicles; conclusions based upon one hundred and fourteen cases. 18 p. 8°. Repr. from: Am. J. M. Sc., Phila., May, 1899, cxvn. The effects of modern fire arms in war. (Address before a joint meeting of the Anthropological and Medical Societies of Washington.) 6 p. 8°. Repr. from: Nat. Med. Rev., Wash., October, 1899, ix. Filtration, the pollution of streams and the purification of public water supplies, U. S. 56th Congress, 1st Session. Senate Document, 1900, 8 p. Protest from the civic center of the District of Columbia against the passage of Senate Bill No. 34, providing for the further prevention of cruelty to animals (Vivisection Hearings). U. S. 56th Congress. Senate Document, 101-111. Report on the housing of the laboring classes in the City of Washington, D. C. Repr. from: Report of the Health Officer of District of Columbia, 1899, 107-121, 1 plate. The fiftieth anniversary of the graduation in medicine of Doctor Samuel Clagett Busey, compiled and edited by George M. Kober, 63 p. ports. 4°. Washing- ton, 1899. ("Dr. Busey, physician, author and teacher," 37-42.) Texas fever (Discussion). Trans. Med. Soc. Dist. Col., 1899, 3. Malaria (Discussion). Trans. Med. Soc. Dist. Col., 1899, 19. Medico-military affairs (Discussion). Trans. Med. Soc. Dist. Col., 1899, 24. Milk laboratories (Discussion). Trans. Med. Soc. Dist. Col., 1899, 36; 145. Report of the Committee on longevity (Discussion). Trans. Med. Soc. Dist. Col., 1899, 103. Uric acid diathesis (Discussion). Trans. Med. Soc. Dist. Col., 1899, 110. Convulsions in typhoid fever (Discussion). Trans. Med. Soc. Dist. Col., 1899, 153. Knee-joint-shot-injuries (Discussion). Trans. Med. Soc. Dist. Col., 1899, 160. Katatonia (Discussion). Trans. Med. Soc. Dist. Col., 1899, 181. 1900 Shall alcohol be considered as a food? 7 p. 8°. Repr. from: Virginia M. Semi- Month., 1900, v. Conclusions based upon 330 outbreaks of infectious diseases spread through the milk supply. 6 p. 8°. Read before Section of Epidemiology and hygiene, 13th Internal. Med. Congress, Paris, August 4, 1900. Repr. from : Am. J. M. Sc., Phila., 1901, cxxi. Army nursing (Discussion). Trans. Med. Soc. Dist. Col., 1900, 18. Tuberculosis (Discussion). Trans. Med. Soc. Dist. Col., 1900, 66; 71. Remarks on science building. Trans. Med. Soc. Dist. Col., 1900, 106. BIBLIOGRAPHY, GEORGE M. KOBER 203 Therapeutic effects of sunlight (Discussion). Trans. Med. Soc. Dist. Col., 1900,173. Paragonimus Westermanni (Discussion). Trans. Med. Soc. Dist. Col., 1900, 179. Typhoid fever infection (Discussion). Trans. Med. Soc. Dist. Col., 1900, 182. Smallpox (Discussion). Trans. Med. Soc. Dist. Col., 1900, 189. Gunshot injuries (Discussion). Trans. Med. Soc. Dist. Col., 1900, 214. 1901 The need of additional playgrounds, parks and reservations. U. S. Senate Committee on District of Columbia, March 27, 1901. The pollution of streams and the purification of public water supplies; comparative efficiency of slow sand and mechanical filters. 8 p.,1 table. 8°. Repr. from: J. Am. M. Ass., Chicago, 1901, xxxvi. The progress and tendency of hygiene and sanitary science in the nineteenth century. (Oration on State Medicine delivered before the meeting of the American Medical Association, St. Paul, Minn., 1901.) 31 p. 8°. Repr. from: J.Am.M. Ass., Chicago, 1901, xxxvi. Also: N. Y. M. J., June 8,1901, 991; Med. Rec., N. Y., June 8, 1901, 898; and also: Lancet, London. Recent books on hygiene (a review). 6 p., roy. 8°. Repr. from: Science, N. Y., 1901, n.s., xiv. Sudden death after gastroenterostomy (Discussion). Trans. Med. Soc. Dist. Col., 1901, 26. Gonorrhea in women (Discussion). Trans. Med. Soc. Dist. Col., 1901, 38. Filtration of the municipal water supply (Discussion). Trans. Med. Soc. Dist. Col., 1901, 55; 68. Tapeworm (Discussion). Trans. Med. Soc. Dist. Col., 1901, 95. Cancer (Discussion). Trans. Med. Soc. Dist. Col., 1901, 105. Obituary on Dr. James W. H. Lovejoy. Trans. Med. Soc. Dist. Col., 1901, 125. Report of the Editing Committee of the Medical Society. Trans. Med. Soc. Dist. Col., 1901, 137. Syphilis (Discussion). Trans. Med. Soc. Dist. Col., 1901, 159. Report of Prof. Waldeyer's visit to Washington. Trans. Med. Soc. Dist. Col., 1901, 251. Uncinariasis (Discussion). Trans. Med. Soc. Dist. Col., 1901, 270. Diphtheria (Discussion). Trans. Med. Soc. Dist. Col., 1901, 302. 1902 Butter and butter substitutes and their relation to health and disease. Abnormal milk and milk-borne diseases. Statement before the Committee on Agriculture, House of Representatives, U. S., Tuesday, January 14, 1902, p. 37-135, Wash- ington, D. C. Milk, butter and butter substitutes (read before the Am. Social Sc. Ass., April 24, 1902). Repr. from: Am. Med., Philadelphia, 1902, in, 1085-1089. The causation of disease. 63 p. 8°. Repr. from: Wash. Med. Ann., 1902, i. Review of five text-books on hygiene. Science, 1902, 218-227. Report of the Executive Committee of the Medical Society of the District of Colum- bia on the proposed consolidation of the medical work in the District Govern- ment. Wash. Med. Ann., April 2, 1902. House-sanitation. Ref. Handb., M. Sc., 2d ed., N. Y., 1902, iv, 750-769. 204 BIBLIOGRAPHY, GEORGE M. KOBER Milk in relation to public health. Milk-borne diseases. Ref. Handb., M. Sc., 2. ed., N. Y., 1902, v, 833-843. See also: Rev. ed., 1914. Milk in relation to public health. The necessity for the enactment of Senate' Bill entitled "A bill to regulate the production and sale of milk and cream in and for the District of Columbia." U. S. 59th Congress, 1st Session. Senate Document 441. 235 p., 15 plates. 8°. Washington, Govt. Print. Off., 1902. See also: Editorials J. Am. M. Ass., 1902, 1397; Phila. M. J., 1902, 653; Med. Rec., N. Y., 1902, 897. The etiology of intermittent fever (Discussion). Wash. Med. Ann., 1902, 25-26. Causation of disease (Discussion). Wash. Med. Ann., 1902, 62. Obituary on Dr. W. W. Johnston. Wash. Med. Ann., 1902, 171. 1903 The canteen. 22 p. 8°. Repr. from: Am. Med., Phila., 1903, vi. The transmission of bovine tuberculosis by milk, with a tabulation of eighty-six cases. 26 p. 8°. Repr. from: Trans. Ass. Am. Physicians, 1903. Obituary on Dr. Walter Reed. ' Wash. Med. Ann., January, 1903. The liver as a factor in the cause and prevention of disease (Discussion). Wash. Med. Ann., May, 1903, 99. Drug adulterations (Discussion). Wash. Med. Ann., July, 1903, 226-227. Human and animal tuberculosis (Discussion). Wash. Med. Ann., July, 1903, 246- 247. Chronic bronchitis (Discussion). Wash. Med. Ann., Sept., 1903, 184. 1904 A review of the work of the Medical Society of the District of Columbia during the past eighty-five years. (President's address.) Repr. from: Wash. Med. Ann., 1904, ii. A plea for a standard medical curriculum (read before the Association of American Medical Colleges). Repr. from: J. Am. M. Ass., Chicago, August 13, 1904. Rheumatoid arthritis (Discussion). Wash. Med. Ann., Jan., 1904, 482. Surgical methods among savage races (Discussion). Wash. Med. Ann., March, 1904, 73. Scarlet fever (Discussion). Wash. Med. Ann., July, 1904, 205. Obstetrics (Discussion). Wash. Med. Ann., July, 1904, 218. Delirium tremens (Discussion). Wash. Med. Ann., Nov. 1904, 357. 1905 The physical and physiological effects of child labor. Address delivered at the Meeting of the National Child Labor Committee, Washington. 4 p. 8°. New York, 1905. Suggestions concerning the administrative control of venereal diseases. 7 p. 8°. Repr. from: J. Am. M. Ass., Chicago, March 11, 1905. Report of the committee on national uniformity of curricula of the Association of American Medical Colleges. 6 p. 8°. Repr. from: J. Am. M. Ass., Chicago, 1905. Etiology of appendicitis (Discussion). Wash. Med. Ann., Jan., 1905, 427. BIBLIOGRAPHY, GEORGE M. KOBER 205 Caesarian section (Discussion). Wash. Med. Ann., Mar., 1905, 87. Rational versus empirical therapeutics (Discussion). Wash. Med. Ann., July, 1905, 204. Modern treatment of tuberculosis (Discussion). Wash. Med. Ann., Sept., 1905, 254. Senile cataract (Discussion). Wash. Med. Ann., Nov., 1905, 295. Smallpox (Discussion). Wash. Med. Ann., Nov., 1905, 313. 1906 Our LL.D.'s response to a toast at the banquet of alumni, Georgetown University. June 4, 1906. In: Georgetown College Journal. The health of the City of Washington. (President's address of the Anthropological Society of Washington.) 14 p. 8°. Repr. from: Charities and Commons, N. Y., March 3, 1906. The prevention and treatment of tuberculosis by state methods. Pan-Am. Med. Congr., Panama, 1906, n, 249-258. Washington Filtration Plant. Discussion on water filtration. Proc, of Soc. Civil Engineers, 1906, xxxn, 959-961. President's address at the meeting of the Association of American Medical Colleges. Proc. Ass. Am. Med. Colleges, 1906. President's address (Discussion). Wash. Med. Ann., Jan., 1906, 336. Gastric ulcer (Discussion). Wash. Med. Ann., Jan., 1906, 359. Diseases among Indians (Discussion). Wash. Med. Ann., Jan., 1906, 386. Appendicitis (Discussion). Wash. Med. Ann., Mar., 1906, 8. Protozoal human parasites (Discussion). Wash. Med. Ann., Mar., 1906, 54. Therapy of pulmonary consumption (Discussion). Wash. Med. Ann., May, 1906, 82. Eye cases (Discussion). Wash. Med. Ann., May, 1906, 86. Obituary on Dr. Louis Mackall (Discussion). Wash. Med. Ann., Sept., 1906, 212. Ophthalmology (Discussion). Wash. Med. Ann., Nov., 1906, 266. 1907 Die Herstellung reiner Milch fur kleine Kinder in Washington. Repr. from: Ztschr. f. Sduglingsfursorge, Leipz., 1906-7, I, 375-380. Arbeiterwohnungen in Washington. Internal. Kongr. f. Hygiene u. Demographic, Berlin, September 23-29, 1907, XIV. Ber., 1908, iv, 339-345. Unterbringung von schwerkranken Schwindsuchtigen und der Luftkur bediirftigen leichtkranken Tuberkulosen in einem und demselben Krankenhause. Internal. Kongr. f. Hygiene, etc., Berlin, September 23-29, 1907, XIV. Ber., iv,423-A:33. The history and development of the housing movement in the City of Washington, D. C. 64 p. 8°. 1907. (See editorial J. Am. M. Ass., Feb. 27, 1909.) The combat of scientific medicine with superstition (Discussion). Wash. Med. Ann., Jan., 1907, 335. Report of tuberculosis cases treated at Starmont Sanatorium (Discussion). Wash. Med. Ann., Jan., 1907, 345. Obituary on Dr. David Henry Hazen. Wash. Med. Ann., Jan., 1907, 410. Tuberculosis (Remarks). Wash. Med. Ann., Jan., 1907, 422-425. Schott treatment of chronic diseases of the heart (Discussion). Wash. Med. Ann., Mar., 1907, 27. Medical inspection of schools (Discussion). Wash. Med. Ann., Mar., 1907, 45-46. Naval medical service. Wash. Med. Ann., 1907, 282; 290; 380. 206 BIBLIOGRAPHY, GEORGE M. KOBER Sanitary milk production. Report of a Conference appointed by the Commissioners of the District of Columbia. U. S. Dept, of Agriculture, Circular No. 114, August 20, 1907. 1908 Industrial and personal hygiene. A report as chairman of a Committee on social betterment of the President's Home Commission, Washington, D. C., 1908. 175 p. 8°. (See Editorials: J. Am. M. Ass., Chicago, 1909, 138; Boston M. and S. J., 1908, 448; Bull. Bureau of Labor, No. 75, Wash., 1908.) Hygiene and public health; a review of Prof. Louis C. Parkes' textbook. Science, 1908, n.s., xxvin, 924-926. The Tuberculosis Hospital in Washington, D. C. 6 p. 4 plates. 4°. Washington, 1908. Conservation of life and health by improved water supply. Address delivered at the Conference on the conservation of natural resources, White House, Washington, May 13-15, 1908. 51 p. 8°. Address delivered at the complimentary banquet to Surgeon General George M. Sternberg on his 70th birthday, June 8, 1908. 30 p. 8°. The fight against tuberculosis in various countries. Opening discussion. Sixth Internal. Cong, on Tuberculosis, Washington, D. C., September 28 to October 5, 1908, iv, pt. 1, 105-110. Pterygium (Discussion). Wash. Med. Ann., Jan., 1908, 432. Internal medicine (Discussion). Wash. Med. Ann., Jan., 1908, 450. Report of the Committee on Public Health. Wash. Med. Ann., Mar., 1908, 30. The causes of typhoid fever in the District of Columbia. Wash. Med. Ann., Mar., 1908, 98-103. Acid-intoxication (Discussion). Wash. Med. Ann., May, 1908, 147. Principles of aseptic surgery (Discussion). Wash. Med. Ann., May, 1908, 186. Snake-poisoning (Discussion). Wash. Med. Ann., July, 1908, 276. Obituary on Anne H. Wilson. Wash. Med. Ann., July, 1908, 284-286. Appendicitis (Discussion). Wash. Med. Ann., Sept., 1908, 307. Congratulations extended by the Medical Society to Dr. Kober on bis White House address. Wash. Med. Ann., Sept., 1908, 315. 1909 Report of the committee on social betterment, President's Home Commission, Washington, D. C. 278 p. 8°. Also: U. S. 60th Congress, 2d Session. Senate Document 644, January 8, 1909. (See Editorials: J. Am. M. Ass., Chicago, 1909, 895; also; April 24, 1909.) Contents of the report on social betterment: Alimentation and foods. Food and home betterment. The causation and prevention of disease. Infant mortality. The prevention of permanent disabilities in childhood. Sexual and moral prophylaxis. The tobacco habit. The alcohol question. Patent and proprie- tary compounds containing sufficient alcohol to be intoxicants. The drug habit. The nostrum evil in general. Sociological studies of 1,251 families. The scale of wages and the cost of living. Suppression of usury. Review of hygiene and sanitary science (read before the Medical Society of the District of Columbia, April 14, 1909.) Repr. from: WasA. Med. Ann., vm, No. 3. BIBLIOGRAPHY, GEORGE M. KOBER 207 The influence of sewers and general sanitation upon the prevalence of tuberculosis. Repr. from: Johns Hopkins Hosp. Bull., 1909, xx. Civics and health: review of Prof. Allen's book. In: Charities, N. Y., 1909., The general movement of typhoid fever and tuberculosis in the last thirty years. Tr. Ass. Am. Phys., 1909. Also: Am. J. M. Sc., Philadelphia, November, 1909. Pure food and drugs. Bull. Vermont State Board of Health, December, 1909, No. 2. Eczema in children (Discussion). Wash. Med. Ann., 1909-10, vm, 428. Gall stones (Discussion). Wash. Med. Ann., 1909-10, vm, 436. Case of acute yellow atrophy of the liver (Discussion). Wash. Med. Ann., 1909-10, vm, 124. Obituary on Doctor Robert Reyburn. Wash. Med. Ann., 1909-10, vm, 141-142. Review of hygiene and sanitary science. Wash. Med. Ann., 1909-10, vm, 167-181. Discussion, 184. A plea for a more liberal diet in typhoid fever (Discussion). Wash. Med. Ann., 1909-10, viii, 199. Flexible instruments in urethral stricture (Discussion). Wash. Med. Ann., 1909-10, vm, 210. Prevention of ear infection in scarlet fever (Discussion). Wash. Med. Ann., 1909-10, vm, 238. 1910 The influence of pure water and air upon the health of communities. Bull. Vermont Slate Board of Health, March, 1910, No. 3. Review of some recent literature with special reference to anti-typhoid vaccination, the hygiene of medical cases, transmission of disease by insects. Bull. Vermont State Board of Health, June, 1910, No. 3. Statement before Senate Committee on Public Health concerning the creation of a Department of Health. June, 1910. Diseases which menace public health and morals (read at the twelfth annual school for the instruction of health officers.) Repr. from: Bull. Vermont State Board of Health, 1910, xi. Milk in relation to public health. Bull. State Board of Health, California, 1910. The dissemination of disease by dairy products and methods of prevention. U. S. Dept. Agriculture, Bur. Animal Industry, Circular 153, April 28, 1910. Re- view: Wash. Med. Ann., 1910, 324-327. Dispensary tuberculosis work (Discussion). Wash. Med. Ann., 1909-10, vm, 370- 371. Thymol in uncinariasis (Discussion). Wash. Med. Ann., 1910-11, ix, 41. Measles and mice (Discussion). Wash. Med. Ann., 1910-11, ix, 60. Obituary on Dr. Thomas Taylor. Wash. Med. Ann., 1910-11, ix, 78-80. The written law in reference to the unborn child (Discussion). Wash. Med. Ann., 1910-11, ix, 160. Digestion in fever (Discussion). Was/i. Med. Ann., 1910-11, ix, 401. 1911 The hygiene of schools and the prevention of permanent disabilities in children. Lecture before the thirteenth annual school of instruction for health officers, Burlington, Vt., August 21, 1911. Bull. Vermont State Board of Health, xn, No. 1. 208 BIBLIOGRAPHY, GEORGE M. KOBER Pernicious anemia (Discussion). Tr. Ass. Am. Physicians, Philadelphia, 1911, xxvi, 294. Toxicity of alcoholic beverages (Discussion). Tr. Ass. Am. Physicians, Philadelphia, 1911, xxvi, 66. The prevalence and control of venereal diseases. Tr. Ass. Am. Physicians, Phila- delphia, 1911, xxvi, 155-165. Use of vaccines in gonorrheal arthritis restoring the power of locomotion (Discussion). Wash. Med. Ann., 1911-12, x, 11. Use of tincture of iodine as an injection in gunshot wounds (Discussion). Wash. Med. Ann., 1911-12, x, 165; 179. 1912 The management and control of infectious diseases. Lecture before the fourteenth annual school of instruction for health officers. Bull. Vermont State Board of Health, 1912, xii, No. 4. The venereal peril. Lecture before the fifteenth annual school of instruction for health officers. Bull. Vermont State Board of Health, 1912, xm, No. 1. The hygiene of occupations (Chairman's address). Tr. XVth Internat. Cong. Hygiene and Demography, Washington, 1912. The management and control of smallpox and other eruptive fevers. Lecture before the fifteenth annual school of instruction for health officers. Bull. Vermont State Board of Health, 1912, xm, No. 1. Tuberculosis as a disease of the masses. Ibid. Psychopathic work at the Washington Asylum Hospital (Discussion). Wash. Med. Ann., 1911-12, x, 240. Typhoid and venereal prophylaxis in the United States Army (Discussion). Wash. Med. Ann., 1911-12, x, 265-266. Rickets and tuberculosis among Indians (Discussion). Wash. Med. Ann., 1912, xi, 118; Shall the professor be in practice? (Discussion). Wash. Med. Ann., 1912, xi, 166. Busey, Samuel Clagett, 1828-1901. In: Cyclopedia of American Medical Biography . . . from 1610-1910, ed. by Howard A. Kelly, Philadelphia, 1912, i, 140-143. Eliot, Johnson, 1815-1888. In: Cyclopedia of American Medical Biography . . . from 1610-1910, ed. by Howard A. Kelly, Philadelphia, 1912, i, 279-280. 1913 The progress of public health and the need of increased federal health activities in the United States. 9 p. 8°. Repr. from: Case and Comment, August, 1913. Occupational diseases, with special reference to the stone cutting industry in Ver- mont. Lecture before the fifteenth annual school of instruction for health officers. Bull. Vermont State Board of Health, xhi, No. 3. A condensed history of the hospitals and medical charities in the District of Columbia. Repr. from: Annual Report of Board of Charities, Washington, 1913. The sense of hearing from a hygienic standpoint (Discussion). Wash. Med. Ann., 1913, xn, 48. Anti-typhoid vaccination in the army (Discussion). Tr. Ass. Am. Physicians, Philadelphia, 1913, xxviii, 466. Syphilis among school children (Discussion). Wash. Med. Ann., 1913, xn, 228-229. Hospital milk (Discussion). Wash. Med. Ann., 1913, xii, 240-241. BIBLIOGRAPHY, GEORGE M. KOBER 209 1914 Sanitation in ancient civilizations (Discussion). Wash. Med. Ann., 1914, xin, 349- 351. Streptococcus sore throat (Discussion). Tr. Ass. Am. Physicians, Philadelphia, 1914, xxix, 292. 1915 Tuberculosis with special reference to its prevention. Address of the President at the Annual Meeting of the National Association for the Study and Prevention of Tuberculosis, Seattle, Washington. Repr. from: Tr. Nat. Ass. for Study and Prevention of Tuberculosis, 1915. The child and the home. Tr. Nat. Ass. for Study and Prevention of Tuberculosis, 1915. Tuberculosis with special reference to its epidemiology, transmissability and preven- tion. Repr. from: Public Health Reports, Oct. 29, 1915, No. 339. Chapter "Avoid house dust" in Washington Health Rules, a collection of chapters dealing with the essentials of hygiene published by the Association for the Prevention of Tuberculosis, 1915. A plea for a cancer clinic (Discussion). Wash. Med. Ann., 1915, xiv, 77. 1916 Address at a memorial meeting in honor of George Miller Sternberg. Repr. from: Wash. Med. Ann., 1916, xv, 81-91. Diseases of occupation and vocational hygiene (edited by Kober and Hanson). 918 p. 8°. Philadelphia, Blakiston Sons & Co., 1916. Dr. Kober wrote the chapter on the effects of diminished atmosphere, with special reference to aviators (p. 211-217), and also the chapters on the etiology and prophylaxis of occupational diseases (p. 417-761). The Army Medical Museum; a history (Discussion). Wash. Med. Ann., 1916, xv, 33-34. Ernest Pendleton Magruder; an appreciation (Discussion). Wash. Med. Ann., 1916, xv, 57. Actinomycosis (Discussion). Wash. Med. Ann., 1916, xv, 61. Responsibility of the physician with respect to the insane patient (Discussion). TFasA. Med. Ann., 1916, xv, 117. Infant welfare and infant mortality (Discussion). Wash. Med. Ann., 1916, xv, 273. Psychoanalysis in its relation to psychiatry (Discussion). Wash. Med. Ann., 1916, xv, 342. Dr. Agramonte's resolution of condolence on the death of General George M. Stern, berg (Remarks). Proc. Second Pan-American Scientific Congress, Wash., Dec. 27, 1915-January 8, 1916, ix, 314. Housing of wage earners, by Dr. Lawrence Veiller (Discussion), Proc. Second Pan- American Scientific Congress, Wash., Dec. 27,1915-January 8,1916, ix, 319-320. International agreements in relation to the suppression of vice, by James B. Reynolds (Discussion). Proc. Second Pan-American Scientific Congress, Wash., Dec. 27, 1915-January 8, 1916, ix, 504. Discussion of papers relating to social medicine. Proc. Second Pan-American Scien- tific Congress, Wash., Dec. 27, 1915-January 8, 1916, ix, 584. The significance of chemistry in water purification, by E. Bartow (Discussion). Proc. Second Pan-American Scientific Congress, Wash., Dec. 27, 1915-January 8, 1916, x, 226-227. 210 BIBLIOGRAPHY, GEORGE M. KOBER Fresh air and ventilation in the light of modern research, by C.-E. A. Winslow (Discussion). Proc. Second Pan-American Scientific Congress, Wash., Dec. 27, 1915-January 8, 1916, x, 243-244. George M. Sternberg: Historical resume of investigations of yellow fever leading up to the findings of the Reed board (Discussion). Proc. Second Pan-American Scientific Congress, Wash., Dec. 27, 1915-January 8, 1916, x, 650. 1917 Artificial pneumothorax in the treatment of tuberculosis (Discussion). Wash. Med. Ann., 1917, xvi, 78. American achievements in medicine (Discussion). Wash. Med. Ann., 1917, xvi; 160. Cirrhosis of the liver (Discussion). Tr. Ass. Am. Physicians, Philadelphia, 1917, xxxu, 478. Effects of dust inhalation upon the lungs. Tr. Ass. Am. Physicians, Philadelphia, 1917, xxxu, 106-107. 1918 Sanitation of rural workmen's areas with special reference to housing. Committee on labor, Council of National Defence. Repr. from: Public Health Reports, September 6, 1918, no. 487. Recent developments in infant feeding. Discussion of Mr. Emile Berliner's address read before the Association for the Prevention of Tuberculosis, Washington, D. C., November 25, 1918. 1919 The venereal problem in civil life. Address delivered at the first of a series of educational lectures and film exhibitions before medical schools. Bull. U. S. Public Health Service, Feb. 1, 1919. Osler's influence on American medicine (Osler's anniversary volume, 1919). In press. Protest by Dr. Kober, dean of the Medical School, Georgetown University, against the passage of Senate Bill No. 1258: Providing for the prevention of experi- ments on the dog. Vivisection hearing before the U. S. Senate Judiciary Committee, November 1-4, 1919, 101-108. Washington, D. C., Govt. Print. Office, 1919. Occupations in relation to tuberculosis. Address delivered before the College of Physicians, Philadelphia, December 17, 1919. In press. Chapters on hygiene for elders. In: Illustrated Health Rhymes for Children, Washington, 1919. Miscellaneous. Description of Frankford Arsenal. Army and Navy Journal, N. Y., August 12, 1871. Auch eine Ansicht fiber deutsche Schulen. Washington Journal, September, 1873. Amerikanisch-deutsche Klinik. Washington Journal, April, 1874. Das Central-Dispensarium in Washington; eine arztliche Anstalt ffir unbemittelte Kranke; das deutsche Element zahlreich vertreten. Washington Journal, June 29, 1874. Aus dem fernen Westen. Washington Journal, June 26, 1877, Rifle practice for the army and navy. Army and Navy Journal, N. Y. August 10, 1878. BIBLIOGRAPHY, GEORGE M. KOBER 211 The Army Mutual ,Aid Society. Army and Navy Journal, N. Y., October, 1878. "St. John's Day." Original poem delivered at Masonic celebration at Fort Bidwell, California, June 22, 1883. Lake County Examiner, Oregon, June 30, 1883. "Eternal vigilance is the price of liberty." Fourth of July oration delivered in Cedarville, California, July, 1885. Columbian oration delivered at Fort Bidwell, California, October 21, 1892. Alturas Plain Dealer, October 23, 1892. Complimentary dinner to Dr. Joseph J. Kinyoun, Washington, May 20, 1899. Address. Repr. from: Georgetown College Journal, June, 1899. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY Rules Concerning Communications 1. Recognizing the universal character and essential unity of anthropological laws and problems, the Journal lays no geographical restrictions on its activities, and will freely receive high-class communications from foreign contributors. 2. At the outset, communications must be restricted to those in the Enghsh language; but as soon as pecuniary conditions permit, the Journal will also be available for articles in Spanish, as the next most important language on the American continent. 3. Articles of merit will not be limited in length. 4. All papers submitted for pubheation will be subjected to careful editorial scrutiny, only those being accepted which present contributions of real value to Physical Anthropology, and which are in correct form. 5. Until the Journal is on a sound financial basis, illustrations, detailed tabular matter, extended quotations in foreign languages, and extensive use of mathematical formulae, must be restricted, unless their expense is borne by the author or his institution. 6. Only carefully prepared, finished, typewritten manuscripts can be considered for publica- tion. To avoid undue delay, but one proof will be submitted to author for correction of typo- graphical errors, except in special cases. Changes in the text or additions can not be considered unless the author bears the cost of resetting. 7. All tables, plates, and figures must be provided with full legends and presented in finished form. 8. Reprints will be furnished at cost. 9. While due care will be exercised in accepting articles, discussions and reviews for publication, the responsibility for these must rest wholly with the authors. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY Vol. Ill-No. 1 JANUARY-MARCH, 1920 CONTENTS Kober, Dr. George M.: Biography iii Newton, Philip: Observations on the Negritos of the Philippine Islands . 1 Keegan, J. J.: The Indian Brain 25 Cameron, John : A New Craniometric Method, Including a Description of a Specially Designed Indexometer for Estimating it 63 Maccurdy, George Grant : Aspects of the Skull: How shall They be Represented? . . 77 Laufer, Berthold : Multiple Births among the Chinese 83 Thompson, WarrenS.: Race Suicide in the United States 97 Hrdlicka, Ales: Anthropometry-E. Osteometry 147 Special Communications: The Morbidity Statistics of Insured Wage-Earners and their Families, Louis I. Dublin, Edwin W. Kopf and George H. Van Buren, 175 ; The Newest Discovery of "Ancient" Man in the United States, Ales Hrdlicka, 187. Notes: Anthropological Society of St. Louis, 197 ; Physical Anthropology at the Museum of the American Indian, 197; Studies in the Far East, 197; Twentieth International Congress of Americanists, 197 ; Dr. A. A. Mendes Correaand the University of Oporto, 197 ; Swedish Investigations in South America, 197 ; Resignation of Dr. Franz Boas, 198 ; Ludwig Stieda, 198 ; Richard L. Garner, 198 ; Horatio C. Wood, 198 ; Chihli collections at Peking Union Medical College, 198; Investigations near Chin-Chow, 198; American Museum of Natural History Collections from Mongolia, 198. Bibliography of Dr. George M. Kober 199 PRESS OF THE NEW ERA PRINTING COMPANY LANCASTER, PA. 1050 1920 Anttiurrsarij ©rtbuif in ^rorge Martin IKnbw. <. H, 0. 3n Cvhbraitnn nf ZDtlj Siriljiiay JFrwtthH attb Assnnato fcdj 28, 192H 3Fra«ris A. ©nttborf, 3. Waatjington, £L CH. 1320 QVICVNQVE . HEIC . LEGATIS GEORGII . MARTINI . KOBER ALMAE. MATRIS. GEORGIOPOLITANAE. DECORIS DICTA . SCRIPTA . FACTA QVA . IPSIVS LVCE . NATIVITATIS . SEPTVAGESIMA ADMIRAMINI . IMITAMINI Scripsit Tondorf. Born, March 28, 1850 LL.D., June 14, 1906, Georgetown University M,D., March 7, 1873, Georgetown University ®rnrge Hi. Kober, JH. S., Dean uf drargetnuiii Uaiueraitg ^rljonl of UHrbirinr Francis A. Tondorf, S.J., Head of the Department of Physiology, Georgetown Medical School. yY S MUCH knowledge does not constitute wisdom nor a facile I memory a philosopher, so mastery of the medical science d°es not °f 'tse^ make a great physician. If he be without a heart, sufferings and countless ills that human flesh is t0 become, to the practitioner so many modes or acci- dents of being, clinical phenomena, to be tabulated, observed, treated and cured, it may be, but there his philosophy of utility exhausts itself. When, on the other hand, to skill and learning is joined the sweet and generous temper of the friend and comforter who knows the precious art of penetrating beneath the sore to the seared soul, then has medicine achieved the pattern set by the first Great Physician of Humanity. It was not by chance that the Anglo-Saxons called the Saviour of the world "Haelend." the healer. The true dignity of knowledge lies in its dedica- tion to the common good. To indicate that the seventy years of the life of Dean Kober measure up faithfully to this standard has made the task of itemizing the following facts one of sincerest love. Dr. George Martin Kober was born to Jacob and Dorothea (Behr) Kober at Alsfeld, Hessen-Darmstadt, Germany, on March 28, 1850. He received his earlier education at the public and grand-ducal "Realschule" of his native town. His father, a revolutionist, had vowed that none of his sons should serve under a German king, prince, or potentate. Accordingly lie early prevailed upon George to emigrate to the United States, which he did in April, 1867. Upon his arrival, he found that his brother Charles, who had preceded him to the States, had secured for him an assignment to the hospital corps at the Carlisle Barracks, Pennsylvania. Under the tutelage of Surgeon Joseph J. B. Wright, U. S. A., Kober began here what might be fittingly styled his pre-medical course. His application in January, 1870, for an appointment as hospital steward was acted favorably on and 217 ANNIVERSARY TRIBUTE. accordingly we find him reporting for duty on January io, at the Frankford Arsenal, near Philadelphia. Here he read medicine privately under Dr. Robert Bruce Burns, a graduate of the University of Edinburgh. Ordered to Washington, to the office of the Surgeon-General, in September, 1871, he found it possible to formally enter upon his medical studies in the Medical School of Georgetown University. With the schedule calling for no exer- cises before 5 P. M., Kober was able to attend all the classes and, not satis- fied with this, he tutored privately under Drs. Johnson Eliot and Robert Reyburn. After two winter and summer courses he was graduated in March, 1873. The following winter he figured as the first graduate of a post-grad- uate course, inaugurated by Drs. Thompson, Busey, Ashford, and others, at the Columbia Hospital, Washington, D. C. During the period of his medical studies, Kober considered himself fortunate in being assigned the duty of indexing all the official communications on file in the Surgeon- General's office from 1812 to the date 'of his departure in 1874. In these dusty records he found many items of extreme scientific, historical, and epidemiological interest: so the reports of Surgeon William Beaumont, sta- tioned at Fort Mackinac, Michigan, on his "Observations and Experiments in 1825 in the case of Alexis St. Martin," who had been treated for a gun- shot wound of the abdomen resulting in a gastric fistula: so too the report of a perforating gun-shot wound of the chest with recovery in the case of Gen. James Shields, of Mexican War fame. Of equal interest were the reports on yellow fever during the Seminole Indian and Mexican Wars, as also subsequent reports on yellow fever and cholera up to the year 1874. Kober learned here to respect the old Army doctors, for when referring to them afterwards, in his lectures, he ever insisted that "they knew how to use the English language better than men of modern times." Whilst engaged in this indexing, Kober had gained the confidence and good will of Surgeon- General Barnes and Assistant Surgeon-General Crane, of Drs. Joseph J. Woodward and George A. Otis, editors of the Medical and Surgical History of the Civil War, and Dr. John S. Billings, in charge of the library, and who, with the assistance of but one hospital steward, was laying the founda- tion of the Index Catalogue. Billings found Kober of service in supplying correct titles for the articles published in the German medical 'periodicals. His fellow clerks fittingly christened him "Index" because of his unselfish devotion to this trying work, and lest the harvester, Time, should rob him of this new birth-right, his close friend, George Dowe, on the occasion of Kober's twenty-fourth birthday, did this title into the following verse: 218 ANNIVERSARY TRIBUTE. Index you are rightly named, Let thy future name be famed. I do not come in grim scholastic mood To fulminate some dreary platitude. But only wish, my loved and honored friend, That hope and peace be yours till life shall end. Hope, the sheet anchor of the youthful sold, And peace zuhen angry zvaz/es of trouble roll. And, while you practice zvell the healing art, Let strength be given to act the manly part; Good common sense to knozu the good from ill, And test the pozuers of plasters, draught or pill. And if, upon some distant honored day, The men and zoomen you have cured for pay Shall add their record to your fair renozon, By zoriting some good testimonial dozon, Be this the message one and all shall send: That every patient zoas your fervent friend. Search carefully true zvisdonds bounteous stores, That all her waiting treasure may be yours. May she attend, zohen years run trembling dozon, With honors zoreath your zohitening hairs to crozun. Appointed acting assistant surgeon, U. S. A., he became post surgeon in July, 1874, at Alcatraz Island, California, which position he filled till Novem- ber of the same year, at which time he was ordered to Fort McDermit, Nevada, in the same capacity. Tn the fall of 1875 he served with the First U. S. Cavalry in the southeastern Nevada expedition against hostile Indians and in 1877 took active part in the Nez-Perces war. From July to October of this year the field hospital at Kamiah, on the Clearwater, Idaho, was under his charge. In November, 1877, he met for the first time Dr. George M. Sternberg, then post surgeon at Walla Walla, and this acquaintance ripened into a life-long friendship. Dr. Kober never tired of acknowledging his indebted- ness to the General for the many inspirations he had received from him. Having served as post surgeon successively at a camp near Spokane, W. T.; at Fort Coeur d'Alene, Idaho; Fort Klamath, Oregon: and Fort Bidwell, Cal- ifornia, he was relieved from this service on the reception of the following- orders, highly commendatory of his efficiency: 219 ANNIVERSARY TRIBUTE. Post Orders) Fort Bidwell, California. No. 104 ) Nov. 11th, 1886. * * * In recognition of the long and faithful professional services rendered to the government during the past twelve years in the field, in pursuit of hostile Indians, and at various posts, the commanding officer cannot part with him without some expression of his feelings of regret, as part of this service was rendered under his immediate command. His devotion to his professional duties has been warmly1 recognized not only by his commanding officer, but by others, and has stamped him as one of the most skilful surgeons in the U. S. Army. A steadfast friend, a faithful officer, with the many acts of kindness to all, pro- fessional and otherwise, he has endeared himself not only to the officers and enlisted men of the garrison, but to the community at large, which he has helped to build up. * * * He carries with him our best wishes for his future welfare and happiness. By order of Major Gordon. (Signed). L. M. Brett, 2nd Lieut., 2nd Cavalry. Post Adjutant. After severing his connections with the army, Kober remained at this sta- tion caring for his many civilian patients until June, 1887, at which time he traveled extensively in America and Europe. He returned to Fort Bidwell the following year. In the fall of 1889, we find him in Washington devoting his time to college, hospital, and literary work. Besides acting as professor of Hygiene and State Medicine in the Georgetown Medical School, he assisted his friend and former classmate, Dr. Carrol E. Morgan, in his specialties, dis- eases of the throat, chest, etc. In the winter of 1889-90, he directed the attention of the District authorities to the sewage pollution of the Potomac water, indicating this as an important factor in the alarming prevalence of typhoid fever in Washington. In August, 1890, he went to Berlin as a member of the Tenth International Medical Congress and there read a paper entitled: "Etiology of typhoid fever with special reference to water-borne epidemics." His California investments necessitated his return to Fort Bid- well in December, 1890. He resumed his medical practice there and for a year or more was again attending surgeon of the post. His alma mater welcomed him back to the lecture room in the fall of 1893. From this date on, health problems of the District, its social and industrial betterment were his one concern. At the request of the Health Officer, in 1895, he investigated the possible causes of typhoid fever in the city and in his report suggested the agency of flies as a transmitter of the disease. His public addresses on various occasions and researches into the relative merits of the various processes of water filtration, very materially influenced Con- gress towards appropriating the necessary funds for the installation of the 220 ANNIVERSARY TRIBUTE. model filtration plant at Brookland, District of Columbia. During the years 1895-96, Kober was a volunteer worker in the Hygienic Laboratory of the Public Health Service of the United States. As a member of the board of directors of the Associated Charities the housing problem for the least resourceful people in the national capital appealed to him with special emphasis and accordingly he is recognized as one of the principal promoters of the Washington Sanitary Housing Company, organized' in 1897 and 1904. Through these agencies sanitary houses, at reasonable rentals, have been provided for over eight hundred wage-earners and their dependents. The success of this earlier enterprise has lent encouragement to a system on a wider basis not only in the national capital but other larger cities of the States and merited for Kober a gold medal of award at the Paris International Exposition of 1900. Acting as secretary of two housing companies from the day of their organization until November, 1915, upon the death of General George M. Sternberg, he succeeded to the office of president. In 1897, he was elected an honorary member of the Association of Military Surgeons of the United States, undoubtedly in recognition of his services as civilian physician in the United States Army as likewise because of his able com- munication "The Place of Military Medicine and Surgery in the Medical College Curriculum." When reviewed in the light of the recent World War this paper and a kindred one entitled: "Higher Medical Education and a Plea for Better Training of the Volunteer Medical Officer," published in [898, have special significance. As a medical educator, Dr. Kober strenu- ously espoused every method of scientific research. Thoroughly convinced that animal experimentation must yield most marvelous results, we find him, as chairman of the Committee of Public Health of the Civic Center on Feb- ruary 15, 1900, filing a most vigorous protest against the enactment of Sen- ate Bill, No. 34, whose purport was to restrict the use of animals for experi- mental purposes in medicine. The brief he submitted on this occasion embodies facts and arguments which convinced even the sponsor of the bill, Senator J. H. Gallinger, that the proposed legislation was superfluous. It may be pertinent to mention here that Kober very effectually recalled this inci- dent before the Judiciary Committee Hearing in November, 1919, when a similar bill by the anti-vivisectionists was under discussion. In 1901, Kober was selected to deliver before the American Medical Association, at St. Paul, Minnesota, the "Oration on State Medicine." His theme was: "The Progress and Tendency of Hygiene and Sanitary Science in the Nineteenth Century." This same year he was invested as dean of the medical school of 221 ANNIVERSARY TRIBUTE. his alma mater. His plans for a curriculum calculated to insure for medical aspirants a more complete and harmonious education was set forth in his "Plea for a Standard Medical Curriculum," read before the Association of American Medical Colleges, in 1904. At this meeting he was appointed chairman of a "Committee on National Uniformity of Curriculum." The report submitted by the committee was approved and it is a pleasing reflec- tion to recall that Dr. William J. Means, in his presidential address, March j. 1919, referred to it in most appreciative terms. June 14, 1906, Kober was the recipient of the honorary degree of Doctor of Law from his alma mater. The citation follows: "It is fitting that universities should show their appreciation of their sons who have done distinguished service in the cause of science and humanity. There'are none more worthy than they who lessen human misery and by their genius and devotion ward off disease and suffering amongst men. They are the true philanthropists, inspired with genuine unselfish love for their fellows. Such is the man whom this university gladly and gratefully honors today; a man who besides his duties to the public, acknowledged and rewarded already by distant nations, has labored in season and out of season for the welfare of the medical school of this university and of each individual student until his work has been recognized by the official medical body of the United States in electing him President of the Association of American Schools of Medicine, and in its public declaration that the course of study introduced by him into Georgetown Medical School should be the standard of all medical schools." President Theodore Roosevelt in 1906, designated Kober as a member of the Board of Charities and in May of the following year as a member of the President Homes Commission. As chairman of the Committee on Social Betterment he drew up monographs on "Industrial Hygiene" and "Social Betterment," which were published as Senate document No. 644 in 1908. At the meeting of the first Conference on the Conservation of National Resources, which convened at the White House May 13, 1908, on invitation of the Presi- dent of the United States, he addressed that body on "The Conservation of Life and Health by Improved Water Supply." Dr. Kober has been a member of the National Tuberculosis Association since its organization in 1905. He is also a member of the local Society for the Study and Prevention of Tuber- culosis. His plans were adopted in the construction of the Tuberculosis Hospital in Washington, formally opened to patients June 28, 1908, and were awarded a medal at the exposition connected with the International Con- 222 1866 1873 1881 1895 1904 . 1916 ANNIVERSARY TRIBUTE. gress on Tuberculosis held in Washington in the fall of 1908. He may be very fittingly designated a pioneer worker in the crusade against tuberculosis, having read as early as 1889 a paper entitled: "Etiology and Prevention of Tuberculosis in the Light of Modern Research/' before the Medical Society of the District of Columbia. This lecture was published by the State Board of Health of California as a special pamphlet in 1890 and was followed by a second in 1893, "A Plea for the Prevention of Tuberculosis," which had been previously read before the State Sanitary Convention of California. Dr. Kober is a Fellow of the American Medical Association, of the Amer- ican Association for the Advancement of Science, likewise a member of the Advisory Council of that same body. Member of the Cosmos Club. Mem- ber of the Association of American Physicians (Secretary from 1909 to 1916, at which time he retired and was elected honorary member). Member of the American Public Health Association( Vice-President, 1916). Asso- ciation of American Medical Colleges (President in 1906). The National Association for the Study and Prevention of Tuberculosis (President in 1915). National Housing Association. Medical and Surgical Society District of Columbia (President 1889, 1917-19). The Medical Association of the District of Columbia (President 1898). Medical Society District of Columbia (President 1903). The Washington Anthropological Society (President 1907, 1918-1919). The Social Hygiene Society of the District of Columbia (President 1918-1919). Chairman of the Committee on Lec- tures, Sixth International Congress on Tuberculosis, Washington, D. C., Sep- tember 28th to October 5th, 1908. Honorary Member of the Medical and Surgical Society of Washington, D. C., 1910. President of Section IV, Industrial and Occupational Hygiene of the 15th International Congress on Hygiene and Demography in Washington, September 23-28, 1912. Chair- man of Sub-Section C, Sociological Medicine of the Pan-American Scientific Congress, held in Washington, D. C., December 27, 1915 to January 8, 1916. Member of the Washington Academy of Sciences (Vice-President 1919-1920.) In 1912, Dr. Kober was appointed by the President of the American Medi- cal Association, Chairman of a Committee on Red Cross Medical Work. This Committee was created so as to provide a body of representative physicians of approved qualification to direct or participate in medical work, carried on by the Red Cross in different localities in times of war or emer- gencies and to advise with representatives of that society in handling medical and sanitary problems incident to such an occurrence. The Committee up to May, 1916, organized committees in 588 county medical societies located in 223 ANNIVERSARY TRIBUTE. 47 states. During the recent world war he was a member of the committee on "Conservation and Welfare of Workers'' and chairman of the Committee of Rural Workmen's Areas with Special Reference to Housing; Member of the Council of Defense, District of Columbia; Chairman of the Committee on housing. Dr. Kober is the author of no monographs, chapters in text books, journal articles and reviews on medical, surgical, sanitary and sociological subjects, and over 120 published discussions. His first medical essay was on "Infantile Paralysis" published in the Pacific Medical Journal in November, 1874, in which he presented all the available evidence that the disease was due to some organic lesion of the medulla spinalis. In the same year he published his Urinology and its practical application. In 1875, he published notes in the American Weekly, Vol. HI, p. 241-243, on chronic dysentery treated with injections of a solution of chlorate of potash, and adenitis (tubercular) treated with injections of carbolic acid and glycerine. In October, 1876, he reported in the American Journal Medical Sciences, a case of gun-shot wound of the knee joint, in which he used probably for the first time an injection of tincture of iodine and carbolic acid. Dr. Edmond Souchon, of New Orleans, in his monograph on "Original Contributions of America to Medical Sciences" credits Dr. Kober as having been the first to publish notes on the three subjects referred to. He also credits him with having been the first to point out that insects, especially flies are doubtless frequently the cause of spreading typhoid fever. Dr. Kober's tabulation of 330 milk-borne epidemics and his monograph on "Milk in Relation to Public Health" and his first book on "Industrial Hygiene," published as Senate documents, and his chapter dealing with the effects of diminished atmosphere upon the health of aviators published in 1916, are regarded as pioneer contributions to American medi- cal literature. Such is the story of a lifetime of sound scholarship and scientific achieve- ments which have made him an ornament to the medical profession and a consolation to his alma mater. No form of human misery has been so low as not to be the object of his solicitude, no need of the University has been so insignificant as not to command complete response. He has done good in the open, he has done good by stealth, but, withal, as one devoid of the spoiling taint of vanity or self-seeking. Of a personal integrity unimpeached and unimpeachable, of unswerving fidelity in adherence to high ideals of medical education, his is the singular privilege to note his name chiseled high on the pillar of the temple of fame. 224 Born March 28, 1850. Dean Georgetown University Medical School June, 1901. ANNIVERSARY TRIBUTE. as 0ran Wilfred M. Barton, M.D., '92. Professor of Therapeutics, Georgetozvn Medical School. June 13th, 1901, was an important day in the history of the Georgetown Medical School for on that date George Martin Kober was elected Dean. Nearly twenty years have since elapsed and preparations are complete for a great testimonial in honor of his 70th birthday and of the high esteem in which he is universally held. The election of Dr. Kober to the Deanship was made at a legulai meeting of the Medical Faculty on motion of Prof. S. S. Adams; and Prof. Joseph Tabor Johnson, Vice-President, was requested to cast the unanimous ballot of the faculty for- him as Dean. Dr. Kober is the seventh Dean which our seventy year old medical school has had. His predecessors were Howard, Eliot, Reyburn, Ashford, Lovejoy and Magruder. In point of years of service only one has equalled him, namely, Eliot who served continuously in the same office from 1856 to 1876. At the time of Dr. Kober's election as Dean in 1901. Rev. Father John D. Whitney was Rector of the University, soon to be followed by Rev. Father Jerome Dougherty. These two distin- guished Jesuit Fathers have intertwined their names into the very tapestiy of Georgetown history and it was under their authority that Dr. Kober began that work for the Medical School which has moulded its form and nuituied its development and progress for a fifth of a century. The acclamation of his colleagues on his election had scarce died away on that night of June 13th when Dr. Kober was called upon to present his report to the Faculty of the meeting of the Association of American Medical Colleges which he had attended at St. Paul on the 3rd of June. We men- tion this report specifically because it gives a key to the character and an example of the sturdy service of the man. He had gone to the meeting at St. Paul as a delegate from Georgetown Medical School, in whose faculty he was professor of hygiene. It was his duty to attend the meetings of the association, to listen to the papers, to partake in the discussions and to report to his colleagues what had been done by those who were interested in medical education. This he did, and on that night after his election he gave a succinct but comprehensive report of what he had seen and heard at the meeting in St. Paul. He told them that the tendency of medical education seemed to be along the lines of emphasizing practical rather than didactic 225 ANNIVERSARY TRIBUTE. teaching in the medical schools. Always on the lookout to have Georgetown in the advance guard of progressive schools and advocating every true reform in medical teaching, Dr. Kober urged upon his colleagues the necessity of striving for the highest ideals to be maintained by the medical school. On many subsequent occasions Dr. Kober pleaded for his high ideals, not always without opposition from those of a conservative group who believed rather in following closely than in leading. It is needless to say that this char- acteristic of Dr. Kober to stake everything on the altar of his ideals has been a chief factor in enlarging the reputation and prestige of Georgetown Medical among the elite colleges of the country. Unendowed and conse- quently handicapped for funds the Medical School has had a somewhat difficult struggle, and a man of less grit than he might well have been excused for adopting an ultra-conservative policy in the face of the many demands being made for higher ideals in medical education. But such a thing never occurred to him to do. If the proposition was to lengthen the hours of work, to increase the burden of endeavor in any direction, if it meant progress for the school, he favored and adopted it. His untiring devotion and support, his disposition to shift no responsibility or labor and, finally, his unfailing optimism have always been factors in overcoming what appeared at first sight to be almost insurmountable obstacles and difficulties. In October, 1902, Dr. Kober brought before the faculty the schedule of minimum requirements for medical schools adopted by one of the Western States, and because of its progressive character earnestly advocated and secured its adoption. The development of a standard curriculum for all medical schools soon took possession of his mind, and to the perfection of this scheme Dr. Kober for several years devoted a great deal of energy. In 1904 he secured the appointment of a committee by the Association of Med- ical Colleges to investigate this question, and in 1905 the report of this committee, of which he was chairman, was adopted. In 1906, Dr. Kober was elected president of the association. It seems incredible that a single mind could develop such power of concentration upon a single topic and yet find energy and opportunity for the pursuit of a great variety of scientific and civic activities; activities which varied from studies of the epidemiology of typhoid fever to sanitary house construction; from scientific work in many fields of public health and hygiene to civic labors of multitudinous variety. Nevertheless this was the case, for during the early years of his deanship, when a thousand details of college and hospital administration and con- struction continually harassed him, he found time to keep up his association 226 ANNIVERSARY TRIBUTE. with scientific bodies of many sorts and with civic and social duties which would have overwhelmed the average man. Dr. Kober has always been a great detailist without being small or petty, a particularist without being narrow or prejudiced. Much of his writing, both scientific and secular, he has often done with his own pen, at what must have been prodigious labor, so careful has he always been that any piece of literary, scientific or even clerical work to which his signature was to be affixed should be absolutely accurate and exact. The history of our University Hospital is all bound up with the name of Kober. At the time of his election to the office of Dean in 1901 all there was of Georgetown Hospital was a small central wing located on a plot of ground next to the corner of 35th and N streets, four stories and a base- ment high, accommodating twenty-nine beds, which had been built in 1898 at a cost of about thirty thousand dollars in money and an amount of human energy and aspiration too great for adequate description. For, this institu- tion small in size at that time, now grown to large proportions, represented the realization of a dream which all loyal medical sons of Georgetown had had for many years to build a clinical hospital in connection with the medical school. Dr. Kober had been a leading spirit in this movement long before he became Dean. He had preached the necessity of a hospital to be attached to the medical School, he had aroused enthusiasm in his colleagues and the public, he had begged funds and given money from his private resources: in short, he had worked with untiring enthusiasm for the realization of his ideal. It is not to be wondered at, therefore, that when he became Dean, Dr. Kober's chief ambition, it may be truly said, was to develop the hospital idea in every possible direction. Anyone who will stand today at 35th and N streets and contemplate the extensive hospital buildings occupying half a city block will feel to what a wonderful extent his dreams have come true and how completely his aspirations have been realized. It will be appre- ciated also with equal force what energy, what indomitable will, what capacity for mental and physical work, what hope and trust under trying circum- stances, were displayed by the man-Our Dean-upon whom all these re- sponsibilties were piled. Dr. Kober's almost herculean labors in behalf of the University Hospital may perhaps be best appreciated by giving a brief account of the develop- ments which have taken place in its growth since he became Dean of the Medical School, in each one of which he took a prominent part both in its 227 ANNIVERSARY TRIBUTE. origin and in its progress. The original small hospital building was eompleted in August, 1898. In 1903 the first addition was completed. This was a wing on the east side, four stories and basement high, which increased the capacity of the hospital to one hundred beds. In 1904 Dr. Kober per- sonally completed and equipped a new operating amphitheatre in memory of his parents. In 1907 the new nurses' home was built. In 1908 the Lisner Memorial addition to the hospital was erected, which increased the capacity to 155 beds, and other additions and improvements were made. In 1910, Mr. E. Francis Riggs was interested by Dr. Kober in the subject of erecting a maternity building, but the untimely death of Mr. Riggs in that year pre- vented him from carrying out this worthy charity. His widow, however, in 1911 generously created the Francis Riggs building fund for the erection of a building in commemoration of her husband. The Riggs maternity was built in 1911. In 1912 Dr. Kober personally authorized the erection of a building four stories high, which was completed in the same year, and has since been known as the Kober Building. In 1914 Dr. Kober installed in this addition a modern x-Ray department. In 1917 an addition was made to the outdoor department, which provided a much greater space and en- larged its facilities. In 1919 two wards were completed, with a capacity of thirty beds, making the total capacity for the hospital three hundred beds. The number of patients treated in the hospital has increased from 273 house cases and 633 dispensary cases in 1908 to 4,329 house patients and 15,325 outdoor patients in 1919. This short resume of the development of the University Hospital during Dr. Kober's service as Dean will give a slight idea of the enormous labor and responsibility involved in their realization. Dr. Kober will always be remembered as the director and part creator of this great work, which in itself would be a sufficient life labor for any man. To feel that he is the recipient of well-merited praise and admiration from his colleagues and friends and all those who are interested in Georgetown University Hospital must always be a source of gratification to him. In considering the subject of Kober as Dean many interesting facts worth recording leap into memory. Unfortunately, limitations of space forbid us mentioning them. There is one circumstance, however, which should not be forgotten. Dr. Kober, in 1893, re-introduced into the medical cur- riculum a course on military surgery and hygiene, for it was at Georgetown in 1864, during the Civil War, that the first course of lectures ever given in 228 ANNIVERSARY TRIBUTE. an American medical school upon this subject was delivered by Dr. Thomas Antisell of the United States Army. The office of dean in the modern medical school has lost much if not all of its original ecclesiastic significance, but Dr. Kober in his unselfish and untiring devotion to Georgetown has managed to reflect upon his work some of the spirituality of the ancient Decani. It will remain for the future his- torian of our Alma Mater-some future Easby-Smith renowned in classical scholarship and love for Georgetown-to write the complete history of the deanship of George Martin Kober. In the meanwhile it is the wish of all that he may be spared for many years to contemplate the fruition of his long labors and see them grow into even greater things. SCnfrer as ihr 3Frwnb John A. Foote, M.D., '06. Associate Professor of Clinical Medicine, Georgetown Medical School. I do not think that any phase of Dr. Kober's career is better known than that of his paternal attitude toward the student in the medical school. There may have been some students who passed through the modest building on H Street with little or no personal contact with the Dean except in the lecture room, but there are not many such. Few men can live four years in the modern medical school without some sort of worry-scholastic, financial- or what not. To the students in trouble Dr. Kober is best known, not as the exemplar of retributive justice, but rather as "one who was born for the world rather than for himself." The delinquent student may have worried about his class standing more than the Dean-but he did not grieve as much as Dr. Kober. The Dean has a soft spot in his heart for those boys whom he has often referred to as "weak vessels." Indeed, he has frequently stood in a painful position-his affection for the student balanced against his desire to uphold the high standing of the graduates from the institution which he loves so well. Poor indeed in discernment is the man who does not see the friendly interest and feel the kindly urge of Dr. Kober's friendship at all such times, and many a heedless or many a loitering candidate for a degree has been spurred to hopeful action by the knowledge that he has a real friend in the Dean's office, who believes in him and counsels him as a father might counsel a son. 229 ANNIVERSARY TRIBUTE. I don't think anyone will really know how many students have gone to him with their financial problems. It is safe to say that no individual willing to work has ever applied in vain to him for aid in eking out tuition at the medical school. Dr. Kober believes that "faith without good works is dead." He is him- self an untiring worker and he has always expected his students to work. It was Dr. John Brown, who said: "I don't expect my students to know every- thing, but I expect everyone of them to be able to do something." Dr. Kober is tolerant of the man who is not unusually intelligent, provided he atones for it by being consistently industrious. Laziness and wastefulness, especially of time, he always has and always will abhor. I can remember very distinctly how in my student days the Dean invited me to his home to attend a meeting of a local medical society, how on another occasion he talked with me on the necessity of the younger man doing origi- nal work and showed me a splendid brochure on urinalysis which he had written when both himself and this branch of clinical medicine were com- paratively young. This was only one of his methods of education employed with the hope of making the student think for himself and have confidence in his own judgments and potentialities. Some day Dr. Kober may be induced to publish a book of letters from fathers taken from the large collection of these epistles which he has received. Very soon the father of the student discovers the paternal strain in Dr. Kober, and that is why the latter's correspondence is so voluminous. From counseling wayward sons to disbursing monthly stipends-all sorts of offices have been intrusted to him by confiding old gentlemen, and many of these rhe Dean has gravely performed, possibly because of the innate courtesy which so characterizes him, but more probably because he secretly likes these offices of vicarious fatherhood to be thrust upon him. As a teacher in the lecture room it was always observed that the lectures on hygiene were well attended and that excellent notes were taken by the students. Dr. Kober's lectures in hygiene were carefully written and delivered slowly and with a vocal distinctness that was eminently satisfying. The largest annual attendance-recruits coming often from both upper and lower classes-was always noted at about the time when commercial beverages were being considered, because it was at one time the custom to have the classes inspect, not only wholesale bottling establishments and dairies, but also a brewery located near the Museum of Hygiene. Needless to say the maximum attendance came and the most diligent attention was observed at the 230 ANNIVERSARY TRIBUTE. lectures on fermented beverages. The enthusiasm of the young men in testing on themselves the physiological action of the malt beverages-these experi- ments being made possible by the too generous hospitality of the brewers on visits of inspection, obliged the cessation of one very popular feature of the course in hygiene and dietetics. To the thoughtful student, Dr. Kober has always seemed more than a, friend, a counselor, or a teacher. The lesson of unselfish devotion to1 the cause of medical education which he instilled by his long hours spent at the school each day, his efforts to know and properly value the work of each student, his personal gifts to the University Hospital, and his scrupulous attendance at all University functions, have long made him more an institu- tion than a mere individual-one whom we did not judge by the ordinary values with which we measure men, but rather as one concerning whom we might quote the lines from Othello: "He hath a daily beauty in his life Which makes me ugly." (genrg? Martin Kniwr An Appreciation. Llewellyn Eliot, M.D., '74. Seventy years today; seventy years of service! It seems impossible for me to realize that for forty-nine of these George Martin Kober has been my fast friend and my guide. Our acquaintance was formed during September, 1871, when he became a student of medicine in my father's office, and as the years rolled by this acquaintance was cemented by a strong bond of friendship. Looking to those years it has been amazing that we should have been friends, since George Kober was my very antithesis in point of disposition and habits. He was studious, moderate, modest and retiring, while I, on the other hand, did not cultivate these qualities so faithfully. As a pupil his* intelligence and understanding, his industry and perseverance made him a graduate of whom any instructor could well be proud. While he was a student we were serving as hospital stewards in the army; and after his graduation Dr. Kober became one of the first matriculants in Dr. J. Harry Thompson's School of Obstetrics and Gynecology, where he passed his examinations without an error, but 231 ANNIVERSARY TRIBUTE. Dr. Thompson was forbidden by the Secretary of War to award diplomas, inasmuch as his school had been established without official authority. We next find Dr. Kober as a contract surgeon in the army at Alcatraz Island, California, serving with that faithfulness to duty characteristic of the man, and it was here that he added the study of hygiene to his other accomplishments. His model reports to the State Board of Health of California were widely circulated, but the first paper published by Dr. Kober himself was a study of Infantile Paralysis, in the early seventies. Then came a Manual on Urinary Analysis, and soon a treatise on "A Case of Gun-shot Wound of the Knee Joint." In this Dr. Kober described the use of tincture of iodine as an antiseptic, and I believe this to be the first published report of such a use for iodine. No attention was then paid to this treatment, but Dr. Kober today sees the general adoption of his idea by the profession, although due to his modesty it is only recently that his claim to priority has been mentioned. Since those early days his publications, each one marked by a master's hand, have become legion, and these, with his splendid work at Georgetown University Hospital, have brought him honors and official positions at home and abroad. To write more of Dr. Kober would encroach upon the fields of others of his friends who will wish to pay him tribute, but none would begrudge the space in which I tender my congratulations and my wishes for continued years of health and happiness to a true friend, a genial companion, an earnest student, a diligent worker in the cause of humanity, a charitable and godly man. What else may one say? ©rihute nf tljr Hrv. 3. Hawns Htdiarbs, 3. President of Georgetozvn University, 1888-1898. 1 am rejoiced to learn that our dear dean and devoted friend, Dr. Kober, is about to celebrate his seventieth birthday and to be myself privileged to add my congratulations to those of his many intimate friends. To grow old is not always a pleasant thing and a cause of rejoicing, in spite of the advantages set forth so attractively by Cicero in the treatise De Senectute that is read with such trustfulness by your youthful students. But to grow old and yet remain young-that is an achievement worthy of admiration and joy! And this is truly Dr. Kober's privilege. 232 ANNIVERSARY TRIBUTE. My first acquaintance with the doctor was at the centennial celebration of the College in February, 1889. He was then in the middle years and had not yet begun those extensive and careful researches in hygienic science or other departments that have since rendered him so well known and distin- guished in his profession. Anyone who may be curious can find his portrait in the centennial group photograph, in the first line of the alumni present, and will be struck by the fact that it differs scarcely a particle from his appear- ance today. Some time afterwards I received a note from him, dated from somewhere in the wilds and mountain fastnesses of Idaho, respectfully drawing my atten- tion to the fact that an omission had occurred in the awarding of honorary degrees at the academic session of the celebration. He considered that Dr. Ethelbert Carroll Morgan, then professor of laryngology in our Medical School, but a hopeless invalid, was eminently worthy of an honorary degree. He set forth strongly the distinguished position held by Dr. Morgan in his specialty and his international reputation, evidenced by his incumbency as president of the American Association of Laryngologists. He added that besides his eminent worthiness, the shadow of his approaching end would make the conferring of the honor a graceful and consoling tribute. Being- then quite fresh in office and not having had the privilege of birth or residence in Maryland, I was not acquainted with the historic family of Morgan, so intimately connected from the earliest times with the Jesuit Fathers, save that 1 had taught Dr. Carroll's younger brother. J. Dudley Morgan (who later became a distinguished figure in medical circles in Washington) in the class of physics in his graduating year. But inquiry among those who knew confirmed Dr. Kober's estimate of this professor. The degree was awarded at the next commencement in June, 1889. That incident was characteristic of George M. Kober. He never thinks of himself, but is keenly alive to the interests and happiness of his friends and the furtherance of every good and noble cause. When Dr. Kober returned from the Wild West, in 1893, and became per- manently associated with our faculty as professor of hygiene, my acquaintance with him became more intimate and ripened into warm friendship. I do not think it possible for anyone to really know Dr. Kober and not love him. It was in the foundation of the Georgetown University Hospital, toward the end of my term as president, that I was most closely associated with Dr. Kober. He was not the very first to work for the hospital, but he was by 233 ANNIVERSARY TRIBUTE. far the most devoted and efficient factor in its inception, as he has been in its growth and expansion. If the history of the hospital is ever written in detail, as it no doubt will be, the name of Kober will shine therein with a lustre beyond all others. At that time the faculty and directors of the College had in view and in desire three great objectives-a gymnasium, a preparatory department sepa- rate in locality from the College itself and a school of physical science and engineering. In remote preparation for the accomplishment of the last of these projects, Dr. Edgar Kidwell, now head of the Kidwell Boiler and Engineering Company of Milwaukee, had made a tour of inspection of the leading engineering schools of the East and had handed in estimates of the faculty and equipment needed for a start and of the probable expense. But when Dr. George L. Magruder, then the energetic and devoted dean of the medical department, reported that the professors had reached the conclusion that a hospital of our own was an absolute and pressing necessity, all other ambitions were laid aside for the time being and all energies were devoted to this object. Dr. Magruder and I called one Sunday morning on Martin F. Morris, the venerable dean emeritus of the law faculty and the chief ad- viser of the College, and, in company with Mr. Morris, went to see Mr. Elisha Francis Riggs, who had shortly before fitted up the Riggs Library of the College. We were most cordially received, and to encourage the movement Mr. Riggs subscribed immediately one thousand dollars. A com- mittee was promptly organized to raise the necessary funds, of which body Dr. Kober was made secretary and treasurer, and soon proved to be the very soul. As the president of the University is ex-officio the beggar-in-chief, I was brought into constant contact with Dr. Kober in our efforts to stimulate the generosity of our friends and the general public. At that time the sys- tematic drives of the present day were unknown. Our methods were com- paratively crude and ineffective. We had secured the cordial approbation of His Eminence, Cardinal Gibbons, who consented gladly to our inviting the Sisters of St. Francis of Glenriddle, Pa., to this portion of his archdiocese. We had the no less hearty co-operation of His Grace, Archbishop Ryan of Philadelphia, whose consent was necessary to the coming of the Sisters. We had the enthusiastic welcome of the people of Georgetown to the plan. But we had no money; and the task of getting it proved anything but easy and agreeable. We received much sympathy but little cash. I can never forget the self-devotion and constancy with which Dr. Kober pursued the quest. It was due to his initiative that the first room was founded by Mr. Lisner, 234 ANNIVERSARY TRIBUTE. whose interest, once awakened, continued until it resulted in after years in the erection of a separate wing of the hospital. Finally Dr. Kober and I made a personal canvass of a number of the business houses of Washington. We were always respectfully, frequently cordially, received. But rebuffs were not wanting and the sums subscribed were in general pitifully small. 1 doubt whether I would have had the courage to persevere had it not been for the example of my companion's constancy and self-abnegation in the work. His imperturbable good humor and optimism in the face of difficul- ties were a perpetual inspiration. When the first tiny building was finished, with a capacity, if I remember rightly, of only twenty-seven beds, and the Sisters had arrived and taker, charge, Dr. Kober's sympathy and assistance were unfailing. The equip- ment of the operating room was his gift, the forerunner of his larger bene- factions in the same line when the greater buildings were added. Fie recog- nized in the good Sisters kindred spirits to his own. Their lives of heroic self devotion without hope of earthly reward mirrored his ideal. Their Superior, Sister Pauline, to whom the Hospital owes much of its success and present prosperity, always found in him a faithful friend, a wise adviser and a most devoted helper. I leave to others to speak of Dean Kober's eminence in his profession and his chosen specialty, of his researches in the statistics of the drug habit and other fields of Preventive Medicine, of his activity and influence in various scientific societies and particularly as President of the Association of American Medical Colleges, of his precision and unalterable patience as a professor, of his wide interest in civic and philanthropic enterprises and most important of all, his wise and tactful administration as Dean of the Medical Faculty of George- town University. In my humble judgment, in the whole record of the activU ties, of his seventy years no item will stand out more prominently than his creative and sustaining work for the Georgetown University Hospital. But greater than all that Dr. Kober has done is what he is! A soul of crystalline sincerity, a modesty and self-effacement betokening true humility, yet a courage that faints at no obstacles, a heart overflowing with kindliness and love toward every human being-all these united to a mind of clear scientific vision and habits of patient and persistent labor-that according to my analysis is the constituent formula of Dr. Kober's character- and a rare and precious combination it is! I may even go a step further, and without, I hope, trespassing upon precincts that ought to be sacred, may say that his profoundly religious spirit is a worthy example to men of Natural Science 235 ANNIVERSARY TRIBUTE. and a proof that the most exalted knowledge of natural phenomena and prin- ciples may and ought to dwell with the simplest and most intense faith. His soul is too wide to harbor any narrow bigotry. Sturdy Lutheran as he is in profession, his heart is so truly Catholic that he might easily be mistaken for a Jesuit in disguise! This celebration is in no sense a farewell! I do not indeed expect to be present at the exercises on Dr. Kober's ninetieth birthday, but only because long before that happy event, I shall have passed to- a better world, where doctors are unnecessary and death shall be no more! But I do confidently expect that God will grant me the privilege of seeing from the eternal hills my old friend still hale and hearty and radiating light, goodness and happi- ness as he has done in the first seventy years of his existence! Dr. IKnhrr (On the celebration of his seventieth anniversary.) To minister, to ease the restless pain; To bring to fevered spirit courage new; To keep a comrade's silent vigil through The aging hours, as life slips back again Into Eternity; to head the train Of nezv-born's heralds in the morning dezv Of life's first rosy infant dozen; to view With charity man's boasted strength so vain; All this, and threescore honored years and ten Are yours, each graven with the artist's care, In finest lines of kindness toward men To leave on ev'ry heart an impress rare. A greeting? Aye! Let salutations pay All mankind's debt on this, the Doctor's Day! Edward F. Mack, A.B., '20. 236 ANNIVERSARY TRIBUTE. Ah&rro Wfure thr Ominwinnm dLliniral James A. Gannon, M.D., '06. Associate Clinical Professor of Surgery, Georgetown Medical School. ft 'is particularly fitting that the Georgetown Clinical Society, which is composed of his former students, should meet on this occasion to remind Dr. Kober of the love and esteem we have for him. He will receive many honors this month at the hands of his other scientific and civil associates but he will hear no words of congratulation which are more sincere, more heartfelt than those we extend to him tonight. We meet to celebrate his seventieth birthday; to show him how glad we are that the completion of three score and ten years of useful life finds him in the prime of mental and physical vigor; to remark how lightly the hand of time rests on his shoulders. We sometimes speak of one who has passed seventy years as old, but Dr. Kober is not old. If ripe judgment born of much experience is a sign of age, if vast knowledge caused by much study and industry is another sign; if high esteem and great reputation among his fellow men, the result of devotion to duty and contributions to scientific literature, constitute another sign-then indeed Dr. Kober is not seventy but one hundred and fifty years old. I met Dr. Kober eighteen years ago when I enrolled as a student at the Medical School. When I reached my third year I took his course in Hygiene. At the close of this year we had our first misunderstanding. This is how it came about. I figured that by paying close attention and taking careful notes, it would not be necessary for me to purchase a text book on Hygiene and I did not purchase one. My omission somehow came to Dr. Kober's notice and 1 was unable to explain that it was due to the clarity of his lectures and to the economic principles with which he sometimes punctuated his remarks. During my more or less stormy career as an interne at Georgetown Hospital, I had occasion more than once to be guided by his good advice thereby pre- venting, 1 am sure, the world having another proof that youth and wisdom are seldom companions. Many times, since I have been in practice I have sought his good advice which has always been sound and worth following. His scientific attainments are many, but as I see Dr. Kober, he would be great without even these, for he possesses a virtue which is too rarely found in this world-charity. Most of the Ten Commandments are written around 237 ANNIVERSARY TRIBUTE. this virtue and he who possesses it to the extent Dr. Kober has shown, is great if he has no other attainments to his credit. His whole life has been one of sacrifice and devotion to his fellow man. Since his retirement from the army, his activities have been toward making the world a better place in which to live. His Medical School and Hospital affiliations, his membership on the Board of Charities and on various commissions for the betterment of morality and living conditions of less fortunate men, his numerous contribu- tions to scientific literature and his legacy to posterity in the form of a volume on Industrial Diseases-have all brought work and worry and responsibility and practically no financial reward. It has been a matter of enthusiastic com- ment, especially among his former students, that, although Dr. Kober has been out of active practice for many years, he has kept up with present day med- ical accomplishment. At medical meetings we have all heard him bring out some point in the discussion which was unknown to the essayist who had given much time and thought to the preparation of his paper. Often when his day's work is done and he would be doing more justice to himself by resting at home, he can be found attending smokers and meetings where medical students congregate, instructing them, advising them, inspiring them. He takes great pride in those he calls his boys and I doubt if there is a grad- uate of the Medical School since Dr. Kober has been Dean whose record is not known to him. There are few members of the faculty who cannot recall the interest he has had in each member of the graduating class. When final examinations were being held, who cannot remember the moisture in his eye and the emotion in his voice when he discovered the failure of some stu- dent to attain sufficient credits to allow him to receive his diploma? Dr. Kober, we have all been of those medical students to whom you have devoted your life; and as children appreciate their parents more after child- hood is past, so with the passing years we have learned to appreciate you more. We feel that we are better doctors and better citizens because of your influence. 238 ANNIVERSARY TRIBUTE. In closing I desire to read a short verse by Leigh Hunt, which is familiar to most of you, and which could be written with truth about Dr. Kober. Abou Ben Adhem {may his tribe increase!) Awoke one night from a deep dream of peace, And saw within the moonlight in his room, Making it rich, and like a lily in bloom, An angel writing in a book of gold:- Exceeding peace had made Ben Adhem bold, And to the Presence tn the room he said, "What writest thou?"-The vision raised its head, And, with a look made of all sweet accord, Anszvered, "The names of those zuho love the Lord." "And is mine one?" said Abou. "Nay, not so," Replied the angel. Abou spoke more low, But cheerily still; and said, "I pray thee, then, Write me as one who loves his fellow men." The Angel zvrote and vanished. The next night It came again with a great wakening light, And showed the names zvhom love of God had blessed, And lo! Ben Adhem's name led all the rest. 239 ANNIVERSARY TRIBUTE. Ufa A (Dr. George M. Kober, who recently celebrated his 70th birthday, began his career as a physician in 1873.) Almost a half century ago He girded on his armour for the fight Against the creeping hordes of Pain and Woe, Almost a. half century ago, The petaled plains of ease, bedecked and bright, Allured him not, he faced creation's blight And girded on his armour for the tight Almost a half century ago. When the bright torch he reared aloft is dim Many a lip mill linger o'er his name Breathing a million blessings over him, When the bright torch he reared aloft is dim. Not scrivened gold, nor the glad cry of Fame Shall serve his humble greatness to proclaim: Many a lip mill linger o'er his name When the bright torch he raised aloft is dim. John A. Foote, M.D., '06. 240 ANNIVERSARY TRIBUTE. A SributP tn Knfwr From a Pre-Medical Student. Three score and ten hath lightly laid its crown Of fruitful toil upon thy thoughtful brow, For you Heaven's "Well Done" comes softly down To approve thy task and us with hope endow. You sought to make life a smoother path for all To tread its uncertain way with steady stride And ever quick to heed Pain's gasping call To ease her ache and leave "good cheer" beside. So upon this day so fraught with tender charm We send aloft this prayer for you our friend, "May God e'er keep your love and friendship warm For those to whom your heritage will descend. Ripe tho unpluckcd! Fearless thy God to face! When plucked thou art, we ask, but to Fill thy place. Thomas E. Mattingly. 241 ANNIVERSARY TRIBUTE. Wtrtlj W er so zvie Du in einem reichen Leben Des Wissens und des Herzens gauze Kraft Dem Wohl der Menschheit vollig hingegeben, Wer redlich, unermudlich hat geschafft, Wer in den Dienst barmherz'ger Ndchstenliebe Sein Wallen und sein Konnen hat gestellt: Der sorgte selbst, dass ihm bestdndig bliebe Die Achtung und die Ehre dieser Welt. Aus deutschem Stamm in dieses Land gekommen Hast Du, von Deiner Rasse Geist belebt, Dem hehren Ziel, das Du Dir vorgenommen, In treuem Pflichtbezvusstsein zugestrebt. Dies Pflichtbezvusstsein, Deiner Vater Erbe, Hat immer Dich den rechten W eg gelehrt Und Du hast es, zvar auch der Weg oft herbe, Dem neuen Land als treuer Sohn bezvahrt. Ein Lehrer bist Du tausenden gewesen Und tausende hat Deine Kunst geheilt, Not und Gebrcste machtest Du genesen, Wo immer Segcn stiftend Du gezveilt. War je ein Leid, das Dir nicht sprach zum Herzen? Jc eine Not, zoo Du nicht halfest gem? Gabst Du Dein Bestes nicht, zu lindern Schmerzen? Was menschlich ist, stand nie und nic Dir fern. So stehst in Deiner siebzig Jahre Krauze Du heut geehrt, bezuundert und geliebt, So kront den Ehrentag mit hellem Glanze Ein Gluck, das lauter ist und ungetriibt: Denn blickest auf die Summe Deines Lebens Am heut'gen Tage priifend Du zurilck, Dann siehst Du, dass Du lebtest nicht vergebens, Und das zu seh'n ist seltnes Menschengliick. Gewidmet vom Kurt Voelkner am 28. Marz 1920 242 ANNIVERSARY TRIBUTE. tEiittorial Georgetown College Journal, March, 1920. Joseph R. Mickler, Jr., A.B., '20. To few men is it given to live their allotted span of three score and ten years in devotion to duty and in service to humanity, and finally to find themselves at the end of those years with their sacrifices appreciated and their services recognized. History is replete with the lives of men whose praises were not chanted until many years after they had been laid to rest in the unbreakable silence of the tomb; where, we may believe, the sound of chant- ing voices is not heard. But of the men who win acknowledgments of their good works before they pass on, one hears but seldom. It is the way of fame, to place a wreath of laurel on a piece of dull, cold marble; leaving the living brow uncrowned. So that a man who receives a generous meed of earthly glory from his contemporaries, and that, too, without any of his own seeking, must of necessity have that about him which stamps him as worthy. I do not know George Martin Kober in person ; I feel that I do not have to. I know his works and 1 know his friends, and I feel that by knowing them 1 have known him as well. They both declare that if ever living man was well worthy to wear the mantle of highest honors, he is that man. With their testimony I am gladly content; since his works and his friends are ecpially insistent in compelling admiration for the man whose seventy years have been spent in generous service to mankind. Seventy years! Years crowded with episode, warmed with altruism, lighted with courage; gliding years, moving now slowly, now swiftly, as their burdens were light or heavy, but gliding always onward to the fulfillment of their glorious promise. And now, to the eyes of youth, it seems that at last he, George Martin Kober, must surely have attained the completes! ful- fillment. Loved, honored, respected, and secure in the consciousness of work well done, can he ask more of life than life has already given? To be sure, he must have met with withering disenchantments, undergone a vast amount of mental drubbing during the eventful years. The vigorous man is destined to a multitude of disappointments while he lives. But from the pleasant security of seventy years must not these appear trivial, must not the whole voyage of his life seem to have been taken under rose-colored skies? In 243 retrospect, life must appear a most joyful thing indeed. Surely Emerson must have erred greatly to suppose that "Life only avails, not the having lived.'' Much more pleasing is the philosophy of Stevenson on the same matter. He says: "To lead an adventurous and honorable youth, and to settle when the time arrives, into a green and smiling' age, is to be a good artist in life, and to deserve well of yourself and your neighbor." This, to me, must always be the goal of human endeavor. How George Martin Kober views it, one cannot say. He has given much to the world in seventy years; more, indeed, than the world can or is likely to repay in seven times seventy years. He has lived in a way that can bring him few regrets, and has well earned repose in this life and in the next. "In the downhill of life, zvhen I find I'm declining, May my fate no less fortunate be!" GEORGETOWN UNIVERSITY. School of Medicine. Washington, D. C., March 28th, 1920. Dr. George M. Kober, Worthy Dean: The Students of the Sophomore Class present, most respectfully, their heart- iest greetings upon this, the occasion of the Seventieth Anniversary of your birth. That the unfathomable future may bless you with a liberal share of lifes' rarest treasures; that our Alma Mater may have the good fortune of a mani- fold repetition of the years of thy faithful stewardship, is the ardent with of a grateful class. James J. O'Rourke, Walter E. McCawley, Vincent R. Reilly, Frank J. Russell. Committee. 244 ANNIVERSARY TRIBUTE. Burkin of tip 0wtrirt nf Columbia Excerpt from the minutes of the Executive Committee of the Medical Society for a meeting held Nov. 3, 1919: "Dr. William Gerry Morgan called attention to the fact that Dr. George M. Kober's 70th birthday will occur March 28, 1920, and suggested that the Society should take cognizance thereof. Ordered: that it be recommended to the Society that a committee be appointed to arrange for a dinner to be held on the occasion of Dr. Kober's 70th birthday as an evidence of the Society's esteem." The foregoing recommendation was adopted by the Society at its meeting held November 5, 1919. H. C. Macatee, Recording Secretary. 1317 Connecticut Avenue, Washington, D. C. November 17, 1919. Dr. George M. Kober, 1819 Q Street, N.W., Washington, D. C. Dear Dr. Kober: It having come to the knowledge of the Medical Society, through the report of the Executive Committee, that you are about to attain the seventieth anni- versary of your birth on March 28, 1920, a resolution was offered and unani- mously passed, that a dinner be given in your honor in celebration of this anniversary. It is indeed rare that one reaches the three score and ten mark in life; rare for one to possess such unusual distinction in the science of medicine, sociology and civic virtues. The Medical Society in honoring you wishes to honor itself, and we trust that you will accept our invitation. The committee finds that March 28, 1920, falls on Sunday, and we therefore request that you designate the date nearest that day that you desire us to celebrate. Sincerely, The Committee: Dr. C. W. Richardson, Chairman. Dr. S. S. Adams. Dr. W. M. Barton. 245 ANNIVERSARY TRIBUTE. 1819 Q Street, Washington, D. C. To: Dr. Charles W. Richardson November 22, 1919. Dr. Samuel S. Adams Dr. W. M. Barton, Committee.' My dear friends: I have the honor to acknowledge the receipt of your letter of the 17th inst informing me that in accordance with a resolution adopted by the Medical Society of the District of Columbia, a dinner will be given in my honor in celebration of the seventieth anniversary of my birth. In response to your communication. I beg that you will convey to the Society the assurance of my heart-felt appreciation of the distinguished honor con- ferred upon me, and of the gratification it gives me to know that my conduct has received the approval of my professional friends and colleagues. Since your Committee finds that March 28, 1920, falls on Sunday, I would suggest that either Saturday, March 27, or Monday, March 29, may be desig- nated for the date of the dinner. Very sincerely yours, George M. Kober. Complimentary Dinner to Dr. George M. Kober in Commemoration of His Seventieth Birthday. A Complimentary Dinner will be given to Doctor George M. Kober on his seventieth birthday by the Medical Society of the District of Columbia and other Scientific and Civic organizations, at Rauscher's, on March 27th, 1920, at 7.30 P. M. Dr. Kober is well-known, respected and admired for his untiring interest in all organizations for the promotion of benevolent projects, and the betterment of social conditions in this community, and undoubtedly a large number will wish, to honor him on this occasion. The cost per plate will be five dollars ($5.00), and the Committee respectfully requests that you send your subscriptions as early as possible to its Chairman that plans may be fully completed. Charles W. Richardson, M.D., Chairman, 1317 Connecticut Ave., Washington, D. C. Samuel S. Adams, W. M. Barton, For the Medical Society. L. O. Howard, For the Allied Scientific Societies. 246 ANNIVERSARY T R I B U 'I' E . W5n loan Sintur tn (gfnrge fHariin Knbtr. 1H. 0., U IE. 0. 31a dekbrattan of ilw ZOtli Shrttybag ba (Hjr <?bual Burkin nf tl|r iistrkt of Columbia anb Allkb JBwttitfa ^nrwtws attb divtr (^oani^atiattH at Saufirb^^'s ^atnrbay, fUarrh 2Z> 192U, at 7.30 p. m., WaabWtnn, 0. d. ANNIVERSARY TRIBUTE. nf (Emigratulatintt Dr. FRANCIS R. HAGNER President Medical Society, D. C. Dr. JOHN A. FOOTE Toastmaster S'pFakFtB Dr. WILLIAM C. WOODWARD Representing the Medical Society, D. C. Mr. WILLI AM H. HOLMES Representing the Anthropological Society Mr. HENRY B. F. MACFARLAND Representing the Civic Organizations Mr. ROBERT S. WOODWARD Representing the Washington Academy of Sciences Dr. HARVEY W. WILEY Representing the Cosmos Club Dr. CHARLES W. RICHARDSON Presentation Dr. GEORGE M. KOBER Response 248 ANNIVERSARY TRIBUTE. Oat nf (Sueats At the dinner given by the Medical Society of the District of Columbia and Allied Scientific Societies and Civic Organizations. Acker, Dr. George N. Adams, Dr. Roy D. Adams, Dr. Samuel S. Adams. Mrs. Annette A. Ailes, Milton E. Arnold, Dr. J. S. Arthur, Col. Wm. H., Med. Corps. Atkinson, Dr. Wade H. Baldwin, William H. Balloch, Dr. E. A. Barker, Dr. L. F. Barton, Dr. Wilfred M. Bauer, Dr. Louis A. Behrend, Dr. Edwin B. Bell, Alexander Graham Bell, Charles J. Berliner. Mr. and Mrs. Emile Bernton, Dr. Harry S. Borden, Dr. W. C. Boswell, Dr. A. W. Bowen, Dr. W. Sinclair Branson, Bruce S. Brett, Col. Lloyd M. Brickenstein, J. H. Brownlow, Commissioner Louis Bryan, Dr. J. H. Bryan, W. B. Bryant, Mr and Mrs. Arthur L. Butler, Dr. W. K. Call, Arthur D. Casteel, Dr. F. A. Clark, Allen C. Clark. Appleton, P., Jr. Coale, Dr. Edith S. Cole, Dr. John T. Constas, Dr. John Cook, Dr. G. Wythe Copeland, Dr. Edgar P. Coville, F. V. Creeden, Rev. John B., S.J. Crosson, Dr. Henry J. Davidson, Dr. E. Y. Delacey, Judge William H. Digges, Dr. J. H. Duehring, Dr. Frank E. Duffey, Dr. H. Clarence Dugan. Dr. C. L. Easton, Dr. Charles D. Edson, Air. and Mrs. John Joy Einhorn, Dr. Max Eliot, Dr. Johnson Eliot. Dr. Llewellyn Ellis, Dr. George R. Eynon, W. J. Fadeley, C. E. Farrand, Dr. Livingston Penning, Frederick A. Fletcher, Alice E. Foley, Dr. Thomas M. Folkmar, Dr. Elnora C, Foote, Dr. John A. Foster, Dr. Romulus A. Fowler, Dr. H. A, Fowler, Dr. W. C. Fox, Albert F. Foye, Dr. A. Francis French, Dr. William G. Friedenwald, Dr. Julius Gannon, Dr. James A. Gans, Isaac Garrison, Dr. Fielding H., U. S. A. Gasch, Herman E. Glose, Rev. Joseph, S.J. Goodman, Dr. William R. Gordon, General David Stuart, U. S. A. Gore, James H. Griffith, Dr. Charles I. Grosvenor, Gilbert H. Gude, William F. Gwynn, Dr. William C, Hagner, Dr. Francis R. Hall, Dr. A. J. Hamilton, George E. Hamilton, Dr. Ralph A. Hammett, Dr. Charles M. c Hatfield, Dr. Charles J. 249 ANNIVERSARY TRIBUTE. Hazen, Dr. Henry H. Hemler, Dr. Wm. F. Herbst, Mrs. and Mrs. William P. Herbst, Miss Herrmann, Mr. and Mrs. J. Phillip Heurich, Chris. Hickling, Dr. D. P, Hilkemeier, Charles Hird, Dr. John D. Holden, Dr. R. C. Holm. Dr. H. C. Holmes, Professor W. H. Hough, Dr. Walter Hough, Dr. William H. Howard, Dr. L. O. Hurtt, Dr. Harry Ireland, Surg.-Gen. Merritt W., U. S. A. Jackson, Dr. V. B. Johnson, Dr. Joseph Taber Johnson, Dr. Loren B. T. Johnson, Dr. Louis A. Johnson, Dr. Paul B. Jones-Taylor, Dr. Louise Judd, Neil M. Kelley, Dr. J. T. Knopf, Dr. S. A. Kober, Miss Gretchen Koons, John A. Krechting Dr. Wilhelm E. H. Lamb, Dr. D. S. Lamb. Dr. Isabel LaFlesche, Francis Langworthy, Dr. Charles F. Leclerc, Mrs. Lizzie I.eComte, Dr. Ralph M. Lee, Dr. Thomas S. Leech, Dr. D. Olin Leech, Dr. Frank Lind, Dr. John E. lank, Mrs. Henry Lowe, Dr. Thomas F. McCarthy, Dr. Joseph J. McCaw, General Wm. D., U. S. A. M. C. McLaughlin, Dr. T. N. Macatee, Dr. H. C. Machen, Dr. Francis S. Macfarland, Hon. Henry B. F. Mack, Edward F. Mackall, Dr. Louis Manning, Dr. W. J. Marbury, Dr. Charles C. Meltzer, Dr. S. J. Merritt, H. B. Michelson, Dr. Truman Mickler, Joseph R., Jr. Mitchell, Dr. Claude N. Moran, Dr. John F. Morgan, Dr. Edward L. Morgan, Dr. William Gerry Moore, Charles Morrison, Dr. Edward L. Moser, Dr. James M. Moulden, Dr. W. R. Murphy, Jerome Muncaster, Dr. S. B. Munson, Col. Edward L. U. S. A. M. C. Neill, Dr. Charles P. Newsholme, Sir Arthur Neumann, Felix Neuman, Dr. Lester Nevills, Rev. Coleman, S.J. Nicholay, Miss Helen Nichols, Dr. H. J. Nichols, Dr. J. B. Nichols, Col. A. J.. U. S. A. M. C. Noble, Gen. Robt. E., U. S. A. M. C. Ong, Dr, Harry A. O'Donoghue, Dr. John A. O'Donnell, Dr. William F. O'Malley, Dr. Mary Owen, Col. W. O„ U. S. A. M. C. Owens, Dr. S. Logan Parker, Dr. Henry P. Pattison, Terrell Peterson. Dr. George Pezold, Mathilda Pfender, Dr. Charles A. Pratt, W. S. Raker. Hon. and Mrs. John E. Ray, A. M. Reeside, Frank P. Reeves, Dr. W. P. Reichelderfer, Dr. L. H. Rench, Dr. V. B. Rudolph, Mr. and Mrs. Cuno H. Richardson, Dr. Charles W. Safford, Lieut. W. E., U. S. N. Sage, C. R. 250 ANNIVERSARY TRIBUTE. Schreiber, Dr. Henry R. Seibert, Dr. E. R. Sexton, Dr. R. L. Shandelle, Rev. Henry J., S.J. Shugrue, Dr. J. J. Shute, Dr. D. K. Silvester, Dr. Richard L. Skinner, Dr. J. O. Sowers, Dr. William F. Spigel, Dr. Harry Spofford, Florence P. Stafford. Justice W. P. Stanton, Dr. W. J. Sternberg, Mrs. George M. Stone, Dr. I. S. Streeter, Dr. Edward C. Stuart, Dr. Daniel D. V. Sullivan, Dr. Robert Y. Sutton, Dr. Richard N. Taylor, Dr. Bruce L. Taylor, Dr. L. H. Tewksbury, Dr. W. D. Thomas, Dr. Ada R. Thomas. Dr. John D. Thompson, Dr. J. Lawn Tindall, Dr. William Tondorf, Rev. Francis A., S.J. Townsend, Dr. J. G., U. S. P. H. Turpin, Perry B. Ufford, Air. and Mrs. Walter S. Vaughan. Dr. George Tully Van Schaick, Dr. Jolin, Jr. Verbrycke, Dr. J. Russell Walker, Dr. Reginald B. Walcott. Dr. Charles D. Wall. Dr. Joseph S. Walsh. Rev. Edmund, S.J. Welch. Dr. William H. Wells, Dr. Walter A. West, Dr. and Mrs. R. Thomas White. Dr. Charles S. White. Dr. William A. Whitmore, Col. Eugene, U. S. A. M. C. Wiley, Dr. Harvey W. Wilmer, Dr. William H. Wilson, George S. Willson. Dr. Prentiss Wolf, Hon. and Mrs Simon Wollenberg, Dr. and Mrs. R. A. Woodward. Dr. Robert S. Woodward, Dr. William C. Wynkoop, Dr. J. C. Yarrow, Dr. H. C. Zehner, Harry 251 ANNIVERSARY TRIBUTE. jfatinratwti Rev. John B. Creeden, S.J. President of Georgetown University. Bless us, O Lord, and these Thy gifts which of Thy bounty we are to par- take. May the useful life of him in whose honor we are gathered be prolonged through other decades in health and happiness. May his example inspire in all of us an effective desire to imitate him in his devotedness to science and to philanthropy. Jlntrnburtnrij Francis R. Hagner, M.D. President Medical Society, District of Columbia. As president of the Medical Society of the District of Columbia, it becomes my pleasant duty after the gastronomic treat we have just had, to open that part of our gathering which will consist in the enjoyment of a feast of a different sort. It is a great pleasure to us to have present tonight representatives of the other scientific and civic societies to which our honored guest belongs. As everyone present is aware we have met here tonight to do honor to our colleague, Dr. George M. Kober, who has reached his seventieth milestone today, and I only hope if I survive the vicissitudes of life until I shall reach his age, I may wear the years as gracefully as he, and count upon the affec- tionate regard of so1 great a number of my confreres. The committee of arrangements has provided a regular program for your entertainment and therefore my part will be ended when 1 introduce to you the genial toastmaster of the evening, Dr. John Foote; T take great pleasure in introducing Dr. Foote. AfcbrpSH nf tljr Qauwtnuwtrr Dr. John A. Foote. Mr. President, Ladies and Gentlemen: Shortly after the American forces went to France we began to hear tales of stupendous task performed with incredible celerity by the American Engineers, so that after awhile it was said that the motto of this corps became : "It can't be done but there it is." 252 ANNIVERSARY TRIBUTE. We have assembled here tonight to celebrate the seventieth anniversary of the birth of a man who has1 spent the greater part of a useful and busy life in our midst, and to testify by our presence here the pride which we feel in his career as a medical scientist, our admiration for his civic virtues and the love which we have; for him as a man. I have not said that we have come here to honor Dr. Kober, for there is no individual, no matter how distin- guished he may be in any field of knowledge, who can add anything to that honor which George M. Kober has earned for himself. We have come here gladly to a rich and pleasant task and we have no desire to leave this duty to posterity. We feel indeed like the man who said: "What do I owe to posteriy? What has posterity ever done for me?" Dr. Kober has done far more for posterity than posterity ever will be able to do for him, no matter how it may praise him. And, while it is true, to para- phrase the words of a favorite poet, that: "Great men grow greater by the lapse of time, We know those least whom we have seen the latest; And they 'mongst all whose names have grown sublime, Who worked for human happiness was greatest." Yet we can conceive nothing more appropriate than the ceremony in which we have so joyfully engaged this evening. Let no one think that this is a meeting in which we will say "Hail!" and then "Farewell!" We have revised our estimate of "old" men in the lessons taught us by the great World War, and we know that to men like Dr. Kober the spirit of '76 means the years 76 and not the year '76. We know that he has the spirit of that great European statesman who said on his eighty-first birthday that while he had always understood that the first eighty years of a man's life were the most pleasant, he had now come to realize that a great many good things had been reserved for the second eighty years. There are many here tonight who have been the associates of George M. Kober in his notable life work, some who are his peers in other branches of science. One of these left us about two years ago to accept the highest post in the health councils of a great northern city. We had long known him when he was with us for his crisp rhetoric, his certain logic and his swift gift of oratory, and after a year's burnishing attrition with the keenest minds of that city whose own sons have on occasion admitted that she is the center of western culture, we may expect of him even greater accomplishment this 253 ANNIVERSARY TRIBUTE. evening. It has been well said, "You can tell a man from Boston, but you cannot tell him very much." I take pleasure in introducing an old friend in the person of Dr. William C. Woodward, Health Commissioner of the City of Boston. Dr. William <L Wnn^warb Health Commissioner of Boston, Mass. Representing the Medical Society, District of Columbia. Mr. President, Our Honored Guest, Ladies and Gentlemen: My introduction by our genial toastmaster has been most embarrassing io me, but it has relieved me of a large part of the sense of responsibility i hat previously I had felt. The rules of the evening provide, the toastmaster tells us, that for any failure in the program of the evening, he, and he alone, is resposible. For my shortcomings, therefore, you will please blame the toastmaster. In so far as shortcomings may be absent, 1 must beg of you to attribute that fact to the inspiration that must come to even the dullest head and the coldest heart, if human at all, on an occasion such as this. Sitting here among my many friends and associates, I can hardly realize why 1 should have been introduced as a gentleman from Boston. It is so natural and homelike to be here with you. But then it comes over me that I am no longer physically and bodily one of you, however much I may still be so in spirit, and I feel more deeply indebted even than before for the honor you of the Medical Society of the District of Columbia conferred upon me when you asked me to be your spokesman on this occasion. I am sure the honor comes through no merit of my own, unless it be a merit to esteem and love the society with which I have been so long identified, and to esteem and love our guest, Dr. Kober. Dr. George Martin Kober was born at Alsfeld, Germany, in 1850, on March 28. In 1867, soon after the close of our Civil War and when he was a mere lad of seventeen, Kober came to the United States, and shortly thereafter entered the army and was assigned to the hospital corps. It was thus that he was put into the way of achieving a boyhood ambition to become a doctor of medicine. His first post of duty was at Carlisle Barracks, Pennsylvania, and there he kept the records of the hospital, acted as pharmacist, assisted in minor dressings, and discharged many of the duties of a clinical clerk. His youth and then slight stature, Dr. Kober says, exempted him from most of the 254 ANNIVERSARY TRIBUTE. usual duties of an orderly, but I surmise that his mental and moral strength, rather than any physical weakness, procured for him the superior opportunities that came with the duties assigned to him, to advance his knowledge of medicine. At any rate, the unusual qualities of the quiet, sincere, studious German lad attracted the attention of the medical officer at the post, Dr. J. J. B. Wright, and of Mrs. Wright, who thereafter lost no opportunity to help him toward his goal. Kober remained at Carlisle Barracks until January 10th, 1870, when he received the appointment of Hospital Steward and was then sent to Frankford Arsenal. Either a knowledge of the esteem in which the lad was held at Carlisle Barracks had preceded him to Frankford Arsenal, or else the medical officer at the Arsenal, Dr. Robert Bruce Burns, was as discerning as Dr. Wright, at Carlisle Barracks, had been; for every facility was extended to Kober here as at his former station to enlarge his knowledge of medicine. Frankford Arsenal was near enough Philadelphia to enable him to attend some of the lectures at the medical school of the University of Pennsylvania, then as now one of the leading medical schools in the United States, and by copying the notes taken by a student at the Arsenal who was able to attend regularly, a son of Dr. Burns, Kober was enabled to make substantial progress. Dr. Kober today, with modesty that is quite characteristic, is profuse in his acknowl- edgment of his obligation to Dr. and Mrs. Wright, and to Dr. Burns, and refers to his good fortune in coming under their guidance, but it is hardly likely that the good fortune came undeserved. It seldom does. The next step in Kober's advancement toward a medical career, came as an assignment to duty in the Surgeon General's office in Washington, in 1871. So far as the record shows this transfer was merely one of the ordinary changes of post that any man in the army must expect to befall him from time to time. Beneath the surface, however, we must recognize the hand of Providence through the discernment, wisdom, and great-heartedness of Dr. Wright, Dr. Burns, and the other friends in the army who had by that time taken a fancy to the very likable and friendly young Kober, now at the threshold of man- hood, and somewhat matured by four years of army life. The medical schools of Washington at that time gave their instruction in the evening, so that an ambitious young man might work during the daylight hours in a government department or elsewhere to earn his livelihood, and devote his evening hours, his holidays, and possibly his Sundays, to study and to clinical instruction. It was hard work, as those of us who have been through it can testify; but 255 ANNIVERSARY TRIBUTE. Kober was not afraid of hard work, and so he promptly matriculated at the medical school of Georgetown University, where he came under the preceptor- ship of Dr. Johnson Eliot, one of the most distinguished physicians and sur- geons in Washington at that time. He was graduated as a doctor of medicine m the spring of 1873. Time will not permit any extended account of Kober's career in the medical school. One event of outstanding importance must be mentioned, however, for it marked an epoch in Kober's career, and has much to do with our present relations with him. For it was while Kober was still an undergraduate that his preceptor, Dr. Eliot, invited him to attend a meeting of the Medical Society. Kober gladly accepted the invitation, and from that time until he left Washington in July, 1874, he was present at every meeting. Promptly after graduation, Kober sought membership in the Medi- cal Society, but before his application was acted upon he had been appointed an acting assistant surgeon in the United States Army and had reported for duty as post surgeon at Alcatraz Island, California. The fact that he was twenty-five hundred miles away for an indefinite period did not lessen his interest, however, and upon election, October 6, 1874, he accepted member- ship, and that membership he maintained continuously during his army life in the far West, upwards of twenty years, and has maintained ever since. Dr. Kober returned to Washington in 1889. The esteem in which he was then held by the medical profession, notwithstanding his prolonged absence, was well shown by his election in the very year of his return, as president of the Medical and Surgical Society of the District of Columbia. In 1898, he was elected president of the Medical Association of the District of Columbia. In 1903, he was elected president of the Medical Society of the District of Columbia, the highest honor within the gift of the local medical profession. In 1915 he was president of the National Association for the Study and Pre- vention of Tuberculosis, now the National Tuberculosis Association. He has been dean of the Medical Department of Georgetown University since 1901. I might go on for the entire evening telling you of Dr. Kober's work, but to most of you his life of service is already an open book, and all of you, I know, are eager to hear the speakers who are to follow. And so with these remarks, a few words in appreciation of Dr. Kober's services, and a few words of congratulation to him on the attainment of this his seventieth birth- day, I might complete the very pleasant duty with which I have been honored by the Medical Society-if Dr. Kober were just an average man. For the life and work of most of us, of the average man, can well be summed up in such a fashion as that which I have thus far followed. A few 256 ANNIVERSARY TRIBUTE. elates, a few incidents of little or no lasting importance in the life of our profession or of the community, a few square feet of earth, a mass of granite- and the life story of the average man has been told. But were I to attempt so to recount the work of Dr. Kober, in order that we might do honor to his life of service, I should certainly fall far short of my obligation as the message-bearer of the Society on this occasion. Dr. Kober is not an average man, or else we would not be here this evening; for to his chosen profession, to the Medical Society, and the community he so diligently serves Dr. Kober has come to be something more than a mere flesh and blood man, something more than a mere series of dates and incidents. He must be studied and appraised rather as an influence--a moral or spiritual influence, if you will-- lending constantly toward the enlarging and uplifting of the lives of those with whom he comes into contact: an influence that will continue to stimulate and direct the activities of the Medical Society long after Dr. Kober has been called from the field of his earthly- labors-which, pray God, may be an event long delayed. If you were to ask me to name the secret of Dr. Kober's influence, I would answer first, loyalty, loyalty to an ideal. To the Medical Society-and it is for the Medical Society that I speak-he has been loyal first, loyal last, loyal at all times and above all things. Picture, if you please, the young Kober, just turned twenty-one years, with all the temptations to idleness and pleasure incident to that age, with the burden of daily toil for his livelihood and evening and nightly toil for an education, and yet after his first introduction into the Medical Society, as a guest, never missing a meeting so long as he remained in Washington. Follow him through nearly twenty years of absence, maintain- ing membership in the Society, without any incentive whatsoever beyond his bare loyalty to it. Then recall him, returning, his place in the medical pro- fession assured and with no intention of practicing medicine, and yet imme- diatelv resuming his position in the councils of the Society. How many of us would have done likewise? None, 1 venture to assert, and not more than a sorry few, I am sure. The record is, I believe, unique in the history of the Society. And after his return, trace his course through the years that fol- lowed--always in his place in the deliberations of the Society, and excelled by no one in interest and zeal in its scientific program and professional and public activities, even right up to the present moment as he rounds out his seventieth year. Do you wonder at the esteem and affection of the Medical Society for Dr. Kober ? 257 ANNIVERSARY TRIBUTE. But loyalty is not a thing that springs up without cause, when and where it will, and it may be well to inquire into the cause for Dr. Kober's loyalty to the Medical Society. We have already seen that his devotion could not have been due to any personal benefit that he might hope to derive, and we may well ask ourselves whether it may not have been due to some distinguish- ing merit in the Society itself or to the attributes of its members. Although our pride may suffer by the admission, we must admit, it seems to me, that such was not the case; it was Kober, not the Medical Society and not ourselves personally, that developed that spirit of loyalty that has marked his career. If you doubt it, search the long list of physicans admitted to membership since Kober became a member. How many of them have been bound to the Society or to ourselves by any such ties of devotion as has Kober, and yet all have had at least an equal opportunity, and many have had better. Merit there is in the Society and in its members, unmistakable merit, merit of a high order; else the Society would have long since perished. But it takes the exceptional man to find that merit, to analyze and appraise it, to avail of it, and build it up and strengthen it so that others may share in it the better; and Kober was one of those exceptional men. Early in life he came under the influence of an ideal-duty, duty, duty-and he has lived steadfastly up to it; duty to his patients, duty to his fellow physicians, duty to the organized medical profession; duty to his fellow man. The Medical Society was an agency that would fit him to discharge that duty, and it became, therefore, from his student days onward, an object of untiring devotion. He owed it to his profession and to his fellow man, he thought, to keep himself abreast of the advances in the science and art of medicine, and the Medical Society was to him a post-graduate school that enabled him to discharge that obligation. But the purely scientific and professional advantages to be gained by attend- ance on the meetings of the Medical Society and by participation in its activ- ities would hardly have bound Kober to the organization as he was bound. There was a human element in the atmosphere of the Society, however, that attracted him, for Kober has always been pre-eminently a lover of his fellow man. Whether that man was the Indian on the plains or in the mountains of the West, a dark-skinned brother in the alleys of Washington, a medical student struggling against odds like those that Kober had met and overcome, or a struggling member of the medical profession, it mattered not. Kober was his friend and brother. The Medical Society afforded a meeting place 258 ANNIVERSARY TRIBUTE. where he could come into contact with his fellow physicians, take part in their discussions, share in their joys and successes, sympathize with them in their griefs and failures, and promote the welfare of his chosen profession in the Capital City; and so he threw himself whole-heartedly into its work, admin- istrative, professional, and public. His investigation of typhoid fever in the District in 1889 and again in 1895 ; his intense and prolonged labor in bringing about the proper filtration of the water supply of Washington; his activity for the improvement of the milk supply; his energy and effort that led ultimately to the establishment of the tuberculosis hospital; his early recognition of gonorrhea and syphilis as presenting grave social problems ; his fight in company with Gen- eral Sternberg, for the' improvement of housing conditions; his untiring, self- sacrificing labors as dean of the Medical School of Georgetown University in the interest of medical education in the District of Columbia and throughout the country; his labors in the interest of industrial medicine and sanitation; these mark some of the high points in Kober's professional career. And these, and his indefatigable energy in recording the results of his studies and observations so that others might reap the benefit of them, serve as a measure of a life that has brought honor and distinction on Kober as a physician, a sanitarian, and a philanthropist, and that has added to the credit of the Medical Society, the scene of so much of his labors. But it is to the human side that we must always recur if we would see the true Kober-always simple, straightforward, honest, friendly, self-forgetting. One of his associates said to me only this afternoon: "I always liked Dr. Kober; he always tells the truth." It is a sad commentary on our present moral standards that a man should be chosen for a friend because he always tells the truth, yet how many of us do. But the observation concerning Dr. Kober was true; he always tells the truth. Who here has ever even so much as suspected him of prevaricating for the sake of policy or expediency, or even of evading or beating about the bush when truth was called for. As must already have become apparent from the picture I have drawn, Dr. Kober is withal a man of profound religious convictions-not in the sense of one who adheres to form or creed but as one in whom the spirit of religion in its very essence lives and breathes and directs and controls his daily life; a man with no religion to talk of and wear on his coat sleeve, but with a religion to live by. In one of our more intimate moments, Dr. Kober told me of a conversation he once had with one of the venerable elders of one of the Indian tribes with whom he came into contact during his life in the Great West-J a conversation about the Great Father and his divine control over the affairs 259 ANNIVERSARY TRIBUTE. of this life, and about the life to come-and often since then 1 have had pass before me as I thought of Kober, the young army surgeon and the venerable old Indian, before the camp fire, out under the canopy of the heavens, dis- cussing the eternal truths as we poor mortals, white man and Indian alike, reach out to grasp them. It has been, I believe, his recognition and acknowl- edgment in his daily life of all mankind as brothers, and of a Divine Provi- dence in the affairs of men, that have made Kober what he is to us today. Truly, the Medical Society of the District of Columbia has occasion to be proud of George Martin Kober. Truly, it is indebted to him for the work he has done and the influence he has exerted over it. Throughout his pro- fessional career he has stood for the best there is in medicine; with Busey, Eliot, and Johnston, with Ford Thompson, and Morgan, and Toner, and a host of others too numerous to mention, in Washington and elsewhere, whose lives have been devoted to the alleviation of the sufferings of mankind and the uplift of the human race. Truly, the Medical Society is but doing itself an honor in acknowledging as it does this evening its indebtedness to Dr. Kober and its esteem and affection for him. Dr. Kober, I pray that you accept from me, therefore, on behalf of the Medical Society, its congratulations on the attainment of this your seventieth birthday. I have been instructed by the Society to acknowledge its indebtedness to you for the work you have done and the influence you have exerted over it. The Society is proud to number you among the very foremost of its members who have brought honor and distinction to it, at home and throughout the land. And it is the prayer of the Society that you may long be spared in your life of service to your fellow men to enjoy the fruits of your labors and to live in the understanding and appreciation of the great esteem and love that we of the Medical Society bear toward you. ♦ The Toastmaster-Introducing Professor William H. Holmes. One of Dr. Kober's attributes is thoroughness. This is true of his scholar- ship as well as of his work. We have long known him as a philanthropist, but he is equally well known as an anthropologist. Dr. Kober loves his fellow-man so well that he is even interested in his natural history. He has been a member of the Anthropological Society of Washington for many years and is a former president of that body. Many members of the Anthropo- logical Society are here tonight and they have chosen to speak for them a former president of the local society who is internationally known as a scientist. He has been president of the Washington Academy of Sciences, 260 ANNIVERSARY TRIBUTE. of the Cosmos Club and is the directing force of the National Academy of Art and the Anthropological Section of the National Museum. It gives me pleasure to introduce Mr. William H. Holmes. ^rnfr^snr William Unlnwn. Head Curator Department of Anthropology, U. S. National Museum. Representing the Anthropological Society. 1 am greatly honored and greatly pleased to be accorded the privilege of saying a word on the occasion of the seventieth anniversary of the appearance of Dr. George M. Kober upon the world stage and to be asked to represent the Anthropological Society of Washington in doing homage to its president )n the thirty-third anniversary of its organization. Dr. Kober's career has been a long, an arduous and a most honorable one, and at 70 he is still in the foremost rank of the advancing columns of science, education and humanization; while about him are a multitude of the younger generation who have grown up under his influence and who are, in turn, press- ing forward into new fields, profiting always by his experience and inspired by his example. There are those present who have a much more intimate knowledge of the Doctor's professional career than I claim and they will doubtless be heard from, and I am thus tempted, at the risk of introducing myself unduly into the story, to recall certain coincidental linkings of his career and mine during the nearly half century of our association with the national service. In 1871, two young fellows reached Washington and began their life work; the one from the valley of the Rhine, the other from the American Rhine-the Ohio. Both at once found employment; the one in Georgetown University and the other in the Smithsonian Institute. Five years later, while the one was acting as surgeon with the military expedition against hostile Indians in southeastern Nevada, the other, in charge of the San Juan division of Survey of the Territories, was just across the border in Arizona having serious trouble with the treacherous Piutes. Whilst the one, during his service in Nevada, turned his attention toward the physical characteristics of the tribes and to the study and collection of their skeletal remains, the other, as a result of his work among the cliff dwellings of the Mesa Verde country, turned his attention from the field of geology to that of archeology and finally to that of anthropology. 261 ANNIVERSARY TRIBUTE. It happened further that the great collection of skeletal remains of the Indian tribes, to which the one contributed while on duty as surgeon in the field, which later was assembled in the Army Medical Museum, was, through the agency of the other, transferred to the United States National Museum, leading thus to the establishment of the Division of Physical Anthropology and to the selection of Dr. Ales Hrdlicka as Curator. This was in due course followed by the founding of the Journal of Physical Anthropology of which Dr. Kober is an associate editor; and the two lives have thus come again in touch, for while the one as President of the Anthropological Society of Washington is here on his seventieth anniversary to receive the commendation of a multitude of friends, the other is here to hand him as a token of their esteem a special copy of the Journal which both, under the direct instru- mentality of Dr. Hrdlicka, were instrumental in founding. To you, sir, on behalf of the Anthropological Society of Washington-a society to which you have belonged for many years and which you have hon- ored by becoming its president, I have to say that we are especially gratified co have this opportunity of further manifesting our appreciation of your services to the society, to the country, and to the nation, and especially of expressing our admiration for the qualities of mind and heart which have so endeared you to all. The Toastmaster-Introducing the Hon. Henry B. F. Macfarland. No one has had a more keen interest in the health of this community than Dr. Kober. Many of his sanitary investigations were begun primarily to help local conditions. It is only fitting that the civic and economic associa- tions of the city should have representation at this meeting and have voice as well as presence at this gathering. The gentleman who will next address you is so identified with affairs of the District of Columbia that he has become almost a godfather to this orphan community. Speaking for the District of Columbia is no new experience for him. In 1900, he delivered the official address at the White House of the National Capital Centennial. At the Buffalo Exposition, the St. Louis Exposition and the Jamestown Exposition he was the chosen orator for the District Day Exercises. For ten years he was chairman of the Board of Commissioners of the District of Columbia, and his interest in local affairs has never lessened. I take great pleasure in introducing the Pion. Henry B. F. Macfarland. 262 ANNIVERSARY TRIBUTE. Hatt llrntrj HL fHarfarlatth Formerly President of the Board of Commissioners of the District of Columbia Representing the Civic Organizations, District of Columbia. Aristotle said that a city was a place where men work together for noble ends. That would be an ideal city. But in every city there are men who are working together for noble ends, men who are willing to make sacrifices that they may give service. Washington is rich in such men and equally rich in women of the same spirit and devotion. No other city surpasses it in this respect. The charge so frequently made that there is lack of public spirit here and therefore lack of self-sacrificing service of the public is absolutely false. One value of such an occasion as this is that it enables us to give the lie to such a charge. So we are honoring our city by honor- ing our guest, for he is typical of the civic patriots who make the most of opportunity in the service of the national capital. They have the satisfaction of knowing, as in this case, that what they do here is seen all over the country by those who are looking for examples of civic service and that they benefit not only Washington, but the United States. Sometimes this is said to be a thankless task. It is often so. But we ought to give thanks not only as reward, but as encouragement. "Our praises are our wages" and men are working for them as for no other wages. Therefore tonight we heartily thank Dr. Kober for his service to our community and to our country through its capital. For thirty years, Dr. Kober has been identified with practically every movement for social welfare of the national capital. He has been an exam- ple to those who, retired from active life, come here to live. He recognized at once his obligation to the community. With his sense of duty, he could not be a parasite. Ever since he came to Washington, he has been active in public service. He became a member of the Board of Managers of the Associated Charities in 1895, one of his first public efforts here and has been ever since faithful to the duties of that office as a member of the Executive and other standing committees and in the line of all his efforts to promote thrift particularly active through the agency of the Committee on. Provident Plans. In 1906, he was appointed by President Roosevelt a member of the Board of Charities. He has served continuously as a member of the Committee on Medical Charities. He designed the Tuberculosis Hospital which was opened 263 ANNIVERSARY TRIBUTE. in 1908 on the Georgia Avenue tract which the Commissioners had acquired for a municipal hospital. The Sixth International Congress on Tuberculosis held in Washington in 1908 awarded him a medal for the design of this hos- pital. He was a pioneer in the campaign against tuberculosis, one of the founders and always- a leader in the local Association for the Prevention of Tuberculosis and a leader also in the National Association of which he was president in 1915. President Roosevelt in 1907, appointed him a member of the Presidents' Homes Commission. He was chairman of the Committee on Social Better- ment and as such prepared monographs on Industrial Hygiene and Social Betterment, published in 1908 as Senate Document No. 644. One of the founders of the Washington Sanitary Improvement Company, organized in J 897, and also of the Washington Sanitary Housing Company, organized in 1904, he served for years as secretary and latterly for a number of years as president of both companies. He has been a member and active worker in the Monday Evening Club, the Civic Center, Social Hygiene Association and Playground Association. He has endowed scholarships for excellence in Domestic Economy in the Public Schools. But then I fail to enumerate all about this model citizen of the National Capital; and after all it is the spirit in which these services have been rendered, rather than the quality and quantity of the service that was given, of which we think first and most tonight. There are men in Washington who get discouraged because they have no political opportunity in the District of Columbia.. They say we are not citizens of the District of Columbia, we have none of the political duties of the District of Columbia; why should we care? Why should we take any interest in the affairs of our city? The time will come, 1 believe, when we shall have national representation in the Senate, the House, and Electoral College, and we shall have full scope for our political talent and activity when it will be no longer possible for our friend from Britain to smile as a reminder that we fought the Revolutionary War for the principle that "Taxation without Representation is Tyranny." But until that time comes, and it may be distant, we shall have constantly before us the common task of the common citizen of any community. And if we have the spirit of Doctor Kober we shall do that task with the zest, the enthusiasm, the thoroughness, and therefore with the success, which has brought us all here tonight in affection and admiration. 264 ANNIVERSARY TRIBUTE. The Toastmaster-Introducing Dr. Robert S. Woodward. Several years before Dr. Kober was born, a Scotch immigrant lad began to work in a mill near Alleghany Pennsylvania, at a salary of $1.20 a week. Last year this boy died after having given away to various philanthropies over $300,000,000. One of the most important of these benefactions, the Carnegie Institution of Washington, was founded in 1905. Great difficulty was experienced in finding a suitable head for this new type of research insti- tution, until the governing body discovered their ideal in a famous research worker who was at that time head of the Department of Pure Science of Columbia University. Under the care and direction of this eminent scientist the notable achievements of the Carnegie Institute of Washington have been accomplished. No one could be better qualified to speak for the scientific societies of Washington-included in the Washington Academy of Sciences than Dr. Woodward. Writing his acceptance of the committee's invitation, he said: "You can count on me to help sound the praises of our colleague and to abuse him appropriately for his delay in joining the septuagenarians." I take pleasure in introducing Dr. Robert S. Woodward, President of the Carnegie Institution of Washington. ®r. ^nheri President of the Carnegie Institution of Washington. Representing the Washington Academy of Sciences. It is a rare and a happy privilege accorded us tonight to celebrate the attainment to the ranks of the septuagenarians of our friend and colleague and coadjutor in all good works, Dr. Kober. It is a special personal privilege, since, having preceded him by many months, nearly a whole year, indeed, in arriv- ing at the proverbial three-score-and-ten epoch, I' am thereby permitted to patronize him a little and to tell you in his presence of the high esteem in which we all hold him. It is a special source of relief also at this time to turn from the turmoil of the affairs of k sadly shattered, if not wrecked, world to a consideration of the altruistic labors and achievements of our versatile, unpretentious, indefatigable and always effective associate, Dr. Kober. The value of a man to society is measured by the work he accomplishes. This may be either of immediate or of future benefit to our race. The work 265 ANNIVERSARY TRIBUTE. of Dr. Kober is conspicuous in both these respects; he has not only sought to remedy existing ills but to prevent their recurrence and to forestall the development of new ills. His vision comprehends at once the past, the present, and the future. He has proved himself to possess both the insight and the foresight of a prophet in the best sense of the word. His activities in the promotion of sound sanitation, from its foundation up, and his preaching and practice in right living make him one of the leaders of progressive pathology. But I presume the best service he has given to society is that rendered as Dean of the Medical Faculty of Georgetown University. Having had some experience in the business of a deanship and allied occupations, I am disposed to bow in admiration to any man who can serve a faculty for twenty years in such a capacity. A dean has a difficult and often thankless task. It is his duty to stand between the conservative body of trustees, or governors, on the one hand, and the commonly impetuous members of the faculty on the other hand. It is his duty to recognize facts and to secure the working relations of reciprocity between these two groups. His capacity and reputa- tion are always under strain and often in peril. Only men with sound diges- tion and a lively sense of humor and proportion can survive. In Dr. Kober's case, however, the indispensable relation of reciprocity just referred to have been furnished in high degree I mistake not, by the university and by the faculty he serves. I am an outsider, as you are well aware, and may not pretend to know much about Georgetown University. Nevertheless, I began making observations on this academic establishment more than thirty years ago, when I had the good fortune to become acquainted with Father Hagen, then in charge of the University Observatory and now (and for years past) in charge of the Vatican Observatory in Rome. It was plain that a fine, high spirit and practice prevailed at the University then and it has become plainer and more impressive as the years have passed. Naturally, in recent years I have heard more of the medical college and of the Georgetown Hospital than of other branches of the University. As a man grows older and more and more in need of repairs, precaution requires him to contemplate the beneficent provision now made in our leading hospitals for bodily derangements. It has been my privilege also to know intimately of the skillful and the merciful treatment accorded at the Hospital to a number of close friends, friends ranging through all walks of life. We have not met on this occasion to moralize. It is an occasion rather for felicitation and for good fellowship. I may be pardoned, however, for 266 ANNIVERSARY TRIBUTE. recalling your attention to the principles for which colleges, universities and other altruistic establishments stand. They are the principles which have survived throughout the ages. They have flourished even amid the ruins of empires. They are espoused, upheld and effectively applied by only a rela- tively small number of representatives of our race. There is much evidence in contemporary events to indicate that such representatives are now needed as never before. All hail, therefore, to Dr. Kober and men of his kind! Let us welcome him as a sage of seventy but indulge the hope that he will long remain young. The Toastmaster-Introducing Dr. Harvey W. Wiley. A much traveled visitor to Washington during the war period, who was a guest at the Cosmos Club, said that he had never before seen so many dis- tinguished men regularly assembled under one roof. Modesty is a virtue which no toastmaster should possess, so I will have to find some other reason for not telling you of the high standard of membership in this club-besides there are many members of the club here tonight who- might perhaps blush. It will be no exaggeration, however, to say that to have been president of this famous organization implies a greater degree of scholarship and achieve- ment than is represented by the highest academic honor in the gift of anv of the universities. It is fitting that a former president of the club should speak of Dr. Kober's connection with it. This gentleman in writing his acceptance said : "I shall be glad to speak after the dinner and tell him what a boy who was six years okhwhen he was born thinks of this callow youth." You will recognize the writer when I tell you that he is "The foremost authority on the chemistry of foods," and the only table he has not made absolutely safe is the peace 'table. Dr. Harvey Wiley really needs no introduction. 0r. gantry W. Wthy Director of Bureau of Foods, Sanitation and Health. Representing the Cosmos Club. Mr. Symposiarch: In your letter which I received in regard to this celebration, I was told that I was to represent the Cosmos Club. Now, fortunately, the day has passed when I can represent the Cosmos Club and I doubt if there is any living person who could represent that remarkable aggregation of intelligence, 267 ANNIVERSARY TRIBUTE. learning, philosophy, pathology and patriotism. I shall not attempt to speak for the club, but what I s?y shall be from my own heart. I have known Dr. Kober for nearly a third of a century. I am inclined to bestow upon him the appellation "right man." I have had some oppor- tunity to ascertain Dr. Kober's attitude on many great problems affecting human welfare and I have never known him to be on the wrong side. You may be interested in knowing how I reached this decision. It is a perfectly simple method which any of you can adopt. In every one of these questions to which I refer Dr. Kober has been on my side. 1 have not sounded him yet on Albert Einstein's theory respecting the mental delinquency of Isaac Newton, but 1 have no doubt when he does make up his mind on that point he will be right, much as Mr. Newton might protest. I am free to confess also that I do not know his attitude on the League of Nations, but I have great faith in my belief that when he does chance to express himself you will find him again occupying the same old position. I will urge him, however, if he desires to be recorded in the matter before the funeral takes place, that he might do well to tell his patient just where he stands now. Almost every- body feels like saying a good word for a corpse. What I recall with most delight and pleasure in my association with the guest of the evening is the great fight that we put up for the Pure Food and Drug Law. Dr. Kober was always to be had on demand. In the 25 years in which this legislation was considered before the Committees of Congress, Dr. Kober was always an interested and helpful attendant. No kind of sophistry on the part of those members of the Committee who wanted to be "shown," ever in the least disturbed his self-poise, his suavity, or his ability to answer the puzzling questions. When he was urged to consider the fact that the measures which he espoused would "ruin business," he did not respond as he might well have done, "business be damned," but he proceeded to impress upon the Committee that the welfare of humanity, the health of the people and their proper nourishment were a great deal more important problems than the accumulation of wealth by a few trading in adulterated and misbranded products. So calm was he in his consideration of the sub- ject, so forceful in his attitude and so truthful in his replies that he always came off victor in these encounters with the Committee. I have had the honor and pleasure of being associated with Dr. Kober in his lifetime devotion to the conquering of tuberculosis. I do not recall ever having been present at a meeting of the Directors of the Anti-Tuberculosis 268 ANNIVERSARY TRIBUTE. Society in the District of Columbia at which he was not present. I regret that owing to many circumstances over which I had no control, he has had many opportunities to note my own absence from these meetings. Dr. Kober early perceived that prophylactic medicine was a greater factor in human welfare than therapeutic medicine. He has, therefore, given all his time, his ability and his means largely in this direction. His monumental work on "Occupational Diseases and Their Control" is an evidence of his zeal, his mastery of the theme, and his helpful instructive work. Those who are able to drive a motor car have often noticed that in one make, quite com- mon, there seems to be an innate faculty of self reparation. For instance, if in driving a Ford one of the cylinders misses fire, you need not get out with a monkey wrench and a screw driver and repair the trouble. All you have to do is to keep on going and presently all will go well. This is a practice which leads one to follow that school of medicine which very properly regards the human body as a Ford motor car, capable of restoring of itself any dis- located parts. All you have to do is just to let "natur caper," and one great function of preventive medicine is to see that nature has a chance to "caper" properly. We have long since learned that drugs do not cure. They may sometimes aid nature, but they never can function when nature gives up the job. He has realized throughout his later life at least, that sanitation, diet, exercise, sleep, play and favorable environment, condition the true vis medi- catrix naturae. In doing this Dr. Kober has not become an osteopath to crack jokes on spinal columns and thus relieve human ills. He has main- tained his view of a true physiologist who sees in the human body the most wonderful complex yet discovered, but nevertheless governed by an unalter- able law. He would not send his ailing watch to a blacksmith for repairs, nor his ailing body to an osteopath. Dr. Kober has fortunately been so situated as to give the greater part of his time to help humanity. If everyone were animated by the same spirit which he has always shown, then the greatest blessing that could come to a man would be to be born with an income so that he might give all his work to philanthropy. In that case, however, Hamlet would soon be minus a job as there would be no one needing help. The man who closes his eyes to' the "will o' the wisp" of fortune-making, and sees only the work he can do for human betterment deserves all the praise. We have come to look upon the acquisition of wealth as the only measure of success. We have also seen some illustrations of the men who acquire wealth who have given most gen- erously to human improvement. In the last few years we have seen legisla- 269 ANNIVERSARY TRIBUTE. live efforts which tend to relieve the wealthy of a large part of their means, in some instances up to 65% of their total income. How much better it would be if we had in this country the same public spirit which ruled Athens in the glorious days of Greek civilization. Although there was no law to that effect, yet public opinion was so strong in that center of culture as to prevent a man from accumulating wealth for his own use. He gave his wealth freely to the state and lived himself in a humble home such as the ordinary citizen of Athens inhabited. Dr. Kober has always been actuated by the noble spirit of the civic life of Athens. Usually when one reaches the dignity of septuagenarian it is expected that the younger members of the community shall do him honor. I feel, there- fore, that I am particularly favored in having been selected as one of those who came to do him honor and still look upon him as a boy. I love to encourage youth. I remember Gladstone's great work entitled "Juventus Mundi,'' written when he had reached his eightieth year and as Gladstone looked down on that sea of youth to which he ascribed the hope and salvation of the world, so do I look down on this youth whom we honor here tonight and trust that now at the threshold of his great career he may keep that strength and courage, that hope and ambition which he has manifested in his boyish days and that now as he steps into the full light and activity of adolescent maturity he. may keep his gaze, as he has already done, on the high mark which he has set, that he may fail not in his aspirations for the betterment of the community, and when, as an octogenarian, he looks back on the most fruitful decennial period of his life, he may feel that he has hitched In's chariot to a star and the hitching' strap has never been broken. The Toastmaster-Introducing Dr. Charles W. Richardson. One of the first and most important tasks which confronted the Medical Society in arranging for this evening's event was the selection of a chairman. It was conceded that the one who was to hold this tried position must be an old and tried member of the Medical Society and must have an unusual capacity for organization. The chairman who was selected has already testi- fied to his capacity for organization by the success of this event. He is a man distinguished in the surgical specialty which has been his life work, called to many posts of honor in the associations of those devoted to rhinology and otology, and distinguished and honored for his work in the office of the Sur- geon General and elsewhere during the great World War. He has something 270 Presented to George Martin Kober, M.D., LL.D., Soldier, Scientist, Physician and Philanthropist, by the Medical Society of the District of Columbia and Allied Scientific and Civic Societies on his Seventieth Birthday, March 28, 1920. ANNIVERSARY TRIBUTE. very important to say both to Dr. Kober and to the guests at this dinner this evening- and I will waste no further words in introducing Dr. Charles W. Richardson, Chairman of the Committee on Arrangements for this evening's function. Dr. Charlo W. IRtrtjartoit President American Otological Society; President American Laryngological Rhinological and Otological Society; At present Trustee American Medical Association. Dr. George Martin Kober-This day, the anniversary of your seventieth birthday, the Medical Society of the District of Columbia and allied scientific and civic organizations honor themselves in bearing tribute to you. We are proud of the fact that each of the contributing organizations here assembled claim you as their own ; but we of the medical profession are prouder of the fact that we have had you in our fellowship longer. This is manifest fur- ther from the evidences you bear of our training, for without this training and the broad humanitarian principles developed in you out of your medical experi- ence, it is possible, but not probable that your mind would have been directed along the various social, civic and philanthropic efforts, to which you have directed your attention during the latter days of your eventful career. You are a living demonstration of what a man of vision, capacity, scientific tiaining, with indomitable courage and persistence may accomplish within three score and ten years. You, sir, epitomize the honor of labor. In whatever field of labor you entered, you gave to it your uttermost efforts. What an example you offer to the youth of the present age! Distinguished in medicine, hygiene, anthropology, general science, soci- ology, philanthropy, you stand today in your seventieth year as one whom this assemblage and the community at large take pride in honoring. And as a special mark of affectionate esteem for you the pleasant task has been accorded me of placing in your hands this emblem of our pride, confidence and admiration. When this evening with its addresses and delightful sur- roundings is all but a memory you may turn to this emblem as the material evidences of the well wishes of your friends for the remaining happy years that are to come to you. "Your health tonight Take from this board of friendly hearts The memory of a proud delight." 271 ANNIVERSARY TRIBUTE. Dr. (Srnrgr ill. Mnhrr Dean of the Georgetown Medical School. Response. Mr. President, Friends and Colleagues: J Q k I thank you from the depths of my heart for this evidence of g'ood will and esteem. Your kindness and the beautiful words spoken are overwhelming and I find it difficult to give adequate expression of my gratitude. When 53 years ago 1 landed in New York Harbor, I was indeed a youth without a country. My father, a German revolutionist of 1848, had vowed that none of his sons should serve under a German prince, king or potentate, and upon arriving at military age one after the other renounced allegiance to the Grand Duke of Hesse, and sought refuge in this hospitable country, the home of the free and the brave. If, in the course of years, I have become a useful citizen of my adopted country, 1 owe it not only to the inspiration of my dear father, who shared the ideals of men like Carl Schurz, but also in large part to my good American friends who always acted upon the Golden Rule. After four years service in the Army 1 met Senator Schurz in Washington, in 1871, and became a ready convert to his doctrines on the Americanization of the German element in this country. There were at that time between five and six thousand German born citizens in this city-all engaged in useful occupations and many of their descendants occupy prominent positions in business and the skilled trades today. It is true they had a German news- paper founded in 1854 by a former townsman of mine-they also had their singing societies, sporting, athletic and dramatic clubs and churches in which the services were conducted in German, because they were in the transition stage and had to acquire a new language. But at heart they were all true Americans, and during the Civil War, the editor of the German Journal organized a battalion of Germans, left his printing office and fought for the preservation of the Union. His son, Edward Koch, has been connected with the United States Census Bureau for many years and is Chief of the Division of Population of the present census. These German gatherings were not infrequently graced by the presence of members of the Cabinet and other men prominent in public life. Senator Schurz and our fellow citizen, the Honorable Simon Wolf, never lost an opportunity on such occasions to impress upon the Germans the importance 272 ANNIVERSARY TRIBUTE. of speedy Americanization. My own contribution to the movement con- sisted in my opposition, in 1874, to the organization of a German Dispensary, but 1 did aid in the reorganization of the Central Dispensary and the appoint- ment of a few German speaking physicians on the dispensary staff. In this I was ably supported by my friend, the publisher of the German Journal. I could accomplish my aim all the more readily, as my prospective appointment in the army and removal to the Pacific Coast precluded all suspicion of sel- fish motives. I look upon my early life in Washington, from September, 1871, to July, 1874, as arduous but extremely profitable. In addition to my duties in the Surgeon-General's Office I attended the evening courses at Georgetown Med- ical College, and have sincerely grateful recollections of my professors and my earnest fellow students. As pointed out by Dr. William C. Woodward, I enjoyed the privilege of attending the meetings of the Medical Society of the District of Columbia as a Senior medical student, but had little suspicion then that I would at some future time be tendered a complimentary dinner by the members thereof and receive enconium for my activities in this Society. 1 fear my former chief has deviated from his usual judicious temper and, like many others befitting an occasion of this kind, has become an over-indulgent critic. He has failed to tell you that I have only partially discharged my obligations to the Society and this community and that without your co-oper- ation my feeble efforts would have been in vain. 1 must own here that whatever success 1 may have attained in my professional career is largely due to the teachings and example of men of the type of Busey, Eliot, Johnston- Mackall, Ashford, Morgan, Ford Thompson and a host of others who espe- cially impressed me by their steadfast purpose to keep abreast with the pro- gress of medical science. I sincerely hope that every physician, young and old alike, will enroll in the ranks of builders of our Medical Temple, where study, honesty and truth serve as watchwords. 1 still am convinced that a medical society is a graduate school in which the members teach each other. This form of education cannot fail to prove of value not only to the members, but also to the public at large. Indeed the progress of sanitation of the National capital is intimately connected with the history of our old and honorable institution. I extend my heartiest thanks to President Hagner to Toastmaster Foote and to two of my oldest yet young friends, Richardson and Woodward, for the kind words spoken. To the members of the Society I owe special thanks for the 273 ANNIVERSARY TRIBUTE. many honors conferred upon me during the last 46 years, and which have cul- minated tonight in this splendid testimonial of your good will. It is my fondest hope that the Medical Society of the District of Columbia may continue to grow in usefulness and influence commensurate with the physical and intellectual development of the capital of a great nation. I also wish to thank the poet of the occasion, my old and true friend, Dr. S. Adolphus Knopf of New York, for his presence and the beautiful senti- ments expressed by a man whose fame as a successful crusader against tuber- culosis is world-wide. Time will not permit me to speak of my military career as a "Soldier and Country Doctor'' from 1874 to 1889. It was a life full of impressive events, and 1 have learned many lessons in humanity and the brotherhood of man from my soldier and cowboy patients, the sturdy pioneers and the devoted Jesuit Missionary Fathers of the Far West. I desire, however, to express my deep obligations to the Medical Corps of the United States Army, and especially to Surgeons Wright, Burns, Barnes, Crane, Billings, Woodward, Otis and last but not least Sternberg, who did much to promote my youthful hopes and aspirations. All of these men have gone to their long home but their descendant representatives here, I am sure, will gladly accept my thanks. The medical officers have achieved great success in preventive medicine, the results of which are of incalculable value to the human race, and it is hoped that a grateful Congress may so regulate the salaries as to attract good men into the public services and keep them there so that the warfare against pre- ventable diseases may go on to a final victory. I greatly appreciate the presence of representatives of the Washington Academy of Sciences and Allied Societies and the kind and friendly words spoken by Dr. Woodward of the Carnegie Institution. I can only say that in all my connections with scientific bodies I have received more knowledge than was 'possible for me to impart. To me these affiliations have been a great source of education-they have given me the power to think, a broader vision of life, taught me the value of pure science, revealed to me the beauties of creation and the marvelous achievements in the different departments of science for the benefit of mankind. I regard science as the conservator of truth and its light is light from Heaven. To my friends of the Anthropological Society of Washington I owe special thanks for their partiality in choosing me as their presiding officer for three different terms. They were also instrumental in the organization of a 274 ANNIVERSARY TRIBUTE. National Committee, which macle the presentation of the Anniversary volume of the Journal of Physical Anthropology possible, and have thus conferred a singular honor which no man, however modest, can fail to be proud of. 1 appreciate the words spoken by Professor Holmes very deeply. May the life of the Nestor of American Anthropology be spared for many years to come, so that his bright, fertile and discerning mind, always urging, encouraging and inspiring, may continue to exert a still greater influence on American Anthropology which, thanks to his leadership, already occupies a most envi- able position among the nations of the earth. My association with men of science in their regular meeting places and in the hospitable home of Dr. Alexander Graham Bell have been so profitable that I cannot refrain from urging my medical friends to seek similar contact. My sincere thanks are due Professor Wiley for his appreciative remarks. He was the author of the Pure Food and Drug Bill and deserves all the credit. I was only a convert to the cause which he represented and followed his leadership. By his successful campaign against adulterated foods and drugs which vitally affect not only the pocket-book but also the health of the con- sumer, he is entitled to the gratitude of the nation. Moreover, the enforce- ment of the law has made for better citizenship. It was arduous work, car- ried to a finish without fear, favor or affection, and I can only express the hope that he may enjoy many years of usefulness in the cause of humanity, good government and good citizenship. After hearing Mr. Macfarland's citation from Aristotle, 1 realize quite fully that both of us, as also Professor Wiley, owe our ideals of civic duties to this great philosopher, who also was a great physician, and showed* his sanitary acumen when he wrote in his Politia: "The greatest influence on health is exerted by those things which we most freely and frequently require for our existence, and this is especially true of water and air." If he had lived in these modern times of food and drug sophistication he would doubt- less have emphasized the importance of pure food and drugs. It is a fact however that no two factors have contributed more to the health of the national capital than the improvement of the air we breathe and the water we drink, and in this Mr. Macfarland, as a private citizen and later as President of the Board of Commissioners, has taken a very important part. Indeed in most of the activities mentioned by him, Mr. Macfarland was one of the lead- ing spirits and so was Mr Charles Moore, Secretary of the Senate Committee 275 ANNIVERSARY TRIBUTE. on the District of Columbia, and now chairman of the Fine Arts Commission and a host of others who are present tonight. In reference to my humanitarian activities in the city of Washington, which have been so appreciatively dwelt upon by Professor Wiley and Mr. Mac- farland, I cannot help but feel that I would not have been a worthy citizen had I failed to do otherwise. I owe all I possess to my adopted country. I began and I completed my medical education while in the Army of the United States, and began the prac- tice of medicine in the army, and within 15 years by a simple life and rigid economy accumulated a modest competency, the income of which I deemed quite sufficient for a man of my frugal habits, and I concluded therefore that I must quit making money and devote my entire time to teaching and work connected with public health and social and industrial betterment. If in the meantime my investments have yielded greater returns and enabled me to enlarge the scope of my usefulness, I owe it to the good management of a former grateful cowboy patient, and see in him and in my numerous triends both in and out of the profession, the rewards of an overruling Providence. If I have been able to accomplish something for the welfare of my fellow man it is due to the hearty co-operation of my co-workers, many of whom are present tonight, while others have gone to their long home. You have indeed brightened the evening of my life by the numerous evidences of good will and esteem. For the kind thoughts of those who organized this cele- bration and for the kind words spoken and for the presence of all my good friends I feel truly grateful. Of all honors which have come to me, none are jnore appreciated than the approval of my conduct by my friends and co-workers. 276 A N NJ V E R S A R Y TRIBUTE. During the course of the dinner the following poem and other tributes were read. Dr. (Smrijr fH. Knhrr, 1U. D., Hi D. Soldier, Scientist, Physician and Philanthropist, on His Seventieth Birthday, March 28, 1920. S. Adolphus Knopf, M.D. Your cradle stood on foreign soil, But love of liberty was your inheritance; Your father was of those who suffered long From persecution and tyranny. He vowed that you should never be The simple minion of a lord of war, Bowing to king and potentate; But if a soldier you should wish to be You then should serve in freedom's holy cause. So you came here and cordial greeting found, For men like you Columbia gladly welcomes And you repaid her well. You served her first as humble helper To sick and wounded heroes of the war. A faithful student of our noble art you next became And soon attained a magister's degree. As soldier and physician you combined True bravery with sympathy of heart, and thus Became the friend of many a suffering soul. And when to former comrades in the field you bade adieu All said "Well done, God speed you on your zvay." A life of great devotion then began, To civic welfare, art and science given; Your earnest studies fitted you to teach To show the younger men what hygiene means, And prove prevention of disease surpasses cure. By your endeavors, plagues and water-borne disease Were banished from within your city fair; 277 ANNIVERSARY TRIBUTE. You found the reason why so many died Of that disease of all diseases; And better housing of the poor became your passion. Now sanitary homes for black and white Arose where once was wilderness. Next to housing of the laboring men You studied how to make his occupation safe And thus prevent disease among the workers. So manifold your triumphs were In battling zvith disease and death, In this small space I cannot count them all, And in your modesty you zmll not tell What greater things you did for God and man. Throughout your long and earnest life Your greatest joy has been to zvork, But never for yourself. To serve, To help zoherever there zvas greatest need Was your ideal, the motive of your life. So then be thanked on this your honor day, For inspiration and example you have given To pupils and to friends, For countless deeds of mercy and of good You gave to others. Nozu may rezvard of peace and happiness Be yours for many years to come And may no cloud of sorrow cast a shadozu On the evening of your life. From the Sisters of the Order of St. Francis. These flowers express in a slight degree only the love and affection of the Sisters in charge of the Georgetown University Hospital for George M. Kober, M.D., LL.D., for his gj;eat kindness to them so cheerfully given at all times since the organization of the Hospital. 278 ANNIVERSARY TRIBUTE. Dr. C. W. Richardson: Had fully expected to be present at the dinner in honor of Doctor Kober tonight, but am prevented. Please extend my congratulations to Dr. Kober. It is very fitting that his high-minded professional success and his unselfish life should be honored by this testimonial dinner. L. F. Barker. (Baltimore.) George M. Kober, care Dr. Richardson at Rauscher's, Washington, D. C.: Accept my heartiest congratulations on your seventieth birthday; may you live long and continue your splendid humanitarian work for which you are so greatly respected and admired. S. J. Meltzer. (New York.) Dr. George M. Kober: Have been looking forward to being present at dinner in your honor tonight but find myself -unavoidably detained by important business in New York. Greatly disappointed and send my warmest congratulations and best wishes for many more years of the same kind of usefulness you have given in the past. Livingston Farrand. (American Red Cross.) Dr. Charles IV. Richardson: Affectionate greetings to Dr. Kober. Sorry impossible for me to leave home and attend dinner in Dr. Kober's honor which I would rather join in than any other celebration I can think of. Charles William White. (Pittsburgh.) And how will the "Kiddie" feel on his birthday next Sunday? Well and contented in mind and body I hope. It is pleasant to grow old as I know full well. May the coming years be as fruitful in friends and achievements as the last have been. W. W. Keen. (Philadelphia.) Dear Doctor Richardson: The announcement of the dinner to be given to Dr. Kober has just been received. I should be only too delighted if it were possible for me to attend, but I am sure that this is out of the question. Will you not express to Dr. Kober my sincere regrets and my great admiration for his untiring interest 279 ANNIVERSARY TRIBUTE. in and devotion to all activities and measures designed to promote the advance- men of medicine and public health. With many regrets that I cannot attend the dinner, I am ' Very sincerely yours, Herman M. Biggs. Dear Dr. Richardson: I have been hoping to be able to attend the complimentary dinner to be given to Dr. George M. Kober on his seventieth birthday by the Medical Society of the District of Columbia and other scientific and civic organizations on March 27th, but find that owing to circumstances over which I have no control, it will be impossible for me to be present. It has been my good fortune to be in a position to number Dr. Kober among my valued friends. I have long felt that he belongs to a small group of lofty idealists-men who have a vision and consistently and persistently pur- sue that vision. Such men who we dare to call our professional brethren deserve our gratitude for the inspiration experienced through their example. It is not so much perhaps the result of their intellectual power as their elevat- ing and stimulating influence, which gives us a higher and in every way, superior perspective of life. How cheerfully I should show my appreciation of Dr. Kober's long and useful life by indicating my presence at the banquet, if this were possible. Please pardon the liberty I have taken to express my feeble tribute to a real hero and ornament of our noble profession. J. M. Anders. (Philadelphia.) My dear Rr. Richardson: Dr. George M- Kober has done so much to advance medicine and the inter- ests of the medical profession in this country that I should be most happy to join in a complimentary dinner to him on the occasion of his seventieth birthday. Unfortunately, it will not be possible for me to leave Philadelphia on March 27th. I trust you will be good enough to extend to Dr. Kober my best wishes for many more years of health and happiness. As long as the world is interested in industrial medicine and occupational diseases, Dr. Kober's work in that field will keep his name alive. David Riesman. (Philadelphia.) 280 ANNIVERSARY TRIBUTE. My dear Dr. Richardson: I am very sorry that I shall not be able to participate in the dinner to be given to Dr. Kober on the seventieth anniversary of his birthday. I have known him and esteemed him highly for a long time. We were together on the Counsel of the Association of American Physicians for a good many years-he as Secretary and I as Treasurer. My congratulations go with this, even though I cannot be present. L. P. Crozier Griffith. (Philadelphia.) . My dear Dr. Richardson: Your invitation to the complimentary dinner to be tendered to Dr. George M. Kober in commemoration of his seventieth birthday, on March 27, 1920, was received during my absence and was handed to me on my return to the city a day or so ago. I am very sorry indeed that it will not be possible for me to be with you on what should be a very memorable evening. Dr. Kober's services to indus- trial hygiene and the advancement of public health in the United States cover- ing many years of tremendous activities have left lasting results which are almost incalculable in value. It is a delight to us who have known him many years to realize that he is still in the enjoyment of the best of health, and that we may have a continuation of his admirable services for many years to come. I hope on an early occasion to have the opportunity of extending my con- gratulations tO' Dr. Kober in person. Should this however not occur prior to the time of the dinner, may 1 ask you to extend to him for me the good wishes of all his colleagues who really have no fitting way of expressing their admiration for him and for the splendid services which he has rendered. Lee K. Frankel. (Metropolitan Life Insurance Co.) Dear Dr. Richardson: I am exceedingly sorry but I shall not be able to get to Washington for the dinner to be given in honor of Dr. Kober. I would be glad to give proof of my personal friendship for Dr. Kober and my admiration of his unselfish devotion and intelligent work for the good of humanity. Unfortunately, I cannot get away from New York at that time. Please express my deep regret to Dr. Kober as well as to your committee. Sincerely yours, J. M. Glenn, Russell Sage Foundation, New York. 281 ANNIVERSARY TRIBUTE. Dear Doctor Kober: It is with sincere regret that I find (owing to a coriza cold) that I shall not be able to be present at the banquet given in your honor this evening. Through all the years that I have known and been associated with you in various scientific activities in Washington, I have always had the greatest regard for your continuity of purpose, sincerity, and self-abnegation if only the result desired could be secured. I trust that the inspiration of the banquet will act as a compelling force to sustain you in your good work for a decade to come, and that ten years from now your friends may have the opportunity of again paying their tribute of friendship, respect and admiration. Sincerely yours, Charles D. Walcott, Secretary Smithsonian Institution. Army Medical School. Washington, D. C., April 12th, 1920. Rev. Francis A. Tondorf, SJ., Editor Kober Anniversary Tribute, Georgetown University, Washington, D. C. My Dear Sir: Answering your note of April 10th, I may say that Dr. Kober is one of my old friends for whom I have a great admiration. I am glad that in his youth, when he came to the United States, the Medical Department of the Army knew a good man when they saw one and therefore were of assistance in starting Dr. Kober on his long and honorable career. I was associated in 1911 and 1912 with Dr. Kober in the organization of the Congress of Hygiene and Demography which met in this city-rather an historic occasion as it was the last of many of these important international congresses, and it seems very unlikely, in view of the world disturbance, that others of the same nature will be held for many years. Dr. Kober was the President of one of the most important sections of that Congress and performed his important functions with distinguished credit to himself and American medical science. Sincerely yours, Walter D. McCaw, Brigadier-General, Asst. Surgeon General. U. S. Army. 282 ANNIVERSARY TRIBUTE. By IEBER Onkcll--H ocher f rent, Gratulicrot wir Dir heut, Wir si nd hi er ini- Geist e nah Bci Dir in Amerika Und dor traute Mutterlaut Griisst Di ch heut als siisse Brant. Wo wir Deiner Jugend denken Und das Deutsche Herz Dir schenken. Wo dein Wiegenfest erschienen Wollen wir Dich froh bedienen. , Weil Du schon von Jugend an Vielen Menschcn wohlgetan. Durch Dcin'n Geist und tiefes Wisscn Legen wir zu Deincn Fussen Jn dem schlichten Doktorkleide Unsern Ehrenkranz mit Freude. Heute danken-tausend Briider Alle freudig,-hoch und nieder Dass in Nachstcnlieh bedissen Du sic hast dem Tod entrissen Feind vom Streit und Vollerei, Von dor Menschheit Tyrannei Hast Du edles Blut geschaffen Durch des Geistcs Sieg und Waffen. Denn gar bald wird es auf Erden Einigkeit und Frieden werden, - Alle miissen wir bekennen Dass sie Dich als Helfer nennen, Dcr so wide hat frei gemacht Von der Siinde, Last und Schmach, Heute bist Du siebzig Jahr Hoch geehrt als Jubilar, Alt geworden mit Vergniigen, Denn Gesundheit muss doch siegen Die der Herr Dir hat beschieden. J.eb durum noch lang in Frieden Wie seither fiir Menschenwohl Immer gut und liebevoll. Helwig Kober. 283 A VINDICATION OF VIVISECTION A COURSE OF LECTURES ON ANIMAL EXPERIMENTATION BY MEN OF THE HIGHEST AUTHORITY IN THE MEDICAL AND OTHER PROFESSIONS GIVEN UNDER THE AUSPICES OF THE GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE IN GASTON HALL OF GEORGETOWN UNIVERSITY, MARCH 28 TO MAY 16. 1920 FRANCIS A. TONDORF, S.R PH. D. WASHINGTON, D. C. 1920 PREFACE. To see life steadily and to see it whole is the serious duty of every true philosopher. And, after all, what is philosophy save unadulterated common sense amplified and systematized. Hence your real sensible man will approach the subject of animal experimentation dispassion- ately and weigh it in its proper relation to the good of the human race. Let him disregard these prime postulates of sound reason and he is headed straight for unbalanced sentimentality and irrational hysteria. The stereotyped arguments advanced against the practice of animal experimentation are two, to wit, brutality and total lack of demonstrable and tangible results as might warrant the physical pain occasioned following the most clever scientifically regulated methods of vivisection. It is the modest purpose of this brochure to make available for the general public a discussion of such accusations and the pertinent responses made by experienced research workers in a series of public lectures given under the auspices of the Georgetown University School of Medicine in Gaston Hall of the Georgetown University from March 28 to May 16th of the year nineteen hundred and twenty. To profit by the content of these pages the reader must divest himself of every prejudice or partisanship and focus his attention not on feeling but on the issue. He must recall that our cynophile friends are persistently dogmatizing that this is a moral question and then evaluate our ethical arguments against theirs. He must learn that their perverted commentary of the text which tells of the findings of medical researches envolving animal experimentation belies the original. He must read into this text the salus populi, the lex suprema. Then may we look for a fair judgment. Francis A. Tondorf, S. J., Ph. D., Editor, Head of the Department of Physiology. Georgetown University School of Medicine. June 30th, 1920. 289 A VINDICATION OF ANIMAL EXPERIMENTATION. Based upon the work of the Rockefeller Institute for Medical Research in New York. By Simon Flexner, Director, M. D., Sc. D., LL. D. Note of the Editor.-The favor and enthusiasm with which the lectures of this symposium were generally received by our audiences have prompted us to extend them to a larger public. The introductory dissertation by Dr. Simon Flexner, head of the Rockefeller Institute for Medical Research of New York City, was not delivered from manuscript, and, unfortunately, no complete steno- graphic report was made. The Doctor left unexpectedly for Europe as American delegate to the International Convention of the Red Cross, and so even his notes were not available. This digest was assembled from notes as jotted down for their own use by University students in attendance upon the lecture, sup- plemented by references to Dr. Flexner's publications, and it is hoped repre- sents the more noteworthy items. It is offered with every apology to Dr. Flexner. The Lecturer after thanking the Rector of the University for his complimentary reference to the work in Preventive Medicine of the Rockefeller Institute for Medical Research, expressed satisfaction that the creation of an institution for the study of medical problems by a great and liberal philanthropist had placed him with his co-workers in a favorable position to accomplish something for the benefit of mankind. The lecturer traced the development of medical science from its earliest inception, giving an account of the methods used by medical men to gain knowledge of diseases and graphically described the tran- sition from an empirical to a rational basis. The result depending principally on our present-day knowledge of physics, biology and chemistry. He declared that at th*e present time the medical profession is better equipped to discharge its duties to mankind than ever before, a condition largely to be accredited to improved methods of attacking medical problems. The major portion of advances in scientific medi- cine having been accomplished within the past fifty years. Dr. Flexner explained why the public should be informed as to the work and methods of scientific men in the medical profession, and explained the reasons for using animals to study disease. He con- trasted the methods of clinical observation at the bedside of the patient with the present method of study by isolation of the causative organ- ism, reproduction of the disease in animals and study of it there. He told of the relative progress of medicine in the last fifty years as com- pared with all preceding history. He declared that man's employment of his inalienable right to use the material things of the world was responsible for the rapid strides in medicine, and pointed out that in the solution of a number of difficult problems the scientific medical 290 investigation in the United States had made important and most creditable contributions. Dr. Flexner expressed keen regret that an effort should be made in the Congress of the United States to prohibit experiments upon living dogs in th District of Columbia or the Territorial or insular pos- sessions of the United States as contemplated by S. 1258, which bill, if enacted into a law, would be a serious blow to the progress of scien- tific medicine, as much of our physiological knowledge and the action of drugs is based upon experiments on dogs, and for some experiments no other animals can be substituted. Dr. Flexner deprecated every effort to restrict this line of re- search work, in view of the fact that any reputable investigator takes special pains to prevent unnecessary suffering by the administration of anesthetics or opiates, and the prevention of cruelty in animals is especially well safeguarded by laws now in force in the District of Columbia. He referred to diabetes, a disease of considerable fre- quency, as illustrating the value of experiments on dogs in promoting knowledge of this important disease of man, and also in contributing to its better therapeutic control or treatment. He stated until the crucial experiments by two German physicians on dogs some years ago the cause of diabetes was unknown The Ger- man scientists extirpated the pancreas on dogs and the animals so operated on developed rapidly fatal diabetes. The practical use of this knowledge was employed by Dr. Allen who by modifying the operative procedure ascertained the manner in which to induce grades of diabetes closely simulating those of man. With these animals he was able to work out a treatment which has brightened the outlook of the diabetic and has prolonged the life of these individuals enabling many of the sufferers to attend their duties and vocations over long- periods of time. These experiments so useful to man have been made on dogs, and no other animal suffices for the purpose. This work was begun at the Harvard Medical School and completed at the Rockefeller Institute for Medical Research. Dr. Flexner stated that he had given a single concrete instance, but the instances could easily be multiplied, through which the benefi- cent use of the results of experiments on animals could be shown. He declared that by animal experimentation we have not only benefited man, but investigation into the disease of animals has led to the eradi- cation of many of the diseases of animals with incalculable economic returns. Our knowledge of yellow fever would probably have been delayed for many years if the work of the Bureau of Animal Industry of the United States on Texas fever had not been done. The Lecturer emphasized the important work done by the Federal Government for animal industry, all of which involved animal experi- mentation, and called attention to the Department of Animal Pathology 291 of the Rockefeller Institute, established a few years ago on a farm of 400 or 500 acres, near Princeton, N. J., with laboratories, stables and other appurtenances, and a highly skilled scientific staff installed for the intensive study of diseases of animals themselves. Could the eco- nomic wastage caused by disorders of cattle, poultry, etc., be con- trolled or reduced, the cost of living, now such a matter of serious con- cern, would be materially diminished. In addition to diseases of eco- nomic animals we have, he said, a real interest in diseases of domestic animal pets, which are themselves the victims of many severe and fatal diseases, such as distemper among dogs. The study of this disease by the experimental method is not only indicated, but it is fair to say that if we learn to control distemper, we should throw new light on the pneumonia problem; and he was tempted to add that had the lower animals the power of voice, they might well ask to be saved from those who appear to be their friends. Contrasting the ancient use of drugs with the manner in which they are employed at the present time he showed how their specific action has been determined by the employment of animals for experi- mental study. Beginning with a tribute to the pioneer work of Pasteur, Koch and other pioneer-research workers, the lecturer traced the various steps in the development of the great branch of bacteriology that em- braces all that we know of the cause, the prevention and treatment of all infectious diseases, including serums and vaccines, and ends at the present time with the researches by Noguchi on the organism of yellow fever As an instance of the curative powers of antitoxins he cited the vast reduction in mortality following the employment of diphtheria antitoxin, which is now less than one quarter of the death rate before the introduction of the antitoxin. Cerebro-Spinal Meningitis. Dr. Flexner said he had been asked to say a few words about the benefits of animal experimentation in relation to epidemic cerebro- spinal meningitis. This disease, also known as cerebro-spinal fever and spotted fever, was described as early as 1805 and has appeared in epi- demic form at various intervals in Europe, in the United States and other parts of the globe. Hirsch distributes the epidemic occurrence of this disease through four periods, namely, 1805-1830, 1807-1850, 1854-1875, 1876 to date. In the first period it appeared in isolated epidemics in Europe and to a much greater extent in the Uhiited States. After its primary appearance in Massachusetts in 1806, according to some epidemologists, it continued throughout New England in various localities for the next ten years. During the second period widespread 292 epidemics occurred in France, Italy, Algeria, Denmark and the United States; during the third period it prevailed in Europe, Asia, Africa, South America and the United States. During the last period it has been specially marked in Germany, Italy and the United States. The disease prevailed in an epidemic form in 1904 and continued to be more or less active until 1910; since then, although less active, it has not entirely disappeared and became again active during the recent war. The organism causing this disease, thanks to animal experimenta- tion, had been isolated and described by Weischselbaum in 1887 under the name of diplococcus intracellularis meningitidis, and although per- fectly familiar with the cause and nature of the disease, the medical profession was helpless in the way of treating this acute infectious dis- ease quite fatal in its tendency. Dr. Flexner in 1904 during the epidemic along the Atlantic sea- board and from there inland, studied the disease at the Rockefeller Institute and proved by inoculation experiments that it was communi- cable to animals. This was an enormous step forward, for it gave him a basis for the hope of being able to treat the disease successfully by means of immunized serum. The work was done on monkeys, and subsequent experimentation proved that not only could the disease be reproduced in these animals, but also successfully treated with immune serum. Later this treatment was and is now being used in the treat- ment of cerebro-spinal meningitis in man. Dr. Flexner said that 25 monkeys had been used in this work. (It has been estimated by Professor Welsh and other competent critics that before this method of serum treatment was employed, out of every one hundred patients seventy-five died, while under the serum treatment the mortality has been reduced from seventy-five to twenty-five per cent. It is not gen- erally known that this demonstration based upon animal experimenta- tion is regarded as one of the most important contributions ever made to scientific medicine and has secured for Dr. Flexner, the Rockefeller Institute and American medicine a place of honor in the medical world. -Editor.) Poliomyelitis. Dr. Flexner recalled the work of the Rockefeller Institute with reference to the etiology and pathology of poliomyelitis, popularly known as infantile paralysis, and explained how they had been able to transmit the disease from monkey to monkey through the secretions of the nasal-pharyngeal mucous membrane and thus secured important information as to the mode of transmitting the disease He said in part: In the United States we are becoming increasingly familiar with epidemics of poliomyelitis. Prior to 1907 infantile paralysis was a rare disease in this country; since then it has prevailed fitfully every 293 summer and autumn, and in one notable instance at least also in the winter season, claiming victims by the score or hundred, until in 1916 an outbreak of unprecedented severity, with its center of violence in New York State, swept over a considerable number of States. Our knowledge of poliomyelitis has grown since Wickman's epochal clinical studies published in 1907. Thanks to animal experimentation we are in possession of precise information covering essential data with regard to the nature of the inciting microorganism, notwithstanding its very minute size, and also concerning the manner in which it leaves the infected or contaminated body within the secretions of the nasopharynx chiefly, and gains access to another human being by means of the corre- sponding mucous membranes and apparently in no other way. More- over, the inciting virus, so called, up to the present time and notwith- standing many and assiduous efforts, has not been detected apart from the infected or merely contaminated human being, and there is there- fore no foundation in ascertained fact for an assumption that the virus is conveyed to persons otherwise than by other persons who harbor it. Control of Yellow Fever Epidemics. As an example of the manner in which an epidemic disease may be eradicated he briefly related the history of the conquest of yellow fever and expressed his satisfaction that the causal organism had been discovered before the complete disappearance of the scourge. If so, it will be the first disease to so disappear since recorded history. We no longer fear yellow fever in New York, Philadelphia and other Northern districts of the United States in which formerly it was a serious pest, claiming victims by the thousands. We are now sufficiently informed of the conditions of its origin and spread to main- tain effective safeguards. The everthreatening hotbeds of yellow fever at Havana and in Brazil are now under control, and can be kept so if we do not relax our vigilance. Prior to the beginning of the present century yellow fever was a peril because no one knew the exact conditions favoring its spread. In 1900 a commission of officers from the United States Army, headed by Dr. Walter Reed, with Drs. James Carroll, Jesse W. Lazear and Aristides Agramonte went to Havana where the fever flourished, and made a series of studies and came to the conclusion that there must be a living organism in the blood of yellow-fever patients in the early days of the disease. They found that a mosquito could act as inter- mediary in conveying the disease. They did not spare themselves, and following the bite of a purposely infected mosquito, Carroll became ill of yellow fever, while Lazear died after a short illness. Reed died in 1902, and his memory lives in the great Walter Reed Hospital at 294 Washington. From this knowledge of the mosquito as a carrier of yellow fever it became clear that the way to prevent the spread of the disease was either by keeping the mosquito from patients in the early stages of their illness through proper screening of windows and doors, or by killing and destroying their breeding places. All these measures were applied in Havana by General Gorgas. They have since been practiced in New Orleans, Vera Cruz and Rio de Janeiro. In the Southern States, however, while the old, aimless and largely futile struggles against the disease when once it had gained a foothold can never come again, there is always the liability of costly and increas- ing local outbreaks so long as permanent nests of the disease exist in countries with which direct social or economic intercourse is main- tained. The everthreatening hotbeds of yellow fever at Havana and in Brazil are now in control and can be kept so at the price of intelligent and unremitting vigilance. But here and there in Mexico and South America and on the west coast of Africa it still lurks unguarded. It is the aim of the International Health Board of the Rockefeller Founda- tion to discover and clean up the remaining lurking places for germs of this disease, along the lines already inaugurated in the fight against hookworm and the eradication of malaria in different parts of the globe. At the request about a year and a half ago from Ecuador for counsel and assistance in solving the problems of yellow fever at Guayaquil, the Rockefeller Foundation and the Rockefeller Institute cheerfully sent General Gorgas and his associates of the International Health Board to study conditions in that country. The Commission was accompanied by Dr. Hideyo Noguchi, the accomplished Japanese bacteriologist, on the staff of the Rockefeller Institute for Medical Research Dr. No- guchi apart from his command of cultural technique and great patience was also well acquainted with a disease called infectious jaundice, which resembles yellow fever. It is one of the diseases whose origin has only recently been traced. The inciting germ, called Leptospira, is a spiral motile organism, parasitic in rats and other animals. In insanitary places frequented by these animals it may gain access to the bodies of humans and incite serious and fatal disease. Noguchi suc- ceeded in inducing in guinea pigs by transference of a small quantity of the blood of yellow-fever patients, symptoms comparable with yel- low fever in the human race. The blood of these experimental ani- mals, when conveyed to other guinea pigs, produced the same disease, and in this infected guinea pig blood, a minute organism resembling the Leptospira of infectious jaundice was detected. Young dogs and monkeys were also found to be susceptible to inoculation with yellow fever blood. Noguchi also succeeded in cultivating from the blood at first of his artificially infected pigs and then of man a living organism which he carried through many successive generations in his culture tubes, and from which by inoculation he could induce the identical fatal dis- 295 ease in the guinea pig. Noguchi called this germ ''Leptospira icte- roidcs." Work is now being carried on by animal experimentation for the solution of unsolved problems, including the perfection of a suitable serum for this disease. It is hoped this work will be entirely successful and prove a blessing to mankind. Control and Management of Other Epidemic Diseases. On this important topic Dr. Flexner reviewed our knowledge of epidemic diseases and the practical hygienic measures, based on this knowledge, which have heretofore been applied, or which in the ordi- nary course of events may be applied with a reasonable hope of pre- venting the spread of these epidemics. The Lecturer expressed the hope that by a careful review of what has been accomplished in the past we may form a judgment of the efficiency of such measures and arrive possibly at new points of view from which to launch a more decisive attack. (Dr. Flexner is evidently a stanch advocate of the doctrine that disease germs have their origin somewhere, and scientific medicine demands that all epidemics must be traced backward to their starting point, and when found the original seedbeds must be stamped out. In support of this doctrine, which is now practically applied by the International Health Board of the Rockefeller Foundation, he spoke in part as follows:-Editor.) Regarding epidemic diseases in general we assume the introduc- tion from without, and usually from a distant locality of a special kind of organism which is held directly responsible for the epidemic ensuing. In the case of influenza wide divergences of opinion re- garding the nature of the inciting microorganisms and the manner of infection still prevail. The reason for these differences are several, but the most important perhaps relates to the common observation of the manner of spread or attack of the disease. While other epidemics proceed from bad to worse, with at least progressive increases of in- tensity, influenza seems to overwhelm communities over even wide stretches of territory as by a single stupendous blow. While in the one case the gradually accelerating rate of speed of extension may be taken to indicate personal conveyance of the provoking microrgan- ism; in the other case, the sudden wide onset appears to be the very negation of personal communication. Hence the invoking of mysterious influences, the revival of the notion of miasm and similar agencies, to account for this phenomenon. Indeed, the public mind in general lends itself readily to such formless concepts, for the reason that there still resides in the mass of the people a large uneradicated residue of superstition regarding disease. One does not need to look far or to dig deep to uncover the source of this superstition. We have only recently emerged from a past in which 296 knowledge of the origin of disease was scant, and such views as were commonly held and exploited were mostly fallacious. It is, indeed, very recently, if the transformation can be said to be perfect even now, that the medical profession as a whole has been completely emancipated. All this is very far from being a matter of remote importance only, since in the end the successful imposition of sanitary regulations involves wide cooperation, and until the majority of indi- viduals composing a community is brought to a fair level of under- standing of and belief in the measures proposed, serious and sustained endeavor to enforce them is scarcely to be expected. Influenza. No better instance of a communicable disease could perhaps be invoked than influenza to exorcise the false idea of the mysterious origin of epidemics. To dwell solely on the sudden and overwhelming stroke of the disease is to wholly overlook the significant incidents that precede the mass infection, because they are of such ordinary nature and lack the dramatic quality. Accurate observers noted long ago that influenza in its epidemic form did not constitute an exception to the common rule regarding epidemic diseases, which are obviously associated with persons and their migrations. What the early stu- dents made out by tracing the epidemic backward to its point of de- parture more modern observers have confirmed by carefully kept rec- ords, often geographically compiled, as in the excellent instance of the Munich records covering the epidemic of 1889-92, which can now be supplemented by a number of similarly constructed records of the epidemic just passed. These records show convincingly a period of invasion during which there is a gradual rise in the number of cases to culminate, within a period variously estimated at from one to three weeks, in a widespread, so-called ''explosive" outbreak of the disease. It happens that the early cases of influenza tend not to be severe, chiefly because they are rarely attended by pneumonia and hence are frequently mistaken, and the confusion in diagnosis is resolved only when the full intensity of the epidemic is realized. In the meantime rich opportunity has been afforded for the free and unrestricted com- mingling of the sick and well, of doubtless healthy carriers of the inciting agent and others, until so high a degree of dissemination of the provoking microorganism has been secured as to expose the entire susceptible element of the population, which happens to be large, to an almost simultaneous response to the effects of the infecting microbe. Deductions of like import can be drawn from the geographical movements of an influenza epidemic. In Eastern Russia and Turke- stan influenza spreads with the pace of a caravan, in Europe and America with the speed of an express train, in the world at large with 297 the rapidity of an ocean liner; if one project forward the outcome of the means of intercommunication of the near future, we may pre- dict that the next pandemic, should one arise, will extend with the velocity of an airship. It is desirable, in the interest of clear thinking, to carry this con- sideration of the characteristics of epidemic influenza a step farther. A feature of the epidemic disease of particular significance is the tendency to recur; that is, to return to a stricken region after an inter- val, usually of months, of relative quiescence Thus the beginnings of the last pandemic in Western Europe and the United States have been traced to sporadic cases appearing in April, May and June, pos- sibly even earlier in certain places, while the destructive epidemic raged during September, October and November of 1918. The dis- ease also prevailed, more or less, in the United States during 1919 and again during the present year. The epidemic of 1918-19 cost more in a few months in human lives than were killed during the five years duration of the great war. The statistics from India alone show something like 6,000,000 deaths. In this country the estimates so far have varied from 600,000 to 800,000, and you can carry that pro- portion around the world. There are very good reasons for believing that influenza is not in itself a serious disease, but that its sinister character is given by the remarkable frequency with which it is followed in particular instances by a concomitant or secondary pneumonic infection, to which the severe effects and high mortality are traceable. Now, it is this high incidence of pneumonia, the product of invasion of the respiratory organs with bacteria commonly present on the upper respiratory mucous membranes-streptococci, pneumococci, staphylococci, Pfeiffer's ba- cilli, and even meningococci-that stamp the recurrent waves of the epidemic with its bad name. If we compare the pneumonic complications of influenza with those that arose in the cantonments in 1917-18, first as attendants of measles and later as an independent infection, we note immediately that in both instances the severe effects and high fatalities arose, not from bacteria brought or imposed from without, but from their repre- sentatives which are commonly resident upon the membranes of the nose and throat in health. Whatever we may have to learn of the microorganisms inducing measles, still undiscovered, and of influenza, still under dispute, and their mode of invasion in the body, no one would question that the bacteria inducing pneumonia are personally home. Streptococcus Pneumonia. In discussing this subject the lecturer pointed out that during the winter of 1917-18 there occurred in several localities within the United States, and also, but in a less degree, in France, at least a great increase 298 in the incidence of a type of pneumonia which previously had been very infrequent. It appears also that the greatest number of cases and of fatalities arose in the United States in the military cantonments; that the disease first prevailed, as already stated, as a secondary pneumonia following measles; but before long the severity of the infection was such .that cases of primary streptococcus pneumonia began to arise. Moreover, at this juncture the disease spread from the military to the civil populations. The nature of the microorganism inducing this form of epidemic pneumonia is indicated in the name which the disease has come to bear. The difficulty in this instance has not been in finding out the inciting microbe, but, rather, in differentiating the streptococci responsible for the epidemic disease from streptococci possessing the ordinary pathogenic properties, or even from those of saprophytic nature so commonly present on the upper respiratory mucous mem- branes without provoking widespread disease. However, numerous studies of the bacteriology of this epidemic of pneumonia, at distinct and often widely remote cantonments, involving much animal experi- mentation, showed that the microbic incitant was in almost every in- stance streptococcus hemolyticus. Moreover, because of the wide oc- currence of the epidemic pneumonia, this type of streptococcus could be found in normal throats and as a secondary invading microorganism in the lungs in cases of ordinary lobar pneumonia. Thus far very little progress has been made in the classification of streptococci, which form a class apparently even more heterogeneous than the pneumococci and will involve much arduous experimental laboratory work. With these various considerations before us we may now discuss the question of the efficiency of our public-health measure in diminishing the incidence of epidemic diseases. It is evident that in diseases in which the inciting microorganism enters the body by way of the air passages, although not necessarily, as in poliomyelitis, directly injuring those parts, protection is not to be secured by applying sanitary meas- ures on a wide scale to an extraneous and inanimate source of the which the inciting microorganism enters the body by way of the air dejecta of typhoid patients, or even to inferior animal species such as the mosquito or the rat, which act as intermediaries in conveying the germs of yellow fever or of infectious jaundice; but it is alone to be attained by methods of personal hygiene, applied on the individual scale of safeguarding one person from another, the most difficult of all hygienic regulations to enforce. As a result of animal experimentation in epidemic poliomyelitis we may fairly claim that we are in possession of the essential facts which, if widely applicable, should enable us to control the spread of that disease. Epidemic diseases in the commonly accepted sense have fixed lo- cations-the so-called epidemic homes of the diseases. In those homes they survive without usually attracting special attention often over 299 long periods of time. But from time to time, and for reasons not entirely clear, these dormant foci of the epidemics take on an un- wonted activity, the evidence of which is the more frequent appear- ance of cases of the particular disease among the native population, and sooner or later an extension of the disease beyond its endemic con- fines. Thus there are excellent reasons for believing that an endemic focus of poliomyelitis has been established in Northwestern Europe from which the recent epidemic waves have emanated. Similarly there are excellent reasons for regarding the endemic home of influenza to be Eastern Europe, and in particular the border region between Russia and Turkestan. Many recorded epidemics have been shown more or less clearly to emanate from that area, while the epidemics of recent history have been traced there with a high degree of conclusiveness. From this eastern home, at intervals of two or three decades, a migrating epidemic influenza begins, moving east- ward and westward, with the greater velocity in the latter direction. Now, since the combatting of these two epidemic diseases, when they become widely and severely pandemical, is attended with such very great difficulty and is of such dubious success, and this notwith- standing the prodigious public-health contests which are waged against them in which the advantages are all in favor of the invading micro- organismal hosts, it would seem as if an effort of central rather than peripheral control might be worth discussion. According to this proposal, an effort at control amounting even to eventual eradication of the diseases in the regions of their endemic survival should be under- taken, an effort, indeed, not occasional and intensively spasmodic, as during the pandemical excursions, but continuous over relatively long periods, in the hope that the seed beds, as it were, of the diseases might be destroyed. That such an effort at the eradication of a serious epidemic dis- ease may be carried through successfully the experience with yellow fever abundantly proves. In attacking the disease the combat was not put off until its epidemic spread had begun and until new territory, such as New Orleans, Jacksonville, Memphis, etc., had been invaded; but the attack was made on its sources at Havana, Panama, and now Guayaquil, to which endemic points the extension into new and neu- tral territory had been traced. Such a plan is now in process of elaboration by the Rockefeller Institute. Encephalitis Lethargica. Another disease that demands animal experimentation and inten- sive study is lethargic encephalitis, apparently only recently introduced in, and already widely distributed through, this country. It is highly desirable that the main facts known should be given publicity; and it 300 may be well that the experience, gained with poliomyelitis, may serve us in dealing more effectively with the encephalitis peril. It appears that the first cases of that disease ■ recognized in the United States occurred in the winter of 1918-19. In contradistinction to epidemic poliomyelitis, there is- no reason to suppose that this epi- demic affection of the central nervous system ever before existed in America. The point is an important one. At present the disease seems to be widely distributed, as cases have been reported from many States. It is possible to trace the cases of lethargic, or epidemic encephal- itis, now arising in this country, to an outbreak which occurred in Vienna and neighboring parts of Austria-in the winter of 1916. Be- cause of war conditions, knowledge of this unusual disease did not at once reach Western Europe and the United States; but nevertheless cases of the disease occurred in England and France in the early months of 1918, and in America about one year later. Both in Austria and in England, in which countries the first cases were observed, respectively, in eastern and western Europe the disease was first mis- takenly attributed to food intoxications. In Austria the early cases were ascribed to sausage poisoning; in England to botulism arising from various foods. This error is not perhaps as remarkable as might at first appear. In the first place, both countries were laboring under unprecedented conditions of food shortage, preserved foods were employed on a scale never before equaled, and, of course, waste and refuse were reduced to a minimum. Furthermore, an early symptom of this encephalitis is third- nerve paralysis-giving rise to diplopia, ptosis, etc.-which happens also to be an early symptom in certain forms of food poisoning and notable in botulism. Ultimately, in both countries the notion of food origin became untenable, and the disease was recognized as arising independently of diet and other usual con- ditions of life, and come to be viewed as probably of microbic origin and of communicable nature. It is now sufficiently obvious why the popular name of "sleeping sickness" has been applied to this malady. The disease is, of course, wholly distinct from African sleeping sickness, which is a trypanosomal infection carried from person to person by means of an insect vector- the tsetse fly. When an apparently new disease arises, it is always important to inquire whether the particular set of symptoms that are taken to characterize it has been observed and recorded before. In the present instance there are significant records which may easily refer to a similar and possibly identical disease. The first one dates from 1712 and refers to an outbreak of so-called sleeping sick- ness centering about Tubingen in Germany. The second record dates from 1890 and deals with a puzzling malady called nona, which is described rather in the lay than the medical literature of the time and seems to have prevailed in the territory bounded by Austria, Italy and Switzerland. In respect to neither instance, however, do the records 301 contain the minuter data which would admit of a certain identification of the disease described with the encephalic malady we are consider- ing. One circumstance is, however, significantly suggestive. The location of the 1890 affection "nona," which was characterized by somnolence, stupor and coma, coincides roughly at least with that of the first cases reported in the present epidemic. The question may, therefore, well be raised whether the endemic home of this epidemic variety of encephalitis may not be that corner of southeastern Europe overlapping the three countries mentioned. If this should prove to be probable, the next question to arise would relate to the circumstances under which the disease slumbered on in ordinary times, and to the conditions that favored a greater activity and a wider spread about the year 1916. To deal with the first one will require particular and intensive studies carried out with the especial object in view to disclose hidden cases in the region originally affected. An answer can in the mean- time be hazarded to the second question. The depressing effects of war, acting by way of hunger, cold, migrations of populations and general insanitation, might initiate the conditions through which a low endemic might well be converted into a higher epidemic incidence of [he disease. It is now a matter of great importance to determine the precise nature or etiology of lethargic encephalitis. Many unsuccessful at- tempts have been made to communicate the disease to monkeys and other animals through the inoculation of nervous tissues showing the particular lesions in the manner so readily and successfully employed in monkeys for poliomyelitis. This circumstance alone would serve to distinguish this epidemic encephalitis from epidemic poliomyelitis. But in two or three instances, what are stated to be successful trans- missions of the disease to animals have been reported. It is still too soon to say whether or not we are now at the thresh- old of clearing up, by way of animal experimentation, the etiology and mode of transmission of this menacing disease, as was accom- plished so recently, and also by animal experimentation in the case of poliomyelitis. But at this moment, and while waiting for the ultimate and convincing experimental results, one need entertain no doubt of the infectious and communicable nature of lethargic encephalitis. In conclusion Dr. Flexner remarked that time would not permit him to discuss many of the problems now awaiting solution or to refer to the work carried on by the staff of the Rockefeller Institute for Medical Research in all of its departments, but expressed the fervent hope that in the interests of the human race and the animals themselves, the progress of scientific medicine would not be impeded Dy unneces- sary legislation. 302 THE LEGAL ASPECTS OF VIVISECTION. By William Creighton Woodward, M. D., LL. M. Health Commissioner of Boston, Mass. Professor of Medical Jitrisprudence Georgetown University. After the exposition that has just been made of the inestimable benefits, in the interest of human health and happiness that have been achieved through animal experimentation, and that would have been impossible without it, no one of you can fail to see the danger inherent in any attempt to restrict that field of research or to hamper operations within it. Certainly any needless restriction and hindrance would be hardly short of criminal, and the burden of showing the necessity for any such restriction or hindrance as may be proposed rests clearly upon the proponents. In the absence of clear evidence of a wrong to be righted, no legis- lation to restrict and hinder animal experimentation is justifiable; and if wrong be shown, then such remedial legislation as may be proposed should have some direct and demonstrable relation to the end to be accomplished and should go no further than is necessary to accom- plish that end. Let us see what the facts are with respect to the legis- lation now pending in Congress to prohibit absolutely and forever, in the District of Columbia and in the Territorial and insular possessions of the United States, all experiments upon living dogs, unless the ex- periment has for its sole purpose the healing or curing of some physical ailment of the very dog experimented upon.a The alleged motive of the proposed legislation is set forth in the preamble of the bill; the enactment of such legislation is, "an act of right and justice to the dog," because "the dog has made a wonderful war record," and "because he has been decorated for bravery, serving his country, following its flag, and dying for its cause." But some doubt seems to be thrown, I am sorry to say, on the sincerity of this preamble by a statement made by one of the leading proponents of the bill, to the effect that "We are so modest that we are beginning with the thin edge of the wedge. We want to save dogs, and later on we will probably try to save other animals."b If dogkind is now to be honored a A bill to prohibit experiments upon living clogs in the District of Columbia or in any of the Territorial or insular possessions of the United States, and providing a penalty for violation thereof. S. 1258, 66th Congress, 1st session. b Hearing before the subcommittee of the Committee on the Judi- ciary, United States Senate, 66th Congress, 1st session, on S. 1258, page 25. 303 in the manner proposed in this bill, because of the distinguished serv- ices rendered by dogs during the war, it is not quite clear why similar honor should be bestowed upon other species that did not render such service; such a course would certainly cheapen the honor bestowed on the dog! And if other species did render such distinguished war service, it would seem as though they, equally with the dog, should be honored now in the pending legislation rather than asked to wait for their honors. The horse and the mule, that did such noble work in transportation; the carrier pigeon, that did such remarkable messenger service; the steer, the sheep, the hog, the chicken, and even the fish, that gave up their lives that the army and the people might live; maybe even the cat, who did her bit in the protection of food supplies from rodent depredations; and most assuredly, the modest guinea pig, that endured so much in testing and standardization of medical supplies -certainly the righteous claims of all of these cannot justly be ignored and lightly brushed aside if the real purpose of this bill is to grant in perpetuity as a reward for war service freedom from all experimen- tation. Waving, however, possible question as to the motive of this bill and proceeding to a study of its text and of the hearing on it, we fail to discover any evidence of "the wonderful war record" of the dog notwithstanding the fact that that record would seem from the preamble to form the very heart of the demand that all dogkind be relieved for all time of its obligation to repay to man in some small degree the affection, care, and effort that man has bestowed upon him, and of the demand implied in it, to transfer to other species the burden that the dog might equitably be expected to share with them, of submitting to experimentation in the interest of mankind and of animals generally. That some dogs manifested faithfulness and courage during the war (to the extent that such virtues can be translated from mankind to the brute creation), no one will deny; but that all dogs tried out in Avar service distinguished themselves by such conduct has never, so far as I am informed, been asserted, nor even that faithfulness and courage were distinguishing characteristics of most of them. And yet this bill proposes to do, homage to all dogs alike; not merely to the faithful, but also to the traitor; not merely to the coura- geous, but also to the cowardly; not merely to the dog that saw war service, but also to the pampered pet in the fashionable, steam-heated apartment house or palace, that lived on the fat of the land, and occu- pied the time of his mistress and maybe a nurse maid or two, that had better been devoted to the welfare! of the men in the trenches ; and that the honors may be entirely even, they extend even to the sheep- killing mongrel that did his best to keep down the meat supply and the wool supply of the country during war time. Finally, as if the present generation of dogs were not numerous enough, and big enough, and strong enough to carry the honors that the proponents of this bill 304 would heap upon the species, it is proposed that such honors be spread over generations of dogs as yet unborn, from now on henceforth for- evermore. Certainly, if the attribute of courage can rightly be attrib- uted to dogkind, no self-respecting dog that did its bit during the war would ask for his offspring forever that it be exempted from all lia- bility to one of the most important services it can render mankind- and brutekind, too, for that matter; for experiments on dogs con- tribute to the well being not only of human beings but of domestic animals as well, including dogs themselves. Even if we were to agree with the proponents of the legislation now under consideration, that for the reasons stated in the preamble honor should be conferred upon dogkind, there would still lie before us a wide field for discussion and debate as to just what honor and how much honor should be conferred. Discussion and debate of this kind would, however, take us so far afield as to render impossible any profit- able result within the time at our command, and the proponents of this legislation, by naming in it a single and very definite form of honor have virtually limited discussion to that form. After the enactment of the proposed legislation it is to be unlawful in the District of Colum- bia or in any of the Territorial or insular possessions of the United States "for any person to experiment or operate in any manner what- soever, upon any living dog, for any purpose other than the healing or curing of said dog of physical ailments" ; and the bill is entitled "A bill to prohibit experiments upon living dogs in the District of Columbia or in any of the Territorial or insular possessions of the United States, and providing a penalty for violation thereof." To be sure of our ground, it may be well to make certain just what an "experiment" is, and the Standard Dictionary is probably a safe guide upon this point. To experiment is, according to the Standard Dictionary, to make an experiment, test, or trial; to submit a thing or person to any process or ordeal, as for purpose of investigation or discovery. And an experi- ment is an act or operation to discover, test, or illustrate some truth, principle, or effect. Manifestly, then, the enactment of the proposed legislation would make unlawful any test or trial upon any living dog for any purpose whatsoever, other than the healing or curing of said dog of some physical ailment. A dog without a physical ailment could not be sub- jected to any experiment, test, or trial, of any kind. A dog suffering from a physical ailment could be subjected only to an experiment, test, or trial that was designed to remove that particular ailment from that particular dog. Whether the experiment, test, or trial was calculated to add to the dog's comfort, to give it pain, or to give it pleasure would be utterly immaterial for the purpose of determining whether the ex- periment was or was not punishable under the law. Probably, how- ever, we can for present purposes ignore the proposed prohibition of comfort-giving and pleasurable experiments, tests, and trials, which 305 maybe the proponents of this bill did not really intend to prohibit- although it would have been much better for them to have expressed their ideas more clearly if that is the case; and we can limit our con- sideration of the matter to the general class of experiments that cause varying amounts of inconvenience and possibly even some pain to the dog experimented upon, varying from the prick of a hypodermic needle to the pain that may be suffered after recovering from the anesthetic administered during some more or less serious and important experi- ment, made in the interest of humanity or of animal kind generally. Is there, or is there not, need for any legislation to prevent the infliction of such pain and inconvenience upon dogs in the District of Columbia and in the Territorial and insular possessions of the United States? Within the time at my command, I have not had the opportunity of examining the laws in force in the various Territorial and insular possessions of the United States relating to the infliction of pain and discomfort on animals. If such laws are adequate there is no need for further legislation ; and the burden of proving inadequacy rests upon the proponents of the legislation now before us. If the legislative bodies of those several jurisdictions have fallen short of their duty,, evidence of that fact should be produced before Congress is asked to assert its jurisdiction in the premises. And I may add incidentally,, the record shows no demand for this proposed legislation from the people of the Territories and the insular possessions-nor from the people of the District of Columbia either, for that matter. The pres- sure for its enactment seems to come largely from persons residing in jurisdictions that cannot be affected by it, and in these jurisdictions they have not succeeded, and possibly have not even tried, in procuring the enactment of such legislation as they now suggest be imposed on communities to which they are in large part strangers. That so far as the District of Columbia is concerned there are laws for the punishment of persons guilty of cruelty to animals is too well known to need comment. Prosecutions are being brought con- tinually under such laws. There is, however, in the law, as in common speech, a distinction between cruelty and the mere imposition of dis- comfort or pain. The imposition of discomfort or pain constitutes cruelty and is punishable only when it is not inflicted for a justifiable end. The determination of the matter now before us, in so far as the adequacy of existing law in the District of Columbia is concerned hinges, then, on the question whether the ends sought by experimenta- tion on dogs are justifiable ends, and whether in connection with such experiments, if the ends sought are justifiable, such pain as is inflicted is or is not a necessary element of the experiment. If, all things con- sidered, the ends sought by such experiments are justifiable, then clearly the experiments should not be prohibited; and if pain is a necessary element in such experiments, then to prohibit pain is to pro- hibit the experiments. A brief examination of the law in force in 306 the District shows that all of these considerations have passed in care- ful review before the legislative authorities of the District of Columbia and that they have been wisely acted upon. Public morals have been duly safeguarded, the humane treatment of animals definitely insisted upon, the rights and opportunities of investigators reasonably safe- guarded, and extraordinary provisions made for the enforcement of the law. The law governing experimentation upon animals in the District of Columbia was enacted by the Legislative Assembly in 1871 and is set out at length in Abert's Statutes in Force in the District of Colum- b'a, pages. 540 et seq.a It makes it unlawful to inflict unnecessary cruelty upon any animal or to authorize or permit any unnecessary torture, suffering, or cruelty of any kind. And if there were any doubt as to whether the provisions of this law were or were not appli- cable to cases in which pain might be inflicted in connection with ani- mal experimentation, it would be very definitely dispelled by the fol- lowing provision: "Section 15. Nothing in this act contained shall be construed to prohibit or interfere with any properly conducted scientific experi- ments or investigations, which experiments shall be performed only under the authority of the faculty of some regularly incorporated medi- cal college, university or scientific society." Stated in other words, no infliction of pain is to be tolerated unless the experiment is of a scientific nature and properly conducted; and in order that there fnay be some assurance that such experiments as are performed are presumptively of this character, they may lawfully be performed only under the authority of some competent, responsible organization, which in effect stands back of the experiment either by authorizing the particular experiment that is to be made or else by vouching, as it were, for the judgment and qualifications of the ex- perimentor to engage generally in that field of work. But in order to guard against the possible incompetence or care- lessness of experimentors, medical colleges, universities, and scientific societies with respect to this matter, it is made the express duty of all police officers and of any member of the Washington Humane Society to prosecute all violations of the act that come to their notice or knowl- edge. And if any member of the Washington Humane Society be- lieves and has reasonable cause to believe that the laws in relation to cruelty to animals have been or are being violated in any particular building or place, he is upon oath or affirmation to that effect, and due application, entitled to a search warrant. And as though to insure beyond the peradventure of a doubt that the provisions of the law would be carried out, it is provided that fines and forfeitures collected upon or resulting from the complaint or information of any member of the Washington Humane Society shall inure to and be paid over to that society. a For the pertinent parts of this Statute see Appendix. 307 On the face of things, the law as set forth above certainly seems ample to prevent cruelty to animals, including within the meaning of the word cruelty all such pain as may be inflicted in connection with unnecessary experimentation and all such as may be needlessly in- flicted in connection with experimentation that is in itself necessary and proper. Dogs and all other animals seem to be amply protected. And when it is remembered that this law has been in effect for almost half a century it seems certain that if there has been any unnecessary inflic- tion of pain in connection with experimentation on animals there must be within that half century some record of prosecutions which, if the law be effective, must have resulted in convictions and punishments and, if the law be ineffective, must have left upon the records of the courts of the District of Columbia evidence of that fact. I had occasion in the year 1900 to look carefully into this matter, the law having been then in force for more than a quarter of a century, and I was then unable to find any evidence of a single prosecution having been brought, either upon the initiative of any private citizen, or of any police officer, or of any member of the Washington Humane Society. No record could be found of a single search warrant having been applied for under the act or of any effort ever having been made to institute any prosecutions under it. It follows, of course, that there was no record of any court ever having construed this law as inappli- cable to cases involving the infliction of unnecessary cruelty in connec- tion with animal experimentation. All of these facts were made pub- lic at the time, and certainly should have served to stimulate the issue of search warrants and to stimulate prosecutions, if reasonable suspi- cion or concrete evidence of violations of the law were at hand. Ever since this situation was made public, the year 1900, I have been inti- mately in touch with the^ situation, and during all that time I have known of no effort to obtain a search warrant under the law, of no attempted prosecution under it, and, of course, of no court decision indicating the ineffectiveness of the law to accomplish its manifest pur- pose. It seems safe to say, therefore, that there is in the District of Columbia no experimentation upon dogs or other animals that is not regulated by existing law, duly safeguarded by the watchful and spe- cial authority of the Washington Humane Society itself. The conclusion just set forth seems too definite and too clearly supported to need reinforcement. If, however, reinforcement be deemed necessary, it may be found by reference to the records of the numerous hearings that have been held from time to time since 1899, before Congressional committees, in connection with bills that have been introduced for the purpose of regulating or preventing experi- mentation upon animals in the District of Columbia. Certainly, if any such bill could ever have found support in the least degree upon evi- dence of any specific instance or instances of cruel experimentation on animals in the District, that evidence would have been forthcoming, 308 for there could be no other evidence of so much weight, and yet I can recall no single instance in which any such evidence has been adduced. It might be argued, however, that even though there be no wrong to be righted by the proposed legislation, yet that its enactment would do no harm and that it would be a very inexpensive way of paying a supposed debt to all dogkind. At best it would be a paying of a sup- posed indebtedness to dogkind by saddling upon other animals the service now rendered by dogs, which would be a most unjust thing to do, since many other species have rendered to mankind in the war and at all other times service far beyond that rendered by the dog. As a matter of fact; however, those who are best qualified to speak with respect to the subject will tell you that certain experiments in the interests of mankind and of animals generally cannot be as well per- formed upon other animals as they can be upon dogs. Moreover, one of the witnesses adduced by the proponents of the measure frankly announces that this bill is but the small end of the wedge with which it may be possible to stop all animal experimentation. Under the cir- cumstances, and in view of the lucid statement made by the preceding speaker as to the wonderful benefits that have accrued from animal experimentation, the passage of this bill could never be condoned on the ground that it was at least harmless-for it is not. The bare fact, however, that the enactment of this bill is unneces- sary, and even the fact that its passage would work harm, is not suffi- cient to prevent the bill from becoming a law. There are persons of wealth, of social standing, and of intellectual standing who believe in it and who have worked and will work actively for its passage. Sen- ators and representatives who will be called upon to consider it are men busy with large afifairs of national and international importance, who have but little time for personal research into the merits of measures such as this, and who may be misled by the plausible arguments of the proponents of the bill unless there be an intelligent and energetic cam- paign to place before these senators and representatives the facts of the situation. It is in such a campaign that Georgetown University is now assuming a position of leadership, and under its banner I ask all of you to enlist and to fight for the cause. 309 Appendix. Extract from section one of an Act of the Legislative Assembly of the District of Columbia, entitled : "An act for the more effectual prevention of cruelty to animals in the Territory of the District of Columbia," approved August 23, 1871. "Whoever, having the charge or custody of any animal, either as owner or otherwise, inflicts unnecessary cruelty upon the same * * * shall for every such offense be punished by imprisonment in jail not exceeding one year, or by fine not exceeding two hundred and fifty dollars, or by both such fine and imprisonment. "Every owner, possessor, or person having the charge or custody of any animal, who * * * knowingly and wilfully authorizes or permits the same to be subject to unnecessary torture, suffering, or cruelty of any kind, shall be punished for every such offense in the manner provided in Section 1. "Whenever complaint is made by any member of the Association for the Prevention of Cruelty to Animals (Washington Humane So- ciety) on oath or affirmation, to any magistrate authorized to issue warrants in criminal cases, that the complainant believes, and has reasonable cause to believe, that the laws in relation to cruelty to ani- mals have been or are-being violated in any particular building or place, such magistrate, if satisfied that there is reasonable cause for such belief, shall issue a search warrant, authorizing any marshal, deputy marshal, constable, police officer, or any member of the Association for the Prevention of Cruelty to Animals (Washington Humane So- ciety), to search such building or place. "It shall be the duty of all marshals, deputy marshals, constables, police officers, or any member of the Association for the Prevention of Cruelty to Animals (Washington Humane Society), to prosecute all violations of the provisions of this Act which shall come to their notice or knowledge, and fines and forfeitures collected upon or re- sulting from the complaint or information of any member of the Asso- ciation for the Prevention of Cruelty to Animals (Washington Humane Society) under this Act shall inure to and be paid over to said associa- tion, in aid of the benevolent objects for which it was incorpo- rated. * * * "Nothing in this Act contained shall be construed to prohibit or interfere with any properly conducted scientific experiments or inves- tigations, which experiments shall be performed only under the au- thority of the faculty of some regularly incorporated medical college, university or scientific society." 310 SOME OF THE ETHICAL ASPECTS OF ANIMAL EXPERI- MENTATION. By Wm. H. Arthur, M. D., F. A. C. S., Colonel, U. S. Army, Retired. Medical Director Georgetown University Hospital. Late Commandant Army Medical School. In a world full of sickness and suffering, in which are daily occurring many thousand premature and unnecessary deaths; with a constant struggle going on in the effort to accumulate money, which is to-day the generally accepted measure of success, there are some unselfish men who, giving up all prospect of pecuniary rewards, or of reputation outside the limits of their own profession, are devoting their lives to reducing the sum to'al of human and animal disease, alleviating pain and prolonging life. The work in this field has achieved already magnificent results but much yet remains to be accomplished. Very few people begin to realize what humanity already owes to these investigators, past and present, and will owe to those to come unless irresponsible interference from outside ends their efforts. Yet while the names of great military commanders or men who have accumulated enormous wealth are familiar to everyone, these great benefactors of their kind are known by name only to the medical profession. Let me illustrate. How many non-medical men or women know who Leishman was or Lbffler or Pasteur or Lister or Walter Reed ? These men (and there are many others) who have conferred the greatest possible benefits on the race, are In tie known to the world generally. Yet the first named, Leishman, devised a method of con- trolling the most common, dreaded and fatal of camp diseases, typhoid fever, which saved at least 290,000 of our troops in ;he great war, ten divisions, from three or four months invalidism, with 30,000 deaths. The morbidity and mortality from this disease that would certainly have occurred in the great army assembled for this war but for preventive inoculation are calculated on what actually did take place during the Spanish war, before this method of preventing typhoid fever was discovered and introduced. Loffler paved the way for an anti-toxin which annually saves hundreds of thousands of child- ren from death or crippling from diphtheria. The combined work of Pasteur and Lister has made modern surgery with all its magni- ficent triumphs possible; and the last, Walter Reed rescued our South Atlantic and Gulf Coasts from the annual terror of yellow fever, which had ever since the colonization of the country become epidemic at frequent intervals, killed thousands of people, and demoralized commerce every year by the enforcement of the April to November quarantine. All of these great benefits to humanity would have been impossible but for animal experimentation. 311 The word 'vivisection' is unfortunate, misleading and inapplicab e to what it is intended to describe. It means simply cutting living tissue. Every surgical operation, involving the making of an in- cision, is a vivisection, but it is done under an anesthetic, local or general, and the same is true of the research laboratory, but the word to the sympathetic, emotional misinformed man or women brings up a vivid and distressing mental picture of a helpless animal tied down, struggling and groaning, while a brutal doctor tortures it, with no other object (for it is claimed, that no useful purpose is accomplished) than the gratification of a morbid, insane pleasure in inflicting and witnessing suffering. This is true only of criminal degenerates and is a very false conception of what actually takes place in these laboratories. Instead of 'vivisection' the term 'animal experimentation' might be used, but even that does not entirely cover the ground, for animals must be used in laboratory diagnosis and in the preparation and testing of certain anti-toxins, sera and vaccines, that have long ago passed the experimental stage, and now provide the sanitarian and the practising physician with their most powerful means of preventing and curing certain very fa al infectious diseases. Many thousand deaths, now easily avoidable, would result if the supply of this material should be cut off. as it would be if the use of animals in scientific work should be pro- hibited by law. The suffering inflicted in the type of laboratory under discussion is grossly exaggerated. A very large majority of the so-called 'vivisections' consist of a prick with a hypodermic needle and an in- jection of the material to be tested or the supplying to or the with- holding from animals of certain food elements. Anesthetics are always used in procedures that would otherwise inflict pain. I am not myself and never have been a laboratory investigator, but I have had under my inspection and control a number of laboratories of this kind in this country and in the Philippines, and have seen a great deal of the work of my subordinates, and I have never witnessed the harrowing scenes so graphically described by the antivivisectionists, most of whom have never entered a labora- tory. The men engaged in this kind of work are normal men, not at all lacking in the ordinary feeling of humanity, quite as merciful as the average non-medical man of the educated class immeasurably more merciful than the sportsman, who hunts for his own amuse- ment, or the trapper who catches animals to secure furs for personal adornment. How often have you heard a big game hunter boast, that though he failed to bring in a deer, he is sure his shot took effect, for the animal limped badly as it escaped and there was. blood on the trail? That deer probably, with a shattered hip or shoulder or some even more serious injury, lingered for days in intolerable suffering, finally dying of starvation or exhaustion. At the cost of 312 what untold suffering were secured the furs of the fox, beaver, marten or other animal, that even the most tender hearted anti- vivisectionist does not hesitate to buy or wear? Yet what is done for sport or vanity seems to be considered perfectly proper and natural, while great indignation is expressed at the relatively negli- gible suffering inflicted in the laboratory, with the highest possible motive, the search for means for reducing the sum total of human misery, and also the suffering of other animals, for animal ex- perimentation saves in cattle, swine, sheep, poultry and dogs, in- finitely more suffering than is inflicted on guinea pigs, rabbits etc. in the laboratory. The bureau of animal industry, the farmer, the stock raiser or poultry man are dependent on animal experimenta- tion for the study of animal diseases. Any scientific veterinarian will bear me out in this statement. It is a very safe assertion that the suffering inflicted on animals in the laboratory is infinitesimal as compared with the suffering other animals are saved as a result of this kind of research. The protestants against the use of the lower animals in scientific research, as well as in diagnosis and in the preparation and testing of material of thoroughly proven and enormous value, base their attack on two assertions, both false ; First: That intolerable cruelty is wantonly practised in the laboratory. Second: That no useful purpose has ever been secured by this method of research. As said before, I venture to assert that more animal suffering results from one day's sport or from a trapper's successful catch, than is inflicted in years in the busiest research laboratory. Yet no one, so far as I know, opposes big or little game hunting, or refuses to wear furs, because they have been secured at the cost of so much suffering; for imagine a fox, beaver or other animal caught in a spring trap, in cold weather, with a shattered leg, slowly freezing to death, unless as often happens the unfortunate animal, to the trapper's disap- pointment, secures his freedom by gnawing off his shattered leg. Nothing comparable with that ever happens in a laboratory, but it is a common occurrence in trapping fur-bearing animals. The second statement that nothing of importance has ever been developed by animal experimentation can be believed only by people incapable of understanding facts or being convinced) by absolute proof, or actual demonstration. The whole science of physiology, the study of the working of the animal mechanism, is built up on animal experimentation. But for it we should know nothing of the circulation of the blood, the functions of the viscera, or the brain, spinal cord and nervous system generally. We should be no further advanced in knowledge of this subject than were Paracelsus or Avicenna, or than is now the old fashioned Chinese doctor, who teaches his students that the intellect resides in the spleen, and the soul in the left kidney. No new drug used by the physician could 313 be safely employed in treating sick human beings, till its effects were tried out on lower animals. Anesthesia, one of the greatest of benefits to mankind ever devised, would never have been intro- duced and used as it is to-day, with incalculable saving of suffering (animal as well as human) but for the use of animals in testing its safety and its general effect. The whole of bacteriology and modern surgery have been slowly worked up to their present position among the sciences by animal experimentation. No surgeon would dare to remove a kidney or suture the intestine, no matter how badly damaged, unless it had been shown it could be done in anesthetized animals with perfect safety, and without suffering. Remember, in passing, that even if all in- vestigators in this field were entirely devoid of the ordinary human instincts, which of course is nonsense (what logicians call a "violent supposition") it would be impossible to do a delicate dissection on an unanesthetized struggling animal. Aseptic surgery, one of the greatest triumphs of modern times, would be impossible without animal experiments. 1 am old enough and young enough to be able to contrast the surgical conditions of forty years ago with the magnificent surgical successes of to-day, impossible without animal experimentation The study of the ultimate cause of diseases, which is the first step in finding means to prevent and cure them, has made enormous progress but much still remains to be done. An intensive study is going on all over the world to find the cause, prevention and cure of cancer. There is still much to be learned of small-pox. The ultimate cause of scarlatina, measles and mumps are unknown, that of influenza not definitely determined. There are many other problems of this kind to be solved. Put a stop to animal experi- mentation and the search must be abandoned. Incaculable dis- aster to the human race and to the lower animals would result, many epidemics now controllable would spread unchecked. The result- ing misery and death no man can begin to calculate, and medical progress would be completely arrested. It is undeniably true that medicine and surgery owe the bulk of what they have accomplished in the last fifty years to animal experimentation. Let me state from my own observation and experience what was accomplished in the eradication of disease in the Philippines in nine years, most of it the result of animal experiments, and methods developed and worked out in the laboratories of different countries, largely by animal experimentation. When I left Manilla, after two years stay there, in 1902, the hospital I commanded contained about 500 very sick men (all light or convalescent cases were sent to a convalescent hospital). These cases included small-pox, plague, beri-beri, Asiatic cholera, typhoid fever, and a great many of tropical amebic dysentery. On my return nine years later as Chief Surgeon 314 of the Philippines I inspected the same hospital. There were 73 cases being treated then and not one case of communicable disease. The changed conditions were the result of American Sanitation, inaugurated by military and carried on by civilian health officers, but the methods by which that improvement was made possible, were the result, in the final analysis, of animal experimentation. Take one disease as an illustration. Beri-beri (known to medical men as disseminated peripheral polyneuritis) was a disease at first unfamiliar to doctors who had had no tropical experience. It affects the nerve endings, causes extensive paralysis, and some of the most frightful cripplings you can imagine. At first this was supposed to be an infectious disease, dt very rarely occurred among our troops, but was a scourge among the natives, and most of them who did not die from it would have been much better off if they had, for many muscles became permanently paralyzed, opposing muscles dragged the unfortu- nate sufferers into the most distressing permanent contortions. The cases were all isolated, and not one of them, or very few, indeed, got well. Two years later during the Japanese-Russian War, the Japanese Navy suffered badly from beri-beri. The surgeon general of that serv- ice proposed a change of diet, and the cases improved and new cases ceased to appear. Later on the matter was seriously studied, and Ved- der, of the U. S. Army Medical Corps, made a series of experiments on fowls, simply restricting their diet to polished rice, which forms the bulk of the subsistence of the Filipinos and the Japanese. He found that chickens developed symptoms of beri-beri which promptly disap- peared when rice polishings were added to their diet. Now beri-beri is almost unknown in the Philippines. In three years I spent there, 1911-1914, I never saw a single case. The fact that it was a dietetic disease, a deprivation neuritis, was definitely proved on a dozen fowl, and by insisting on the natives eating unpolished rice the disease has practically disappeared, for there is some element in the husk or the pericarp of the rice grain that contains an essential food principle, found in the ordinary diet of all persons except those whose food is almost entirely starch. This is a good illustration of what may be accomplished by animal experimentation. Simply restricting the diet of a few fowls for a time proved positively the cause of this disease. One of the methods of proving Vedder's theory was to give the fowls rice polishings as soon as symptoms of paralysis developed, when they very soon disappeared. If I were allowed thirty hours instead of thirty minutes, I should find the time too limited to enable me to enumerate and describe the great benefits to the race that these great investigators have bestowed upon it through animal experimentation. Should not every intelligent min or woman, worthy to be called civilized, do all in his power to encourage and help these unselfish benefactors of the race? Can you conceive of people calling them- 315 selves educated or intelligent, so misguided as to misrepresent, hamper and even to make every effort to put a stop to a kind of scientific work that has already conferred incalculable benefits on the human race and domesticated animals, and is full of promise of even more than it has already achieved. Yet there actually are such people. If they would confine- them- selves to anything remotely resembling the actual facts, they could easily be silenced, but they harrow up the feelings of unthinking emo- tional people with the most absurd and extravagant misstatements. Only a few days ago in this city one of these propagandists made the assertion that medical students were forced to witness the torture of dogs, in order to make them callous to the sight of suffering, harden them morally and eliminate all humane instincts from embryo medical men. Can there be approximately intelligent people, who can listen patiently to and even believe such fantastic nonsense? The answer is "no," for to credit such absurdities is in itself proof of the nonexist- ence of any intelligence at all. WHAT ANIMAL EXPERIMENTATION HAS DONE FOR GYNECOLOGY AND ABDOMINAL SURGERY. By Thomas S. Cullen, M. D., Professor of Clinical Gynecology. Johns Hopkins Hospital. To discuss adequately this important subject would require more time than your patience would allow, and I am reminded of the statement made by President Hadley, of Yale, that no one is converted after twenty minutes. Consequently, in the time at my disposal I shall give you only a panoramic view of the advances in abdominal surgery and gynecology during the last thirty years. We are continually reminded of the wonderful way in which nature has developed our bodies, and in no part of the human economy is this more evident than in the abdomen. It would be impossible for any man, no matter how skilled he was, to pack away in a small com- partment so many vital structures, and to so arrange them that no one organ seems to be crowding out the other. If we examine the abdominal cavity, we find that it is in large measure filled by the gastro-intestinal tract. The upper part of this is the stomach. Next comes the duodenum which is only a few inches long and is continuous with the small intestine which is many feet in length. This, in turn, passes into the large bowel through a valve-like opening, in the vicinity of which is the .appendix.' The large bowel is a few feet in length and terminates in the rectum. The intestines as a whole are over twenty-two feet long. 316 Occupying the right upper abdomen and lying chiefly under the ribs is the liver and snuggled up under the edge of this organ is the gall-bladder. In the left upper abdomen is the spleen, and lying prac- tically behind the stomach is the pancreas. In the female the pelvis contains the uterus, tubes and ovaries. Lying outside the peritoneal cavity on either side are the kidneys and from each a small tube, the ureter, passes downward to the base of the bladder. Such is the general topography of the abdomen. Some of the older members of my audience will probably remember that thirty years ago one rarely heard of an abdominal operation except for the removal of an ovarian cyst. At that time we had cases of typhilitis, a term used to designate inflammation around the appendix, or were told that a patient had liver trouble or an inflammation of the gall-bladder, but no operation was suggested or performed for any of these important conditions. During those dreadful epidemics of typhoid fever that from time to time passed over a community like a prairie fire, a perforation of a typhoid ulcer was diagnosed and that meant almost certain death, as the surgeon was unaware that operation could be of any value. As we glance back to former days we remember that many of our friends were chronic invalids, and we looked upon their permanent disability as a matter of course, little realizing what might have been accomplished had they the advantages of the wonderful advances in abdominal surgery made during the last quarter of a century. Just imagine the dilemma we should be in today if none of our appendix or gall-stone cases could be operated upon! The normal appendix is about as big around as a small lead pencil and varies from two to three or more inches in length. It is a very innocent looking object, and one would not for a moment think St could do harm. Nevertheless, it is the "stormy petrel" of the abdo- men. It is lined with the same velvety membrane as that of the large bowel, and its lumen which is about the size of the lead in a lead pencil is continuous with the cavity of the bowel. We all know how quickly a nostril will close if we catch the slightest cold. If there be a slight inflammation of the large bowel this often extends to the appendix, and its opening into the bowel speedily closes. It is now a closed sac, and if the inflammation persists the appendix swells up and finally gives way at some point allowing its foul contents to escape into the abdomen. General peritonitis often results and the patient dies. Appendicitis was the "inflammation of the bowels" of former days. Many of you will doubtless wonder why the various stages in the development of appendicitis were not thoroughly understood long be- fore, but when we remember that abdominal operations for this con- dition were not performed and that when the abdomen was opened 317 after death in the cases in which peritonitis had developed, pus was found everywhere, we cannot wonder that the true cause was usually overlooked. If one is in a house when it catches fire he is usually in a position to tell how it started, but when the whole building is ablaze when he reaches the. scene it is very difficult, or impossible, to determine the starting point. To Louis Pasteur, the people of the world owe an eternal debt of gratitude for his discovery of the usual causes of infection or blood poisoning; it was he who pointed the way to avoid infections. His discovery was promptly embraced by Joseph Lister who applied it to surgery. As a result of the labors of these two men it was soon possible to open an abdomen with little or no fear of subsequent infec- tion. This opened up to the surgeon an entirely new field, one here- tofore in large measure forbidden ground. It likewise enabled him to explore the abdominal cavity in very early stages of various abdominal diseases. Hq was thus not only able to follow the disease from its beginning but, what was more important, was often able, figuratively speaking, to confine the fire to one room and to extinguish it effectually. When a new country is thrown open to the public the desirable farm land is soon taken. Small villages spring up, roads are located, and in due course the community is thoroughly organized and takes its proper place in the State. Precisely the same thing has taken place in abdominal surgery. At first the appendix and gall-bladder were given special attention because in these originate the two most impor- tant and most frequent abdominal maladies that the abdominal surgeon has to deal with. After these had been thoroughly mastered other and less frequent abdominal diseases were given due consideration. Perhaps I may be able in a few words to give you a comprehen- sive idea of the more common abdominal conditions with which the surgeon has to deal. In the stomach we have ulcers. These may cause alarming hem- orrhage or perforation may occur. The surgeon makes an opening between the stomach and intestine in such a way that the food does, not pass the ulcer. This leaves it quiescent and gives it a chance to heal. If a perforation has occurred, he at once sews up the hole and drains the abdominal cavity to get rid of the stomach contents that have escaped. When cancer of the stomach is detected early he removes a por- tion of this organ and usually attaches the remaining part of the stom- ach to the intestine, in such a manner that the contents can readily pass along their way. Ulcer of the duodenum is of common occurrence. Here practi- cally the same operation is performed as for ulcer of the stomach. Throughout various portions of the small and large .intestine tumors may develop. The necessary segment of the bowel is cut out, 318 the cut ends are approximated, and in many cases the patient makes a perfect recovery. In the female we often find pus in the tubes connected with the uterus, and it is usually necessary to remove these if the patient is to regain her health. It is a significant fact that pus tubes are infinitely less frequent in the well-to-do than they were a decade ago. This is undoubtedly due to the better education of the public and to the fact that women in the higher walks of life will have nothing to do with their husbands if the latter be infected. The next decade will un- doubtedly show the same attitude on the part of the women in other walks of life. These facts were emphasized by Dr. Roland Hill in his recent Presidential address delivered before the Western Surgical Association in Kansas City. They are most significant. Uterine and ovarian tv mors in their development often push the blood vessels, the tubes from the kidneys to the bladder and other structures, far out of place so that the surgeon finds it difficult to get his landmarks. In such cases he is often like the mariner traversing an uncharted sea. Sometimes the tumors reach a very large size and grow so fast to the intestines and large blood vessels that it is necessary to remove parts of the intestine and occasionally portions of the impor- tant blood vessels together with the growth. Now and again a crisis arises and almost certain disaster seems imminent. It is then that the surgeon must act with instant decision and with the utmost coolness. He cannot back out, and any minute may be on the rocks. When in such a predicament I have been re- minded of the man in the signal tower. The limited was coming rapidly toward him and beyond control. A moment's delay and a head-on collision would occur. He thought quickly-'better one wreck than two'-pi lled the lever and sent the limited into a mud bank. No man has any right to do abdominal surgery unless he is pre- pared to do any abdominal operation that may be necessary, and unless he is ready to cope with any abdominal emergency at a mo- ment's notice. You may be able to duplicate a train-you can never reproduce the same individual. An abdominal surgeon must in the first place be a man with a good fundamental knowledge of medicine. He must be a good diagnosti- cian ; he must be thoroughly familiar with the gross appearance of all abdominal lesions and also with the appearance of these structures under the microscope. He must be a good bacteriologist so that he can carry out the technique of the operation in such a way that there will be little or no chance of subsequent infection. He must be able to join up intestines so that they will not leak or will not allow gas to escape. He must be able to join blood vessels so securely that the blood stream will be continuous, and he must approxi- mate parts in such a manner that they are left perfectly smooth. In 319 short, in addition to his scientific qualifications he must be a good plumber and gas fitter, and a first-class tailor. The successful surgeon does not confine his knowledge to medicine and surgery alone, but embraces every opportunity to learn all he can about business in general, and especially concerning manufacturing plants of all sorts. In this way he picks up many points that are in- valuable to him in his chosen field. Above all a liberal supply of good horse sense is his most valuable asset. Problems. Nearly all manufacturing plants retain a corps of experts who are continually on the look out for new things and who are suggesting new methods whereby the existing products are improved and produced with less cost. Precisely the same applies to abdominal surgery. Our methods are as a result of experiments rendered more effective and as a result of animal experimentation we are rapidly reducing the cost-in lives. The experimental intestinal work of Halstead, Mall, Murphy and others upon dogs has been of the greatest value. They have given vs methods of so bringing the bowel ends together that we now rarely have a leak after the ends have been approximated. As a result of experimental work we are now able to bring to- gether the ends of blood vessels with the assurance that the blood will continue to pass normally through this spliced vessel. In some operations the tube from the kidney to the bladder has been cut across during the operation, not through any fault of the operator, but because it has been carried far from its normal positio by a tumor. As a result of experimentation on animals we now know how to join up effectually the ends of the cut tube and thus save the kidney which would otherwise have to be sacrificed. In former days when a patient had a strangulated hernia which had existed for four or five days he would usually die even after we had released the bowel. Animal experimentation has taught us that the death was due to poisons absorbed from the temporarily paralyzed bowel. We now open the bowel above the point of the hernia, allow the poisonous intestinal contents to escape and achieve success where failure usually followed. As a result of experiments on animals we have learned that chlo- roform causes widespread necrosis of the liver; hence this anesthetic has been practically discarded in this country, except in obstetrical cases where it is employed only for a few moments. As a result of experiments on animals we have been able to dis- cover how much intestine can be removed and the patient still live. As a result of experimentation a knowledge of the stomach juices was learned. 320 These are but a few of the fundamental truths that have been ascertained as a result of operations on animals-truths that have enabled the surgeon to save myriads of lives. The question is often asked, "Why use the dog?" In many laboratory experiments mice, rats, guinea-pigs, rabbits and other ani- mals have been employed. In experimental work dealing with the advancement of abdominal surgery we have to use a larger animal, an animal whose abdominal organs resemble in some degree those of the human being, and the dog is the only animal that we can satisfactorily employ. It may be of interest to describe briefly the method of operating on dogs. The instruments are carefully sterilized by boiling. The sponges and dressings are prepared in precisely the same manner that they are in a hospital operating room. The operator and his assist- ants scrub up and go through the same solutions that they employ in preparing for a regular abdominal operation. A trained assistant is selected to put the dog to sleep and the abdominal preparation of the animal is carried out with the utmost care. The operation itself is carried out with the same precision that is in vogue in any well-organized operating room, and the operator is keen to see if he can successfully perform the new operation that will in the future enable him to relieve conditions in the human being that have heretofore baffled the surgeons. As soon as the operation has been completed the dog is placed in a comfortable cage and given morphia or some other drug that will in large measure relieve his suffering. His diet is also carefully super- vised until he is able to be up and around again. This scrupulous care of the animal is absolutely essential otherwise many of these valuable and successful experiments would end in failure. It is interesting to note that, when the animal operating room at the Rockefeller Institute was established, the head nurse of one of the best operating rooms in the country was selected to take charge of this department. When a physician who was visiting the Rockefeller Institute dropped in to see the dogs that had been operated on they immediately started to bark furiously, but as soon as the surgeon who had per- formed the operations and watched them subsequently, appeared their barking ceased and the dogs wagged their tails furiously. The dogs, of course, did not know that the surgeon had produced their suffering. They were asleep. They only knew that he had been kind to them when suffering. Further comment is unnecessary. The Training of Young Surgeons.-The public has a right to de- mand the best surgical service obtainable. In the early days many a man after years of general practice gradually drifted into operating. The surgery of today requires such perfection in diagnosis, such a knowledge of pathology, operative technique and after treatment that 321 the embryo surgeon must after spending one or two years in a medical clinic start at the bottom rung of the surgical ladder and work up. He will begin as a junior assistant taking histories on the wards, mak- ing the necessary routine laboratory examinations, handling instru- ments at operations, and in looking after the patients that have been operated upon. After a year in such work he may become a second assistant. His responsibilities are now greater, and he may be allowed to do minor operations. When he has won his spurs he is advanced to be first assistant, and finally becomes the resident surgeon in the hospital. The assistant learns much from his chief, and in due time is able to perform complicated operations, but there are some that he can rarely if ever successfully perform the first time. This is perfectly natural. The plumber's assistant might watch his employer success- fully weld joints for months without being able to do so himself. In order to become a master plumber it is necessary for him to do some of the welding himself, and some of his first attempts in this direction are doomed to failure. With the plumber's apprentice this does not matter much; he can try over again, and if necessary secure new pipes. When the surgical assistant attempts for the first time to bring the two ends of a bowel together and so suture them that the joint is absolutely water and air tight he is often doomed to failure and the patient, if a human being, usually succumbs. It is essential that he do the opera- tion on dogs first and after from one to four or five trials he can with ease make a perfect joint. The same applies where he has to join up the small tube that con- nects the kidney with the bladder. It also is applicable in several other abdominal emergencies. When we look at the subject squarely it resolves itself into this-• in the first few operations in which abdominal tubes are to be joined up failures are bound to result and death ensues. Is it better to lose a few dogs or a corresponding number of people while the surgeon is securing the necessary skill in the performance of these important and difficult procedures? Surgeons are often thought to be lacking in sympathy, but I have never met a more warm-hearted group of men. The nature of their calling, however, does not allow them to let their feelings run away with their judgment. They are often called upon to operate upon their nearest and dearest relatives, at times not knowing whether they will be able to get them off the table alive. There is nothing in this world that pulls harder on the heart strings of any man than such an ordeal, and yet throughout the entire operation the surgeon must com- bine consummate judgment with absolute coolness, otherwise he can- not do his best. There is little wonder that the busy surgeon must take frequent vacations otherwise he would snap under the strain. To physicians and surgeons the innermost life of the community is 322 laid bare. The veneer and camouflage of society are torn aside, and the true life of society as it actually is stands out in bold relief before him. Could any man except one with a heart of stone under such circumstances fail to develop to a large degree an unbounded sympathy with mankind? All surgeons have been small boys, and it is the exception to find a lad who does not love animals and above all dogs. Well do I remember the mongrel dog that was my boon companion, just after I had learned to toddle around. The pranks of my large New Found- land dog, Ponto, will always linger in my memory. That splendid thorough-bred collie, Toby, was a delight to us all, but like some of his race he occasionally exhibited diabolical qualities, and like a flash would bite members of the family. In a moment his anger subsided, and for days he would in every way manifest his sor- row for the outburst. When it became necessary to put him to sleep on account of his being a menace to the neighbors there was a sadness in the family akin to the loss of one's very own. Late one warm July night in 1906, long after we had retired the door bell rang, and the expressman brought in a small crate. On opening the door of this a small, shaggy mite four weeks old and not over six inches long toddled out. At first he was very shy, but after drinking a saucer of milk became friendly In a few days he owned the house. He had the usual children's diseases, such as distemper and intestinal upsets, and in each of these was tenderly nursed. Like all young children he manifested a tendency to run away, and on one occasion was missing for two days. Scotties are no beau- ties', and an advertisement for "an ugly-looking little black dog" brought him back promptly. When four or five years old he was des- perately ill, and we feared for his life. He was at once taken over to the Hunterian Laboratory-the dog hospital of the Johns Hopkins Medical School-and put under the care of the young surgeon in charge. Appropriate treatment was at once instituted, and when we left him there, those wistful and pleading eyes followed us to the door. No human being could have spoken more plainly. Next morning we went over to the hospital expecting to find him dead. Imagine our joy and surprise to see him running around the cage and wagging his tail furiously. One summer we went to Europe and he was put out to board. On our return a more seedy and bedraggled little animal could not be found. That settled it, he has his own trunk, and each year he travels with the family to the back woods of Canada where for two months he is continually busy in chasing chipmunks, digging holes and in locating bones that he had buried in previous years. For a long period he and I lived alone, and each night he was faith- fully waiting for me at the head of the stairs, and each night he and I went for a walk before retiring. Sometimes, when an emergency op- 323 eration has detained me late into the night, our stroll has been deferred until 1 or 2 o'clock in the morning, but he never misses it when I am home. Killie is now nearly fourteen years old. He cannot climb as he once could, he has a cataract in one eye, and he is an old man, but he is still an inseparable member of the family and beloved by all. He has brought untold happiness to the household and is a most valued friend. As I write this he is lying at my feet. If one of my family were desperately ill, and if it were necessary to try some animal experiment with the hope of saving their life, and if it were impossible to secure another dog for the purpose, then I should with great reluctance be forced to operate on Killie. Physi- cians and surgeons in the past have not only risked but given their lives for their patients and will continue to 'do so in the future. We can well imagine the agony in the heart of Abraham when he was prepar- ing to offer up his son, Isaac, as a sacrifice. When considering the subject of vivisection I am continually re- minded of the woman who was visiting an asylum. In her curiosity she opened a door and saw a man riding a broomstick. Though some- what startled she said "I see you are riding a horse." The man replied, "No, it is a hobby, if it were a horse I could get off." We all have our hobbies, or should have them. It is the man or woman who has a hobby that accomplishes things, but in following out our hobbies let us view the subject from every standpoint, let us see if we are on the right track. In the Hunterian Laboratory at Hopkins and catching ones eye as he enters the building is a conspicuous list of rules which are and have been rigidly enforced for years. Among other rules is the following: "Any attendant who strikes a dog is to be discharged at once." Every precaution for the humane treatment of animals has been scrupulously observed. We should be as careful and considerate of animals as we are of people, but if by the experimentation on a few animals we can save many lives, is it not our duty to do so? Would you be willing to lose one of your dear ones rather than have the surgeon sacrifice a few dogs-you certainly would not when the acid test came What would you think of an apprentice carpenter being given valuable mahogany to work on. You would consider it absurd. He should practice on the cheapest kind of lumber until he has gained sufficient skill to handle adequately the rare and more costly woods. Human beings are the mahogany of surgery. Why is it that American surgeons when ill abroad and needing surgical operations, if possible, take the first boat for America? It is because they feel that they can get better surgical treatment in this country than anywhere else in the world. The wonderful advances in 324 American surgery have in no small measure been due to the careful and painstaking animal experiments carried on in the United States. The people of the world owe a tremendous debt to Louis Pasteur, to Joseph Lister and to the results of animal experimentation. Myri- ads of useful men and women, now alive and well, would have long since passed to their eternal resting place had it not been for the funda- mental discoveries of Pasteur and Lister, and for the new and better methods revealed to us by experiments on dogs. The citizens of the United States, when ill, rely absolutely on the judgment of their surgeon and place themselves and their families under the care of these surgeons, knowing full well that they will receive the best possible surgical care. Such being the case, the public can with confidence rely on the surgeon to be careful, conscientious and humane in his experimentation on dogs, which is absolutely essen- tial to the continued advancement of this important branch and to Medicine as a whole. ACHIEVEMENTS OF ANIMAL EXPERIMENTATION IN GENERAL SURGERY. By . . George Tully Vaughan, M. D., LL. D., F. A. C. S. Professor of Surgery, Georgetown University. Man in the beginning was given control of all inferior animals for use, but not for abuse, and this right to use extends to confining the animals in captivity, making them work for him, and even taking their lives for any good and sufficient reason. Man gives his own life and often sustains great hardship and suf- fering in support of a worthy cause, or for the benefit of his kind; then why should he hesitate to use the lower animals, who have been given into his keeping, for any worthy purpose? I am as much opposed to cruelty in the true meaning of that word as the most violent and senseless antivivisectionist, but the use of ani- mals and their sacrifice at times even with suffering, when done for the benefit of the human race, is not cruelty. I have read a number of attacks on all who believe in the prin- ciples I have just stated, and especially on the members of the medical profession, but the most remarkable and amusing of them all is a book by Stephen Coleridge. Stephen Coleridge, in his book entitled "Vivisection-A Heartless Science," 1916, feels it his duty to attack vivisection as he is a repre- sentative in the fourth generation from the one who wrote the "An- 325 cient Mariner," and modestly continues, "I may claim with some par- donable pride to have acquired my convictions from three generations of ancestors, whose title to distinction in the fields of law and letters cannot be gainsaid." After reading his book one is compelled to believe that however much he may know of "law and letters," his knowledge of physiology is woefully deficient. To select one from the numerous examples of erroneous deduction, ignorantly or wilfully made, read his criticism of certain experiments made on animals by keeping them continually under the influence of alcohol, as showing his idea of cruelty: "Surely it is time that all decent men and women in England raised their voices in solemn protest against these dreadful claims of physi- ology, claims that revolt the heart and shock the conscience." Coming from a man of such pride in his logic, education, and hereditary convictions, this hysterical outburst is surprising over a condition in which the animal is blissfully unconscious of worry and certainly free from all pain. The issue, he writes, is/'whether vivisection as practiced is right, not whether it is useful to science." What sophistry-the killing of a man in the abstract is not right, yet it is universally conceded that circumstances often make it right. He attacks the support or aid of medical schools by hospitals, criticiz- ing Lord Lister's approval, and pays his respects especially to the affairs of St. Bartholomew's Hospital, conclusive evidence that he fails to see the benefit which the schools with their students and physicians bring to the hospital, and showing his prejudiced and distorted opinion of the medical profession. The deductions from Sir Victor Horsley's answers to questions by the Royal Commission on Vivisection are unfair and unwarranted; the insinuation that men like Brunton, Powers, Schaefer, Morris, Swazey, Bruce, Osler and others obtained their honors by practicing or supporting what he regards as an infamous practice, is slanderous; but the tribute to the leading lights of science in America, in the sug- gestion that asses' ears be grafted on the heads of the operators, is amusing, as the idea instantly occurs to the reader that the head of the author would be much more appropriate for adornment with these emblems of unreasonable obstinacy and stupidity. To read the author's own account of how he has punctured the inflated arguments of his opponents with his irresistible logic, marks him as a regular Boanerges in control of the lightning and thunder, and to oppose his judgment or opinion is to invite destruction. The charge of megalocephaly (bigheadedness) made against Sir Edward Schaefer is another instance of transferring one's own pecu- liarities to the shoulders of another. The entire tone of the book forces the conclusion that the author is a man whose self-conceit is colossal, whose skill in distorting language from its honest meaning to suit his 326 purpose is phenomenal, but whose faith in the integrity of those who differ with him is pitiable, and whose logic is ridiculous. Let us hear now some of truth and soberness: After the Royal Commission on Vivisection had concluded its sessions and the examina- tion of numerous advocates and opponents of vivisection, the Earl of Cromer, who might be regarded as an unprejudiced party, thus ex- presses his opinions: "I felt strongly that the vivisectionists and not their opponents were the true humanitarians. * * * The argument that the re- searches of the vivisectionists have been barren of results ought to be finally discarded by all save those who are not open to conviction. * * * The case of the antivivisectionists, when submitted to the test of cross-examination, broke down helplessly." A word now regarding some of the benefits we enjoy from animal experimentation. Seventy-five years ago little was known as to the exact relations between the anatomy and the functions of the brain, spinal cord and nerves. Watson in 1845 (Head) said: "The structure of the nervous system has no perceptible or understood subservience to its functions," and he believed that the brain was the seat of a sort of generalized function with no special centers. Now we know, thanks to the experi- ments of Ferrier, Hitzig, Sherrington, Greenbaum and others, on the brains of monkeys that every motion and sensation in the body has its center or little group of cells in the brain which control it, so that any stimulation or injury to that center in the brain is shown by a certain sensation or movement of the muscles of the part so controlled. It is an ordinary event now, in injury or disease of the brain for the surgeon by observing, for example, movements or paralysis of the muscles of the foot, hand, eye, mouth, etc., to know exactly in what part of the brain to look for the blood clot, tumor or whatever may be causing the trouble. This was illustrated in the case of a prominent presidential candi- date, when twitchings or paralysis began in one of his feet, the surgeon knew just where to look for the cause in the brain, namely, the center controlling that foot, so he opened the skull and found and removed a tumor. It was Charles Bell's experiments on a donkey about 1811 that established the difference in function between the fifth and seventh cranial nerves and thus enabled us to operate successfully on thousands of cases of neuralgia of the face. The surgery of the thyroid gland and the intelligent treatment of goitre was worked out by animal experimentation; even great anato- mists like Luschka having no appreciation of the functions of the thyroid or parathyroid glands and their important relation to life and health. In the first operations sometimes all of the thyroid and para- thyroid glands were removed, when the patient either died in convul- 327 sions or lived a short, crippled life with bloated features, cold and thickened skin, intellectual stupidity, ending in imbecility. By investiga- tion on animals it was found that when all of the parathyroids were removed, the animal dies of tetany, so that now in surgical operations for goitre we are always careful to leave at least one parathyroid gland. Before removing the larynx for cancer in man, Czerny experi- mented on dogs and found that they survived the operation and con- tinued in good health and now it is an established life-saving opera- tion for man. Likewise Simon in 1869, before removing a kidney from man, established the fact that dogs survived the loss of one kidney without any detriment to their health, and that is now a very common opera- tion for malignant tumors, tuberculosis, abscess, stone, etc., and the man lives and enjoys life seemingly as well off with one kidney as with two. In 1867 Ollier proved by experiments on animals that bone or periosteum would live and grow and make new bone if transplanted from one part to another of the same animal, or if transplanted from one animal to another animal. From the knowledge obtained in this manner have come the numerous and wonderful operations on bones. In older times surgeons could make a new nose (for one whose nose had been destroyed) by turning a flap down from his forehead or getting a flap from his arm, but it was a soft, mushy nose. Now, when this is necessary, we transplant a piece of bone to stiffen the soft parts, obtained from the outer table of the skull, from the end of a finger or from one of the ribs. Parts of the skull are sometimes destroyed by wounds leaving the brain covered only by the soft parts which may cause fits or lead too easily to injury to the brain. These defects in the skull are filled in now, not by silver or celluloid plates, as was formerly done, but by bone obtained by splitting off a piece of the outside table of the skull near the defect or by cartilage obtained from the ends of the patient's ribs. A long bone partially destroyed may have the gap filled in by transplanting a fragment from some bone large enough to spare it-placing and fixing the fragment between the ends of the two fragments and holding it in place until union occurs. Where the thumb has been lost or all the fingers, a substitute for the thumb for the fingers to press against, or a substitute for the fingers for the thumb to press against, has been made by transplant- ing a suitable bone or fragment and fixing it in its new position. For the treatment of tuberculosis of the spine, which leads to hunchback, a fragment taken from the larger bone in the leg is transplanted into the part of the spine which is diseased in order to hold the parts at rest until cure takes place and prevent the deformity of hunchback. Even entire joints, as the knee, have been transplanted success- fully-the diseased joint is cut out and a healthy joint of proper size from a recently amputated limb is fixed in its place until union occurs. 328 Metchnikoff in 1903 inoculated apes with syphilis, and in 1905 Schaudin and Hoffmann discovered the germ of the disease. A few years later, in 1910, Ehrlich discovered his famous 606, or salvarsan, after 605 other remedies had been tried unsuccessfully. In 1816 Gussenbauer and Winiwarter experimented on dogs' stomachs and were surprised and pleased to find after cutting out pieces and sewing them together that the parts united and grew together as kindly as do wounds of the skin, instead of being digested or destroyed by the gastric juice as was the common belief. In 1861 Billroth did the first successful pylorectomy (excision of a portion of the stomach) on the human being. In 1884 few surgeons were bold enough to open the abdomen even for the treatment of gun- shot wounds. Then it was that Parkes, at Chicago, experimented on thirty-seven dogs by shooting them through the bowels while etherized, then operating on the wounds and proved that opening the abdomen and sewing up the bullet holes was the best method of treatment. This has led to the saving of thousands of lives, and the surgeon of today who fails to operate in such cases would be negligent of his duty. Not only do we operate for wounds of the stomach and bowels, but for many diseases, such as cancer and ulcer. A portion of the stomach containing the cancer is cut out and the ends sewed together, or the ends may be closed by stitches and a new opening made between the stomach and the bowel. When the disease is so far advanced that removal is impossible, the stomach or the bowel above, and the bowel below the disease, which causes obstruction are united, "short circuited" as it is called, so that the obstruction is relieved and the patient's life prolonged and made more comfortable. It was also found that the entire; stomach could be removed and the patient live. Schlatter at Zurich, Switzerland, did the first successful complete removal of the stomach in 1897, and the patient lived about one year, dying of a return of the disease (cancer) in some other form. Since then the operation has been done many times with good results. Forty years ago no one had dared to operate on a human heart. If it was penetrated by a knife or bullet, the patient was permitted to die without any interference on the part of the surgeon. Even with this method of no treatment some patients recovered, and in 1867 Fischer published a list of 456 wounds of the heart with an estimated recovery of 5 to 10 per cent; but as no operation'was done, it is prob- able that most of the recoveries were in those in whom the heart had not been wounded, and it would be nearer correct to assume that recov- eries from penetrating wounds of the heart treated by the "watchful waiting" plan would not exceed 5 per cent. In 1895 Rosenthal and Del Vacchio made a number of experiments on dogs and found that they could be cured when the heart was wounded by opening the chest and sewing up the wound in the heart. The next year Farina, of Rome, sewed up a wound in the heart of a 329 man, and the man lived six days and died of pneumonia. During the same year Rehn performed the first completely successful operation of sewing up a wound in the heart. Twelve years ago (1908) I col- lected 150 cases in which wounds of the heart had been sewed up and 35 per cent (52) of the patients recovered-a gain of about 30 per cent over the do-nothing method. Since that time many other patients with wounds of the heart have been saved by operation. All of us hope to see the time when diseases of the heart can be operated on and cured in the same way. In diseases of the heart, the valves often become too small, or the natural openings by which one chamber opens into another or into the great blood vessels, become too large or too small, so a leak occurs. Carrel and his co-laborers at the Rockefeller Institute have demon- strated the fact that in dogs the valves in the heart and the natural openings can be sewed up, enlarged, or reduced in size without killing the animal. In the same way large blood vessels which have been wounded have been preserved by sewing up the wounds, or where they have been divided by sewing the ends together, or where much of the vessel has been destroyed, by transferring a piece of another ves- sel which can be spared to take the place of the portion which has been destroyed. In several cases one lobe (that is nearly half) of one lung has been successfully removed, and in one case Lilienthal removed almost the entire lung with recovery of the patient. I cannot do better in closing than to quote the words of Dr. W. W. Keen, the Nestor of American surgery, in comparing the achievements of the friends of experimentation with the achievements of its oppo- nents. Under Experimentation. "1. They have discovered and developed the antiseptic method, and so have made possible all the wonderful results of modern surgery. "2. They have made possible practically all modern abdominal surgery, including operations on the stomach, intestines, appendix, liver, gallbladder, pancreas, spleen, kidneys, etc. "3. They have made possible all the modern surgery of the brain. "4. They have recently made possible a new surgery of the chest, including the surgery of the heart, lungs, aorta, oesophagus, etc. "5. They have almost entirely abolished lockjaw, after operations, and even after accidents. "6. They have reduced the deathrate after compound fractures from two out of three; i. e., 66 in a hundred to less than 1 in a hundred. "7. They have reduced the deathrate of ovariotomy from 2 out of 3 or 66 in a hundred to 2 or 3 out of a hundred. "8. They have made the deathrate after operations like hernia, amputation of the breast, and of most tumors a negligible factor. 330 "9. They have abolished yellow fever-a wonderful triumph. "10. They have enormously diminished the ravages of the deadly malaria, and its abolition is only a matter of time. "11. They have reduced the deathrate of hydrophobia from 12 to 14 per cent of persons bitten to 0.77 per cent. "12. They have devised a method of direct transfusion of blood which has already saved many lives. "13. They have cut down the deathrate in diphtheria all over the civilized world. In 19 European and American cities it has fallen from 79.9 per hundred thousand of population in 1894, when the anti- toxin treatment was begun, to 19 deaths per hundred thousand in 1905-less than one-quarter of the deathrate before the introduction of the antitoxin. "14. They have reduced the mortality of the epidemic form of cerebro-spinal meningitis from 75 or even 90-odd per cent to 20 per cent and less. "15. They have made operating for goitre almost perfectly safe. "16. They have assisted in cutting down the death rate of tuber- culosis by from 30 to 50 percent, for Koch's discovery of the tubercle bacillus is the cornerstone of all our modern sanitary achievements. "17. In the British Army and Navy they have abolished Malta fever, which, in 1905, before their researches, attacked nearly 1,300 soldiers and sailors. In 1907 there were in the army only 11 cases; in 1908, 5 cases; in 1909, 1 case. "18. They have almost abolished childbed fever, the chief former peril of maternity, and have reduced its mortality from 5 or 10 up even to 57 in every hundred mothers to 1 in 1,250 mothers. "19. They have very recently discovered a remedy which bids fair to protect innocent wives and unborn children, besides many others in the community at large, from the horrible curse of syphilis. "20. They have discovered a vaccine against typhoid fever, which among soldiers in camps has totally abolished typhoid fever, as Presi- dent Taft has so recently and so convincingly stated. The improved sanitation which has helped to do this is itself largely the result of bacteriologic experimentation. "21. They are gradually nearing the discovery of the cause, and then- we hope of the cure, of those dreadful scourges of humanity, cancer, infantile paralysis and other children's diseases. Who that loves his fellow creatures would dare to stay the hands of the men who may lift the curse of infantile paralysis, scarlet fever, and measles from our children and of cancer from the whole race? If there be such cruel creatures, enemies of our children and of humanity, let them stand up and be counted. "22. As Sir Frederick Treves has stated, it has been by experi- ments on animals that our knowledge of the pathology, methods of 331 transmission, and the means of treatment of the fatal 'sleeping sick- ness' has been obtained and is being increased. "23. They have enormously benefited animals by discovering the causes and, in many cases, the means of preventing tuberculosis, rin- derpest, anthrax, glanders, hog cholera, chicken cholera, lumpy jaw, and other diseases of animals, some of which also attack man. If suf- fering dumb creatures could but speak, they, too, would pray that this good work should still continue unhindered." On the other hand, what have the foes of experimentation achieved ? "1. Not a single human life has been saved by their efforts. "2. Not a single beneficent discovery has been made by them. "3. Not a single disease has been abated or abolished by them, either in animals or man. "4. All that they have done is to resist progress-to spend $500,- 000 in 30 years in Great Britain alone, and very large amounts of money in the United States-and to conduct a campaign of abuse and gross misrepresentation. "5. They apparently care little or nothing for the continued suf- fering and death of human beings, the grief and not seldom the ensuing poverty of their families, provided that 26 out of every 1,000 dogs and cats, monkeys and guinea pigs, mice and frogs experimented on shall escape some physical suffering. "6. They insist, therefore, that all experimental research on ani- mals shall stop, and-astounding cruelty-that thousands of human beings shall continue year after year to suffer and to die." ACHIEVEMENTS OF THE MEDICAL CORPS OF THE ARMY IN PREVENTIVE MEDICINE. A VINDICATION OF ANIMAL EXPERIMENTATION. By George B. Foster, Jr., M. D., Dr. P. H. Major, Medical Corps, U. S. Army. 1 have been asked to discuss animal experimentation in its relation to the advances that have been made in preventive medicine through the work of military surgeons. It is not my intention to approach this subject in a controversial way, as I feel that the scientific achievements of the Medical Corps of ■the Army offer, in themselves, an argument that is incontrovertible. I shall endeavor to outline briefly two of the more important problems that have been solved, leaving entirely to your judgment the question as to whether they have contributed to the safety, happiness, and pros- perity of mankind. 332 In considering the relation that animal experimentation-and lab- oratory methods in general-bears to great sanitary triumphs, one must remember that no great achievement has been the work of one man or of one institution. To Marshal Foch has been attributed the remark that "battles are won with scraps." This applies equally in the field of preventive medicine. Magendie, the great French physiologist, likened himself to a chiffonier-a rag-picker-wandering through the realms of science, picking up fragments of knowledge, piecing them together and applying them to his own problems as he went along. Many times the observations of clinicians at the bedside or of epi- demiologists in the field furnish the clue that leads to some epoch- making discovery in the laboratory; while, au contraire, in innumerable instances the truths elucidated in laboratories, applied practically by -sanitarians and clinicians, have resulted in the conquest of disease. Now let us see what has been accomplished. Typhoid Fever. The great scourge of armies during the nineteenth century was typhoid fever. At the beginning of the Franco-Prussian War, the infection existed in every corps of the German Army and was epidemic in at least one division. After mobilization the disease spread like wild-fire, especially among the troops besieging Metz and Paris. Within two months after mobilization typhoid had spread so rapidly among some of the German troops that one man out of every six was sick of this disease. The total cases of typhoid in the German Army during that war was 73,396, or nearly 10 per cent of the average strength. In the Afghan War of 1878-80 typhoid fever developed at nearly every station occupied by British troops, although some of these re- gions were practically uninhabited. During the Oran campaign, in 1885, the French troops camped in desert stations never before occupied, and yet typhoid fever not only occurred, but the outbreaks assumed the proportions of alarming epidemics. Many similar instances might be cited where troops were furnished drinking water of unimpeachable quality and occupied ideal camp sites that could not possibly have been typhoid polluted previously, yet typhoid invariably occurred. The only explanation of such outbreaks is that an army carries its typhoid with it in the form of mild undetected cases, or of the so-called "healthy carriers" of the disease-individuals who have had typhoid and recovered, but who still harbor and excrete from their intestinal tracts virulent typhoid germs capable of infecting others. The infec- tion is then passed on from man to man by direct or through some in- termediary-the usual intermediaries being, as we now know, "food, fingers and flies." 333 In our Civil War the army suffered severely from typhoid, espe- cially the Army of the Potomac. In the four years between July 1, 1862, and June 30, 1866, there were 57,400 cases, resulting in 5,360 deaths. Another tragic page in medical history is that of typhoid fever in the Spanish War.Every regiment constituting the First, Second, Third, Fourth, Fifth and Seventh Army Corps developed the disease. More than 90 per cent of the volunteer regiments were heavily infected within eight weeks after going into camp. Typhoid was almost equally prevalent in some of the regular regiments. The disease occurred in small camps as well as large, and in the north as well as in the south. There were 20,738 cases in a little army of 107,973 men; nearly one- fifth of the army contracting the disease. The toll paid to typhoid in that war was 1,580 lives, or 86 per cent of the mortality from all causes. Had the war been a real one with a powerful enemy at our doors, military effort would have been largely frustrated, we would have been subjected to invasion and perhaps ultimately to defeat. Remembering that what has just been said applies to armies in the pre-vaccination days, let us pass on for a moment to a brief considera- tion of the development of preventive inoculation against typhoid fever. From the discovery of the typhoid bacillus in 1880, and its suc- cessful cultivation in artificial media by Gaffky, a Prussian army sur- geon, in 1884, the investigation of methods for the control of typhoid fever have been greatly advanced by the work of army surgeons ; the whole matter of protective inoculation-experimental and applied- having been elucidated for the most part in armies. Widal, a French army surgeon, working with Chantemesse in 1888, first demonstrated that white mice could be made immune to the pathogenic effects of the typhoid bacillus by previously inoculating them beneath the skin with sterilized cultures. Incidentally, while conduct- ing these experiments, Widal discovered the phenomenon of aggluti- nation of bacteria in immune serum-a reaction now bearing his name and of great value in the laboratory diagnosis of typhoid and other diseases. Carrying further the work of Widal, Sir Almroth Wright, of Dub- lin, Ireland, a British Army officer and professor of pathology at the Army Medical School at Netley, after much preliminary experimental work on laboratory animals, demonstrated for the first time, in 1896-97, through the results obtained in the experimental inoculation of over 3,000 soldiers in India, that vaccination of man was practicable. Dur- ing the following three years the lessons were applied practically in the preventive inoculation of the British troops in South Africa. In 1909, preventive inoculation against typhoid was introduced in our army by Major (now Colonel) F. F. Russell, Medical Corps. He went to Europe, studiously investigated the French, British and Ger- man methods in vogue at the time, and, returning to the Army Medical 334 School in this city, organized and established a vaccine laboratory, in which all the vaccine since used by our army has been prepared. Each batch of this vaccine is carefully tested for sterility by injection into mice, and its immunizing properties are ascertained by the inoculation of rabbits. These animals are indispensable to the standardization of the vaccine. At the beginning vaccination was voluntary-the first volunteers being officers and enlisted men of the Medical Department-and only a part of the entire army was vaccinated during this period. It was first made compulsory for the 20,000 men mobilized as the Maneuver Division at San Antonio, Texas, in the spring of 1911. During the months that these-20,000 men lived under war conditions there were but two cases of typhoid fever among them-one occurring in a non- vaccinated civilian teamster and the other in a Hospital Corpsman, who confessed to me while ill that he had only received one of the three inoculations prescribed, and that he had evaded the remaining two by falsifying the records. Following this conclusive demonstration of the efficacy of protective inoculation the procedure was made compulsory for the entire army in 1912. In 1909 there were 173 cases of typhoid in the army, while in 1912, the first year that inoculation became uni- versally compulsory, the statistics dropped to nine cases with a single death. The peace-time army from then on remained practically free from typhoid. Now we come to the recent World War. Let us consider the statistics of the American Army, now protected by anti-typhoid vacci- nation. Prefacing these statistics, however, I desire to bring home the fact that-, with the exception that these troops had been immunized by protective inoculation, conditions favoring the development of typhoid were exceedingly comparable to those existing in the Spanish War. The army was composed almost entirely of troops hastily drafted from civil pursuits-comparable to the volunteers of 1898-and the citizen soldiers of the National Guard. They were hastily mobilized and sent to camps, many of which geographically were in close proximity to the plague spots of '98, and in many instances adequate sanitary ar- rangements had not been completed before the arrival of troops. That portion of the army that subsequently went to France suf- fered great overcrowding for many days in improvised transports, and, upon arrival at ports of debarkation, were herded into box cars and rushed to the front. The earlier troops, during the fall of 1917 and winter of 1917-18, were billeted in insanitary surroundings, the condition of which can be appreciated only by those who were there. I remember the very amusing incident of a French peasant woman in- dignantly demanding that the American soldiers billeted in her barn be removed as they talked at night and kept the sheep awake. The proximity of outhouses to water supplies may be imagined from the request made by the peasants in another locality that the Americans 335 interdict the use of disinfectants in their latrines as this procedure imparted a disagreeable taste to their drinking water. The conditions in the trenches would have been a sanitary re- proach had it been possible to correct them. Later, as trench warfare developed into open battles of movement, the troops at times lived under sanitary conditions that are indescribable. At Chateau-Thierry, for example, our troops moved into territory just evacuated by the retreating Germans that were nasty beyond description-dead bodies, dead horses, pools of feces and myriads of flies. In the Argonne, transportation difficulties, the nature of the terrain, and the dispersion of troops often iliade it impossible to furnish properly treated water at all times, and the troops drank from stagnant pools, collections of water in shell holes and whatnot. Nor were the troops stationed in towns in the rear free from danger of infection. Systematic bacteriological examination of the water supplies in various parts of France showed that over 80 per cent of these were polluted and not fit for drinking purposes without pre- vious chlorination or boiling. In many instances the water was veritable sewage and could not be used even after treatment. Yet, during the two years of the World War, in which approxi- mately 4,000,000 men served in the Army, half of whom saw service in France, there were but 1,065 cases of typhoid fever. In the Spanish War there occurred one case of typhoid among each six men ; in this war one case in every 3,756 men. The official statistics of the Sur- geon General's Office for the period September 1, 1917, to May 2, 1919, show that there were but 213 deaths from this disease. Had the death rates of the Spanish War prevailed, 51,133 deaths would have occurred, and had the Civil War rates applied, 68,164 lives would have been sacrificed. We of the Army Medical Corps are thrilled with pride at this achievement of one of our colleagues. The mothers, wives, sisters and sweethearts of the 50,000 men whose lives were saved by anti- typhoid vaccination should breathe a prayer thanking God that there was a Russell-and animal experimentation. These are the results of preventive inoculation against typhoid fever. I ask you, do they compensate for the lives of the laboratory animals sacrificed experimentally in perfecting this procedure? Yellow Fever. Perhaps the most spectacular achievement of the Medical Corps of the Army is the epoch-making discovery of the transmission of yellow fever by the mosquito. Yellow fever, peculiarly a disease of the American continent, is one of the most fatal to which the human race is subject. The early colonists suffered severely from this disease, and it had an important 336 bearing upon colonization in the Western Hemisphere. Its ravages in tropical America macle this section a veritable plague spot for white men, resulting in the settlement and development of the temperate regions rather than the tropics. Untold agricultural and mineral wealth was diverted from the world's markets for 150 years by this grim reaper of human lives. As Vaughan so graphically states, "A certain dread and romance attaches to its history." Formerly the disease existed perpetually in Havana, and from there it made frequent devastating incursions into the United States. Outbreaks occurred along the eastern seaboard as far north as Boston. It wrought its greatest havoc, however, in the Southern cities, where, during the great epidemic of 1878-only 42 years ago-16,000 persons died, and the economic loss was estimated at $100,000,000. This catastrophe focused public attention for a time and resulted in the birth of a National Board of Health to protect the United States from another invasion. As most of the epidemics that had visited the United States were imported from Havana, it was evident to sanitarians that great pro- tection would be afforded the United States were it possible to eradi- cate yellow fever at its source. The opportunity so long desired arrived when Havana came into our possession in 1898. At this time nothing was definitely known as to the cause of yellow fever, or the means of its transmission. Sanarelli, an Italian doctor, had just announced the discovery of an organism which he called Bacillus icteroides, and he claimed it as the specific cause of this disease. Immediately keen interest was evinced in this discovery, and General George M. Sternberg, Surgeon General of the Army, him- self a pioneer investigator in yellow fever, who had paved the way for subsequent workers, appointed an Army Board, consisting of Maj. Walter Reed and Dr. James Carroll, to investigate and report upon the relation of bacillus icteroides to yellow fever. This was in 1897. Reed and Carroll, through numerous experiments on swine and other animals, proved conclusively that Sanarelli's bacillus is a variety of the common hog cholera bacillus and has nothing to do with yellow fever. In 1899, when yellow fever appeared among the American troops stationed in Havana, Reed and Carroll again, with Drs. J. W. Lazear and Aristides Agramonte, constituted a commission sent to Cuba to investigate its cause and transmission. Shortly after arrival Reed was afforded an opportunity to study an epidemic of yellow fever among our troops at Pinar del Rio, and he became convinced, through his observations there, that the theory then governing all preventive measures, that transmission occurred through infected utensils, clothing, bedding, etc., was erroneous. He determined to give up, for the time being, further search for the spe- cific cause of the disease and to devote all his efforts to the immediate 337 pressing need of the elucidation of the means of transmission in order that effectual preventive measures might be instituted. The belief that the disease was transmitted by mosquitoes, ex- pressed by Dr. Carlos Finlay, of Havana, nearly twenty years before, appealed to Reed as the most logical theory to investigate. The only way of proving or disproving this theory was to permit infected mos- quitoes to' bite susceptible persons as laboratory animals were thought to be immune. After weighing the terrible responsibility of carrying out such experiments on human beings, the commission decided that if they succeeded in transmitting the disease experimentally through mosquitoes, the benefit to humanity would justify the hazard. They agreed,. however, that in justice and fairness they themselves should be included among the volunteers. Female mosquitoes of the variety known as stegomyia fasciata were obtained from Dr. Finlay, infected by feeding on patients acutely ill with yellow fever, and then applied to the volunteers. The first experiments were carried out by Lazear as Reed had been recalled temporarily to the United States. Lazear's first attempt to infect himself was unsuccessful. Later he was bitten by a mosquito while collecting blood from a patient in a yellow fever ward, and he purposely permitted the mosquito to take his fill. Several days later he became ill of yellow fever and died. In the meantime Lazear had applied infected mosquitoes to Carroll, and this resulted in the first successful experimental inoculation. It can best be described in the words of Carroll himself: "The insect, which had been hatched and reared in the laboratory, had been caused to feed upon four cases of yellow fever, two of them severe and two mild. The first patient, a severe case, was bitten twelve days before, the second, third and fourth patients had been bitten six, four and two days previously, and their attacks were mild, severe and mild, respectively. In writing to Dr. Reed on the night after the incident, I remarked jokingly that if there were anything in the mos- quito theory I should have a good dose; and so it happened. After having slight premonitory symptoms for two days, I was taken sick on August 31, and on September 1, I was carried to the yellow fever camp. My life was in the balance for three days, and my chart shows that on the fifth, sixth and seventh days my urine contained eight-tenths and nine-tenths of moist albumin. On the day that I was taken sick, August 31, 1900, Dr. Lazear applied the same mosquito, with three others, to another individual who suffered a comparatively mild attack, and was well before I left my bed. Thus it happened that I was the first person to whom the mosquito was proved to convey the disease. On the eighteenth day of September, five days after I was permitted to leave my bed, Dr. Lazear was stricken and died in convulsions just one week later, after several days of delirium with black vomit. Such is yellow fever." 338 This experiment on Dr. Carroll was followed by eleven others, nine of which were negative and two positive, and, upon this evidence Reed felt justified in pronouncing, without hesitatiton, that "the mos- quito acts as the intermediate host for the parasite of yellow fever." The experiments did not stop here, however. The idea of mos- quito transmission was contrary to what a great many men believed, and it aroused a storm of adverse comment and criticism. Reed and his colleagues decided, therefore, to repeat and simplify the experiments under conditions that would leave no doubt as to their conclusiveness. They established an experimental station, a mile removed from the nearest habitations, and surrounded it with an armed guard. No intercourse was permitted with the town except through an immune ambulance driver and an immune hospital steward who transported supplies from Camp Columbia. The personnel and such susceptible individuals as were admitted for experimentation were sheltered in tents placed twenty feet apart. This station was named Camp Lazear. A small frame building was built, 14 x 20 feet, so screened with wire netting that mosquitoes could not get in or out. The interior of the building was divided into two compartments by a partition made of wire netting running down the center. Two susceptibie persons were put in this building-one in each compartment. Breathing the same air and subjected in every way to the same conditions; but entirely separated by the wire netting, they lived and slept in these compart- ments for several days to show that there was no yellow fever infection in the building. Reed then put fifteen infected mosquitoes in one of the compartments, left a man in the compartment for thirty minutes, and announced that this compartment was now infected. He took the man out of this infected compartment, but left two men in the compart- ment on the other side of the wire netting. The man from the infected compartment returned for twenty minutes in the afternoon of the same days, and again, for fifteen minutes on the following day. During these three visits he was bitten by mosquitoes fifteen times. At the end of the fourth day the man from the infected compartment was down with yellow fever and the two men who had remained in the other compartment separated only by the wire netting and breathing the same air, were perfectly well. Reed then announced that he would disinfect the infected com- partment simply by catching and removing the fifteen mosquitoes. Following the removal of the infected mosquitoes a nonimmune soldier was again placed in each compartment, left there several days and they remained perfectly well. Although the experiment created a profound impression and the skeptics now admitted fhat the disease could be transmitted by the mosquito, they still maintained that it could be, and generally was transmitted in other ways, such as by soiled clothing, bedding, and by contact with persons sick with the disease, etc. 339 Reed then had constructed another small building that was almost air-tight-practically devoid of ventilation. In this building he placed material from the yellow fever hospital at Las Animas-mattresses on which yellow fever patients had died, sheets, pillows and pillow cases liberally smeared with black vomit, excreta and discharges; and even the pajamas worn by yellow fever patients throughout their illnesses. This material was opened up and spread out in this close room, and Reed asked for volunteers to sleep in the room. Dr. R. P. Cook, of the Army, and several soldiers responded. These men wore the paja- mas mentioned and slept on the bedding for twenty consecutive nights. All the men remained well-not a single case of yellow fever developed from this exposure. This demonstrated, once and for all, the fallacy of the filth or fomit'es theory of the transmission of yellow fever. The experiments were generally accepted as proving beyond question that yellow fever is conveyed from man to man by the mosquito alone and in no other way. The Board conducted further experiments demonstrating that the virus of yellow fever exists in the patient's blood only during the first three days of the disease; that the virus is ultramicroscopic, being capable of passing through a porcelain filter that holds back ordinary bacteria, and that it is killed by a temperature of 55° C. in ten minutes. They also showed that the female mosquito, only, can convey the dis- ease ; that after biting an infected person a period of twelve to twenty days must elapse before the mosquito is capable of transmitting it to another; and that following the bite another period of from three to six days elapses before the patient develops the disease. These experiments are the foundation upon which all sanitary campaigns against yellow fever are now based. Let us now consider what they have done for humanity. For nearly two years prior to the conclusion of Reed's experi- ments the Army had been in entire control of sanitary affairs in Ha- vana. Our cleverest sanitarians, among them Victor C. Vaughan, of the University of Michigan, probably the foremost American epidemi- ologist, had failed dismally in controlling yellow fever by means of methods based on the filth theory of disease. Following Reed's demonstration that the disease is transmitted solely by the mosquito, the sanitarians paid no more attention to fomites, but proceeded to apply practically Reed's experimental evi- dence in the following ways: (1) A strict quarantine was established to keep infected persons from entering the city. (2) A daily inspec- tion of all nonimmune persons was made in order to detect new cases during the first three days of the disease-the only period, you will remember, during which the virus is in the blood. (3) All persons sick of yellow fever were immediately screened and isolated so that mosquitoes could not bite them. (4) A vigorous antimosquito cam- paign was instituted aiming at the destruction of all mosquitoes-kill- 340 ing the insects in habitations by wholesale fumigation and energeti- cally searching out and doing away with their breeding places. Considerable effort, anxiety and experimentation were extended in perfecting the methods, but on September 26, 1901, seven months after the; institution of these methods, the last case of yellow fever occurred, and Havana was free from this disease for the first time in 140 years. During that 140 years not a single month had passed with- out a death from yellow fever, nor had there passed a day in which there had not been some person sick of yellow fever within the city. Conquest of Yellow Fever in Panama. Soon after the conquest of yellow fever in Havana, our Govern- ment began outlining plans for one of the greatest, if not the greatest engineering project in history-namely, the construction of the.Pana- ma Canal. Early in 1902, while still stationed in Havana, where he had di- rected the sanitary work that had rid the city of yellow fever, Major (now Major General, retired and recently Surgeon General) William C. Gorgas, of the Medical Corps, invited General Sternberg's attention to the enormous loss of life from tropical diseases that had occurred among the French while working at Panama; emphasized the fact that these fatalities had resulted for the most part from yellow fever and malaria; and suggested that the methods that had been so effective in Havana, if carried out in Panama, would greatly reduce the mortality that might be anticipated among American workers on the Isthmus. General Sternberg concurred in this opinion and recommended that Major Gorgas, on account of his previous experience in Havana, be placed in charge of the sanitary work in Panama. The contemplated route of the Panama Canal lay through a low, swampy, densely vegetated country, alternating with rugged moun- tainous regions, where the rainfall was excessive and yellow fever and malaria prevailed to an alarming extent. The French attempt, in the eighties, to unite the waters of the Atlantic and Pacific by this isthmian route, although directed by one of the greatest engineering geniuses of all time-Ferdinand de Les- seps-had to be given up because of the enormous price paid in human lives. The French lost 22,189 laborers by death and sunk millions of dollars. It is said that the price paid in building the old Panama rail- road was a human life for each tie laid. One of the towns on this railroad was named Matachin, from the Spanish words meaning "dead chinaman," because a thousand imported Chinese laborers and a thousand African negroes laid down their lives at this point in six months. Colon at one end of the canal was a veritable white man's graveyard; while the town of Panama at the other end bore the un- savory reputation of being the plague spot of the universe. There 341 was poverty, there was vice, there was every noisome thing that crawls and creeps. There were pestilences, and the greatest of these were yellow fever and malaria-another mosquito-borne disease. Then came Gorgas with his trained corps of sanitarians-fresh from their victory in Havana. The story of the sanitation of Panama under the administrative, direction of Gorgas is'a long one, and I shall not bore you with details. Suffice is to state that by instituting sani- tary measures similar to those used in Havana-destroying mosquitoes, making habitations and hospitals mosquito-proof by screening, isolat- ing all suspected cases of yellow fever and malaria, removing under- brush, filling and obliterating stagnant pools and swamps, paving and guttering streets, and installing sanitary water supplies and sewerage systems, Gorgas entirely eradicated yellow fever within a year, and there has not been a single case of this disease in the Canal Zone since May, 1906. Coincidentally with the disappearance of yellow fever there was a drop in the incidence of malaria. At the beginning of this great sanitary campaign 800 cases of malaria occurred annually in each thousand workers. By 1913 the rate had been reduced to 76 per thou- sand. The general annual death rate in the Canal Zone from all dis- eases at the present time is about 20 per thousand-a figure comparing very favorably with that of New York or Washington. The work of Gorgas alone made possible the building of the Panama Canal. But this is not the greatest benefit derived from that tremendous task, so spectacularly and effectively accomplished. By salvaging the Isthmus of Panama through sanitation the great lesson learned is that the tropics can be made as habitable for white men as the temperate zone. How different would have been the history of the Americas had it been learned 300 years earlier. In contemplating this-the greatest achievement of modern times- let us not forget Walter Reed-and experimentation. The triumphs over typhoid and yellow fevers have not been the only scientific achievements of the Medical Corps of the Army. Did the time allotted to me permit I would tell you of the work of Stern- berg, the first American bacteriologist, discoverer of the diplococcus of pneumonia, pioneer worker in yellow fever, author of important treatises on infection, immunity and disinfection, founder of the Army Medical School, and a former surgeon general of the Army; of the demonstration by Ashburn and Craig that dengue fever is due to a filterable virus and that it is transmitted by the mosquito and amenable to prevention by the methods successfully used in malaria and yellow fever; and of the work of Chamberlain and Vedder, who, by experi- ments on fowls, disarmed the tropical disease beri-beri-tearing from it its mysticism, robbing it of its terrors and placing it in the category of curable as well as preventable diseases. The conquest of hook-worm disease in Porto Rico, work based largely on the demonstration by experiments on animals that the para- 342 site enters the body through the skin, is the work of Bailey K. Ashford, a medical officer of the Army and a graduate of your own university- Georgetown. Many other instances might be enumerated of scientific endeavor redounding to the benefit of humanity. Those cited, however, should be sufficient to show that all advances in preventive medicine have their basis in experimentation-on animals as a rule, but on men when necessary and justifiable. Without animal experimentation we must inevitably stagnate, and many pressing questions as to the cause and prevention of devastating epidemics of transmissible diseases-influenza is one of these-must remain unanswered. I submit to you-shall animal experimentation be prohibited or no ? THE LABORATORY WORK OF THE UNITED STATES PUBLIC HEALTH SERVICE. By A. M. Stimson, Surgeon, U. S. P. H. S. Assistant Director, Hygienic Laboratory, Washington, D. C. In an attempt to familiarize you with some of the laboratory re- searches of the U. S. Public Health Service, I find it necessary to select certain illustrative examples from an almost endless list. The Public Health Service did not launch into existence on any definite date, save in name. Its development was gradual. From time to time as the emergency arose, Congress assigned it new duties and granted it fur- ther power. The purpose of the Service in general may be stated to be the promotion of public welfare by conserving and improving the health of the inhabitants of the country. In order to carry out intel- ligently and efficiently the duties laid upon it by law, the Service has had to engage in a great deal of laboratory work. In the course of this work it has been absolutely essential to use the lower animals. Before taking up in detail a discussion of the particular functions of the Service, it is necessary to make clear what is meant by "the experimental method." If we review the works of the ancients, we find that there was no lack of intellectual acumen among them; in literature and in the arts they give abundant evidence of high mental powers. Why was it, then, that in matters of science they made very little) progress, and that for centuries medical science especially was in a state of almost complete stagnation? The difference, I believe, is readily traceable to the lack of proper methods. Just as in mathe- 343 matics the lack of the calculus prevented the solution of a certain math- ematical problem, so in the physical sciences the lack of the experi- mental method effectually barred the door to progress. We can easily imagine that primitive man was satisfied with the explanation of a thunderstorm that it was due to a combat between devils fighting above the clouds. His explanation of disease was akin to this with the one exception that the conflict was limited to his own interior. In ancient India the Brahmins have accumulated some very interesting anatomical information; for example, they stated that in the human body there are 100,ObO vessels, each divided into seven tubes, which carry ten different kinds of gases to all portions of the body. Moreover, the origin of the pulse they located in the abdomen; it was said to be two hands high and three hands wideband from it little tubes radiate to all parts of the body. When Greece was in her prime her philosophers had elab- orated a most intricate system of medical doctrine; indeed, their theo- ries curried favor far down into the period following the Rennaissance. Disease was due to the conflict of various humors and spirits which cir- culated throughout the body. It will be noted that all of the philos- ophers up to this time had approached disease from a purely theoreti- cal standpoint. Investigation on the body by dissection and experi- ment had been resorted to very rarely and very superficially, and the practical knowledge of the prevention and cure of disease was, to all purposes, negligible. Let us contrast this mode of introspective philosophy with the method used by William Harvey, discover of the circulation of the blood. This great scientist, who was one of the earliest to use the experimental method in its perfection, actually dissected the body of man and of the lower animals; he conducted experiments on the living bodies of animals, and only after he had carried on his investigations for more than ten years did he venture to make public the results. These findings were so at variance with the accepted doctrines which had been handed down from the Greeks that Harvey was derided and maligned, but it is gratifying to note that within his own lifetime his views were accepted and his practices emulated. The remarkable progress of recent years in the medical sciences is directly traceable to the methods of experimental investigation introduced by William Har- vey and other men of courage who were unwilling to sponsor unsup- ported tradition and who had to see with their own eyes before they tabulated conclusions. The U. S. Public Health Service has, of course, found much of its information concerning disease ready made. Other data it has established by experimental anethods, and it is important to see that not only in beginning work related to public health is it necessary to use information gleaned from experimental methods involving the use of animals, but that in the actual continuation of the work after routine fashion, it is imperative to rely upon the same. 344 Bubonic Plague. I have selected as the first illustration of the laboratory work of the Service its operations in connection with a disease which probably has solicited the attention of but very few persons in this audience. Bubonic plague, to the average person, is looked upon as a distant, tropi- cal, exotic disease little to be worried about, and my reason for select- ing it is the fact that were it not for the employment of methods which were learned from experimentation this plague might very well be in our midst today. Daniel Defoe has handed us a pen picture of a plague epidemic in London; that this was not overdrawn has subse- quently been proven by many historic recurrences. Fancy a city dis- tracted, the inhabitants rushing about in a frantic effort to escape the pestilence, only to be met at the borders of the city by armed guards stationed to prevent their exit; unburied bodies line the streets and abandoned children are left to starve; traffic and commerce is dis- organized, famine follows close upon pestilence. Such occurred in the days before science pointed out the cause of the plague and of its spread and suggested a rational, effectual mode of combating the disease. At the present time there is an infection of this plague in one of our larger American cities, yet no panic reigns, tourists visit the city in large numbers, and all is apparently prosperous. This because there is constantly being carried on in that city a quiet, effective campaign to meet the emergency. The experimental investigations have shown that plague is essentially a disease of rats; that it is conveyed from rat to rat, and may be communicated from rat to man through the flea. With this known it is found to be practicable to prevent the spread of plague by systematic examinations of rats captured in all portions of the city. When a plague rat is trapped intensive antirat operations are carried on at the place where this rat was apprehended, and thus an incipient focus of plague infection is wiped out before gaining head- way. The claim that general methods of sanitation will effectually prevent plague epidemics is unsubstantiated; they merely limit rat infestation. Diphtheria. Turning now to a disease more familiar to us I shall review the work of the Service on diphtheria. Diphtheria continues to be preva- lent, chiefly because the germ which causes it may be carried about in the noses and throats of perfectly heafthy persons. Since it is im- possible to examine an entire population in order to discover who these so-called "carriers" are, and since it would be impossible to quarantine them all when apprehended, the efforts of health officials have been only in oart successful toward eliminating the disease, but by method? 345 which were devised by animal experimentation it is possible to reduce the death rate from this disease to a very favorable figure. For ex- ample, the method of making an early diagnosis by laboratory methods has enabled us to treat cases earlier and more effectually and to pre- vent infection of those who associate with these cases. Diphtheria antitoxin also is one of the most remarkably efficient remedies known to man. But suppose no supervision were exercised over the manu- facture of this antitoxin, and that inert and worthless samples of the product were freely marketed, we can readily estimate how many lives would in consequence be sacrificed. The Public Health Service controls the manufacture of antitoxin, making sure, by methods of animal experimentation, that this product as it. is sold in the drug store is potent and reliable. Furthermore, by animal experimentation a method has been devised for examining the bacteria which cling to the throats of patients following their convalescense to determine whether they are dangerous to others or not. Serums and Vaccines. The Service supervises in like manner the commercial production of many other serums and vaccines which are used for the treatment of various diseases. I may mention in this connection the serum for tetanus, or lockjaw, through which many a soldier in the trenches was saved to the nation. Typhoid vaccine, a product of great efficiency, is standardized by methods in which animals are used; rabies vaccine more familiarly known as the Pasteur treatment for Hydrophobia, is prepared by the Service, and its preparation necessitated the use of animals. This list might be prolonged indefinitely, but it is safe to say that there is scarcely any useful product of this general class which has not necessitated the experimental use of animals, either in its dis- covery, in its preparation, or in its standardization. At the jDresent time there is being conducted throughout the United States an energetic crusade against venereal diseases. While these diseases involve a moral problem for all, to the sanitarian they present also a purely medical problem. Hence it is essential that every-person known to be infected from syphilis should be treated to prevent his being a menace to those with whom he may come in contact. To effect this arsphenamine is preeminently efficient. The preparation of this substance is difficult, and, unless the greatest care is taken, a product may be issued for distribution which is unduly poisonous and would, if administered to patients, beget most disastrous results. The Public Health Service is charged with the duty of examining each batch of this substance offered for sale. To do this the lower animals must be used. From time to time reports reach the Bureau of the U. S. Public Health Service of the occurrence, in this or that part of the country, of 346 a new or rare disease. This calls for an immediate investigation to ascertain whether this condition is likely to spread and become serious, or possibly to end in a nation-wide menace. Such have been pellagra, Rocky Mountain spotted fever, the so-called "deer-fly disease," and a disease called after; its discoverer, Dr. Brill. In nearly all of these instances it was imperative to make extensive inoculations of animals in order to determine the nature and cause of the disease, to find out what animals beside man might be afflicted with it, and, in some in- stances, to devise a remedial agent. During the war a considerable number of cases of anthrax, or malignant pustule, occurred among soldiers, and an investigation, in which the use of animals became necessary, showed that these cases were due to a natural infection of shaving brushes through the hair from which they were made. Regu- lations were immediately issued to inhibit the use of harmful material in the manufacture of these articles. Tuberculosis., We have with us at all times a disease which is so common that we perhaps do not fully appreciate what a tax it entails on the economy, the health and the happiness of the populace; tuberculosis occurs ac- tively in perhaps 1 per cent of the population and occasions at least one out of every ten deaths. If this occurred in an isolated epidemic we should be appalled. Great as have been our advances in the knowl- edge of this condition, there remains much to be investigated and learned. We have been obliged to experiment upon animals in ob- taining our present information and this practice will necessarily con- tinue, if we are to find out more. The Service is at present engaged in an experimental investigation of tuberculosis with the view to dis- covering some method which will aid in the fight against this insidious malady. Every now and then a new and wonderful cure for tuber- culosis is ushered in with much sound of trumpets and flaring head- lines in the newspapers. Some of these so-called "remedies" are little less than unadulterated, heartless fakes; others are somewise bolstered by scientific plausibility; unless the public be informed by a reliable authority as to the true merits of these "cures" a most pitiable state of affairs is likely to transpire. Sufferers from all parts of the country, many of them in the last stages of the disease, many having spent their last cent for railroad fare, flock to the center where this new remedy is obtainable, only to share disappointment, and frequently to die from exhaustion. It is felt that the Service in investigating and furnishing the public with reliable information on the subject of certain of these reputed "cures" has rendered a valuable service to the country. In such investigations it is necessary to use experimental animals, as it is, indeed, in arriving at a diagnosis in many suspected cases of tubercu- losis. 347 Other Problems. Probably no drug is more freely prescribed in diseases of the heart than is digitalis. Yet unless this remedy is of a standard qual- ity, it is apt to be harmful rather than beneficial. Accordingly, with the aid of animal experimentation, the Service has formulated a test which unquestionably establishes the strength and purity of the drug. It has been recently estimated that there are perhaps a million persons in the United States who are addicted in some degree to the use of habit-forming drugs. The pernicious effect of these drugs on the individual himself and on the civilization of which he is a unit are well known; and yet there is a real need for the alleviation of pain and other symptoms of drugs which have an action similar to the habit-forming drug, but free from this distressing feature. Some progress has already been made in devising suitable substitutes, and in this work an indispensable factor has been the use of animals. Those opposed to vivisection and, indeed, to animal experimenta- tion generally, are accustomed to characterize many of the investiga- tions carried out by scientific men as being due to idle curiosity. It is true that investigations are made into various phases of the disease problem without there being at the time any apparent way in which the information gained can be practically applied. Nevertheless, such information sooner or later is almost certain to merit its place in devis- ing something of value to humanity. One instance, as an example of this, is anaphylaxis. If horse serum be injected into a guinea pig, even in large amount, it ordinarily provokes no appreciable effect, but an investigator noticed that if, after an interval of ten days or more, another injection of horse serum be given the same animal, it acts as an acute poison, often killing the animal within a few minutes. This finding invited the closest research. No immediate practical benefit to mankind was at first anticipated, but, as a matter of fact, the infor- mation thus gained has been of great value in diagnosing hitherto obscure disease conditions in man and in suggesting preventions and cures. Another example: During the examination of the bodies of rats for plague infection, a disease of quite different origin, but closely simulating plague in the lesions caused, was unexpectedly brought to light. Through animal experimentation the bacterium causing this disease was cultivated. No immediate bearing of this fact on human health or happiness could be foreseen, yet within a very few years it was discovered that many could suffer a distressing infection due to this same organism. Problems regarding measles, infantile paralysis, hookworm and the like placed before this Service for solution might very profitably be called to your attention, but time- forbids. In concluding I beg leave to advise you that the benefits which have accrued to man con- sequent to animal experimentation have touched not only physical 348 but aslo his moral well being. It is true that vice predisposes to disease, but it is no less true that disease, innocently contracted, brands as a criminal one who otherwise would have been a useful citizen. There so appears here a vicious circle between disease and crimi- nality ; there are those that would break the continuity of this circle in the reformation of all criminals, and we wish them well, but surely it is not a step toward the wrong if, with the means at our disposal, we, too, interrupt this closed line, ridding the community of the dis- eases, which, directly or indirectly, are responsible for a great part of it. THE ECONOMIC ADVANTAGES DERIVED FROM ANIMAL EXPERIMENTATION By Ernest Charles Schroeder, M. D., D. V. M. Superintendent, Experiment Station, U. S. Bureau of Animal Industry, Bethesda, Md. The economic advantages derived from animal experimentation are so abundant and diverse that it is impossible in the time I am privileged to discuss them to do more than indicate their far-reaching importance. To verify this statement I need ask only a few questions like the following: Is it an economic advantage to have the Panama Canal? Is the defeat of Pan-Germanism an economic advantage? Is it an economic advantage to have food and clothing in sufficient quantities to insure health ? The Standard Dictionary defines economics as "the science that treats of the development of material resources, or the, production preservation and distribution of wealth, or the means of living well for the state, the family and the individual." If we accept this definition we may conclude that anything, not an actual, inseparable part of ourselves, that contributes to the better development of the human race and tends to make life more desirable, is an economic advantage; hence, the rational answers to the several questions must be affirmative. The Panama Canal would not have been built if animal experimen- tation had not revealed the etiology of yellow fever. The French failed to build it, not because they lacked intelligence, courage or perse- verance, but because they did not know how to combat yellow fever. Under the same conditions the Americans would have failed. If the Canal had been constructed with no better knowledge about yellow fever than was available at the time the French abandoned the gigantic project, after they had sacrificed more than twenty-thousand lives, 349 success would-have cost so many valuable lives that the very thought of it is horror inspiring, and the established short-cut between the Atlantic and Pacific Oceans probably would have proved so perniciously unwholesome and destructive to those who used it that it soon would have earned a name for itself something like, "dhe water-lane of the yellow death." What the Canal has done and promises to do in the conservation of man-power, time, shipping, fuel, etc., and how much it will facilitate the development of the world and particularly the countries on the western coast of the two Americans, I leave to your imagination. If animal experimentation had not provided vaccines, bacterins and antitoxic sera; if it had not aided in the development of new methods of surgery and the discovery of reliable means to diagnose infectious diseases, and had not taught us how to use war gases and how to defend our soldiers against them, the recent war would have cost many additional thousands of lives and would have produced many additional thousands of cripples ; it would almost certainly have been prolonged and it is seriously questionable whether Pan-Germanism, with its numerous, villainous atrocities, could have been defeated. The economic significance of its prolongation, leaving morbidity and mortality out of consideration, may be judged from the estimate that the war cost the human race three hundred billion dollars, and about the economic meaning of defeat we should suspend judgment until we have tried to visualize the world under the domination of a victory- elated despot, whose megalomania, fostered by an exultant, reaction- ary, Prussian aristocracy, would have prompted him to assume the rank of a divinity. If animal experimentation had not taught us how to cure many diseases of the lower animals and how to suppress appallingly de- structive animal plagues, the hunger and starvation now prevalent in many parts of the world would be practically universal. I might say, however, if animal experimentation had not provided the means to control human diseases like small-pox, Asiatic cholera, bubonic plague, typhus fever, yellow fever, etc., it is not at all likely that the population of the world would have become great enough to make the spread of food-destroying diseases like rinderpest, foot and mouth disease, anthrax, Texas fever, hog cholera, surra, swine erysipelas, contagious pleuro-pneumonia of cattle, sheep scab, etc., economically very im-» portant, as food has no value for those who are dead and those who fail to be born. Vegetarians, who do not recognize the need for abundant supplies of meats, animal fats, wool and hides, and persons who hold extreme views on animal rights, may mistake this statement as an exaggeration. Their attention should be called to the fact that it is questionable whether sufficient food for the present population of the world could be produced without the use of animals to convert coarse, vegetable 350 substances, unfit for human stomachs, into easily digested, nutritious food, and to the fact that, in addition to serving as indispensable sources of food, clothing, power and pleasure, domestic animals are so importantly, related to the production of vegetable foods and textile fibers that practical agriculturists are convinced that the cultivation of the soil without animals is economically impossible. The spiritual and intellectual nature of man requires that we should look upon him as a unique and unparalleled being, but materially, that is physically and chemically, he is not fundamentally unlike the higher mammals; consequently, most knowledge valuable for the protection of man's health and the treatment of his diseases is similarly valuable for the lower animals, and discoveries, like the circulation of the blood; the capillary circulation; the vasomotor mechanism; the functions of the nervous system generally; the flow of the chyle in the lacteals and its passage through the lymph ducts into the venous circulation; the nature of the digestive fluids and the chemical transformation of food through their action; the functions of the liver, lungs, kidneys and other organs, the reaction of the cells to various kinds of stimuli; the significance of the endocrin glands; the nature of inflammation and other pathological processes, and practically every other discovery in physiology, pathology and biochemistry, are as serviceable in the work of the animal husbandman and veterinarian as in that of the hygienist and physician, and in this sense have great, material, economic value. The discoveries referred to, and many others, too numerous to mention, were all made through'animal experimentation, and could have been made in no other way that has ever been defined. Veterinarians and physicians use drugs, and if the pharmacopoeia contains valuable drugs about which our knowledge has not been enriched through animal experimentation, I must confess that I do not know what they are. A superficial and insufficient knowledge of the actions of some drugs was admittedly obtained through accidental or unintentional, unguarded and undesirable occurrences among per- sons and animals, but the precise knowledge we have of the therapeutic, physiologic and toxic actions of the innumerable substances from which our useful drugs have been selected, is all the product of care- fully planned, intelligent animal experimentation. If we did not know through animal experimentation how the drugs now in use act, on the body as a whole, on special parts of the body, directly or indirectly through the nervous system, and whether their action is immediate or cumulative, the death rate among persons and animals would be griev- ously multiplied, and the greater losses among the latter would prove a factor of serious, economic disadvantage. Before experimental methods were used to study living organisms in health and disease, the practice of medicine was little better than a presumptive art, based on disconnected and largely misinterpreted observations, and sick persons and animals were tortured as often, if 351 not oftener, than they were helped by the measures taken to restore their health. Since then, fortunately for all sentient beings, medicine has become a true science, and those who practice it make real, un- mistakable contributions to recovery from sickness, the preservation of health and the prevention of suffering. In animal industry this means fewer losses and greater productivity, or, in other words, better and less expensive food and apparel. I wish to emphasize that nearly every discovery that has thrown light on the nature of the human body and its relation to its environ- ment has also thrown light on the nature of the bodies of the lower animals and their relation to their environment, as this fact enables us to recognize that even that portion of animal experimentation, primarily undertaken to secure knowledge for the prevention and better treatment of human diseases, rarely fails to confer benefits on the lower animals; hence, if the proportion between the pain animal experi- mentation has caused and prevented among animals alone was taken as the major factor in determining whether animal experimentation is or is not morally sound, we would not be left in doubt a single moment, as the pain that has been caused is insignificant in comparison to that which has been and is being prevented. The men who treat diseases among animals probably relieve more pain every day than animal experimentation causes in a score of years, and they do this through the agency of the knowledge animal experimentation has supplied. Diseases of animals like those of persons may be divided into two kinds, the infectious and the non-inf ectious, or those caused by para- sites and those due to other causes. The economic advantages derived from animal experimentation, through the light it has thrown on the infectious diseases of domestic animals, are of astounding value, and this can be shown in no better way than by discussing several of them separately. I will begin with Texas fever of cattle, which has the distinction of being the first disease proved to attack its victims exclusively through the agency of intermediate host or carrier of its causative germ or microparasite. It is a member of a large group of exceedingly de- structive, infectious but not contagious, diseases; other members of the group are malaria, yellow fever, typhus fever, Rocky mountain spotted fever, African sleeping sickness, spirillosis of fowls, nagana, African coast fever of cattle, piroplasmosis of horses and sheep and dogs, etc. The intermediate host of Texas fever is the Southern cattle tick, a blood-sucking parasite which absorbs the germs of the disease with its food when it lives on the bodies of infected cattle. The female ticks, after they reach maturity, drop to the ground, produce two thousand or more eggs, the eggs hatch and the young ticks inoculate the susceptible cattle to which they attach themselves. It is perfectly safe to permit healthy cattle to association with those that are affected 352 with Texas fever, provided no cattle ticks are present, and cattle ticks do not convey or cause the disease unless they are the progeny of ticks' that matured on the bodies of infected cattle. Infected cattle, when we deal with Texas fever, means all cattle that are either actively affected with the disease or that have apparently recoverd from it, as the Texas fever microparasite, once it has entered the blood of cattle, evidently remains as a permanent contamination. In one of the lectures of the present series Dr. Simon Flexner of the Rockfeller Institute for Medical Research expressed the opinion that our knowledge of yellow fever would in all likelihood have been delayed if the work of the Bureau of Animal Industry of the U. S. Department of Agriculture on Texas fever had not been done. I have already pointed out that the Panama Canal would not have been constructed without the knowledge animal experimentation gave us on the etiology of yellow fever. Think of the modest investigator whose patient study of a mysterious cattle disease proved a great pioneer work in the field of medical research, and incidentally opened the door to knowledge required for the junction of two oceans at a point thousands of miles removed from where nature permitted their waters to mingle. Draw a mental picture of the man and his work; it will give you an inspiring view of intellect successfully combatting evil. But it is unnecessary in speaking about Texas fever to dwell longer on the role of animal experimentation in the accomplishment of a great engineering feat, as there are other impressive and exceedingly important things to talk about in connection with this disease that must also be credited to animal experimentation. Less than fifteen years ago the prevalence of Texas fever and cattle ticks in our Southern States necessitated the maintenance of a cattle quarantine which included an area larger than three quarters of al million square miles, known as the permanently infected area. In this area, more than three and one-half times as large as the French Republic and nearly three and one-half times as large as the former German Empire, the losses caused by Texas fever and its carriers were enormous, to say nothing about the frequent, troublesome spread of the disease northward. Most of the cattle raised were undersized, large-boned, unthrifty mongrels and inferior producers of milk, meat and hides. Much of the food they consumed was worse than wasted, as it was diverted from sharing in their growth and development, after their bodies had been taxed with digesting and converting it into blood, to feed the ticks which irritated the surfaces of their bodies and the microparasites which lived beneath the surface. A fairly reliable idea may be formed of the losses caused by ticks alone when we know that female cattle ticks multiply their size and weight by about ten-thousand during the approximately four weeks they remain attached to the skin and feed on the blood of their hosts; 353 that the adult female tick is about as large as the terminal joint of a woman's little finger, and that ticks of all ages and sizes, often in unbelievable numbers, are present on the bodies of the cattle in the infected territory during the greater part of the year. A light infestation with ticks has been proved to reduce the milk yield of dairy cows 18%, and a heavy infestation reduces it more than 40%. Think of the loss, to which must be added the loss, in beef pro- duction, the lower value of roughened and scarred hides and the deaths due to Texas fever, which latter, averaged for eleven states, amounted to 13%, or a half per cent more than one-eighth of the total cattle. The reason cattle could be raised at all in the infected and infested territory is that Texas fever in calves rarely is the severe, acute, highly fatal disease it commonly is in susceptible adult cattle. It attacks the calves, has a mild, chronic course, plants its microparasites permanently in their blood and gives them a high degree of immunity against severe attacks later on. Agriculture may be compared to a complex machine; there are many parts to it, and if one part gets out of order all the others are affected. The cattle industry is as necessary to American agriculture as tires are to an automobile, and to practice agriculture with cattle ticks, Texas fever' and a cattle quarantine, resembles driving an automobile over a rough road, littered with cutting and puncturing objects and under- going constant repairs that require long detours. Hence, it is not surprising that agriculture in many parts of the quarantined area was unprosperous and that the farmers and breeders were discouraged and depressed. In the year 1906, the methods for eradicating Texas fever and cattle ticks, revealed through animal experimentation, were put into practice by the U. S. Bureau of Animal Industry, and since then, over half a million square miles, a territory one-hundred thousand square miles larger than the combined areas of the French Republic and the former German Empire, have been cleaned of the disease and its carriers and released from quarantine, and in only a few years more the two related plagues will have been wiped entirely out of our Country. Fully to appreciate what this means, and to measure its economic value, we must know that the formerly infected and infested, quaran- tined territory includes some of the best agricultural and cattle lands in the world, and that it has begun to produce cattle that compete successfully, and on terms of equality, with the finest that enter our stockyards, and that recently it has produced cattle that captured blue ribbons at National livestock shows. The farmers and breeders have taken heart and are working with renewed courage, and increased prosperity and contentment are widely evident. The choice, well- bred, healthy, heavy and profitable cattle are being produced at no greater expenditure of labor and forage than the undersized, suffering 354 runts required, as cattle raising and feeding has ceased to mean raising and feeding a combination of cattle, cattle ticks and Texas fever parasites. It is now safe to send cattle from the North into the rich pasture lands of the South, where, a little while ago, it was unsafe, notwithstanding difficult precautions, to send thoroughbred animals for breeding purposes. Think of the economic advantage. Think of the increased produc- tion of food, think of it with the fact in mind that well-informed men assert that the morbidity and mortality in the world directly due to undernourished are so great in many places that they over-shadow the horrors of the war. Those who are not informed about the evils incident to under-nourishment and long continued dependence on food that lacks essential nutritive elements, and how serious the food shortage in the world is today, may find it difficult to believe that millions of human beings in this so-called civilized age, beings and feelings, affections and souls like our own, are being stunted spiritually and physically and are being hurried prematurely out of life because they cannot get enough to eat or enough of the right kind of food, and yet this evidently is the truth. In the United States the population has increased faster than the number of domestic animals, and this probably is one of the causes for the high price of food. In Europe the war has reduced the number of domestic animals so much that a replenishment from Countries, ours included, in which the animal industry was less severely injured, is urgently needed. Let us take a look at another disease, about which much unfruitful guessing was done until the truth was learned through animal experi- mentation ; the commonest and most widely disseminated of all diseases, namely, tuberculosis. Animal experimentation proved that the manifestations of tubercu- losis in different portions of the body and in the bodies of different species of animals all have one, essential cause; it proved that the disease is contagious; it showed how and why it is contagious; it led to the discovery of the tubercle bacillus; it proved that the tubercle bacillus in nature is an obligatory parasite; it proved that the bacillus is quickly destroyed by light and may long remain alive and virulent in dark places; it proved that there are three types of tubercle bacilli, the human, the bovine and the avian; it proved that human and avian types have no important significance for cattle; it proved that the avian type is not an important cause of disease among mammals; it proved that the human type is the commoner cause of tuberculosis in human beings; it proved that children often are attacked by the bovine type; it proved that the bovine type is the commonest cause of tuberculosis among domestic mammals; it led to the discovery of tuberculin, without which, used as a diagnostic agent, the control and eradication of tuberculosis among food-producing animals would be impossible, etc. 355 If animal experimentation had not proved that tuberculosis among cattle can be eradicated, wholly exterminated, and its recurrence pre- vented, without regard to its continued persistence qmong human beings, the cattle tuberculosis eradication work, for which Congress now appropriates one and one-half million dollars annually, would have the character of a hopeless and ridiculous project, unless utterly unreasonable measures were taken to prevent the reinfection of cattle with tubercle bacilli from human sources. One of the difficulties in combatting tuberculosis, among persons as well as the lower animals, arises from its usually insidious, slowly- progressive nature, through which its subjects often become dissemina- tors of its germs long before their dangerous condition is suspected. Until tuberculin was discovered and its diagnostic value proved, no means were available to detect more than a small proportion of the existing cases of tuberculosis among cattle, and the overlooked and neglected cases, through their unavoidable introduction into healthy herds, insured a further, rapid spread of the disease. Just what this means in terms of economy may be judged from the fact that tubercu- losis among the cattle of some of the older and more densely popu- lated countries of Europe is from four to five times as common as it is among the cattle of our Country, and that it is from fifteen to twenty times as common among the cattle of our older and more densely populated, than it is among those of our newer and less densely popu- lated states. Through the use of tuberculin the cattle tuberculosis eradication work is making excellent progress, and this should be gratifying, as the disease is a food destroying evil which should not be left as a burdensome heritage to coming and more populous generations of mankind, who, no doubt, will find the production of sufficient food, even under normal as distinct from war conditions, more difficult than we and past generations have found it to be. The food producing area of the world is fairly constant; actually it does not change much from generation to generation; relatively it grows smaller as the population increases. Tuberculosis among animals in the United States alone, on the basis of the lowest estimate, which I am convinced is entirely too low, destroys at least twenty-five million dollars worth of urgently needed food per annum. This estimate was made before the war, at a time when milk cost the consumer eight and not eighteen cents per quart, and when prime, roast beef and porterhouse steak retailed at from eighteen to twenty-five cents per pound. What I have said about seemingly harmless but seriously dangerous disseminators of disease germs in speaking about tuberculosis applies also to other infectious disease; hence, the discovery of methods that help to distinguish more certainly between safe and dangerous animals reduces the difficulties that confront our efforts to control and eradicate 356 other costly animal plagues, and this is a field in which the economic advantages derived from animal experimentation are particulrly valuable. If the various biological tests for diseases, discovered during the last thirty years, had been in use a century or two ago, the importa- tion of several destructive animal plagues, now causing heavy losses in the United States, could have been prevented. For example, our Government is successfully eradicating a disease among horses known as dourine, which entered the United States and gained a foothold because its virus is at times carried by horses which show no symptoms of their dangerous condition. The closest study of such infected horses during the period of time imported animals are subjected to quaran- tine does not lead to their detection; the complement fixation test for dourine detects them at once; the test was not known until after the unfortunate importation of the disease. This plague would continue to spread rapidly unless impossible sums of money were spent to check it if the apparently innocent carriers and disseminators of its causative microparasites could not be distinguished through the agency of the test animal experimenta- tion has supplied. Horses may not be as indispensable today as they were before tractors, motor-trucks and other types of automobiles came into use, but the prices asked for them indicate that it will be sometime before we can get along without their services or afford to neglect their diseases. To offset the example I have given of an instance in which a bio- logical test was discovered too late to exclude an animal plague from our Country, though early enough to insure its eradication, I will give one in which a test was available early enough to exclude a more serious plague. The disease in this instance is surra, a pernicious evil, indigenous in the southern portion of Asia, from which it has been spread to several other portions of the world, and which is not at all choice in its victims, as it may attack such widely different species of animals as cattle, horses, sheep, goats, camels, elephants, monkeys, rats, etc. In cattle surra may run a mild course, but once they are atacked they are apt to carry its microparasites in their blood and to remain sources from which the disease spreads for a long time. A little more than a dozen years ago an attempt was made to in- troduce a herd of about fifty East India cattle into the United States, to be used in Texas, where it was believed the native cattle could be made resistant to southern cattle ticks by crossing them with the Indian cattle, which are alleged to be strongly tick resistant. Repeated examinations of the blood of the Indian cattle were made before their departure from Asia and while they were en route to and after their arrival in the United States, and nothing to arouse suspicion was found; but, while they were in quarantine, rabbit inoculation tests 357 gave absolute proof that their blood was infected with the germs of surra. The economic advantages derived in this instance from animal experimentation, a pattern of things that repeat themselves over and over again, are so great, irrespective of whether we estimate them in money, in food saved or in suffering prevented, that they stagger belief. A somewhat similar story can be told about a threatened in- troduction, into the United States, with a shipment of milk goats, of Malta or Mediterranean fever, a disease of both persons and animals, which may exist in goats in a form that cannot be detected through other means than the use of a test which animal experimentation has given us. Personal experience which stamp lasting impressions on our minds often. make instructive illustrations. About thirty-five years ago I witnessed the examination, condemnation, slaughter and autopsy of a magnificent, handsome, vigorous, sleek and apparently healthy horse, owned by a wealthy man who maintained a stable of four or five horses for family use. Horse after horse in his stable had contracted acute, easily diagnosed glanders and had been condemned, killed and replaced, only this one fine animal seemed immune, until suspicion was directed to it as the probable source of infection, but not until seven or eight valuable horses had been lost. The owner expressed himself to the veterinarian in charge of his stable to the following effect: "If you believe that the circumstantial evidence which points to this horse as the source of infection is strong enough, I am willing that it should be killed, though it has never been sick during the time I have owned it, excepting that on one or two occasions it had a slight cold with a meager, clear, watery discharge from its nostrils." The autopsy revealed a group of small, perfectly typical glanders ulcers on the wall of the larynx and a few small, chronic nodules in the lungs, so located that they could not be detected in the living animal. During two years following the removal of this originally unsuspected source of infection from the stable, after which I have no record, no further cases of glanders occurred. If the mallein or complement fixation test for glanders, later products of animal experi- mentation, had been available at that time, every horse in the stable would have been tested immediately after the first case of glanders was discovered, and the seemingly healthy spreader of the disease found and prevented from causing further losses. Glanders is transmissible to man, and a hopeless, painful and disgusting disease when it attacks man. Its frequency among horses has enormously declined since it has become possible to pick out the seemingly healthy carriers and dis- seminators of its microparasite through the use of special tests which must be credited to animal experimentation. Think a moment and realize the significance of the following state- ment : If the narrow and ridiculous requirement was made that nothing should be favorably credited to animal experimentation but the pain 358 against which it has safeguarded the lower animals through the use of the tests it has given us to discover otherwise undiscoverable sources of infection, we would be obliged to admit that it has paid-for itself thousands upon thousands of times over again. Hog cholera is another disease that merits attention, as the losses due to it in some past years have amounted to a hundred million^ dollars, and in one year are alleged to have reached the two hundred million dollar mark. A serum and a virus to protect hogs against cholera have been developed through animal experimentation by the United States Bureau of Animal Industry, and are now widely used with excellent, economic results. Before they were available many hog breeders and feeders believed that it was a good business policy to assume that their crop of hogs would be destroyed by cholera and be a total loss, on a general average, about once every five or six years. The losses did not occur at regular, determinable intervals, so that a feeling of security could be enjoyed during the four or five years following a loss year. On the contrary, it could not be predicted in any year from the occurrence of previous years whether the hogs would go to market or whether the cholera would get them. This uncertainty did not encourage maximum production; the hog breeding and feeding business was unattractive to conservative men; it was too much like investing money in debatable securities that promise high rates of interest and too often prove utterly worthless. And, bear in mind, when the high rates were paid on money invested in the hog industry, it was the consumer who settled the bill. How much animal experimentation has affected the price of pork products may be judged from a statement made by the Secretary of Agriculture and recently published in a News Letter of his Depart- ment. This statement asserts that the losses from hog cholera in the United States have been reduced sixty per cent since the year 1913, and that this equals a saving of forty-one million dollars per annum. Let us measure this in food terms. Forty-one million dollars worth of hogs, assuming that the average retail price of pork products is forty cents per pound, amounts to one pound each of nutritious meat or fat on every one of the 365 days in a year for 280,820 human beings. The assumed average price of pork products probably is a little too high; make, it lower and the number of human beings benefited in- creases. The importance of the hog as a source of human food ranks next to that of the dairy cow. The money saved in the United States in one year, through the economic advantages the hog industry alone has derived from animal experimentation, invested in Victory bonds, would yield an annual income greater than the sum annually appropriated by Congress for the study and control of all the plagues that occur among the domestic animals of our Country. This is a fact which should be kept in mind by those persons who claim that our Government is more eager to 359 fly to the rescue of the sick hog than it is to care for the sick child. The clear-minded men in our Congress who are behind the appro- priations made for the protection of our animal industry are not moved by sentimental consideration for hogs or other kinds of livestock; not even by consideration for the 'breeders and feeders of domestic animals, or for any special industry or class of men. They know what a relaxation of the fight against the existing and possible evils that destroy food-producing animals would mean to the whole people of the Country, and that the health and welfare ofea nation depend on no one thing quite as much as an abundant supply of wholesome food. Lengthy dissertations, similar to the brief statements I have made about Texas fever, tuberculosis, dourine, surra, Malta fever, glanders and hog cholera, to show the value of the economic advantages derived from animal experimentation, could be made about other animal plagues, such as contagious pleuro-pneumonia, rinderpest, foot and mouth disease, anthrax, blackleg, sheep scab, etc., but our time is too short. Contagious pleuro-pneumonia of cattle was imported into the United States seventy-seven years ago. Animal experimentation, which definitely proved its contagiousness and further proved that various, seemingly feasible methods of control were useless, led to the adop- tion of the methods through which it was; speedily eradicated. If we had been tardy about applying the knowledge animal experimentation gave us, the losses from this plague soon would have mounted to hundreds of millions of dollars. Rinderpest, a terribly destructive disease of ruminants, which has repeatedly spread from its native place in Asia into and over Europe during and after wars, but has fortunately never reached the United States, is being controlled by a method similar to that which is effective against hog cholera. Permit me to give you a few statistics on this plague, as they will help you to comprehend how large the food problems are with which animal experimentation deals, and will show you that the question, whether such experimentation should or should not be hampered by legislation, cannot reasonably be settled by possibly well-intentioned but uninformed and emotionally misguided persons. Introduced into France after the Franco-Prussian war, rinderpest killed 56,533 cattle in two years. Introduced into Great Britian in 1865, it killed 500,000 cattle in 18 months. Introduced into Italy towards the end of the 18th century, it killed 3,000,000 cattle in three years. Introduced into South Africa it killed 980,000 cattle in the Transvaal in 1897 and 1,300,000 in Cape Colony during 1897 and 1898. Since I have touched on the subject of statistics, let me give you a few about other diseases. Anthrax, which is most fatal to sheep and cattle but also attacks a variety of other animals, including man, is 360 being controlled through the agency of a vaccine supplied by animal experimentation. In France, vaccination reduced the death rate due to this disease among sheep from 10% to 0.94% and among cattle from 5% to 0.34%. Rouget or swine erysipelas is a widespread disease in Europe, the losses from which were reduced through vaccination from 20% to 1.45%. Think of the enormous losses before vaccination; think of the more than 90% reduction in these losses. In one region in Europe, in wh^ch tetanus or lockjaw is endemic and apt to follow wounds of all kinds, 259 cases occurred among untreated horses, and not one among 7,000 which received injections of tetanus antitoxine. I advise the anti-vivisectionist who visits this region and accidentally steps on a rusty nail not to fight too hard against the preventive treat- ment for tetanus or lockjaw, because its discovery cost the lives of a number of experiment animals. Blackleg, like anthrax, is caused by a spore-forming, vegetable microparasite. The spores of both diseases live and retain their viru- lence long periods of time when they enter the soil, and on infected soil it is economically impossible to raise sheep and cattle unless they are immunized. The United States Department of Agriculture an- nually distributes from two to four million doses of blackleg vaccine, because the men who raise cattle in portions of our country where the infection exists have learned through experience that the losses from blackleg among their young stock, unless it is immunized, are unbear- able. Practical men do not look upon the use of antitoxic sera, vac- cines, bacterins and other biological products as an academic question or a subject for sentimental speculation. With them a thing must pay; else it is discarded. Quack remedies may receive a trial but are soon discredited, and when thousands of level-headed business men demand and use the same agent year after year, it must have real virtue. About foot-and-mouth disease we know relatively little, although we do know how extremely contagious and destructive it is, and that it may attack a number of different species of animals. The recent outbreaks in the United States should be fresh in the minds of those who are interested in the source of our daily food. To keep this plague out of the country, to detect it at once when it gains entrance, to suppress it without extravagant and unnecessary expense, is possible only through tests in which living animals are used. Through animal experimentation it has been proved that this plague, the losses from which would soon mount to unbelievable figures if it were permitted to ravage unchecked, may be imported in ways that cannot be opposed by animal quarantine. Sheep scab, which at one time threatened to destroy the wool- growing industry in some parts of the world peculiarly adapted for sheep culture, has become a relatively unimportant evil through animal experimentation. The mysteries of infectious abortion disease of cattle, an evil 361 which might have been kept out of our country if the agglutination or complement fixation test had been available early enough, are gradu- ally but surely being revealed through animal experimentation, and this widespread, chronic plague, prevalent especially among dairy cattle, and which is estimated to cost the Nation upwards of forty million dol- lars per annum, it is hoped will soon be amendable to control. It is an uncommonly prolific disease in those unsuspected and dangerous carriers and disseminators of infection which can be detected only through the use of the special biological tests. As I indicated in the introductory paragraph of my address, the economic advantages derived from animal experimentation are so great, numerous and varied that only the high points can be touched here and there in the time at my disposal. Volumes could be written on the subject without exhausting it or doing it justice. For instance, I have not referred to the excellent work that has reduced the losses caused by the larger parasites of domestic animals, parasites about which we have gained much knowledge through animal experimentation and about which more, urgently needed knowledge can be gained by further experimentation, as is well illustrated by the light recently thrown on the life history of the ascaris, a large parasitic, round worm with which most persons are acquainted. This worm, which inhabits the intestine in its adult stage, is now known to have a larval stage during which it lives in the lung, where it can cause inflammatory proc- esses and may be found to be a direct and secondary cause of trouble. Another line of experimentation I have not referred to concerns animal foodstuffs, a field in which an enormous amount of work has been done, the value of which lies not only in securing the best balanced and most economical rations for animals, but also in making foods available which, if their value had been determined by accidental occurrences, would be a total waste,, as is shown by the history of cotton-seed products as food for animals. The early use of cotton-seed products caused many deaths among cattle and was particularly fatal to swine. Today cotton-seed products must be ranked amortg the abundant and very nutritious feeds of domestic animals. Thanks to animal experimentation. You see it is a large subject. Those who are in doubt about the value of the economic benefits derived from animal experimentation should first learn what they are and then try to determine what this world would be like today if unreasoning sentimentality had led us to place animals on a plane too high to justify their use for experimental purposes. Ask what it would mean to have a long list of parasitic and microparasitic diseases ravag- ing unchecked, each causing yearly losses that could be expressed in no less than seven, eight and nine figures, and the total of which in our country would require ten figures. Remember the part animal experi- mentation played in the construction of the Panama Canal; in the enor- mously increased prosperity of a territorial area in the United States 362 great enough in size and fertility to maintain a population in excess of one hundred million human beings; in the exclusion of foreign food and apparel, destroying diseases and in the control and eradication of infectious diseases native to our soil and those that unfortunately entered from without. And, while thinking of these things, bear in mind that, though great things have been accomplished, much remains to be done. The experimental method of studying living organisms and the things that may affect them beneficially and adversely is comparatively new. Practically everything we know about physiology, pathology, biochem- istry and the actions and uses of drugs is less than a few hundred years old, most of it less than a hundred years, and practically everything we know about infectious diseases, excepting that they are communicable and harrowingly destructive, is no older than many men who are now alive. I myself remember when the contagiousness of tuberculosis was a common subject of controversy; when it was profoundly believed that the disease was hereditary, and when Koch's discovery of the tubercle bacillus was regarded as an amusing claim rather than a great, mo- mentous addition to our knowledge. We must go unhampered in this work; to check its progress, to put obstacles in its way, to delay the acquisition of the further knowl- edge it will give us, means ingratitude to the splendid workers who have provided the foundation on which we can build; inhumanity to those who look forward hopefully to relief from numerous preventable causes of pain, sorrow and loss, and good reasons to expect the con- tempt of unborn and more enlightened generations. Animal experi- mentation truly is a lamp that has illuminated many dark places, and the light from which is urgently needed to expel remaining darkness. Do not permit it to be extinguished or dimmed. Only a few words more, and they concern the opinion expressed now and then that future generations will laugh at what we call our knowledge as we have laughed at some of the so-called knowledge of past generations. We should not quarrel with this opinion when it is limited to hypotheses and theories, which are rarely permanent and which every educated person accepts as temporary substitutes for unobtained knowledge. But its application to demonstrated facts is wholly another matter, which fails to take into consideration that the longest and most important stride forward in the world's intellectual development of which we have any record, so far as material things are concerned, was taken when the experimental method to gain knowl- edge was adopted. And now I am talking of the experimental method generally, and not specifically of that part of it which necessitates the use of living animals. The experimental method has made it possible to discover and prove facts, to distinguish between facts and theories, and to discard untenable beliefs and hypotheses. Facts are permanent additions to 363 the sum total of human knowledge and constitute real knowledge. The present generation does not laugh at the facts revealed and proved by past generations, and coming generations will not laugh at the facts our generation reveals and proves. The experimental method, which insists on demonstration before acceptance, has the healthy responsi- bility for our present low valuation, not of the real knowledge of any age or time, but of the speculative philosophies and sophistries which burdened the minds even of wise men before it came into use. THE ACHIEVEMENTS IN DENTAL MEDICINE AND ORAL HYGIENE. By Ralph A. Hamilton, M. D. Professor of Bacteriology and Pathology, Georgetown University Medical School. To one in constant contact with the varied phases of human suffer- ing occasioned by disease; to the laboratory worker, whose life is con- secrated to the task of seeking out the hidden causes of disease; to the sanitary officer whose duty calls him to protect the health of the community ; to the armies of trained investigators whose mission is to protect the world from the ravages of epidemic and pandemic disease, the question of being obliged to defend the methods necessarily em- ployed seems, at first glance, to be an insult to the public intelligence. During the present period of world-wide stress we find ourselves witness to an example of experimental legislation that seriously im- pairs our personal liberty in this theoretically free country. By simi- lar methods of pernicious propaganda the opponents of vivisection, without justification other than motives of misguided sentiment, for the sake of a comparative handful of animals, contemplate the destruc- tion of the entire fabric of scientific medicine, and by retrograde metamorphosis would relegate us to the middle ages to prescribe imaginary remedies for diseases as they exist in the nomenclature of speculation. It is of utmost importance that the public be placed on guard against this insidious campaign of distortion and misrepresenta- tion, which, if successful, would stay the march of medical progress, would destroy the possibility of an exact medical science and would result in greater toll of human life than imagination can conceive. In the limited time at my disposal I shall endeavor to show the necessity for animal experimentation in the practice of dentistry, and 364 by the introduction of some of its problems point out the future possibilities of an art so closely allied to that of medicine that the border line between the two professions becomes obliterated. I he evolution of dentistry as a science parallels that of medicine to such an extent that discoveries in either branch have left a common impress. The Egyptians practiced as specialists at an early date, and mummies recovered from their resting places bear mute testimony to the .dexterity with which the teeth were filled and crowned with gold. At the school of Salernum instruction was given in the surgery of the mouth and operations bn the teeth. Under the influence of this school dentistry was taught as a part of the surgeon's routine practice. France in 1700 was the first country to recognize dentistry as a specialty. The first complete treatise on dentistry was written by Fauchard in 1728. Previous to this date gleaners of dental literature must seek the medical and surgical writings. Three centuries ago, Francis Bacon made an exceedingly accurate comment on the practice of medicine. "Medicine is a science which hath been, it is said, more professed than labored; and yet more labored than advanced ; the labor being in my judgment rather in circle than in progression; for I find much iteration, but small addition." The accuracy of Bacon's diagnosis remained unchallenged for nearly 200 years, when Jenner in 1796 presented his gift of vaccination to human- ity, and fifty years later the priceless boon of anesthesia was introduced. Thus did medicine escape from that vicious circle so aptly epitomized by Bacon. In the discovery of anesthesia the dental profession claims equal share of honor. Long and Jackson being physicians; both Wells and Alorton were dentists. At that instant animal experimentation became more humane, more useful and more accurate. The use of the microscope as a scientific instrument had its origin in 1683 when Van Leeuwenhoek, the Dutch lensmaker, made observa- tions on tartar scraped from the teeth and described bacteria for the first time. It is recorded that in his enthusiasm for scientific research he extracted one of his own teeth and thereupon discovered the tubular nature of dentine. To the genius of Louis Pasteur is accredited the introduction into the world of Bacteriology, a young giant destined to revolutionize medi- cal thought and research, to banish empiricism and to place medicine on a rational and scientific basis. In the last forty years it has accom- plished more for the benefit of humanity than has any other branch of science in many centuries. Beginning with Pasteur's investigations into the cause of fermentation, and the overthrow of the theory of spontaneous generation, it gave to Lister in 1875 his inspiration which resulted in the so-called antiseptic surgery ushering in a new era. By the adoption of sound principles of treatment based on the prevention of infection much of the odium attached to hospitals at that time was 365 removed To this changed viewpoint may be attributed the success and popularity of the present-day hospital. For a considerable period after Pasteur's first discoveries bacterio- logic investigations marked time- while methods of cultivation and study were being improved. So that the young science was'not firmly fixed upon its pedestal until Koch formulated his famous postulates. The observance of these laws in the course of bacterial study placed a necessary curb on overenthusiastic investigators and enabled the conservative ones to verify their work in many instances with the precision of the mathematician. "1. The specific organism must always be associated with the disease. 2. When isolated and (3) introduced into a healthy sus- ceptible animal it must produce the same disease. 4. From that ani- mal it must be again obtained in pure culture." These simple rules based on the employment of animals constitute the rock upon which the science of Bacteriology was founded. The rock of science which the antivivisectionists would annihilate that we might build our house once more upon the shifting sands of ignorance. I shall not burden you at this time with a picture of that trium- phant march of discovery that began under the leadership of Pasteur and continues to this day as a true crusade in the cause of humanity. Riggs in 1875, actuated by the rapidly crystallizing germ theory of disease, recognized the bacterial factor in the production of that symptom-complex known as pyorrhea alveolaris, the curse of the human race for ages. Riggs's disease has experienced more vicissitudes of classification than any other disease in the nomenclature. From the time of its first recorded observation in 1746, it has been the storm center of controversy between those who believe it to be a constitutional affection and others having firmly fixed opinions as to its purely local character. It is pleasant to note in passing that research work now being done-by means of animal experimentation-bids fair to settle the controversy in the near future. About thirty years ago Miller, distinguished for his work in dental pathology, directed attention to oral sepsis as a possible cause of consti- tutional disease, but failed to impress either profession with the impor- tance of his observations. In 1910 William Hunter, of England, pointed out the possibility of systemic infection through lesions of the mouth, and at a later date his observations were verified by the laboratory findings of Rosenow, who, in the course of investigation of the blood in certain anemias, rheumatism and heart disease, was able to isolate certain organisms from the blood and frequently found them to be identical with the bacteria cultured from patients suffering from pyorrhea and dental abscesses. While bacteria are capable of entering any unprotected or injured part of the body, it was found by Rosenow that the most com- mon portals of entry were through the mouth, the nose and the tonsils. 366 It was verified clinically by the prompt amelioration of symptoms when the dental abscesses and the pyorrhea received proper treatment. The term focus of infection means that disease-producing bacteria have established a permanent residence in some part of the body, and from that point their toxines (or poisons) are continually absorbed to the detriment of the individual's health. In some instances and under favorable conditions, the organisms themselves may enter the blood stream and be transported to some other part of the body where serious disturbances may arise after their arrival in the new territory. Thus it is that certain forms of anemia, rheumatism, diseases of the heart and kidney may be traced back to some original focus of infection. When we become possessed of a new automobile it is difficult to repress the tendency to violate the speed laws. When a new idea in the form of a medicine or surgical operation is brought to light, it is often seized by its partisans as a last hope of salvation. The effect of this overstimulation is seen by an immediate epidemic of prescription writing or of needless operations. I distinctly remember that surgical era when the combination between a small boy and a hatful of green apples meant a probable operation for appendicitis. Fortunately with the progress of scientific medicine these hasty conclusions are becoming more and more rare. It is also true that teeth have been extracted when the focus was in the tonsil or even in the gall bladder. Hence it is of greatest impor- tance that the oral surgeon be especially qualified for a task that demands the greatest diagnostic skill and judgment. The time is now at hand for an interchange of viewpoint between the medical and dental professions. To many minds the ideal solution of the problem would be to raise the standard to such an extent that a knowledge of medicine would be a prerequisite to the study of dentistry, and the practice of oral surgery would take its proper place as a specialty of medicine. Roswell Park entertained these views twenty-five years ago, and their correctness has been amply verified. The present status of the graduate in dentistry in this country is due in great measure to chance. Chapin Harris, a physician, recogniz- ing the need for more thorough training in the dental art, visited several medical schools in the endeavor to make dentistry a specialty of medi- cine. These schools lacking the breadth of Salernum declined the overtures, and Dr. Harris in 1839, organized the first dental college in the world-the Baltimore College of Dental Surgery. The achievements of dentistry in the past are due in great measure to a high development of mechanical skill, recognized throughout the civilized world; those of the future will depend on the result of inten- sive research, now in progress, along the lines of preventive medi- cine, diet, metabolism and oral surgery. It is not mere speculation to say that the present high cost of living accompanied by the inevitable food substitution will furnish new problems for solution by experi- mental means. 367 Our beloved autocrat, Dr. Oliver Wendell Holmes, in addressing a class of dental graduates in 1872, had this to say of oral hygiene: "You can tell the state of a village by going to the mill. If it has enough to grind and grinds it well and cheaply, you will find good farms and well-fed people; so if you see a good square jaw, filled with good sound teeth, and moved by a set of muscles that mean business, and do it, you will find in all probability that they nourish a sound frame in man or woman." The history of medicine tells us that all great wars have taught their lessons. One of them of interest from a medico-dental stand- point is the report of the provost marshal's office. We find that over 34 per cent of the registrants in the draft of about 10,000,000 men were rejected on account of disability. We also note that many of the diseases for which the registrants were rejected are diseases directly traceable to focal infections. In view of the fact that 90 per cent of the people of this country never consult a dentist we can readily account for so many rheumatic and heart diseases. When we add to this information the commonly repeated statement that between 80 and 90 per cent of our school children are afflicted with decayed teeth, we are impressed by the magnitude of the problem. Decayed teeth obvi- ously reduce the child's ability to study, lower the resistance to disease, and pave the way for future illness. This is a problem in which the oral hygienists, the school authorities, the social workers and physicians may unite to effect a solution. From the foregoing it will be seen that there is still need for laboratory animal experiments. The initial lecturer in this series, Dr. Simon Flexner, presented a magnificently pictured outline of the world-wide activities of the great Rockefeller Foundation, tracing the development of scientific thought and of the means that have been employed toward the elimi- nation of all disease. With unlimited resources at its disposal it has been of untold benefit in the reduction of mortality from disease. At the present time it has adopted the world as its patient, and regarding epidemics as focal infections has sent investigators to the most remote regions of the globe in order that these scourges may be swept from the face of the earth. We trust that this institution, one of the most powerfully organized and intelligent forces in the cause of humanity, may, as years roll on, attain the goal of its ambition. It has been clearly shown that man has a right to use, for any pur- pose, the animals that have been placed in his domain. It has been shown that animals must of necessity be utilized for the purpose of determining the specific nature of micro-organisms, for the standardi- zation of drugs, for the manufacture and standardization of antitoxines and vaccines, and also for the perfection of surgical operations. Any curtailment of this right would result in irreparable damage to scien- tific medicine. Each of the lecturers voice with me their contempt of wanton cruelty and needless sacrifice of animal life. It has been shown 368 conclusively that no necessity for additional legislation for the protec- tion of animals exists. 1 his is clearly shown by.the failure to respond to the challenge issued by the Health Officer of the District of Columbia in 1901, to produce a single authentic case of cruelty to animals within the walls of any medical school in this city. Let us not forget that some of our most far-reaching discoveries were made possible by experiments on heroes who voluntarily sacrificed their lives upon the altar of science. When we think of the great economic benefits derived from animal experimentation, of the lives that have been saved, of the maimed and crippled that have been restored to usefulness, of the pain and anguish that has been assuaged, can we imagine that the faithful dog, could he have voice, would give his consent to the assassination of science ? CONCLUDING REMARKS TO THE COURSE OF LECTURES ON VIVISECTION By George; M. Kober, M. D., LL. D., Dean of the Georgetown University School of Medicine. These two excellent lectures of singular importance conclude our course, at least for the present. We have already bespoken our ap- preciation to the two speakers of the afternoon, and I deem it a duty now to voice our indebtedness to the Rev. Francis A. Tondorf, S. J., the responsible party for the inauguration of this splendid course of dissertations on a subject of such vital importance to the progress of medicine and hence to the entire community. You are aware, no doubt, that there is a bill now pending before the Senate which is to prohibit all experimentation on dogs and which would eventually lead to the prohibition of experimentation on all ani- mals. Hearings were held before the Senate Judiciary Committee last November, and these were attended by leading scientists from all over the country. Father Tondorf had been invited to address this body, and his appeal for the rejection of the bill was based entirely on moral principles. As indicated above, the Committee's judgment is still pending. It seems quite certain that they are not in favor of the measure, yet it is not impossible that they may report favorably on the bill at some future date, yielding to public sentiment, should such sponsor the cause. Accordingly the Washington Humane Society has been urging an active propaganda along these lines. In the earlier part of February last a mass meeting was adver- tised to be held at the Shoreham Hotel under the auspices of the above- named society. The notice met the attention of one of the premedical 369 students of the Georgetown University who promptly advised Father Tondorf of the proposed meeting, asking him, if possible, to be present that both sides of the question might be presented. Father Tondorf, in turn, advised me of the same, and after consultation it was decided that both of us should attend the meeting and that we shotild see to it that the movement should not gain headway without the public being made conversant with our side of the question. The meeting was addressed by a Mr. Russell, one-time editor of the New York Times, a journalist of considerable repute. In the course of his remarks he most insistently pressed all present to activity toward the passage of the bill, adding that once a legislative measure had been enacted regarding the dog, the way to the other animals would be easy. He hinted that a new powerful weapon was within reach, to wit, women suffrage. His impeachment of the medical pro- fession was scathing. Vivisectionists were branded as materialists. His attitude in its entirety was extremely aggressive. Father Tondorf asked Mr. Russell whether he had ever read the life of Louis Pasteur, and when he replied that he had not, he advised him to do so, before ever again repeating such statements, as he would find that Pasteur was not only a most fruitful scientific experimenter, but also much beloved and revered by all who knew hirn for the beautiful spiritual life that he had led. Mr. Russell had also sketched in sarcastic language the history and development of medicine, referring especially to the blood letting and calomel era in the treatment of disease. I informed the audience that there were periods when medical men were obliged to experiment upon man instead of the lower animals, which involved lamentable consequences. According to Professor Finkelnburg of Bonn me aver- age span of human life in the sixteenth century was between 18 and 20 years; at the close of the seventeenth century it was between 25 and 30 years, at the close of the eighteenth century it did not greatly exceed 38 years, while at the close of the nineteenth century it was between 45 and 50 years. Death is inevitable, but human life and happiness has been prolonged, and this has been accomplished largely by animal experimentation in which our faithful canine friends played a very important part. The press comments of the following day relative to this meeting left little doubt that Father Tondorf's able rebuttal amply met Mr. Russell's charges. Yet we, of the opposition, left this meeting convinced that a new plan of campaign was imperative. Hitherto vivisectionists were gen- erally contented in waiting on the defensive. Accordingly Father Ton- dorf called a special meeting of the faculty of the Georgetown Uni- versity Medical School on February 23. Forty members of the faculty were present. The matter was freely discussed, and it was generally agreed that, as similia similibus curantur, we, too, should launch an aggressive campaign. 370 A committee, appointed by the president, consisting of Col. Will- iam H. Arthur, U. S. A., Director of the Georgetown University Hos- pital ; Rev. Francis A. Tondorf, S. J., head of the Department of Physi- ology, Georgetown University Medical School, and myself, settled upon this course of lectures on animal experimentation, viewed in its various aspects of Medicine, Philanthropy, Ethics and Economics, by men of the highest authority in the medical and other professions. I also called this matter to the attention of the members in session upon the Congress on Medical Education held in Chicago March 1 to 3, with the result of the unanimous adoption of the following resolution: "The Annual Congress on Medical Education^ composed of the Council on Medical Education of the American Medical Association, the Association of American Medical Colleges and the Federation of State Medical Boards of the United States, has learned with regret that serious efforts are being made to enact Senate bill 1258, 'A bill to prohibit experiments upon living dogs in the District of Columbia and in any of the Territorial or insular possessions of the United States.' "The highest aim of scientific medicine is the eradication of pre- ventable diseases. The average span of life in the United States has been lengthened fully eight years during the past twenty-five years, largely the result of animal experimentation in the study of the causes, prevention and treatment of communicable diseases. "A careful examination of the law in force in the District of Co- lumbia shows that the provisions of the current law are ample and sufficient to prevent cruelty to animals, and since the enactment of the bill would be the death knell to the progress of scientific medicine, this Congress respectfully but earnestly protests against its enactment as unnecessary legislation and detrimental to the best interests of the human family, and to animal husbandry.'' The course of lectures just completed has sustained the position of our Faculty and that of the Congress on Medical Education, and it is hoped that even our opponents have profited by this campaign of enlightenment. We now rest this matter with the fair-minded public. Should our well-meaning friends, misguided though they be, fancy that any undue advantage has been, taken of them, I am quite sure the University authorities will gladly afford them an opportunity of refut- ing from this same platform any statement made by any of the lecturers. 371 MORAL ASPECTS OF VIVISECTION. A Digest of the Statement of Rev. Francis A. Tondorf, S. J., Ph. D. Head of the Department of Physiology Georgetown U niversity School of Medicine Before the Subcommittee of the Committee on the Judiciary of the United States Senate, November 4, 1919, 5". 1258 on A Bill to Prohibit Experiments Upon Living Dogs in the District of Columbia or the Territorial or Insular Possessions of the United States. Mr. Chairman : The topic now under discussion presents two phases, to wit, the sentimental and the moral. The former. I take it, deserves little, if any, consideration, where human health and happiness are at stake. The latter rests wholly on philosophical principles. These I purpose, with your kindly indulgence, briefly to review. God has unquestionably placed the creatures of His hand under man's dominion that they may be of service to him in the prosecution of his necessary end. Accordingly he has an unequivocal right to the use of these creatures for any lawful purpose he sees fit. I insist on lawful purpose, the norm being that in this use man violates no obli- gation toward God, himself or his fellowmen. Pleadingly our friends, the antivivisectionists, bid us add a fourth condition, namely, that the animal's right be held sacred. I answer, as anyone familiar with the first principles of ethics must answer, an animal has no rights. A right is a moral power, and a moral power is resident only in a rational being. To invoke barnyard rights is to codify barnyard morals. Very logically it is now inferred that no irrational being can suffer an injustice, for there can be no injustice where the injustice is not recognized, and where there is on the part of the subject no expression of unwillingness. Nor have we here the semblance of a sanction for any wanton use of animals in laboratory experimentation. The second condition above indicated strictly inhibits this. To preclude any pos- sible misconception of the term wanton, I would define it as any such use as would occasion unnecessary pain. It may be urged that granting all this, vivisection still lacks justifi- cation in that no useful results have ever accrued therefrom. You have just heard the curious recital of data by the opposition in their attempt to prove that our many hours of research have been hours idly spent, and you have heard my colleagues to the contrary. Your 372 judgment is easily anticipated. But were we to admit, for the sake of argumentation, that all our efforts to date have been fruitless, with the possibility of future experimentation, important findings might still be reasonably hoped for, a sufficient warrant surely for the con- tinuance of researches. But no, the atrocities must not be permitted to continue because they are "Sanctioned Infamy," "Scientific Torture." So the first speaker on the other side. A catalogue of our cruelties has been handed you. They all have their foundation in the pain we inflict. To fix a footrule of this, so-styled, cruelty therefore we first need evidently understand what pain might be. Physiologists know com- paratively very little about pain. They inform us that of all the senses, this sense is the most widely distributed, naturally so, as it is the body's safeguard. That it is a poorly localized sense. The nerve fibers medi- ating pain they hand us accurately charted. But no one seems to touch a point which is of vital import right here, and that is whether the pain sense is as specialized in the brute as it is in man. The indi- cations are all in the negative. Such the brute's position in the scale of anatomy. Such the post-operative behavior which every experi- menter cannot but have noticed, a behavior indicating a minimum suf- fering. Such, finally, the ante and post operative consequences to a lack of anticipation of pain, a factor which so tellingly exaggerates this sense in the human subject. In the light of the above it is not hard to see that the tales of all our cruelties are but the wild fancies of prejudiced imaginations. With the right to inflict pain on the animal established, and I might state that this we rarely do as most operations are done under an anes- thetic, I ask to what extent this infliction is permissible. As far as is necessary. Nor am I of the mind that this is only a right but more a solemn obligation we men of the medical profession owe mankind. I rest my argument here and challenge the opposition to reply. Statement of George Martin Kober, M. D., LL. D. Dean and Professor of Hygiene and Preventive Medicine, Georgetown University Medical School. Before the Sub Committee of the Committee on the Judiciary of the United States Senate on November 4, 1919. Mr. Chairman: As dean and representative of the medical school of Georgetown University, I am directed to enter a respectful but em- phatic protest against the passage of Senate bill No. 1258, to prohibit experiments upon living dogs in the District of Columbia, etc., for the reason that a careful examination of the law now in force made by Dr. William C. Woodward, our professor of medical jurisprudence, for- 373 merly the efficient health officer of this city and now health commis- sioner of Boston, shows that the provisions of the current law are ample and sufficient to accomplish the laudable object of the advocates of the bill, which, I take it, is the prevention of cruelty to animals, including our faithful friend and companion, the dog. If, on the other hand, the advocates insist in prohibiting experiments upon living dogs, and this sentiment is enacted into a law, it will be the death knell to scientific medicine and the amelioration of sickness and distress for reasons already explained to you by other speakers. As we understand the case, under the current law, enacted in 1871, or 49 years ago, amended in 1873, 1885, and 1892, the members of the Washington Humane Society have extreme power relative to the search of private premises in which there is reason to believe animals are being needlessly tortured; that it is not only the privilege but also the duty of every member of that society, as well as of every peace officer, to enforce the law against such offenses; and that members of the Washington Humane Society are offered a special inducement to per- form their duty by reason of the fact that all fines and forfeitures become the property of their society; and, finally, that any person undertaking to perform experiments involving suffering on the part of any of the lower animals is protected from punishment only when such experiments are performed under the authority of some regularly in- corporated medical college, university, or scientific society, and even then only as long as they are properly conducted. If this interpretation of the law by Dr. Woodward is sustained by your honorable committee or its referees, the current law is broad enough to accomplish the purpose. If, on the other hand, it is claimed that the present law is defective and inoperative, the burden of proof for additional legislation clearly rests with the advocates of this meas- ure and should emanate from unbiased sources. Technically, the proper way for obtaining such an opinion would appear to be by the presentation of a specific case to the prosecuting attorney and his refusal to institute proceedings because of the inefficiency of the present law or by the presentation of a specific case to the court and its dismissal by the court for the same reason. Is there a real need for additional legislation? The answer to this question may be found in the fact that the Washington Humane Society, clothed with extraordinary powers, has failed to demonstrate during the last 49 years a single instance of abuse. If this be true, it is fair to assume that the evils complained of do not exist, or that the members of that society have been derelict in their duty. The writer is unwilling to accept the latter explanation, since the members of the society have shown marked zeal and devotion not only by their per- sistent efforts year after year in pressing the so-called "antivivisection bill" but also by th,eir indefatigable efforts to collect and present evi- dence in favor of the bill. For this purpose the files of newspapers, 374 periodicals, medical journals, and the transactions of the British Royal Commission on vivisection have been searched, but a most careful scrutiny of the evidence fails to reveal a single instance of cruelty to animals committed in the District of Columbia. Mr. Chairman, the highest aim of scientific medicine is the eradi- cation of preventable diseases. In this we have made most commend- able progress, for medical history reveals the fact that during the Civil War out of every 1,000 soldiers enrolled 65 died annually, and that during the Spanish-American War the losses were still 30 out of every 1,000, while during the recent World War the mortality was only 14.8 per 1,000. These brilliant results were largely made possible by animal ex- perimentation in which our faithful canine friends played a very important part. But, Mr. Chairman, let me remind you that man himself, the high- est of God's creatures has shared the dangers on the battle field against the foes of mankind, and our great and glorious country may well be proud of the heroes who gave up their lives or offered them- selves for experimentation for the benefit of humanity. The yellow fever commission, with Maj. Walter Reed as chairman, in 1900 demon- strated the transmission of yellow fever by the mosquito, which more than anything else made the construction of the Panama Canal possible, and without which the ultimate eradication of this scourge could not be accomplished. I shall never forget the glowing tribute which Dr. Reed paid his colleagues for their share in the work which made him famous, especially to that brave young soldier, Kissinger, from Ohio, who on December 5, 1900, was the first volunteer to be bitten by in- fected mosquitoes, with the only provision that he should receive no pecuniary reward, since as he expressed it, he was actuated "solely in the interest of humanity and the cause of science." Such exhibition of moral courage, in the opinion of Dr. Reed, has never been surpassed in the annals of the Army of the United States, and I will add, could never have been inspired except by a man of Dr. Reed's greatness. The story of Sternberg, Reed, Agramonte, Carroll, and Lazear in the battle against yellow fever has never been acclaimed with flags or decorations but a grateful country has recognized the services of those noble workers by granting a pension or annuity to the surviving members or families, except in the case of Dr. Agramonte, who is still alive, a faithful worker and teacher in preventive medicine in the city of Habana. Other medical men in the United States who with genuine Ameri- can manhood have fallen victims of scientific research are Dr. Howard T. Ricketts, who investigated typhus fever in Mexico; Dr. Thomas B. McClintic, of\he United States Public Health Service, who died from Rocky Mountain fever contracted while investigating the cause of this disease; and Dr. William W. Miller, of the same service, who died of typhoid while investigating that disease in this city. 375 The recent World War has also developed a number of striking demonstrations of genuine devotion to science and humanity. We read in the Journal of American Medical Association October 11, 1919, that two groups of our brave men modestly made a great sacrifice for their country and for mankind in connection with scientific investiga- tions during the Great War. One group offered themselves as sub- jects for the study of the puzzles that threatened to work great havoc among the forces at the front. As trench fever apparently is not transmissible to animals, the recourse to human subjects became imperative. The volunteers lent themselves to the demonstration that the blood of trench-fever patients is infective in order to ascertain what element of the blood contains the virus and to discover the relation of the louse to the dissemination of the disease. The story of some of these endeavors and sacrifices has been recorded in the report of the medical research committee of the American Red Cross (New York Oxford University Press, 1918). "Words fail," says the report, "in attempting to express admiration of the morale "and courage of the volunteers. They have more than done their part by endeavoring to aid in the accuracy of the experi- ments." Today trench fever can be controlled. Another volunteer sacrifice has been recorded in the efforts of the Army Medical Staff to find a method of preventive inoculation against measles. No physician need be reminded of the dangers to which this disease subjected millions of our men in the two years just passed. Here again, in time of need, to quote Maj. Seilards, who conducted the tests, "the individual soldier was found ready and willing to offer his services and accept such risk as was inherent in these inoculations." This demonstration proved that measles could not be inoculated with blood from measles patients. To these loyal men the following tribute has gone. "The Surgeon General has been informed of the fact that you volunteered for the measles investigation. He desires to express to you his appreciation of the patriotism and devotion to duty that you have shown, and to assure you that your contribution to the cause is appreciated by him just as much as was the bravery of the men who went into the fight in France." In the Journal of the American Medical Association for October 25, Surg. Gen. Braisted of the United States Navy tells us that his annual report for 1919 (now in press) contains the names of 138 enlisted men of the Navy who volunteered to undergo certain experi- ments to determine the mode of transmission of influenza. The ex- periments were performed when the epidemic was at its height, and the men who volunteered for them not only knew of its awful fatality but also had been witnesses of the demoralization and terror that beset communities and individuals as this public calamity garnered its thou- sands and tens of thousands of victims. 376 As well expressed by Dr. Braisted, "These men are heroes in the fullest and most beautiful meaning of the word, and we should know about them and publish to the world the story of their deeds. "It is impossible to honor too highly the nobility of these men who voluntarily, calmly, cheerfully jeopardized their lives in the'conduct of an experiment undertaken to elucidate the obscurities of diagnosis and treatment, who do this with none of the inspiring features of battle and no prospect of being welcomed home as heroes, if they survive, yet have had fully explained to them the risk they incur." Realizing as we all do that sickness is the most potent cause of poverty and distress, it is clearly our duty to diminish the ravages of disease. May I not, as a teacher of hygiene and preventive medicine, venture to express the hope that the bill before you will not be enacted, so that the warfare against preventable diseases which has been so successfully waged by man and his pet companion may go on until the eradication of the invisible foes of mankind is finally accomplished. Mr. Chairman, I have always been a friend of the dog, and am familiar with his faithfulness and keen, almost human intelligence; indeed, one of my great personal losses in life was the death from hydrophobia of a family pet, who was the victim of the bite of a rabid dog, which might have been prevented had not our well-meaning but misguided friends of the Washington Humane Society objected to the muzzling of dogs. I thoroughly appreciate many of the virtues of the dog set forth in the Bill S. 1258, and recall with genuine admiration the almost human sympathy which my own pet companion evinced for the sick and wounded soldiers under my care in the early seventies, which sta- tioned at some of the frontier military posts in the far West. His display of affection seemed almost supernatural, and I would never have dared to mention some of the evidences of canine sagacity except for a letter published in the Philadelphia Medical Times, dated May 1, 1875, on page 496, written by Dr. Walter F. Atlee, one of America's great surgeons, which is as follows: "Dear Sir : In a letter recently received from Lancaster, where my father resides, it is said, 'A queer thing occurred just now. Father was in the office and heard a dog yelping outside the door; he paid no attention until a second and louder yelp was heard, when he opened it and found a little brown dog standing on the step upon three legs. He brought him in, and in examining the fourth leg found a pin sticking in it. He drew out the pin, and the dog ran away again. "The office of my father, Dr. Atlee, is not directly on the street, but stands back, having in front of it some 6 feet, a stone wall, with a gate. I will add that it has not been possible to discover anything more about this dog. "This story reminds me of something similar that occurred to me while studying medicine in the same office nearly 30 years ago. A man 377 named Cosgrove, the keeper of a low tavern near the railroad station, had his arm broken and came many times to the office to have the dressings arranged. He was always accompanied by a large, most ferocious looking bulldog, that watched me most attentively, and most unpleasantly to me, while bandaging his master's arm. A few weeks after Cosgrove's case was discharged I heard a noise at the office door, as if some animal was pawing it, and on opening it saw there this huge bulldog, accompanied by another dog that held up one of its front legs, evidently broken. They entered the office. I cut several pieces of wood and fastened them firmly to the leg with adhesive plaster after straightening the limb. They left immediately. The dog that came with Cosgrove's dog I never saw before or since." These remarkable observations on canine sagacity by a distin- guished and reliable surgeon lead me to the conclusion that if the faithful, courageous, and cheery friend of man could be heard in this controversy his answer would be in the spirit of "self-sacrifice" for the benefit of the human race. In conclusion I submit a further statement in support of our plea prepared by Dr. Murray Galt Motter, formerly professor of physiology, and desire to emphasize the moral aspect of the question as presented by Rev. Father Francis A. Tondorf, at present professor of physiology in our medical school. The Christian virtues and human sympathies of both of these men are well recognized in this community. Since some of our friends have questioned whether a man in black cloth( is competent to speak on this question, I may say that it is not unusual for a priest to be engaged in the scientific study of medicine, for Garrison, in his History of Medicine, tells us' that the earliest of the microscopists was the learned Jesuit priest, A. Kircher (1602-80), who was at once a mathematician, physicist, optician, orientalist, mu- sician, and virtuoso, as well as a medical man, and who was probably the first to employ the microscope in investigating the cause of disease. In his Scrutinium Pestis (Rome, 1658) he not only details seven experi- ments upon the nature of putrefaction, showing how maggots and other living creatures are developed in decaying matter, but found that the blood of plague patients was filled with a countless brood of worms not perceptible to the naked eye, but to be seen in all putrefying matter through the microscope. While Kircher's "worms" could not have been identical with the Bacillus pestis, as they are invisible with a 32- power microscope, yet it is quite within the range oi possibility for him to have seen the larger microorganisms,, and he was undoubtedly the first to state in explicit terms the doctrine of a "conragium anima- tum" as the cause of infectious disease. 378 A PLEA FOR SANITY IN LEGISLATION ON ANIMAL EX- PERIMENTATION (WITH SPECIAL REFERENCE TO THE DOG). By Murray Galt Motter, M. D. Formerly Professor of Physiology Georgetown University Medical School. No scientist worthy the name would for a moment justify or tol- erate cruelty (the infliction of unnecessary pain), first, because his primary objective is the enlightenment of ignorance and the relief of distress; secondly, because the infliction of unnecessary pain defeats both the method and the object of his investigation. "It is the right of experiment and not the right to inflict pain for which plea is offered. Pain is an irrelevant factor which time and skill are in process of elimi- nating altogether from surgical operating and animal experimentation." A dark and ancient blot on the escutcheon of medical art has been its empiricism, and empiricism today is synonymous with quackery and charlatanism. The experience of the ancient empirics, methodists, and dogmatists was had in an atmosphere thick with the fog of preju- dice and ignorance, which prohibited the profanation even of the cadaver by the scalpel of the anatomist. The physician of today must study not merely dead tissue, but living organisms, and as from the dawn of creation the lower forms of life have contributed to the welfare of the higher, so must man ever draw upon the lower animals for the means of his life, health, and knowledge. Only through the medium of experimental research may medicine be raised from the realm of empiricism to that of exact science. Salus populi, suprema lex. If by law the method and means are prohibited by which the health of the people can alone be secured and promoted, not alone will the people suffer, but the very raison d'etre of the guardians of the people's health will be removed and their incentive killed. Why establish a Public Health Service, empower it under the law to "study and investigate the diseases of man and conditions in- fluencing the propagation and spread thereof," endow it with huge funds for that purpose, and then by subsequent legislation proscribe the recognized means and methods of pursuing such study and investi- gation ? Why should the burden of proof in this argument be thrust upon the medical profession, so small a proportion of the community at large, when it is the safety of the latter which is at stake? Recent events and current costs have shown that greater ease and higher emoluments are to be found without than within the medical profession. Why 379 should the doctor worry? When, by reason of his special training and experience, this work is assigned to the biologist, why question not only his judgment but even his motives in the selection of the instru- mentalities through which he shall render this service to humanity? Does the patient or his family dictate to the surgeon what anesthetics or antiseptics he shall use, how he shall place his ligatures, what instru- ments and procedures are necessary in a capital operation-because, forsooth, these questions have all been settled by animal experimen- tation ? As was well said in the hearings before the British Parliament on the dogs protection bill (happily defeated the past summer) : "This bill is a test case-not for the dog nor the medical profession, but for the intelligence of the House of Commons." and, .again, "The passage of this bill must involve an unnecessary continuation of pain, disease, and death among men, women, and children," to say nothing of dogs. But there is still another, reflex influence of such legislation, which must revert to the detriment of the public; if the spirit of research be thus ruthlessly stifled and killed, the intellectual standards of the medical profession must suffer and, consequently, the power and efficiency of the medical practitioner be impaired. To come more specifically to the matter in hand: The argument that some animal other than the dog can be used for experimental pur- poses is wholly unworthy of those who would advance it. If the pur- pose of antivivisection legislation is the protection of animals, no class distinctions can be admitted, but to be thoroughly consistent these ad- vocates must at once and forever forego all animal foods and become absolute vegetarians. Nay more, should they not at once cease in any way to use any of the lower animals for their own selfish benefit? This aside, however, the dog can not be replaced by any other ani- mal in the research laboratory for certain kinds of experimental work. Fishes, frogs, and turtles, birds and poultry, mice, rats, guinea pigs and rabbits, goats, sheep, pigs, cows and horses, monkeys and apes, all have their uses, and are used in experimental biology and medicine, but no one of these has so manifested a desire for the companionship and service of man as to live with him under the same roof and partake of the food from his table. Similarity of environment and habit are important and determining factors in comparative biology ; moreover, availability, size, and character of tissues must all be taken into con- sideration in the selection of the proper animal for experimental purposes. It is for these reasons that the dog has been an especially fruitful object of experimentation in the study of the functions and disorders of the digestive system. Not every surgeon, such as William Beau- mont, has the opportunity of making direct, experimental observation upon a human object, such as Alexis St. Martin; and the difficulties entailed in bringing the human subject to heel, and keeping him under 380 such control as is essential for accurate results, are sufficiently obvious. Recent investigations as to the causes, nature, and methods of preven- tion of diabetes, rickets and disorders of the teeth Rave been made possible through experimental observations on the dog; and the modern wonders of intestinal surgery, without the dog as a medium, would have been impossible. In the study of the functions and disorders of the heart and cir- culatory system, the dog has been invaluable and irreplaceable. Save for the aid afforded by our faithful friend and servitor, the dog, no surgeon would venture to suture a stab wound of the heart; and many of our boys, sore wounded on the battle fields "over there," have re- turned and recovered only by the aid of the dogs used in the develop- ment of modern vascular surgery and the technique of blood transfu- sion. Was this service any more dangerous or less effective, than that rendered by the military dogs, sent through the hail of machine gun fire to ferret out the wounded doughboy in no man's land? Some of the survivors of the latter group have, with universal approval and applause, been decorated "for distinguished service," shall we deprive their survivors of the possibility of similar distinguished service. In the fevered search for some means of withstanding the hellish Hun assaults with poisonous gas, it was tried out on the goat; but the goat proved immune, and therefore ineffective, and again the dog came to the rescue of man as the sacrificial test object. Goats, pasturing in fields submerged with poisonous gas, cropped their fill unconcerned. Men, sent to ascertain which was at fault, goat or gas, succumbed. The dog was found to be sufficiently susceptible, available, and effective in the experimental researches which enabled us finally to outhun the Hun in his devilish method of modern warfare. Nor has the dog been, always and solely, the sacrificial victim. Through the study of the dog and its diseases, by exactly the same methods and with exactly the same motives, experimental pharmacol- ogy has devised and used the means of curing the dog of a distressing and fatal distemper. Many dogs have been awarded medals for rescuing human beings from drowning, not a few have lost their lives in the effort, and their memory has been perpetuated in stone and bronze. Let us have a me- morial laboratory, erected to the honor and glory of the dogs which, shall yield their lives in the rescue of human subjects of dropsy, beings drowned in their own juices. The problems of cerebral localization were solved, and the opera- tive procedures, which have rescued human victims of brain traumas and tumors and restored them to length of years and functional activity, have been perfected through experimental work on dogs. The antago- nism between the blood serum of dogs and the microbic cause of tuber- culosis has lead to some interesting and helpful results in the fight against the great white plague. The deleterious effects of alcohol and 381 narcotics upon the vital economy have been studied on dogs; and, to- day, the experimental, laboratory dog bids fair to rescue unnumbered children from the torments of tetany. It is just because the dog is the friend of man, has lived in the same environment and on much the same food, that it is indispensable in the studies which shall lead to the alleviation of many of the ills to which human flesh is heir. If, as some of our dogophile friends would seem to imply, we are to endow the dog with a soul and higher aspirations for service, while we pay tribute to its eminent faithfulness and service in the past, can one conceive a higher ambition for the superdog of the future than thus to continue in the faithful and necessary service of man, by stalk- ing and balking, the grim monsters of distress, disease, and death?