ANTHROPOMETRY 
AND 
Physical Examination. 
A BOOK 
FOR PRACTICAL USE IN CONNECTION WITH GYMNASTIC WORK AND 
PHYSICAL EDUCATION. 
BY 
JAY W. SEAVER, A.M., M.D., 
III 
isident of the Chautauqua School of Physical Education. Lecturer on Physiology and 
Anthropometry in the New Haven Normal School of Gymnastics. Ex-President 
of the American. Physical Education Association. Member of the 
Connecticut State Medical Society, etc. 
NEW HAVEN, CONN. 
1905 Copyrighted 1905, by Jay W. Seaver. 
PRESS OF THE DORMAN LITHOGRAPHING CO. 
NEW HAVEN, CONN. CONTENTS. 
CHAPTER I. 
HISTORY OF ANTHROPOMETRY. 
Its source in art.-Greek standards.-Roman and Egyptian can- 
nons.-German and modern art proportions.-Anthropologi- 
cal purposes.-Its methods.-Pedagogical purpose. . . 7-16 
CHAPTER II. 
RECORDS AND INSTRUMENTS. 
Description of modern instruments.-The various books, cards, 
charts, etc., for general and private use.-What points should 
be noted. ........ 17-31 
CHAPTER III. 
WHAT TO MEASURE AND HOW TO MEASURE. 
The technique of measurement.-The personal element.-The 
official list of items and rules of the American Assoc, for the 
Adv. of Physical Education.-Criticisms and suggestions. . 32-56 
CHAPTER IV. 
PERSONAL HISTORY AND EXAMINATION OF THE SPECIAL SENSES. 
The private record.-Family history.-Importance of the sense 
organs.-Directions for examining the eye, ear, etc. . . 57-67 
CHAPTER V. 
TEST OF STREbGTH. 
Importance for prescribing exercises.-The mercurial dynamome- 
ter.-Method of using.-Results obtained. . . . 68-76 
CHAPTER VI. 
SPECIAL INSTRUMENTS. 
The pelvic obliquity and its measure.-Instruments.-The length of 
legs.-The deviations of the spine, etc. . . . 77-85 
CHAPTER VII. 
GRAPHIC ANTHROPOMETRY. 
The tabulation of data.-Averages, means, percentages, etc. . 86-113 4 
Contents. 
CHAPTER VIII. 
THE LAW OF GROWTH. 
The increase in height and weight from birth to maturity, in males 
and females. ....... 114-127 
CHAPTER IX. 
THE PERCENTILE METHOD OF TABULATION. 
The preparation of a table. -Probable Deviation. . . . 128-134 
CHAPTER X. 
EXAMINATION BY INSPECTION. 
Training the eye.-What is to be seen from various aspects.- 
Table. ........ 135-146 
CHAPTER XI. 
EXAMINATION BY PALPATION. 
Methods and results.-Normal and abnormal conditions.-Tumors. 147-151 
CHAPTER XII. 
EXAMINATION BY AUSCULTATION AND PERCUSSION. 
Methods.-Areas.-Nirmal sounds of lungs,heart, etc.-Abnormal 
sounds. ........ 152-162 
CHAPTER XIII. 
THE SIGNIFICANCE OF CERTAIN PHYSICAL SIGNS. 
Discussion of heart sounds.-Sphygmograms.-Table of heart 
sounds. ........ 163-173 
CHAPTER XIV. 
PRESCRIPTION OF EXERCISE. 
The standard of physique.-Respiratory inefficiency.-Neuras- 
thenic cases.-Circulatory disturbances.-Prescription form. 174-184 
CHAPTER XV. 
THE EXAMINER HIMSELF. 
The need of physical training and the standard for the examiner.- 
Personal advice. ....... 185-189 
Bibliography. ........ i-iv PREFACE. 
The purpose of this book in its first edition was to place 
in the hands of directors of gymnasia, who were expected to 
examine people and prescribe exercise for them, a manual 
that should be a constant guide in securing measurements 
and an efficient help in pointing out the vital matters that 
should be considered in making a physical diagnosis, or an 
estimate of the organic condition of the various parts of the 
body and their habit of action. 
The purpose of the present book is the same as that of 
the former editions. The failures of the last have been partly 
eliminated and the methods of measuring more carefully dis- 
cussed and illustrated, as well as the tabulation and compari- 
son of material. 
The instruments for securing more exact data, especially 
in new lines of research, have been given more attention, 
as it is believed that the most valuable anthropometric work 
of the future will be done without attributing so much value 
to space relation or size. The important question will be, 
What can the human machine do? and not, How large are its 
various parts? 
I have been more and more deeply impressed with the 
value of the percentile method for the analytical study of 
human measurements and I have tried to give a clear concep- 
tion of the processes by which a percentile table is computed 
so that the student may have a full appreciation of the 
significance of the table and its various grades. 
To the investigators in this new field of study, who have 
already added much to our knowledge of the working power 
of the human body, I am specially indebted for much new 
and valuable material. I wish also acknowledge the many 
courtesies that I have received from other authorities who 
have permitted the use of material for which credit is given 
in the text. 
New Haven, Conn., June, 1905. History of Anthropometry. 
7 
CHAPTER I. 
HISTORY OF ANTHROPOMETRY. 
There can be no study of more interest-than that which 
pertains to human life and development. It is the center 
around which all thought and all energy crystallizes. Youth- 
ful ambition, parental solicitude and mature counsel all aim 
at the elevation of life to a higher standard and more com- 
plete form; the child is to be better than the parent, the 
race is to evolve toward perfection. 
The highest ideal of art has been to portray life in its 
most perfect form, whatever may have been the vehicle of 
the thought: stone, color, tone or word. The outward form 
and its action has also become the test of the inward man; 
the thoughts, the impulses, the feelings, are recognized as. 
having a physical basis that can be measured in some way 
and thus serve as a partial guide to the possibilities and 
probabilities of the future. Psychology looks for its material 
in the physical data that can be gathered, and no longer has 
its roots in speculation and personal opinion but in physi- 
ology. A determination of the law of physical growth for 
the human animal has done more to correct educational 
methods than any other influence in pedagogy. Keen obser- 
vation had made great teachers before, but their methods 
were never reduced to law. The nearest approach to this 
was the establishment of the kindergarten by Froebel. But 
even here the establishment of the fact of a normal develop- 
ment of the control of fundamental muscles before the acces- 
sory has introduced vast improvement into his method. 
We must study then to "know ourselves" physically if we 
are to train ourselves into the highest type of mental devel- 
opment as well as into the perfection of health and bodily 
vigor. 
In studying the law of organic growth it became necessary 
to record in definite terms the changes that characterized the 
various periods of life, and measurements of size and form 
were made. Thus the knowledge of modern human propor- 8 
History of Anthropometry. 
tions has been derived from the measurements of living 
persons of all ages and of both sexes. For this process, 
Quetelet coined the apt word-Anthropometry. 
In considering the science of anthropometry it may be 
worth our while to glance somewhat briefly at its history. 
It is young as compared with other sciences, but was devel- 
oped primarily for purposes of art, rather than for those of 
physiology or anthropology; and art, which is said to be "the 
daughter of the imagination,'' did not consider originally 
the true proportions of the human body, but tried to repre- 
sent an ideal that corresponded closely to the modern con- 
ventionalized forms, or so-called fashion. We see this in 
Egyptian art, where both hands were made right, and where 
a peculiar facial type is given which certainly did not repre- 
sent the ordinary beautiful face of the race, but an idealized 
face. 
The development of art gradually called for a closer 
adherence to the normal type of body, and probably the 
greatest incentive to imitate life came through the Greek 
admiration for the athlete; it being a law that the successful 
competitor at the Olympic games should have his statue 
carved in marble. The influence of this custom undoubtedly 
modified Greek art favorably, and brought it to the highest 
standard that sculpture has ever attained. We know that 
certain artists, who were celebrated for the excellence of 
their work, left as their masterpieces statues that undoubt- 
edly represent victors at these games. Polycleitos is said to 
have made five statues of victors at Olympia, and a head of 
Hera that was "like a verse from Homer." 
The study of human proportions as related to art expres- 
sion was carried to a high degree of perfection by Polycleitos, 
who, after mature study, sought to fashion a model that rep- 
resented the ideal man. While this statue, called the Dory- 
phoros or Spear Thrower, has been lost, undoubted copies of 
it, in fair condition of preservation, are extant.* 
The Doryphoros, '"'viriliterpuer" was, in intent and by 
general consent, the representation of absolute perfection in 
human proportion. It was the canon followed by succeeding 
*See Reber's "History of Art," Waldstein's "Essays on the Art of 
Pheidias," Collignon's "Histoire de la Sculpture Grecque," and Sybel's 
Weltgeschichte der Kunst." History of Anthropometry. 
9 
schools in portraying the highly developed figures while the 
companion figure, the Diadoumenos, "molliter juvenis," con- 
structed on the same proportions of length, became the model 
of younger types. As a result of his minute study of human 
proportions this artist left a large number of statues,, all of 
which are considered by art critics to be of the highest 
standard of excellence. 
The Roman sculptors to a certain extent followed the 
Greek canons, and at the same time developed original lines 
of thought in connection with human proportions. We do 
not know, however, that they derived these ideals from many 
measurements of proportion, but have reason to believe that 
they were the result of the study of graceful 
forms and of ripened judgment in regard to 
physical beauty. The table of proportions 
given by Vitruvius does not give evidence'of 
actual measurements taken and compiled but 
he probably drew on' older canons-the 
Egyptian or the Greek. 
Among more modern artists the same effort 
to secure a law of proportion, that should 
apply to all artistic productions, has been 
made, and with comparatively little advance 
from ancient canons. The failure in these 
methods has been from the attempt to find 
some one part of the body that should be a 
common measure of all the other parts; as 
in the ancient Egyptian canon (Fig. i), where 
the length of the middle finger was considered 
a common measure of all the other proportions, five fingers 
being the height of the knee, ten fingers the height of the 
pubic arch, eight fingers the length of the arm to the tip of 
the fingers, three fingers being the length of the head and 
neck, and the total height being nineteen fingers. 
The physiologist Carus of Dresden conceived the vertebral 
column to be the unit of measure and this he divided into 
twenty-four parts, according to the number of vetebrae, 
assigning to each the same value, as in embryonic life. 
The great German artist, Albert Durer of Nuremberg 
worked on a canon of proportion, considering the total height 
to be unity. The length of foot was one-sixth of this total, 
Fig. i. 10 
History of Anthropometry. 
the head one-seventh, the hand one-tenth, etc. Durer made 
the ratio of height between women and men as 17 to 18, 
while among English people the ratio is as 12 to 13. This 
showed his method to be that of the artist rather than of the 
anthropologist. The artist Schadow of Berlin saw the failure 
of Durer's canon and drew up tables of proportions, derived 
by averaging the measures of various models. The tables 
represented each year of life from birth to maturity. 
PROPORTIONS OF THE BODY. 
Schadow 
Bowditch 
Porter 
Hastings 
Age 5, 
Height 1098 
1058 
- 
1060 
7, 
" 1177 
1164 
1140 
1160 
9- 
" 1229 
1264 
1244 
1260 
" ii, 
" 1307 
1356 
1338 
1360 
" 13, 
" 1464 
1447 
1429 
1450 
" i5, 
" 1674 
1584 
1549 
1580 
Maturity, 
1726 
1730 
This is fairly near the standard established for modern peoples as seen 
by comparison with recent anthropometric date. 
Later artists have in general endeavored to follow the 
classic canons or to educe a new modulus after the Egyptian 
type and perhaps the most successful effort toward this end 
has been that of Story,* whose method is based on the 
mathematical relation of certain geometric figures. 
In the middle of the last century the strong trend of 
study toward the natural sciences led to the more thorough 
investigation of the natural history of mankind, and several 
more or less valuable treatises were published on anthro- 
pology. This gave a new impulse to the study of human 
proportions, for in studying different races of men it was 
found that they had marked peculiarities of physique, as well 
as marked mental peculiarities and customs. 
About the middle of the last century Quetelet, who was at 
this time director of the Royal Observatory at Brussels, and 
a leading mathematician of his day, conceived the idea of 
assisting anthropology in its classification of human races by 
the determination of their physical proportions, believing that 
each race had such peculiarities as would constantly serve as 
* l,The Proportion of the Human Figure, According to a New Canon, 
for Practical Use."- W. W. Story. History of Anthropometry. 
11 
a means of identification. He had already published his 
book "Sur 1'Homme" in 1841 and began his work with much 
zeal, but soon found that it had a much broader scope than 
he anticipated when he began his research. He writes in 
the first chapter of his book on anthropometry, published in 
1871, that he is appalled by the magnitude of the field of 
research into which he has entered. However, being accus- 
tomed to deal with numbers, and having the enthusiasm of 
the true scientist, he proceeded in his work, and has given 
valuable material for all students of anthropology and anthro- 
pometry since his day. He was the first investigator to apply 
purely mathematical methods in determining the physical 
constants of the human body, and he demonstrated that the 
"binomial law,''or "law of chance,''applied to human propor- 
tions. This so-called law of chance, or probability, has been 
found to be true in its general application. It has been made 
the basis of more recent investigations, and has been spe- 
cially applied in graphically representing the racial type; 
as, for instance, in the representation of the difference be- 
tween tall and short races, as the Patagonian Indian and. e 
Chinese. After establishing this law as applied to his own 
countrymen, he endeavored to determine the physical con- 
stants of other races, and perhaps the only criticism that can 
be made of his work is that he sometimes drew conclusions 
from insufficient data. For instance, in determining the size 
of the American Indian,* he concluded from the measure- 
ment of a few specimens that were on exhibition in Brussels 
that the Indian is of excessive height and size as compared 
with the ordinary European which conclusion has been found 
by more recent invstigators to be not in accordance with the 
facts. He did determine the fact that various races follow 
special laws in their growth and development, as do the 
various organs, and the discovery of this fact has led to im- 
portant results, not only in anthropology but in physiology, 
as we find that those types having comparatively long trunks 
and short limbs possess higher resisting power than the 
opposite types We also find that the size of certain physi- 
cal organs, like the chest, has a direct relation to the working 
power of the individual when considered as a machine. The 
* Anthropometric, p. 54, ed. 1871. 12 
History of Anthropometry. 
relation of total size to the respiratory power is an important 
physiological factor, as is also the relative length of different 
levers when the adaptability of the individual for special 
occupations is considered. It may be said that in more 
recent years the incentive to anthropometrical investigation 
has not lain in artistic or anthropological lines, but in peda- 
gogical, psychological and hygienic. 
By far the greater part of anthropometrical work that has 
been done in the last twenty-five years has been done in con- 
nection with educational institutions and for educational pur- 
poses, and it may be truly said to-day that the investigators 
who are most active are the ones connected with departments 
of psychological study. The reason for this may be clearly 
seen in the fact that the racial type having been considered, 
the study of the individual for the sake of bringing him up to 
a high degree of excellence becomes the next important duty 
of the educator. In this country especially it may be said 
that the work has tended in this particular line, while in 
England the research has been devoted to such departments 
as tend to the determination of general anthropological laws. 
In 1884 Francis Galton established in connection with the 
Health Exposition of London a bureau of anthropometry, for 
the purpose of gathering material that should determine the 
physical constants of English men and women, and serve as 
a check on work done before on the Continent, and that 
might possibly lead to the discovery of new laws. A prepara- 
tion for this work had been made by Charles Roberts, of 
London, when, in 1878, as secretary of the British Association 
for the Advancement of Science, he published the "Report 
of the Committee on Anthropometry," and presented some 
interesting material gathered by himself. The material 
gathered by Mr. Galton was extensive and was studied by a 
new method, which has been quite generally adopted during 
the last fifteen years and which has a high utility in showing 
the distribution of proportions. His plan, in brief, was to 
group all the measurements of any particular item, as height, 
weight, etc., into percentile groups, or into such groups as 
could be represented by integral parts of one hundred. 
These measurements being grouped in this particular way 
made a determination of the mean easy {Quetelet's "I'homme 
moyen"), and showed that the proportions, when so grouped, History of Anthropometry. 
13 
followed the binomial law. This method enabled him to say 
of any given individual that he excelled in any item, as 
height, a certain percentage of other persons, or that he was 
excelled by a definite percentage of individuals. This, there- 
fore, became a valuable method of graphically representing 
the size of any person, for, after having determined the dis- 
tribution of the sizes of any particular item, the position of 
the individual in this distribution was easily determined. If, 
then, we group all the items of measurement of a similar 
class of persons, according to the percentile form, and have 
a table prepared that shows this distribution, we have an 
easy form of graphic representation. This method has been 
followed out most completely in this country as applied to the 
student classes of the community, no one as yet having 
undertaken the general measurements planned by Galton in 
England. The nearest approach to this English standard 
for mature individuals is probably found in Gould's Sanitary 
Commission Memoirs,* gathered from recruits who were 
examined during the Civil War. This memoir is a fairly 
comprehensive study of the actual and relative proportions 
of over a million men between the ages of sixteen and forty- 
five years. 
In our educational institutions since 1880 we have largely 
followed the example set by Dr. Hitchcock of Amherst in 
1861 by making a physical examination of the students who 
were admitted to the gymnasia connected with our colleges. 
In connection with this physical examination a measurement 
of some of the more important items has been made. This 
method has resulted so satisfactorily that it is now applied, 
not only to the students of the leading colleges and universi- 
ties throughout the land, but in very many of the better class 
of secondary and private schools. 
The data gathered and published by Dr. Hitchcock is the 
most complete regarding men in the period from 17 to 25 
years of age to be found in this country. This work has 
also been extended by the investigations of persons who have 
been interested in physiological or experimental psychology, 
and large numbers of school children of various ages have 
been measured and tested in order to determine, so far as 
* 1869. Published by United States Government. 14 
History of Anthropometry. 
possible, what relation might exist between physical condi- 
tion and intellectual activity. Tables representing these 
investigations will be found in another part of this volume. 
In this connection we must mention the very thorough 
study of the growth of American school children made by 
Dr. Bowditch in 1877. The result of his investigation deter- 
mined for the first time the law of growth for Anglo-Saxon 
children between the ages of five and sixteen years. This 
investigation had been preceded by a somewhat similar one, 
made by Dr. Fahrner of Zurich, Switzerland,* although his 
results never received the attention accorded to the work of 
Dr. Bowditch, because that of the latter was far superior in 
accuracy and extent. Dr. George W. Peckham of Milwaukee, 
Wis., in 1880-83, made a study of the growth of school 
children, and a like investigation has been made in 1892-93, 
by Dr. W. T. Porter, upon children in the public schools of 
St. Louis, Mo., which confirmed the conclusions of Dr. Bow- 
ditch, and established several new facts pertaining to the 
physical and mental growth of children. 
In 1880 Dr. D. A. Sargent of Harvard University began 
the systematic measurement of students, and the compilation 
of the data that he had gathered was published .in 1893 in the 
form of percentile tables for the various years of college life 
for both men and women. The mean, or 50 per cent record, 
was graphically represented in plaster figures of both man 
and woman, and were exhibited at the World's Fair Exposi- 
tion at Chicago in that year, where they created a wider 
interest in the cultivation of the physical growth of students 
and gave a healthier trend to the gymnastic teaching that 
has followed. Similar, though less extensive, studies have 
been made by Drs. Hitchcock of Amherst, Flitchcock of 
Cornell, Gulick of New York City, Hanna of Oberlin and 
Seaver of Yale, and by Miss Wood of Wellesley and Mrs. 
Clapp of University of Nebraska. 
In 1902 a study of the growth of the human body from the 
fifth birthday to the twenty-first was made by Dr. W. W. 
Hastings of Springfield. The result of his work was the 
publication of a "Manual for Physical Measurements'' for 
both boys and girls. This book gives in percentile form the 
* Das Kind und der Schultisch. History of Anthropometry. 
15 
records of children in the public, schools of Omaha, Neb., and 
adolescents from that state and Connecticut, in groups for 
each year of age and for convenient gradations of height. 
This material has been arranged on cards for individual use 
in recording personal measurements graphically and has thus 
found a wide field of use and has given an excellent standard 
by which even the untrained can detect at a glance the 
deviation from the standard for that type. 
In 1893-94 Dr. E. M. Hartwell made a study of the rela- 
tion of the nervous phenomenon of stuttering to growth and 
to the "specific intensity of life,'' among the school children 
of Boston.* The term "specific intensity of life,'' is used to 
express the ratio between the number of children living at 
any age and the number dying at that age. Incidentally he 
demonstrated the direct relation between the specific intensity 
of life and acceleration of growth. 
The anthropometric method has been applied to the study 
of nervous phenomena by Francis Galton, by G. Stanley Hall 
and others, and in their relation to growth the results so far 
as published have given basis for a critical discussion of 
pedagogical systems that is already bearing fruit. In the 
same field of inquiry are found some papers by Dr. E. W. 
Scripturef of Yale and Dr. J. Allen Gilbert.^ 
Dr. G. W. Fitz of Boston has also called attention to some 
of the nerve reactions that help to declare the condition of a 
person,§ and has invented some instruments that record the 
time of reactions. In foreign countries the study of physical 
data obtained by anthropometric tests has been carried to a 
high degree of perfection along physiological lines. Axel 
Key of Sweden has studied the relation of growth to tem- 
perature and climate, as marked by the seasons of the year, 
and to the pubertal period. Bertillon and Demeny of France, 
Mosso and Levi of Italy, Schmidt and Voigt of Germany, and 
many others have made additions to our knowledge of the 
human body and its development. The problems of the 
* School Document, No. 8, 1894, Boston. 
■| Ninth Annual Report of American Association for Advancement of 
Physical Education, now the American Physical Education Association. 
$ Studies from the Yale Psychological Laboratory, Vol. II. 
§ Tenth Annual Report of American Association for Advancement of 
Physical Education. 16 
History of Anthropometry. 
future will lie in a determination of the influences affecting 
the neuro-muscular mechanism and its dominating center, 
the intellect; the exact values of heredity and nurture as the 
determining factors of a large part of life; and the evolving 
of a pedagogical system that shall train the young to the 
highest possibilities of their faculties. Records and Instruments. 
17 
CHAPTER II. 
THE RECORDS TO BE KEPT AND THE INSTRUMENTS TO BE USED. 
For taking the measures of a person several instruments 
are needed, but the outfit may be very simple. For several 
reasons the record should be taken and kept in the metric 
system: ist. It is the scientific standard in use in all coun- 
tries, and is in use in every other department of scientific 
investigation in this country. 2d. It enables one to be very 
accurate without trouble, as the unit is very nearly one 
twenty-fifth of an inch. 3d. There are no fractions to com- 
plicate compilation, or computations, or records. 4th. It 
helps to introduce an improved system of weights and 
measures into general use, and, as the ordinary person has 
no idea whether his record in English units is large or small, 
but only judges by comparison with the standard, he will get 
as good an idea by the metric system as by any other. 
The record book should be made of the best ledger paper 
and ruled transversely into spaces enough for all the items to 
be recorded. The perpendicular ruling can be made to 
divide the space into six columns, for the records when 
measurements are repeated. This will enable one to see at a 
glance what the change has been in any item, from time to 
time. If the space is economized, there will be plenty of 
room on the two pages that face together to record the 
measures of three individuals, six times each, and keep such 
items of history as should appear in such a book. The list 
of items recorded will be seen on a later page. 
The books should be bound in volumes of about one 
hundred and fifty leaves, with heavy leather, as they are 
handled frequently. 
A second way of keeping the records, that has advantages 
in compiling the figures, or tabulating, has been devised by 
Dr. F. Swain. It consists of a card, with all the items of 
measurements and room for two records. These cards are 
simply filed in alphabetical order and kept for reference. In 
tabulating results they are assorted into piles representing 18 
Records and Instruments. 
various grades of value that may have been decided upon for 
any item, as height, or weight, etc. It is not a desirable form 
for a permanent record but, as the personal property of the 
■examiner, is preferable to a book. 
In the form of record book devised by Dr. Gulick for use 
in Y. M. C. A. work, the historical data are placed at the top 
third of the page, the remainder being divided into a column 
for prescription, and several narrow columns for measures. 
The number of items measured is smaller than the list pre- 
scribed by the American Physical Education Association. 
It would seem that the card system of record could be 
used profitably in Y. M. C. A. work, as there is no special 
reason for permanently keeping the data except at some 
central bureau, where they can be tabulated for scientific 
purposes. In schools and colleges a permanent record is very 
important for history and comparison. 
A method of duplicating a record for the benefit of the 
person measured has been suggested by Dr. E. Hitchcock, 
Jr., in connection with his graphic chart described later, and 
consists of a duplicate page to be inserted under the record 
page with a sheet of carbon paper between. By writing the 
record with a stiff pen the figures are duplicated on the chart 
page. 
Another very satisfactory method of recording measures 
is by the author's anthropometric table bound in book form, 
and the measures indicated on it by dots and lines; or the 
actual record can be written at top or bottom and the graphic 
indications marked afterward. This gives a person looking 
over the record for special cases a comprehensive knowledge 
of the special form of the subject at a glance, where the 
■examination of a list of measures even by an expert would 
be long and unsatisfactory. On the back is printed the fol- 
lowing blank for historical data and a complete report on the 
physical conditions not capable of size relations. There is 
also abundant room for notes on the further development of 
the case, and the special exercises prescribed. 
Name, 
Birthplace, Date of Birth 
" of Father 
" " Mother, 
" " Paternal Grandfather Records and Instruments. 
19 
Birthplace of Paternal Grandmother, 
" " Maternal Grandfather, , 
" " " Grandmother, 
Occupation of Father, 
Father died of 
Mother " ' 
Common diseases in family, 
Resembles in physical build, Father's, Mother's family, 
Accidents and surgical operations 
Diseases, 
Condition of eyes Vision, color-blind, 
" " ears hearing, nose, . 
" " muscles, hard, soft, medium, 
" " digestive organs, bowels, 
" " kidneys, skin 
" "lungs, former diseases of, 
" " heart, pulse, 
" " nervous system, sleeps 
" " spine, 
" " shoulders legs,. 
Previous work or exercise, 
" health 
Color of hair, 
" " eyes, 
Use of tobacco tea, coffee, alcoholics, .... 
Notes, 
A card containing blanks to be filled with the historical 
matter by the person to be examined saves much time for the 
examiner and should always be used. The following form is 
serviceable: 
Volume, page, No. 
Your appointment for examination is 
at M.,atroom ..: Gymnasium. Please 
fill out this blank and bring it with you at that time. 
As no name is attached, the data here given will be strictly private, 
and will be retained by for statistical purposes: 
Name in full, 
Date of birth, 19 
Birthplace of Self, Town State, 
" " Father, State, 
" " Mother, " 
" " Father's father, State, 
" " Father's mother, " ' 
" " Mother's father, " 
" " Mother's mother, " 
Father's occupation, 20 
Records and Instruments. 
Do you most resemble your father's or mother's family in physical 
build? 
If either parent is dead, of what did father die? 
Of what did mother die? 
State any illness that has been common in the family, due to diseases, as 
follows: 
Heart, Lungs, 
Digestive organs, Skin, 
Kidneys, Nervous system, 
Scrofula Rheumatism, 
Defective vision, or physical peculiarity, 
Have you ever had any illness that confined you to the bed for two weeks, 
or more? What? 
Have you ever had trouble with the eyes? or ears? 
Can you breathe freely through each nostril? 
Is your digestion good? Are you ever troubled with 
bilious attacks? or with constipation? 
or chronic diarrhea ? . 
Is a cold more likely to locate in your nose, throat or lungs? 
Do you suffer from nasal catarrh? 
Do you faint easily? 
Have you ever had palpitation of the heart? 
Are your feet and hands usually cold? 
Do you have headaches frequently? 
Do you sleep well ? How many hours? 
It is advisable for each examiner to keep a private book 
for containing information of a purely personal nature, 
and for the guidance of the instructor in prescribing exercise. 
This private record will give him an amount of material for 
study and comparison in a few years. 
This private book should contain a careful record of 
personal peculiarities that may have a bearing on health and 
development. Any history of previous disease or accidental 
injury, even if recovery seems complete, should be recorded. 
Advice in regard to exercise and the results of-the advice 
should be noted. This book should be a history of the 
person's physical welfare during the past and while he is 
under observation, and thus correspond to a physician's case- 
book. The examiner will learn more from this record than 
from the book recording size and strength, when he studies 
the result of gymnastics. 
The following instruments are needed for measuring: 
i. A set of scales, with high bar for convenience in read- 
ing. These are made with metric graduation (Fig. 2). 
2. A graduated pole, with a slide moving at right angles Records and Instruments. 
21 
on it for taking- heights (Fig. 3). The arm of the slide 
should not be over 125 mm. long. The pole may have the 
metric system marked on one side, and 
the English on the other, like the one 
shown in the cut. It is essentially two 
meter sticks, on one of which is fixed 
at the end an arm 125 mm. long at right 
angles to it. A slide bearing a similar 
arm is made to run closely on the stick. 
The height is readily taken by holding the 
ends of the sticks together by the left 
hand while the right lowers the slide to 
the top of the head. Care must be 
taken to have the sticks perpendicular. 
The height sitting, height of pubes and 
knee are taken with the one stick, which 
is much lighter and more readily 
handled than a long pole. The same 
stick, with slide, can then be used 
for taking the breadths. It may also 
be used for taking depths, by having 
two blades in the faces of the arms 
that may be turned out when needed for use (Fig. 4). A 
stadiometer is used by some persons engaged in anthropo- 
metric work that consists of a pole mounted perpendicularly 
on a box 18 inches square and 12 
inches high (Fig. 6). The pole carries 
a sliding arm that can be moved to any 
region for measuring heights as the 
subject stands or sits on the box. The 
device is expensive in time required in 
using, as the subject has to be re- 
located for each record. and the stretch- 
Fig. 2. 
ing against the pole tends to give larger records in height 
than is deserved. The constant change of position and 
Fig. 3. 22 
Records and Instruments. 
manipulation of the subject is unpleasant for both parties 
and should be avoided when possible. 
3. A pair of slide calipers (Fig. 5), for taking breadths, 
will be needed if a pole is used for heights different from the 
one described. This adds to the expense of the outfit as well 
as to the number of articles to be 
handled. 
4. A tape measure of steel or 
cotton (Fig. 7). The metal is 
uncomfortable to the skin, but 
does not stretch and can be kept 
clean. A linen tape stretches on 
being moistened, and many sub- 
jects will sweat so freely as to wet a cloth tape. A painted 
tape is about as unpleasant to the touch as one of steel, 
A tape must be renewed often and as the cotton tapes are 
inexpensive they are a very desirable form for general use. 
A little instrument is made by the Narragansett Machine 
Co., at the suggestion of Dr.Gulick, 
for attachment to the end of a tape 
to indicate the proper tension, so 
that the pressure may be always 
alike (Fig. 8). It is a good device 
for the beginner, but useless after 
practice has given a habit in making 
the tension. 
Fig. 4. 
Fig. 5. 
5. Calipers for taking depths (Fig. 9). These may be of 
wood or metal and should have large extremities, so that a 
slight variation in pressure will not vary the record greatly 
by indenting the flesh. An index should be on the instru- 
ment, for reading while in position and a spring should give Records and Instruments. 
23 
a constant pressure while the instrument in being used. If 
the attachment to the measuring pole shown in Fig. 4 is 
used, this instrument will not be 
needed. 
6. A capacity spirometer (Fig. 
11) for recording the amount of 
air that can be inhaled and then 
exhaled, or the complemental, 
tidal and supplemental air of res- 
piration. Hutchinson's wet spiro- 
meter is considered the most re- 
liable instrument of the kind. It 
is made in various forms and 
should record the capacity in 
liters. 
7. A stethometer or pressure 
spirometer (Fig. 10) is used by 
some persons, but is utterly 
worthless as far as information 
elicited by it is concerned. A 
person may blow by means of a 
rubber tube and suitable 
mouthpiece into an ordinary 
steam gauge that is made for 
recording low pressures, or an 
instrument devised by the author may be used. A piece of 
glass tubing of 5 mm. diameter is bent into the form of a 
Fig. 6. 
Fig. 7. 
Fig. 8. 
right-angled triangle, having one angle of about 350. The 
side adjacent to this angle.should be about 400 mm. long and 
should be horizontal when the triangle is fixed against a flat 24 
Records and Instruments. 
wall for support. A rubber tube with a glass mouthpiece is 
attached to the short side, and mercury is drawn in to fill the 
horizontal part. Now, by blowing into the mouthpiece, the 
mercury is forced up the hypothe- 
nuse of the triangle. 
The graduation is easily made 
by measuring the perpendicular 
line from the base to any point in 
the hypothenuse, and affixing a 
scale to the support back of the 
tube. The pressure will then be 
indicated in millimeters of mer- 
cury column. 
8. A hand dynamometer (Fig. 
12), for taking the strength of 
the flexor muscles of the forearm, 
may be used where a universal 
mercurial dynamometer is not available. 
There are several forms of this instrument, the more com- 
mon ones being the oval, and the form with the two sides 
always parallel (Fig. 12), the re- 
sistance being two spiral springs. 
This second form gives all the 
fingers an equal opportunity to 
exert their pressure. A "push 
holder'' and a "pull holder'' (Fig. 
13), are made to use with the in- 
strument for enlarging its range 
of utility. 
9. A dynamometer for lifting 
with the back and legs, and 
taking the strength of the pecto- 
rals and retractors of the shoul- 
ders is shown in Fig. 15. The 
instrument may be replaced for 
the first two tests by a lifting 
machine with spiral spring re- 
sistance and a graduated index applied from actual tests. 
The advantage of this latter form is the quick adjustment to 
the height of the person. 
10. Parallel bars for testing arm extensors in "Push up.'' 
Fig. 9. 
Fig. io. Records and Instruments. 
25 
A short pair of bars (Fig. 15), about 750 mm. long, attached 
to a frame with suitable braces, and made to move up and 
down against the wall in being adjusted to any height desired, 
can be used for this test and also 
for the "Pull up,'' or test of flexors 
of the upper arm. Otherwise a 
horizontal bar (Fig. 16). trapeze 
bar, or pair of swing rings, must be 
used for this last test. This bar 
frame should be hung with a coun- 
ter weight and latch for easy and 
quick adjustment to any height. 
The bars have an attachment for 
carrying a cord three inches above 
them, to which the chin must be 
lowered in taking the test. 
11. A stethoscope for listening 
to heart and lung sounds, etc. (Fig. 
17). Camman's binaural is a suita- 
ble instrument. The soft rubber 
bell is useful at times to secure per- 
fect coaptation to the surface of the 
chest. It requires some practice to 
secure all the advantages that a 
stethoscope can give, as the pressure of the nib in the ear is 
a distraction of the attention at first, and any slight move- 
ment of the fingers on the instrument causes vibrations that 
are not understood. If 
the examiner wishes to 
hear the valvular 
sounds of the heart, 
without the interfer- 
ence of muscular vibra- 
tion sounds, he can in- 
terpose a thin cloth be 
tween the bell and 
skin, but in general the 
instrument should be 
placed directly against the surface of the body. 
The phonendoscope, invented by Bianchi (Fig. 18), is con- 
sidered by many prominent teachers in physical diagnosis 
Fig. ii. 
Fig. 12 26 
Records and Instruments. 
superior to the stetho- 
scope in some respects, 
and more desirable be- 
cause it can be conven- 
iently carried in the 
pocket without detaching 
the tubing, and clothing 
does not seriously inter- 
fere with its reception of 
sounds. A combination 
of the principles used in 
the two instruments has 
been made by Dr. Bowles, 
and the result is an im- 
provement over any of the previous means of studying inter- 
nal sounds. The Bowles stethoscope may now be obtained 
from any dealer in surgical supplies. 
In addition to the above-mentioned instruments, the fol- 
lowing are useful at times and for 
special work: 
12. A sphygmograph, or ky- 
mograph, for taking pulse trac- 
ings. Dudgeon's instrument is 
perhaps as satisfactory as any 
(Fig. 19). It is small, easily ap- 
plied, can be carried in the pocket 
and used in the gymnasium as 
well as in the office. It cannot be 
applied to all pulsating surfaces. 
Marey's instrument is used to 
some extent, but the pneumatic 
kymograph is employed in all 
physiological laboratories, and 
does very satisfactory work. 
13. A laryngoscope, rhino- 
scope, otoscope and tuning fork, 
for examining the throat, nose 
and ears. 
14. A Clinical thermometer. 
15. A Pleximeter and Per- 
cussor (Fig. 20 and 21). 
Fig. 13. 
Fig. 14. Records and Instruments. 
27 
16. A Microscope of 20 mm. focal distance for examin 
ing the skin. 
17. A case of urinary tests for sugar and albumen. 
Fig. 15. 
Fig. 16. 
i8. Test worsteds, glasses and charts, for examination of 
eyes for color blindness and errors of refraction. 
These instruments can be obtained of any first-class dealer 
in surgical instruments and optical goods 
except 17, which can be obtained of 
Parke, Davis & Co., or other manufac- 
turing chemists and druggists. 
The historical data that should be 
gathered at each examination are of 
varied character, and of the highest 
importance. It not only gives the exam- 
iner an idea of the 
immediate weak- 
nesses that are to 
be met and com- 
bated by proper 
advice and train 
ing, but it places 
the law of heredity in bold relief, and 
enables the counsel to be far-reaching 
in its results. 
For instance: with a record of tuber- 
culosis, extending through two or more 
generations, there would seem to be 
sufficient warrant for advising not only 
the thorough development of the chest, 
but the careful avoidance of excessive 
FlG. 18. 
Fig. 17. 28 
Records and Instruments, 
exercise, such as would 
be required in many- 
athletic sports that 
might seem, at first 
thought, especially 
suitable for a person of 
consumptive diathesis. 
To know a man well 
you must know his 
father and grand- 
father. 
Growth and organic 
perfection are gained 
only by a use of all the 
tissues-but use is one 
thing and abuse quite 
another. The eye is developed and improved by a repeated 
use in distinguishing colors, shapes and sizes; but a long- 
continued strain of the eyes over a Greek or German text is 
not exactly beneficial, as the spectacle-mounted noses of our 
students, especially the Germans, bear witness. So, while a 
good run in the open air may be beneficial to a person of 
sensitive or weakened lung tissue, it does 
not follow that training for a mile run or a 
"hare-and-hounds" chase would be. 
The condition of the 
person during the pre- 
vious years of his life is 
valuable in making a 
prognosis or a judgment 
of the future history of the case, and in 
deciding what quality of endurance the sub- 
ject possesses, for the violent exercise of one 
man is a mere nothing for another. The boy 
who comes to school from the farm or work- 
shop may be no better developed than his 
classmate who has never known what physical 
work is, and yet be able to endure twice as 
much prolonged physical exertion. His life 
has been spent out of doors, and he takes 
kindly to out-door sports, running, football, 
Fig. 19. 
Fig. 20. 
Fig. 21 Records and Instruments. 
29 
boating, etc.; or, if his life has been in a shop where skilled 
manipulation has engaged his energy, he prefers gymnastic 
exercises, becomes an adept at club swinging, fencing, etc., 
or a good performer on the bars, rings and other apparatus. 
The city-bred boy has a latent aptitude for anything, and 
with proper training is a strong competitor with his country 
classmate in every line of athletics or gymnastics, but his 
exercise will need to be progressive or he will suffer from 
local strains that may affect vital organs. 
If, on the other hand, the history discloses a pre- 
vious life of activity and physical hardship, and the plan of 
life is directed toward sedentary pursuits, the recommenda- 
tion must be toward retrogressive exercise. A man with 
benign hypertrophy of the heart is not in the best condition 
for sitting at a desk all day-there will be too much local 
congestion for good brain work, or the metamorphosis of 
muscular tissue in the heart itself will end in fatty degenera- 
tion, or softening, and impaired vitality result. This is 
undoubtedly the reason for the numerous cases of functional 
and organic diseases of the heart that are found among 
ex-champions. 
The history may also disclose a tendency to disease in 
the subject that will modify the prescription of exercise very 
materially, if the examiner is alive to the exigencies of the 
case and informed as to its requirements. 
On the record book, in connection with the measures, the 
subject's name and birthplace should be kept-there is no 
reason for secrecy about these matters. It is also well to add 
the birthplace of parents and grandparents to this general 
record, for it makes the material valuable in studying the 
effect of location or environment in differentiating classes or 
social groups; the occupation of the father, the resemblance 
in physical build to father's or mother's family; past exercise 
in work and recreation, pulse rate, color' of hair and eyes, 
vision and hearing, use of tobacco and stimulants. In the 
private book should be recorded the cause of death of either 
parent if not living, any disease that has been common in 
the family (it is better not to use the word hereditary in this 
connection), such as lung diseases, heart diseases, rheuma- 
tism, neuroses, Bright's disease, cancer, scrofula, varicose 
veins, dyspepsia, diarrhoea, constipation, catarrh, etc.; also 30 
Records and Instruments. 
any disease that may be found affecting the subject, as vari- 
cocele, rheumatism, synovitis, etc., any deformity and its 
cause, if discoverable; any injury in the way of broken 
bones, surgical operations, strains, etc.; any previous severe 
illness, such as peritonitis, zymotic fevers, etc.; any tendency 
to deranged functional activity, as constipation, biliousness, 
indigestion, insomnia, etc. 
In this connection it may be well to call attention to the 
rule that, if a child strongly resembles in physical build the 
side of the family that has no hereditary taint, the other side 
having some pathological diathesis or dyscrasia, the proba- 
bility of his inheriting the disease is diminished. 
It is well to record the special kind of athletic or gym- 
nastic work that has been taken and whether this has been 
under the personal direction of a teacher or trainer. 
If there is any lesion of the heart or other organs that 
has been due to or been attributed to athletic or gymnastic 
work under supervision, look up the instructor and get the 
previous history of, the case. You may find that the so-called 
instructor or trainer was an ex-prize fighter or dilapidated 
"bummer," but, if so, use him to discredit the popular trust 
in ignorance. If he does know his business, he will perhaps 
be able to enlighten you as to the cause of the trouble. 
It would seem to be desirable to establish some general 
system of marking physical condition so that a man who had 
been properly examined could have a statement, in such com- 
mon terms as could be understood by lay people anywhere, 
that should give his condition of health, the important items 
of his size, the condition of all his so-called vital organs, his 
strength and apparent working capacity as well as his proba- 
bility of life. Francis Galton has called attention to this 
desideratum in a communication to the American Associa- 
tion for the Advancement of Physical Education (see report 
1891). I believe this to be a perfectly feasible matter and 
would suggest in connection with a graphic and numerical 
statement of size that there be a more extended system of 
strength tests. 
An arbitrary numerical mark could be given to represent 
the heredity, the condition of heart, lungs, digestive organs, 
kidneys, nervous system, skin, visual organs, hearing, etc. 
If these were all marked on a scale of ten, which should Records and Instruments. 
31 
represent perfect Condition, lower numbers representing com- 
parative deviations from this standard, a comprehensive view 
would be given of the mechanical conditions which tend to 
make a durable as well as satisfactory machine, for from one 
point of view man may be truly considered as a machine. 
These points suggested above might well be divided into two 
classes and marked "essentials" and "desirables." Under 
essentials might be placed the condition of the heart, lungs, 
kidneys and nervous system. The other items might be 
classed as desirables but where slight deviations from perfect 
condition could be tolerated. A report of this kind would be 
of high value to an employer who might be seeking a perma- 
nent helper in any line of work. 
A very valuable work in this line has been done by Dr. E. 
E. Holt, of Portland, Me., and published in the Journal of 
Medicine and Science for September, 1904, under the title, 
"Physical Economics." The purpose of the paper is to give 
a mathematical expression for the economic or earning 
ability of a person. An analysis i3 made of the various 
sources of power and these factors are so combined as to give 
a working formula that may express with fair accuracy the 
■disability occasioned by damage to any part of the organism. 32 
What to Measure and How to Measure. 
CHAPTER III. 
WHAT TO MEASURE AND HOW TO MEASURE. 
In making a physical examination and measurement it is 
well to have the subject entirely nude, and consequently the 
temperature of the room must be kept as high as 750. 
During the measurement the examiner should be alert in 
noticing any peculiarity, or deformity, or disease, or external 
indication of disease. The subject may then dress the 
lower extremities and the minute examination of the chest 
be continued. 
When the examination is made for an institution, and is 
to include the measurement of many men, the services of a 
clerk will save at least half of the time and leave the exam- 
iner free from merely clerical work, and enable him to give 
all his attention to the examination in hand. With such 
assistance, the fifty measurements can easily be made, after 
a little experience, in five or six minutes, and from fifteen to 
twenty minutes should be devoted to each individual; the latter 
amount if advice in regard to methods and forms of exercise, 
and instruction concerning diet, bathing, sleep, etc., is to be 
given at the time of the measurement. To economize time, 
the specially weak or undeveloped parts should be pointed 
out to the subject himself, and the simplest exercises for 
developing those parts be recommended and illustrated if 
possible at a subsequent meeting. 
A greater advantage will come from exercise if the object 
of the exercise is known than if a routine is simply followed 
without interest. A muscle will undoubtedly grow faster if 
watched and made the object of thought during its activity, 
and if attention is turned to it during its period of rest. The 
reason of this is found in the inter-relation of the trophic and 
motor nerves, and the influence of central attention on the 
latter. 
The hygienic instruction can be given by lecture to whole 
classes, and a case needing special care and supervision can What to Measure and How to Measure. 
33 
be asked to come to your office at some other hour when you 
will have time to go over the case thoroughly and examine 
into all thfe details of his habits, a knowledge of which will 
alone enable you to give the best advice. This will save- 
time in the examination and enable you to attend to the 
other work more privately and make your work less mechani- 
cal. 
If you are examining many cases in succession you will 
need to possess a quick memory of faces and facts or some 
notes will have to be taken at the time of examination 
that will recall the existing conditions in each case. It is- 
well to train the memory in this matter, but take careful 
notes to fall back upon. A client will feel that you 
remember him and have given his case thought if you can 
show that you know just what his condition was when you 
saw him last. 
The number of items measured is not of so much import- 
ance as the thoroughness of the work done and the care and 
judgment displayed in discovering weak parts that can be 
strengthened, and recommending the proper remedies. But I 
would advise a strict adherence to the advanced standard of 
measurements recommended by the American Physical Edu- 
cation Association, for uniformity of methods is of great im- 
portance in giving scientific value to work of this kind. 
Then, if a person has a special desire to ride some hobby 
of his own and take such measurements as the horizontal 
length, the occipito-mental diameter of the head and the 
length of the os calcis, all of which points are of some im- 
portance and have a bearing on anthropology and practical 
anthropometry, he is at liberty to do so. 
The following technique of measuring is suggested as one 
that has been found to be the most economical in time and 
energy, and most likely to give correct interpretation of the 
physical proportions. 
First secure the height record as follows: Place the sub- 
ject in an easy erect standing position, with heels together; 
then step behind him and place the foot of the pole (Fig. 22} 
near the heels in the median plane and bring it to a perpen- 
dicular positon, holding the parts firmly together with the 
left hand. With the right hand bring the movable hand of 
the caliper down upon the top of the head. Remove the pole 34 
What to Measure and How to Measure. 
and read the number indicated, as you wish to have it recorded 
by the clerk. There will be a tendency on the part of the 
subject to put himself in an unnatural position, and while it 
is essential for the person to hold himself perfectly erect it is 
desirable for him not to stretch himself into unusual positions. 
If a person does stretch himself unduly it is well for the exam- 
iner to move him one or two steps before taking his height. 
This puts him off his guard and enables the examiner to secure 
his normal height record; or the sub- 
ject may be moved to one side with 
the same result.' The method of taking 
heights by placing persons against a 
wall is faulty, as is also the stretch- 
ing a person against a fixed pole, for 
the reason that it gives an abnormal 
poise. The ordinary standing height 
of persons with deep lumbar curve 
will increase by 20 to 30 mm. by 
having him stretch against a fixed sup- 
port. The time of day when the 
measurements are taken also modifies 
the reading to some extent, the total 
height being greater in the morning 
by some 10 to 18 mm. This is due to 
the elasticity of the intervertebral 
cartilages and improved tone of the 
muscles that carry the body erect. A 
series of careful experiments, extend- 
ing over a year, have been made by 
Mr. F. H. Curtiss of Purdue Uni- 
versity, on three young men to dis- 
cover the- loss of weight, and gain in 
height, during sleep. The ages of the 
young men were approximately 17, 19 and 20 years at the 
beginning of the observations. His results are as follows:* 
Fig. 22. 
Age 
Weight 
(Kg.) 
Loss 
(Kg.) 
Height 
(Mm.) 
Gain 
(Mm ) 
E. 
17 
5&- 
•32 
1698 
16.3 
J- 
19 
55-5 
•33 
1723 
18. 
F. 
20 
62.7 
•39 
1680 
18.8 
* Phys. Ed. Review, Dec., 1898. What to Measure and How to Measure. 
35 
Somewhat similar work has been done by Dr. T. A. Storey 
of Stanford University.* 
Next, step in front of the person, placing the foot of the 
pole in the median line and slightly in front of the line con- 
necting the tips of the toes. Bring the pole to a perpendicu- 
lar position so that the movable arm will rest in the sternal 
notch and read the record. Then, if the height of navel is 
seen to be more than one meter, push the sliding arm up 
above the head and place the pole near enough to the body 
so that it will touch the abdominal wall 
when perpendicular, then read (Fig. 23). 
If the height be less than one meter use 
only the upper part of the pole, placing 
the end of it on the floor and measure as 
before. 
The height of the pubic arch is read 
from the pole while in this same posi- 
tion. In these two measures it is not 
necessary to use the sliding arm of the 
pole although this may be done by 
reversing the pole and then reading to 
the upper edge of the slide, instead of 
the lower, in order to compensate for 
the thickness of the fixed arm that will 
lie between the floor and the beginning 
of the graduation. 
All records to this point are to be 
taken without having the subject move 
from the original position. 
Next, have the person sit on a stool 
provided for this purpose, which should 
vary in height according to the general 
height of the group to be measured, the 
essential point being to have the thigh horizontal when the 
person is sitting. For fairly mature subjects this will be 
about 35 cm., and less for children. Standing behind the 
person, place the lower end of the upper half of the pole 
upon the top of the stool and bring the slide down upon the 
top of the head (Fig. 24). Care should be taken to see that 
the subject is sitting perfectly erect and that the poise of the 
Fig 23. 
* Phys. Ed. Review, Dec., 1901. 36 
What to Measure and How to Measure 
head is correct, as undue ele- 
vation or depression of the chin 
seriously modifies the record. 
The length of trunk to the 
episternal notch is taken by 
placing the end of the pole on 
the stool between the thighs 
and then bringing the sliding 
arm down until its tip rests in 
the sternal notch with the pole 
perpendicular. 
Take the height of the knee 
by stepping to either side and 
placing one hand upon the top 
of the knee so that the thumb 
shall press firmly into a notch 
found at the top of the fibula, 
and holding the rod in the 
other hand perpendicularly, 
bring the sliding arm up under 
the tip of the thumb and read 
(Fig. 25). If the rod is placed close to the thumb the per- 
pendicular position will be more easily secured. There 
seems to be no reason for not making this a bone measure- 
ment, as it is a length of bony structure that is sought. The 
most convenient land-mark for measuring seems to be the top 
of the head of the fibula, this being 
on the outside of the leg, and on a 
level with the articular surface of the 
joint and with the upper edge of the 
biceps tendon. It is, therefore, easily 
found in all cases. 
The top of the patella has been 
used as a landmark by some examiners 
and also a measurement to the top of 
the knee. It is obvious that neither 
of these records give the true length 
of the leg for comparison with the 
length of the thigh. 
It is convenient now to take the 
length of the feet, and the pole is 
Fig. 24. 
Fig. 25. What to Measure and How to Measure. 
37 
applied on the inner side of the foot as it 
rests on the floor so that its fixed arm rests 
against the greater prominence of the os 
•calcis, the pole touching the inner surface 
of both the heel and the ball of the foot 
(Fig. 26). This saves handling the foot 
and insures uniform accuracy. 
The subject now stands and the length 
of the arm from shoulder to elbow is 
secured by placing the forearm against the 
chest in a horizontal position (Fig. 27). 
The pole is applied against the front of 
the arm with the fixed arm of the caliper 
resting on the acromion process; the slid- 
ing arm is moved up against the olecranon 
process. 
The length of finger tip is next secured 
by placing the fixed arm of the caliper 
against the olecranon tip and letting the rod lie along the 
back of the forearm. Then bring the 
slide against the tip of the middle finger. 
Care must be taken not to apply the rod 
in such a way that the fixed arm of the 
caliper rests against the triceps muscle, 
but essentially at right angles to the 
humerus. There appears to be no ade- 
quate reason for taking the length of 
both right and left arm. 
The stretch of arms may next be 
taken by grasping the upper end of the 
lower half of the pole, and by applying 
the other end of it to the wall about the 
height of the shoulder of the subject, and 
directing him at the same time to put 
the tip of his finger against the wall at 
the same place. While he is doing this, 
bring the second part of the rod to posi- 
tion so that when you ask him to extend 
the other arm you have everything in 
position, so that you may readily move 
the slide against the tip of his middle 
Fig. 26. 
Fig. 27. 38 
What to Measure and How to Measure. 
finger while he is in a position of complete extension. It 
will be convenient to make this the first measurement taken, 
as the lower half of the rod may then be laid aside after 
taking height of navel. 
Now lay aside the lower half of 
the rod and take breadth measure- 
ments, beginning with breadth of 
head. This and the next three 
records should be taken standing 
behind the person. In taking all 
breadths, care should be taken to 
hold the rod so that the sliding arm 
may be moved by the right hand. 
Press the caliper firmly at a point 
high enough to insure including the 
broadest part of the skull then lower 
until it touches the tops of the ears, keeping the right thumb 
pressed lightly on the carriage of the sliding arm. The 
widest part will have been included. 
Great care must be exercised in securing the breadth of 
neck, as the tissue is extremely susceptible to change under 
pressure. Measurements should be taken from behind with 
the left hand resting on the left shoulder of the subject in 
such a way that the thumb 
and forefinger can bring the 
fixed arm of the caliper to 
touch the left side of the 
neck (Fig. 28). The thumb 
of the right hand can then 
move the sliding arm of the 
caliper up to touch the right 
side of the neck and the cor- 
rect breadth be thus secured. 
I see no reason why the 
breadth of shoulders should 
not be taken at the level of 
the acromions and have 
always so taken it. This accounts for the difference in 
records shown on the percentile charts of Amherst and Yale 
students. The subject should stand in easy position without 
throwing the shoulders back (Fig. 29). 
Fig. 28. 
Fig. 29. What to Measure and How to Measure. 
39 
The technique should obviously be the same for taking 
breadth of waist as for securing the breadth of the neck 
except that the left hand should rest upon the hip instead of 
the shoulder. The record should be taken at the narrowest 
part of the trunk or over the last rib. 
After taking breadth of waist, pass in front of the subject 
and measure the breadth of chest by placing the tips of the 
caliper in the axillary spaces at the level of the nipples, 
taking care not to place them so far back as to include any 
part of the latissimus muscle. The breadth of nipples should 
next be taken from center to center if measured at all. I 
perceive no adequate reason for making this record. The 
breadth of hips should next be measured by pressing the 
caliper arms firmly against the trochanters, as this should be 
a bone measurement. It may be well 
to note that the height of this diame- 
ter is the height of pubis. 
In recording the measurements of 
women it is advisable to measure also 
the breadth of the hips at the pelvic 
crests. This can be done without 
including muscular tissue by apply- 
ing the tips of the caliper arms to the 
outside of the anterior superior spinous 
processes of the ilii. 
, The measuring pole may now have 
the attachments for taking depths 
opened on the arms as shown in Fig. 4, or the caliper (Fig. 9) 
may be used. In taking depths, care must be exercised to 
secure the normal position of the subject, as slight muscular 
movements change the depth greatly. The depth of chest is 
taken by applying one foot of the caliper to the spinous 
process, and the other to the sternum on a line between the 
nipples in such a way that the plane of the caliper will lie at 
right angles to the axis of the spine (Fig. 30). The caliper 
must be so constructed that a spring shall hold the caliper 
arms against the chest with a constant tension, and a pointer 
affixed to one arm moving along the graduated arc will indi- 
cate the antero-posterior movements of the sternum during 
respiration and the maximum reading indicate the depth of 
chest at ordinary inspiration. The depth of the abdomen is 
Fig. 30. 40 
What to Measure and How to Measure. 
next secured with the caliper in the same relative position to 
the spine, and the anterior arm resting slightly above the 
navel. This record is valuable only in a general way. 
The author believes that in all cases where there is obvi- 
ous asymmetry of the chest, or where there is found pul- 
monary disease or bone deformity, it is well to take other 
depth measurements as well as those prescribed by the 
American Association. The depth of right and left sides 
may well receive consideration, and their record may be 
taken at various heights and at indifferent phases of respira- 
tion for private records. 
The girth measurements should next be taken. It is con- 
venient to begin with girth of head, which should be taken 
round the largest part and over frontal and occipital promi- 
nences. The tape 
may be conveniently 
applied by holding it 
between the thumb 
and forefinger of each 
hand, with the hands 
at such a distance 
from each other that 
they shall represent 
about the distance to- 
be measured (Fig. 31). 
The tape thus ex- 
tended should be 
lifted over the person's head with the examiner standing at 
the right of the subject; the hands to be raised or lowered as 
may be necessary to bring the line of tape into conjunction 
with the greatest diameter, which may be readily appreciated 
from this position. After reading the tape in position, it 
should be lowered to the neck and the record secured by- 
measuring around the smallest part just below the larynx. 
It will be noticed in carefully observing the contour of the- 
neck that there is usually a smallest part, the neck being 
formed essentially by two truncated cones applied to each 
other. 
The tape is now removed from the neck and applied to 
the chest under the arms in such a way as to have the unit 
end lie upon the right half of the chest in front. The tape 
Fig. 31. What to Measure and How to Measure. 
41 
should embrace the lower ends of the scapulae and lie 2 cm. 
above the nipples. It is convenient to record first the normal 
chest. (It need hardly be said that no girth measurement 
should be taken with the finger under the tape, but the 
author has seen this done by people of some little experience, 
especially in taking chest measurements.) Then without 
moving the tape have the subject inhale and expand the 
chest to its greatest capacity, the tape meanwhile to be 
removed from the front wall by raising the ends of the tape 
so as to allow free play during expansion. After the reading 
is made have the subject exhale, flattening the chest as com- 
pletely as possible. Apply such tension to the tape as shall 
keep it against the skin, but care must be taken that no 
greater tension is applied to the tape during the time of 
reading the record for contracted chest than for expanded 
chest, as will be the tendency. The girth of chest should 
then be taken below the pectoral muscle about 8 cm. below 
the nipple in both forced inspiration and expiration. This 
is usually called the girth at the ninth rib, the tape crossing 
the ninth rib in the axillary space. 
The girth of waist should be measured around the 
smallest part of the trunk. 
Care must be taken in securing this record that the sub- 
ject does not contract the abdominal muscles and thereby 
diminish the normal size of the waist. If the subject does 
this, I would advise the examiner to pass the tape line down 
and secure the girth of hips, then secure girth of waist, 
which will then be found usually in normal form. 
In measuring girth of hips the tape should pass horizon- 
tally over the greatest protrusion of the gluteal muscles, the 
subject standing with heels together as in heights and 
breadths. After the tape has been put around the trunk for 
the first chest measurement it should not be removed until 
the girth of hips is read. 
It is convenient now to begin the measurement of the 
limbs, and the subject should stand with the feet about 15 
cm. apart with the weight borne equally upon them. 
Beginning with the right biceps place the tape around 
the largest part, in a plane at right angles to the axis of the 
humerus, while the muscle is strongly flexed. The arm is 
then straightened and the tape placed midway between the What to Measure and How to Measure. 
42 
ends of the humerus for girth of arm (Fig. 32). The posi- 
tion of the greatest enlargement during the contraction 
varies greatly in different people, being dependent on the 
relative lengths of the tendonous portions. It seems desira- 
ble that we should have a record for both biceps and arm, as 
a relative size of these two records gives a strong indication 
of the muscular condition of the subject, for if the size be 
largely made up of fatty tissue, the difference between the 
two records will be comparatively small. 
The girth of elbow is supposed to indicate to some extent 
the bony development of the subject, if measured around the 
condyles. However, this record is always found to be large 
if the girth of the forearm be large, since the measurement 
must of necessity include heads of both flexors and extensors 
of the forearm, and these are 
the muscles that are measured 
over their largest parts in the 
forearm. 
I prefer to have this girth 
indicate the extent to which 
the tissues of the arm extend 
to and coalesce with the tissue 
of the forearm. Consequently 
I measure above the internal 
condyle around the smallest 
part of the arm. The dif- 
ference in the two methods is 
shown on the percentile tables 
from Amherst and Yale students. 
The tape is next lowered to the largest part of the fore- 
arm, while the hand is tightly closed, and the girth recorded. 
It is then lowered to the smallest part of the wrist, i. e., 
below the styloid process, while the thumb is kept well in 
toward the palm. 
The thigh is next measured close to the gluteal curve and 
the tape then lowered to the knee over the center of the 
patella. The girth of calf is taken around the largest part; 
the ankle around the smallest part. The tape is then 
removed and placed around the instep over the tarso- 
metatarsal joint. The left side is then measured in the 
same order. The examiner stands at the side of the subject 
Fig 32. What to Measure and How to Measure. 
43 
while securing these limb measurements, rather than in 
front (see Fig. 31). 
REPORT OF THE COMMITTEE ON REVISION OF PHYSICAL 
EXAMINATION. 
At the convention of the American Physical Education 
Association, held in Detroit April 6-9, 1903, there was 
appointed a committee to "revise the Physical Examination.'' 
This committee consisted of Dr. Paul C. Phillips, chairman; 
Dr. Dudley A. Sargent, Dr. George L. Meylan, Dr. William 
W. Hastings and Dr. C. E. Ehinger. 
The committee decided it was advisable, in their revision, 
to publish a minimum list of measurements and strength 
tests, containing the most essential records. This decision 
was based largely on the demand of physical directors in 
many fields for a shorter list, which would require less time 
to take, promote accuracy in the taking and give more time 
for the medical examination and study of the individual. 
Some, it was thought, would adhere to the old list, or a 
greater portion of it, where time and means were obtainable, 
but the minimum list would constitute a basis to which addi- 
tions might be made to suit the individual field. 
It was recognized, moreover, that the report of the former 
committee represents quite inadequately the entire list of 
qualities,' now measurable, which it is, in general, desirable 
to include. 
It was deemed wiser, however, for the present, not to 
incorporate purely psycho-physical or anthropological tests 
in a minimum list. 
It seemed inadvisable to attempt to modify this list to suit 
perfectly the requirements in the various fields of work. 
The committee recommends, however, a list for the public 
schools. 
As a basis of selection value to the individual examined 
was given first place, the value to science in general being 
considered secondary. For this reason many measurements 
of great anthropological value were omitted. 
In the case of a few the preponderating argument was 
the interest of the individual in the measurement or test. 
Inability to change a measurement by exercise was con- 
sidered a strong argument against its retention. Those 
measurements and tests which together formed the best 
index of the individual's organic vigor or vitality were voted 
most valuable to him. Hence the large proportion of meas- 
urements of the body proper. 
The committee did not reduce materially the data required 
in family and personal history (as this is generally given 
on a blank by the one examined, and so requires little of the 44 
What to Measure and How to Measure. 
director's time) but attempted mainly to make more definite 
the questions in order to obtain more definite information 
regarding nationality, birthplace, health of ancestors, etc. 
It seemed desirable to get fuller information regarding 
not only the organic but the functional disturbances of the 
individual and if necessary of his ancestry. Hence the ques- 
tions added. 
PERSONAL AND FAMILY HISTORY BLANK. 
Date 19. ... 
Name in full 
Birthday, year month day 
Age in years and months 
FAMILY HISTORY. 
Nationality of paternal grandfather 
Nationality of paternal grandmother 
Nationality of maternal grandfather 
Nationality of maternal grandmother 
Residences of father before your birth 
Residences of mother before your birth 
Note-Name the towns or cities, stating length of time lived in each. 
Occupation of father before your birth 
HEREDITARY CONDITIONS. 
Do you resemble your father's or mother's family in physical character- 
istics? 
Father died of at years of age. 
(If living, how is his he'alth?) 
How was it before your birth? 
Mother died of at years of age. 
(If living, how is her health?) 
How was it before your birth? 
Number of brothers and sisters living dead 
Causes of their deaths: 1 2 3 
Check all of the following diseases which have been common in your 
ancestry: Rheumatism, Consumption, Heart disease, Kidney disease, 
Cancer, Nervous affections, Digestive troubles. 
PERSONAL HISTORY. 
Residence. State where the first 17 years of your life have been spent, 
giving your age at each residence: In the city 
Suburban town (under 8,000 pop.) 
Country town (under 8,000) ... 
Country.... 
Viz: City 1-17; or country 1-10, country town 11-17. 
Occupation. What has been your occupation (work) since boyhood? 
Mental physical 
In what forms have you taken your exercise (recreation)? What to Measure and How to Measure. 
45 
Sicknesses. What diseases have you had? Name all, giving dates and 
length of time each sickness kept you in bed. ... 
State any ill effects of these sicknesses which remain. 
Ailments. 
Is your appetite good? Are you ever troubled with 
indigestion? constipation? bilious attacks? 
Are you subject to colds?-nose, throat or chest? 
Can you breathe freely through either nostril? 
Are you subject to headaches? 
Do you have trouble with your eyes? ears? 
Did you ever faint? Do you get out of breath easily? 
Do you sleep well? * ... .How many hours average? 
Average number of hours spent in the open air each day? 
MEDICAL EXAMINATION. 
Vision: R= L= 
Hearing: R = L = 
Skin: 
Form and Posture. 
Head, spine shoulders 
chest abdomen 
Pelvis legs 
feet 
Heart and Circulation 
Respiration. 
Nose throat lungs 
Digestion , 
General Condition 
Abnormalities 
Remarks 
GENERAL DIRECTIONS FOR TAKING MEASUREMENTS. 
Inasmuch as the value of these measurements, both to 
the individual and to science, will largely depend on the 
accuracy with which they are taken and since there can be no 
real comparison between the results of different observers 
unless absolute uniformity of method is adhered to, the fol- 
lowing directions are first given: 
Each examiner is advised to review at least once a year 
the directions for taking the measurements and tests, to be 
sure he has not departed from the standard. 
The use of the metric system of weights and measures, 
justified by its history among the scientists of the world, is 
advised for its accuracy, ease, and its world-wide acceptance. 
Linear measurements should be recorded in millimeters, 
centimeters are too inaccurate, weights in kilos and tenths, 
capacity in liters and hundredths. 46 
What to Measure and How to Measure. 
If it is impracticable to use the metric system, inches and 
tenths may be used for linear measures, pounds and tenths 
for weights and cubic inches for capacities. 
For accuracy in individual comparisons it is best to take 
later measurements of an individual at the same hour of the 
day as that of his first. 
In taking the girths the tape should be pulled sufficiently 
tight to adapt it as far as possible to the body surface, this 
tension is about one pound and may be measured by the 
spring tape devised by Dr. Gulick. 
It is important to remember that girths should be taken 
at right angles to the long axis of the part measured. 
The most satisfactory tapesof cloth,inextensile and about io 
m.m. wide. They should be 1,500 m.m. long (about 5ft.) gradu- 
ated to m.m. on one side and inches and tenths on the other. 
Proper hygiene conditions should be observed with all 
instruments used. Mouth pieces should be sterilized in three 
per cent carbolic or other antiseptic solution before each use. 
They should be frequently cleaned. Tapes should be fre- 
quently renewed or cleaned. 
MINIMUM LIST RECOMMENDED FOR COLLEGES, SECONDARY SCHOOLS 
YOUNG MEN'S CHRISTIAN ASSOCIATIONS, ETC. 
Height. 
Weight. 
Body length (episternal). 
Girth of Neck. 
Girth of Lower Chest Expanded 
(gth Rib). 
Girth of Lower Chest Contracted 
Girth of Waist. 
Girth of Right Thigh. 
Girth of Left Thigh. 
Girth of Right Calf. 
Girth of Left Calf. 
Girth of Right Upper Arm, up. 
Girth of Left Upper Arm, up. 
Girth of Right Forearm. 
Girth of Left Forearm. 
Girth of Right Wrist. 
Breadth of Shoulders. 
Breadth of Chest, normal. 
Breadth of Waist. 
Breadth of Hips. 
Depth of Chest, normal. 
Depth of Abdomen. 
Capacity of Lungs. 
STRENGTH TESTS. 
Strength of Back. 
Strength of Legs. 
Strength of Triceps (Push up). 
Strength of Biceps (Pull up). 
Strength of Right Forearm, 
Strength of Left Forearm. 
MINIMUM LIST RECOMMENDED FOR PUBLIC SCHOOLS. 
Weight. 
Height. 
Sitting height. 
Girth of Neck. 
Girth of Chest Expanded (at 
Nipples). 
Girth of Chest Contracted (at 
Nipples). 
Breadth of Shoulders. 
Breadth of Chest, normal. 
Breadth of Waist. 
Depth of Chest, normal. 
Lung Capacity. What to Measure and How to Measure. 
47 
■" Age. Record years and months, as: 21, 9, i. e., twenty- 
one years and nine months; and also birthday, as: Aug. 4. 
1884. To be doubly sure regarding this important item, 
ask the examined how old he or she is and also the date of 
birth (year, month and day). 
Height. The height should be taken without shoes and 
with the head uncovered. The weight should rest squarely 
on both feet. The head and figure should be held rigidly 
erect, eyes to the front, and the heels together. This posi- 
tion is best secured by bringing the heels, buttocks, the spine 
between the shoulders, and the back of the head, in contact 
with the measuring rod. 
Weight. The weight of the body should be taken without 
clothes. Where this is impracticable the weight of the 
clothes should be deducted. 
Body Length [Episternalf Let the subject sit on a hard* 
flat surface about 15 inches high, such as is afforded by a box or 
chair, with the head and body rigidly erect. Measure the per- 
pendicular distance from the box to the interclavicular notch. 
Girth of Neck. With the head of the subject erect, pass the 
tape around the neck half way between the head and body, 
or just below the "Adam's apple.'' 
Girth of Lower Chest ^th Rib), Contracted and Expanded. 
These measurements are taken over the ninth rib where it 
crosses the mammary line. Pass the tape around the chest 
midway between the lower border of the large pectoral 
muscle and the lowest free rib. Take the first measurement 
after a full inspiration and the second after a full expiration. 
Girth of Waist. The waist should be measured at the 
smallest part midway between the twelfth rib and the crest of 
ilium, after a natural inspiration. 
Girth of Right and Left Thighs. With the feet of the sub- 
ject about six inches apart, the muscles set just enough to 
maintain the equilibrium of the body and the weight dis- 
tributed equally to each leg, measure around the thigh in 
gluteal fold, just below the nates at right angles to the long 
axis of femur. 
Girth of Right and Left Calves. With the heels down and 
the weight of the body supported equally on both feet, meas- 
ure around the largest part of the calf. 
Girth of Upper Ri^ht and Left Arms, Contracted. With the 
arm of the subject flexed at the elbow, palm of hand toward 
the shoulder, firmly contracting the biceps, and held away 
from the body in a horizontal position, pass the tape around 
the greatest prominence at right angles to long axis of 
humerus. 
Girth of Right and Left Forearms. With fingers of subject 
tightly clinched, measure around the largest part, just below 
elbow. 48 
What to Measure and How to Measure. 
Girth of Right Wrist. With the hand of the subject open 
and the muscles of the foream relaxed, measure between the 
styloid process and the hand. 
Breadth of Shoulders. With the subject standing with 
arms at sides as in position of "attention." shoulders 
neither dropped forward nor braced backward, measure the 
broadest part two inches below the acromion processes. 
Breadth of Chest, Normal. Measure with breadth calipers 
between the axillae at the level of the nipples (or fourth rib) 
after a natural inspiration. 
Breadth of Waist. Measure at the narrowest part mid- 
way between the twelfth rib and the crest of the ilia. 
Breadth of Hips. Measure at the widest part over the 
'trochanters. 
Depth of Chest. Taken after natural inspiration. Place 
one foot of the calipers 
on the sternum midway 
between the nipples, and 
the other foot on the spine 
at such point that the line 
of measurement is at right 
angles with the axis of 
the spinal column. 
Depth of Abdomen. 
Place one foot of the 
calipers immediately 
above the navel, the other 
on the spine at such a 
point that the line of 
measurement is at right 
angles to the axis of the 
spinal column. 
Strength of Back. The 
apparatus used for this test 
is a spring dynamometer of a capacity of 900 kilos. This must 
not be attached to .an eyebolt or staple directly to the floor 
or a table or platform as formerly (prior to December 30, 
1903), but it must be attached to a movable wooden foot-rest 
of the following dimensions (Fig. 33): A. wooden plank 20 
inches long, 12 inches wide and 1^- inches thick. Mortised 
into this plank should be a boxed frame work made out of 
a-inch hard-wood stock, 9 inches high, 5 inches wide and 4 
inches deep. This box should be placed near the longitudi- 
nal center of the plank, with the front edge of the box two 
inches from the front edge of the plank, and the box should 
have a slot cut in the top and bottom large enough to allow 
the ends of the dynamometer to be inserted for support and 
protection. The dynamometer should be fastened on the 
'under side of the plank with a 6-inch steel bolt fastened 
Fig. 33. What to Measure and How to Measure. 
49 
with screws. TLhe top of the box frame should also be 
fastened with screws so that it could be removed if necessary 
in order to release the dyna- 
mometer. A steel chain if 
inches long of T5g-inch wire 
and i^-inch links should be 
attached to the top of the 
dynamometer by a screw eye- 
bolt. The handle used must 
be at least i inch and noi 
more than inches in dia 
meter and not over 12 inches 
long. The steel hook attached 
to the handle should be made 
out of -J-inch steel and not more 
than 3 inches long. Fig. 34. 
Directions for Back-Lift. 
Stand upon the movable foot 
rest in order to hold it dowr 
to the floor with the weight of 
the body while lifting. Neithei 
the foot-rest nor the dyna- 
mometer must ever be fastened 
to the floor by screws, nails 
or any device whatever. Ad- 
just the handle to the chain sc 
that when standing erect the 
outstretched fingers placed in 
front of the thighs will come within about three inches of the 
handle. Incline the body forward at an angle of about 6o° 
(viz., 300 from the perpendicular), grasp the handle, take a 
full breath, and without bending the knees, give one hard, 
steady lift, mostly with the back. No swaying of the body 
backward or forward, or throwing the weight on to the 
handle will be allowed. 
Strength of Legs. With the same apparatus arranged as 
for the back-lift, standing upon the foot-rest with the body 
and head erect, chest thrown forward, and bending the knees 
until the handle, grasped with both hands, rests against the 
thighs, take a full breath, and give one hard, steady lift, 
mostly with the legs, using the hands to hold the handle in 
place. Lifts made by "snapping," "jerking" " or jumping" 
up the dvnamometer, will not be accepted. 
The Forearm Test. The apparatus used for this test is an 
oval-shaped spring dynamometer of a capacity of no kilos. 
Directions for Testing the Forearms. Holding the dyna- 
mometer squarely in the hand, with the dial turned inward, 
squeeze the spring as hard as possible: note the squeeze of 
the right hand, and then the squeeze of the left hand taken 
Fig. 34. 50 
What to Measure and Hozu to Measure. 
the same way. In making this test the individual must be 
cautioned against touching any part of the person or any object 
whatever with the arm or hand holding the dynamometer. 
Capacity of Lungs. This test is made with a wet spiro- 
meter with a capacity of 400 cubic inches (6.56 litres). 
Directions. Fill the lungs to their utmost capacity and 
blow slowly into the spirometer, finishing the effort with a 
little spurt. Note the highest figures which appear on the 
rising tube. 
As there is some objection to the use of the manometer 
for the "strength of lungs'' test, it has been decided to accept. 
2-^ of the lung capacity in centilitres as a fair equivalent of 
the former. This will enable those institutions having the 
two instruments to allow their pupils an option as to which 
one they will have reckoned in the total strength test, and 
allow those institutions using only the spirometer to enter 
these tests on terms that will make them comparable with 
those which have been made for years with the manometer. 
The Strength of Upper-Arms (Triceps') and Chest. The 
apparatus for making this test are parallel bars, which must 
stand at least five (5) feet from the floor and be eighteen (18) 
inches apart, inside measurement. Eighteen inches from the 
end of the bars there must be a screen or partition 18 inches 
wide and about 30 inches high erected vertically, and a cord 
or tape must be stretched between two pegs at a height of 3. 
inches above the level of the top of the bars. 
Directions. After taking a position of rest upon the 
parallel bars, supporting the weight with the arms straight, 
let the body down until the chin touches the cord or tape 
suspended between the bars, then raise the body until the 
arms are fully extended. Count the number of times the 
body is raised from the first time the chin touches the cord. 
In making this test the legs must be kept straight and as 
nearly as possible on a line with the trunk. 
Strength of Upper-Arms (Biceps') and Back. The apparatus 
used for making this test is a horizontal bar not less than r 
inch or more than ij inches in diameter, suspended 8 feet 
from the floor. 
Directions. Take hold of the horizontal bar with ordinary 
or reversed grasp and hang with arms and legs extended at 
full reach. From this position raise the body until the chin 
is level with the top of the bar and return to the extended 
position. Count the number of times which the body is so 
raised from this position. In both the parallel and the hori- 
zontal bar tests the legs must be kept straight and the exam- 
iner should check the tendency to swing or any other form of 
vibration. 
(In case the individual is not able to raise his weight once 
on the parallel or horizontal bars, or where the total strength What to Measure and How to Measure. 
51 
of women is to be compared with men, tests No. 2 and 3 from 
Dr. Sargent's Universal Test for Strength, Speed and En- 
durance may be substituted for the ordinary "dipping" and 
"chinning." In this case only instead of of the weight 
is multiplied into the number of "dips" and "chins" in 
computing the strength of arms-chest and arms-back.) 
Total Strength. The points that make up the total 
strength are reckoned as follows: The number of kilos lifted 
with the back bent, and the number of kilos lifted with the 
legs bent, added to the strength of the grip of the right and 
left hands, and of the weight in kilos multiplied by the 
number of times the person can raise his weight by dipping 
between the parallel bars and pulling his weight up to his 
chin on the horizontal bar as previously described, plus of 
the lung capacity in centilitres; or, 
me e t (D + P) x W L. C. 
T. S. =B + L + 2F+ - + 
IO 20 
DIRECTIONS FOR TAKING THOSE MEASUREMENTS RECOMMENDED 
FOR THE PUBLIC SCHOOLS WHICH ARE NOT IN THE LARGER 
MINIMUM LIST. 
Sitting Height. Let the subject sit on a hard, flat surface 
about 15 inches high, such as is afforded by a box or chair, 
with the head and body rigidly erect so that the body at the 
buttocks, between the shoulders, and at the back of the head, 
shall touch the measuring rod. Measure the distance from 
the box to the vertex. 
Girth of Chest, Expanded and Contracted. Pass the tape 
around the chest sc that it shall embrace the scapulae and 
cover the nipples and lie at right angles to the long axis of 
the chest. Measure girth after a complete inspiration and 
after a complete expiration. 
Breadth of Head. Measure with breadth calipers at the 
broadest part at the level of the tops of the ears. 
Length of Head. Meaure with breadth calipers the 
greatest length between the median line of the forehead and 
occipital bone at its upper prominent part. 
The following criticisms of this Report, that now stands as 
the official list of the Association, are presented: 
In taking the Girth of Lower Chest the directions are not 
sufficiently specific for the tape may be lying in any plane 
and there is some doubt as to whether the ninth rib crosses 
the mammary line in all cases, as this line is determined by a 
perpendicular let fall from the nipple. 
It would seem advisable to direct that the tape should 52 
What to Measure and How to Measure. 
bear some relation to the lower angles of the scapulae on the 
posterior aspect of the chest and to the lower borders of the 
pectoral muscles or to the nipples in front. If the tape be 
placed on the chest so that it will lie two to three centimeters- 
below the lower angles of the scapulae and five to six centi- 
meters below the horizontal line of the nipples it would seem 
to include the most movable part of the chest. This position 
could be named from the ensiform cartilage that will usually 
be included by the tape. The position of the ninth rib is 
lower that is usually supposed and from its oblique position 
does not give any definite landmark. The position suggested 
here is undoubtedly higher than is intended in the official 
directions. 
In the directions for taking Strength of Back there is- 
some confusion because of the failure to have a single definite 
statement of the method without the use of complicating 
terms. No person has a clear idea of degrees as units of 
measure. If the handle be so placed that it is " three inches " 
below the finger tips as the person stands erect there will be 
no question as to the angle of the body when the handle is 
grasped, if the knees be kept in complete extension. It would 
seem that emphasis should be placed on the position of the 
knees and that the handle should not be allowed to touch the 
thighs during the effort. 
In the test of Strength of Upper-arms and Chest there is 
no restriction in the use of the neck to drop the head forward 
until the chin touches the cord and thus relieve the arms of 
the necessity of taking a position of complete flexion. The 
rule should cover this point as well as that of extension. 
In taking strength of arms, chest and back by these move- 
ments of "dipping" and "chinning," as they are commonly 
called, we do not use the same kind of a test that is employed 
in the leg lift, grip of hand, etc., where the muscles are 
required to contract to their greatest ability for a single time 
and the force of the movement is recorded, but we make it a 
test of working endurance where the load carried is essentially 
the maximum under which the muscles can contract. It 
would therefore seem to be more fair to reduce the test to 
terms of actual work done so that any perversion of the 
method could not add to the record obtained. This can 
easily be done by an instrument devised by Dr. W. G. Ander- What to Measure and How to Measure. 
53 
son of the Yale Gymnasium and consisting of a lever some two 
meters long and having one end attached to the waist of the 
subject by a belt, while the other is made to carry a pencil 
that marks on a moving paper the reduced excursion of the 
long arm that is attached to the waist. The number and 
extent of the elevations of the body can thus be definitely 
measured and the total amount of elevation of the weight be 
computed. 
The computation of "total strength" includes the inconsis- 
tent record of lung capacity that probably bears no direct 
relation to strength. What is more surprising is that this is 
permitted as a substitution for " Strength of Lungs " or expi- 
ratory pressure that has been taken by blowing into a pressure 
guage. The intent of this test was originally to discover the 
power of the expiratory muscles but a difficulty has been found 
in eliminating the influence of the buccal muscles that are 
much stronger than the expiratory groups, so that when a 
person is asked to blow as hard as he can into the apparatus, 
and keep the throat open, as in respiration, he will involuntarily 
close the pharynx with the back of the tongue and palate, 
and then bring the muscles of the cheeks and lips into active 
contraction, and, with a few efforts, acquire such skill as to 
rival the cornet player in the record secured. 
This test should be dropped from the strength records 
altogether, for by so doing the scientific value of the data is 
improved and the value of past records in comparisons is not 
impaired. 
The breadth of shoulders should be a bone measurement as 
nearly as possible; for I conceive the object of it to be the 
determination of the extent of the bone tissue to which the 
more important muscles of the upper extremities and thorax 
are attached. If we measure below the acromion, as directed, 
we give a person credit for broad shoulders simply because he 
has a thick deltoid muscle and the muscles of the chest and arm 
add to the record, in such cases, by making the arm hang at 
an angle instead of perpendicularly, as expected. 
The length of trunk, depth of chest and breadth of chest 
are three factors, that, multiplied together, may roughly be 
considered to represent the "vital capacity" of a person. We 
can get the length of trunk in another way-by substracting the 
height of sternum from total height, which will give the length 54 
What to Measure and How to Measure. 
■of head and neck; and, by substracting this remainder from the 
height sitting we shall have the length of trunk. If the height 
of knee is to be measured, the most convenient land mark is to 
top of the fibula, as the subject is sitting. 
For those who are making a special study of athletes a 
measurement suggested by Dr. Savage of New York is worthy 
of notice, namely, the length of the os calcis, this being the 
lever arm of the muscles that extend the foot; its relation to 
the metatarsal and phalangeal portion is doubtless of impor- 
tance in determining the ability for such exercises as running, 
walking, jumping, etc. 
Dr. Mosher thinks that depth of chest should be a double 
measurement, showing thickness of right and left chest, and 
the suggestion is a good one, because, in many cases the sternum 
is depressed and the record, if made strictly by rule, would be 
-smaller than the subject deserves, and this method would show 
any asymmetry of the chest. 
Some points in minute anthropometry have been suggested 
by various specialists, but obviously such work should be left 
to those who wish to study some particular phase of the subject. 
The height of ear, girth of ankles and hands, depth of pelvis, 
neck and head, length of hands, fingers, ears, etc., have all 
been recorded by some observers. 
The French police regulations require a minute measure- 
ment of the ear and middle finger for identification of criminals 
if they are arrested a second time. These measures help in 
classifying the photographs that are taken so that they can be 
readily found among thousands. 
Some form of anthropometrical tests can no doubt be made 
more serviceable in establishing identity in a "rogues' gallery" 
than photography. The physiological picture of a man as 
shown on a graphic chart is sure to retain some characteristic 
feature, whatever may be his condition. The imprint of the 
papillary ridges of the thumbs has been shown by Galton to be 
an efficient means of identification. 
Photography may be wisely used as an adjunct of anthro- 
pometry. Since Prof. Muybridge made his wonderful pictures 
of animal locomotion by instantaneous process the value of a 
photograph to show physical deficiencies as well as excellence 
has been established. It makes a record in an artistic way that 
is made by tape and calipers in a mathematical or scientific way. What to Measure and How to Measure. 
55 
Already at some of the better equipped gymnasiums photog- 
raphy is made to assist in preserving the record of a man's 
physical condition. 
It is well to have all instruments kept in a cabinet where 
they will not be handled except when in use, as they are 
liable to get soiled and injured so that they work poorly or 
inaccurately. A simple case for this purpose is shown in Fig. 
35. All instruments should be 
tested for accuracy frequently 
and the less they are handled 
by those who do not under- 
stand their use the more pre- 
cise will be their readings with- 
out adjustments. 
The tests for accuracy and 
strength may be made by a 
series of athletic exercises and 
show something of the nerve 
training that the subject has 
had-in other words, the self- 
controlled power. In a person 
we may test the strength of fifty 
groups of muscles acting sepa- 
rately so far as possible and, 
while our record may be high, 
we may still have a very inade- 
quate estimate of the co-ordina- 
ted power-the real strength of 
the individual, which may be 
small. Probably the best exhibit 
of a man's power is seen in such 
games as football, where the 
strength of every muscle is 
tested both as to its own quality 
and its adjustment to other muscular groups and to mental 
stimuli. 
Another refinement of anthropometry is taking the spe- 
cific gravity of a man. This may not be a feasible addition to 
practical anthropometry but for minute study may afford an 
interesting field of investigation. The record can be taken by 
immersing the subject to the face or any suitable point in a 
Fig. 35. 56 
What to Measure and How to Measure. 
reservoir of water that is situated on a scale for weighing. 
From the weights of the reservoir full of water, the displaced 
water and the immersed subject in the reservoir the specific 
gravity has been calculated. The fact has been often noted 
that men of small girths often show a weight far above what 
would be fairly estimated, but as yet there has been no scien- 
tific study of this class of cases to discover the relation of high 
specific gravity to health, strength, endurance or longevity. 
The specific gravity of any body is represented by the quotient 
obtained by dividing the weight of the body in air by the loss 
of weight when weighed in water. 
The discovery of the superficial area of a person is of some 
value and may be found by the following formula: Surface, 
(in square centimeters) = 11 x ^/Weight2.' (in grams). Personal History and Examination of the Special Senses. 
57 
CHAPTER IV. 
PERSONAL HISTORY AND EXAMINATION OF THE SPECIAL SENSES. 
In examining young people the condition of the organs of 
special sense becomes a legitimate and important field of 
inquiry and record. Civilized man is as much the product of 
nerve reactions as he is the result of material influences that 
we ordinarily call hygiene-food, air, temperature, etc. The 
intellectual working of the brain is, in fact, more strongly 
influenced by defective sense impressions than it is by 
defective nutrition. The tinnitus of a diseased ear has 
driven many a person insane, and the nerve strain of an 
imperfect eye has produced the most serious functional 
diseases of the nervous system.* 
The eyes should be examined by a specialist in ophthal- 
mology if there is the slightest indication of nerve irritation 
and the superficial examination, such as is indicated here, 
shows the slightest errror of refraction or muscular insuffi- 
ciency. 
The record of color-blindness should be kept, not as a 
disease, but as a peculiarity that would render the subject 
unfit for some occupations. In many cases of supposed color- 
blindness the sense is probably simply uneducated. Cases of 
color-blindness among women are very rare (1 in 25,000) and 
are not frequent among men. 
Among school children and adults who are engaged in 
sedentary occupations requiring the almost constant use of 
the eye it becomes absolutely necessary that the visual organ 
be essentially perfect if the brain is to work with its maximum 
of power for a long period. That the examination of the eye 
* See the New York Medical Journal for January 7 and 14, 1888, and 
the same journal February 27 and March 13, 1886, containing articles by 
A. L. Ranney, M.D., on "The Treatment of Functional Nervous Diseases 
by the Relief of Eye-Strain," etc. Also the Belgian Prize Essay by Dr. 
Stevens of New York, and the Report of the Stevens Commission, pub- 
lished in the Neurological Jotirnal, 1889. See article by Dr. Gould in 
American Medicine, January 21, 1905, and Journal oj American Medical 
Association, 1904. 58 
Personal History and Examination of the Special Senses. 
is important is proved by the number of cases of error of 
refraction to be found in any group and the very complete 
remedy that is found in properly adjusted lenses. 
Dr. Seelye has found that only about twenty-seven per 
cent of the students have normal vision. The following table 
shows the variety and prevalence of errors by percentages: 
Emmetropia. 
Hyperopia, 
Myopia. 
Astigmatism. 
Amherst 
27 
44 
23 
22 
Yale 
42 
23 
19 
35 
New York University.... 
57 
14 
29 
- 
The difference in these results is largely due to the 
standard of working. In the figures from Amherst the 
greatest accuracy exists, as all the tests were made by a 
trained specialist in ophthalmology. 
A few brief definitions of terms used may be of assistance 
in understanding the table. By Emmetropia is meant normal 
or perfect vision. All rays of light coming from a distant 
object focus or meet at one point exactly upon the retina and 
form a clear image there. 
Myopia or '''near-sightedness" is due to the eye being so 
long in the antero-posterior diameter that rays of light which 
enter the eye parallel or from a distance come to a focus a 
little in front of the retina and hence an indistinct image is 
formed on the retina. 
In Hypermetropia or "far-sightedness" the eye is too short 
in the antero-posterior diameter, and hence parallel rays 
entering the eye focus behind the retina, and thus the image 
made on the retina is a blurred one. 
In Astigmatism the anterior part of the eye is irregular 
in curvature, and therefore rays of light entering in the 
different diameters focus at irregular distances on, in front 
of, or behind the retina, so that the image of the object seen 
is distorted. That is, all rays do not focus or meet at the 
same point. 
The following directions are given for testing the refrac- 
tive power of the eye and its color sense and also for deter- 
mining the auditory power: 
Procure from any optician the "pocket-test case'' made by 
the Julius King Optical Co. of New York City, or two pairs 
of spectacles, one with convex glasses, No. +.75 Dioptric 
(equal to No. + 48 in the old or English system), and the Personal History and Examination of the Special Senses. 
59 
other with concave glasses, No.-.75 Dioptric. Also obtain 
a copy of Snellen's test letters of any optician, to be hung 
up at six meters distance, and a copy of Green's astigmatic 
lines, in the form of a clock face, to be hung up at the same 
distance. 
Test. Seat the subject at a distance of six meters from 
the test cards, which should be hung in a good light. 
Examine each eye separately, keeping the other covered by a 
card held in front of, but not touching it, or use the blank of 
the test case. Never press the fingers against the closed lid. 
There are a number of lines of letters on the test card, 
numbered from 4 to 60 meters, which indicates the distance 
the letters can be read by the normal eye. If. now, the sub- 
ject can read the next to the smallest letters on the card, 
with the right eye (R. E.) alone, his vision (V.) is recorded 
as f or 1. (V. R. E. = i.) If he sees nothing clearly 
above the eight meter line from the bottom, but can read 
that correctly, then V. R. E. =f. If he cannot read any of 
the lines, then V. R.E. is less than -g^. Whatever the vision 
without glasses may prove to be, always next put on the 
convex spectacles and again cover the other eye. If now he 
can still with the right eye see as well or better than with no 
glasses at all, and can read the same line as before, he is 
Hypermetropic (H.) in that eye (i. e., far-sighted). For 
example, if without glasses it was found the V. R. E. =^-5-, 
and now, after adding the convex glass, his V. is improved 
to f, the record would be V.R.E. =T67 + H. But if the 
vision is neither improved nor made worse by the convex 
glass, the record will be thus: V.R.E. =|+H. =|. If the 
convex glass can be used at all without decreasing the 
vision, no further testing with this card is needed; the sub- 
ject is hypermetropic in that eye. If it is found that the 
vision of the right eye equals 1, without glasses, and then 
the addition of the convex glasses blurs the letters, the eye 
is Emmetropic (Em.)-that is, there is no error of refraction. 
If, however, the vision without the glasses is less than 1., 
for instance only f, and the convex glasses make even that 
line more indistinct, then put on the concave glasses. If now 
the vision is improved so that smaller line can be read, the 
eye is Myopic, or "near-sighted," and the record will be 
V. R. E. =|+M. =f. Or again, if the vision without glasses 60 
Personal History and Examination of the Special Senses. 
in the left eye is found to be and then with the concave 
glasses the ten-meter line can be read, the record will stand 
thus: V. L.E.=-^0-+M. = 16-(j-. After testing each eye separ- 
ately, place the record of one above the other, for example 
thus: 
( V.R.E. = i. Em. 
(V.L.E.=/o + M.=A 
This completes the testing for simple hypermetropia, 
myopia and emmetropia. 
After testing the eyes as above, if the vision has not yet 
been found perfect in either, leave on the proper correcting 
glass, the convex if there is hypermetropia, or the concave 
if there is myopia, or use no glass if there is neither; then 
direct the subject's attention with one eye alone, the other 
being covered, to the card of radiating black lines. If he 
sees one or more of the lines running in any direction clearer 
or blacker than those at right angles to them, the eye is 
shown to be astigmatic. Either the perpendicular or the 
horizontal lines usually appear the blacker to the astigmatic 
person. If the previous record was V. R. E. = |, and this 
defect is found, then it will be V.R.E. +-A. Or if before 
it read V.L.E. + M. =f, and astigmatism is found, it 
will read, V. L.E. = T6K + M. =f+ A. Astigmatism may exist 
either alone or in combination with M. or H. If alone we 
might have a record thus: V.R E.=f+A.; V.L.E.=^ + A., 
or if with hypermetropia, thus: V.R.E =T%- f- H. + A. 1 
v.l.e.=^+h.=A4-a. 
To recapitulate, in brief: if it is found that V. R.E. = i, 
then the R.E. is Emmetropic or Hypermetropic. If ne- 
tropic, the convex glass will markedly impair the vision; if 
hypermetropic it will not. If the V. R.E. = f- or less, then 
the R E. is either hypermetropic, myopic, astigmatic or 
amblyopic. 
ist. If it is H. the convex glass will help, or not greatly 
impair the vision. 
2d. If it is M. the concave gla.ss will improve V. 
3d. If it is A. one of the radiating lines is blackest. 
4th. If neither of these defects exist and the V. is less 
than t6t, then Amblyopia or partial blindness may be 
recorded. It may read thus: V.L.E.^^ + Am. 
Caution-Ahvays try the convex glass. Never try the concave Personal History and Examination of the Special Senses. 
61 
unless the convex glass blurs the vision. Have subject close 
the eyes when not being tested. 
In addition to the text of vision for distinctness at dis- 
tances, it is well to test the power of the eye at near points. 
To do this is a very simple matter and requires only a card 
printed with Jaeger's test-type of sizes from No. i to 5 
inclusive. The size of No. 1 is that commonly known to 
printers as "Gem" or "Brilliant," and the other numbers 
are the successive sizes of type larger than this. The cards 
can be obtained at any optician's. In using the card, the 
main point is to discover the ability of the person to read 
near print and thus show the power of accommodation, and 
hypermetropia, for the far-sighted eye cannot see objects 
clearly at near range. The person being examined should 
take the card and try to read the various paragraphs as near 
to the eye as possible, each eye being tested by itself as 
before, and the examiner, with a tape or ruler, measures the 
distance at which the card is held from the eye. This may 
then be recorded as follows: Near point of right eye equals 
Jaeger's No. 1 at 25 c. m.-or whatever the record may be. 
This may be abbreviated as follows: N.P.R.E. = J., No. 1, 
25 c. m. A record of 25 c. m. for this size of type would be 
very good and in most cases of hypermetropia the larger 
type will have to be used. The record then might be as 
follows: N.P.R.E.=J. No. 3, 15 c. m. 
In the following cases the subject should be recommended 
to consult an oculist concerning the advisability of wearing 
glasses: (tz) if the vision without any glasses is less than 
in either or both eyes; (#) if he complains of weak, 
watery or painful eyes, headache, especially in reading, and 
any degree of hypermetropia or astigmatism is found to 
exist; (f) if the eyes are unlike to the extent of two lines on 
the test card. 
DIRECTIONS FOR TESTING THE COLOR SENSE. 
A set of test worsteds of different primary colors and 
shades may be procured. To make the examination, spread 
all the worsteds out on a white cloth placed upon a table. 
First lay the green test skein a little to one side of the 
others, and then tell the subject to throw out of the pile 
and lay along side of the test skein, all the lighter and 62 
Personal History and Examination of the Special Senses. 
darker shades of that color,, or all the skeins containing a 
shade of that color in any degree. Avoid naming the color 
"green" to him. If he throws out only shades of green or 
light blues his color sense is normal (C.S.N.) and the test is 
completed. But if, in addition, he throws out light grays, or 
any other shade of gray, or light yellows, salmons, or pinks, 
he is color-blind. If he handles or fumbles over those shades 
a good deal and hesitates, as if in doubt about them, but yet 
does not throw them out, he probably has "feeble color 
sense" (C.S.F.). The examiner in these cases must use his 
judgment in making a certain amount of allowance for the 
stupidity of some persons in understanding what is wanted 
especially in the young and uneducated. 
If the subject is found to be color-blind, next lay down 
the purple or rose-colored test skein, in place of the green, in 
order to determine the nature of the defect. Now tell him 
to throw out all the different shades of that color. If he only 
throws out pinks and light reds and shades approaching 
these, he is only partly color blind (P.C.B.). But if he 
throws out decidedly bluish purples, blues, violets, greens or 
grays, he is completely color-blind (C.C. B.). Completely 
red-blind if he throws out the blues, violets., etc., or green- 
blind if the grays or greens. 
No further testing is needed, but as a matter of curiosity, 
and to prove the result, the red test skein may next be tried 
in the same way. If he matches with it browns or greens 
and grays he is completely color-blind. Dark brown or green 
if red-blind, and light brown or green if green-blind. 
It is important to record whether the complete color- 
blindness is red or green blindness. The following classes 
may be recorded: Color sense normal= C.S. N.Color sense 
feeble = C. S. F. ; Partial color-blindness= P.C.B.; Complete 
color-blindness=C.C. B. 
Color-blind individuals should be warned against engag- 
ing in any occupation where this defect would prove dan- 
gerous or inconvenient. 
DIRECTIONS FOR TESTING THE AUDITORY SENSE. 
Use any ordinary watch and a tuning-fork, letter A or C, 
as tests. Seat the subject with his right side toward you and 
then, while the room is perfectly quiet, see how far off he Personal History and Examination of the Special Senses. 
63 
can hear the watch tick. Having previously learned by a 
few experiments what is the furthest distance at which the 
tick can be heard by normal ears, make that number of 
inches the denominator of a fraction, and the hearing dis- 
tance of each person examined thereafter the numerator. 
Having found the normal distance (=H.D.) to be, for 
instance, about sixty inches, and that of the subject now 
examined to be, say forty inches, his record for the right ear 
would then be: H.D.R.E. If it had been or i, the 
ear would be normal. would show an abnormally acute 
sense of hearing. If the watch could only be heard while in 
contact with his ear, it would be recorded: H.D.R.E. =-^. 
If not heard at all, then H. D. R. E. =-$%-. Next test the left 
ear in the same way. Voice sounds in talking will often be 
easily heard by persons quite deaf to the watch tick, so that 
the latter is not always a reliable practical test. 
Suppose we have found H.D.R.E. =|^-, H.D.L.E. = i, this 
implies some deafness in the right ear, and the tuning-fork 
will now help us to decide whether the cause lies in some 
defect of the auditory nerve or internal ear, or in the external 
or middle ear or Eustachian tube. Strike the fork against 
some solid substance, and then place the end of the handle 
against or between the subject's front teeth. If both ears 
are normal he will probably seem to hear the ringing of the 
fork equally well in both ears. But if there is a defect in one 
ear he will either seem to hear it louder or more feebly in 
the affected ear. If, as in the case we are examining, the 
fork is heard best in the deaf ear, this tells us that the deaf- 
ness is due to some defect in the more external parts of the 
organ, and it can probably be corrected by appropriate 
treatment. But if it is heard best in the good ear, it goes to 
prove that the defect in the other ear is more deeply seated 
and cannot probably be greatly benefited by treatment. This 
effect of the tuning-fork is contrary to what would ordinarily 
be expected, and it is often a matter of surprise to a deaf 
person to find that he hears with his teeth apparently better 
on the deaf side. 
We may now add to our record in this case: T.F. best 
R. E. If it had been heard equally well in both ears we 
would read: T.F. = N. (or normal). Where the defect in 
hearing is at all marked, a specialist in ear diseases should 
be consulted. Personal History and Examination of the Special Senses. 
64 
Oar record in a normal case might be thus: H.D.R.E. = i, 
H.D.L.E. = i, T.F. = N.; or in an abnormal case it might be 
thus: H.D.R.E. = i, H.D.L.E. = 6°q, T.F. best in R.E. This 
would imply that the subject was so deaf in the left ear as 
not to be able to hear the watch tick at all, and the fork held 
between the teeth could be heard best in the good ear, con- 
sequently his trouble is probably seated in the deeper struc- 
tures of the ear, or in the nerve itself, and treatment would 
not be expected to help him greatly. The tuning-fork need 
not be tried unless the watch tick shows some defect in 
hearing. 
When tests of the hearing are made, any dullness or 
difference in the auditory sense of the two ears should lead 
to an examination with the otoscope. The channel may be 
partially or completely occluded with wax or the debris of a 
previous inflammation or an exostosis of the wall of the 
meatus. If the opening is normal,the tympanum, or drum, 
will be seen at a depth of about two centimeters as a 
smooth, shining, semi-transparent membrane of slightly 
pinkish-gray color. In cases of inflammation the drum be- 
comes decidedly pink. Slightly below and in front of the 
center is a white spot as though some white body pressed the 
drum slightly forward at that point. This is the end of the 
bone, the malleus, that conveys the vibrations back to the 
internal ear. In most cases a gray streak can be seen 
extending upward and forward, which is the body of the 
bone. Sometimes the drum will appear bulging and convex, 
from the pressure of serum within, and the vibrations of the 
drum are prevented, with resulting deafness. Again the drum 
may appear cupped or concave from the stoppage of the 
eustachian tube and the subsequent absorption of air in the 
middle ear, so that the drum is pushed in by the atmospheric 
pressure. This is by far the more common condition and 
only impairment of hearing results until the case is of long 
standing, when complete deafness may ensue. Openings in 
the drum are of frequent occurrence as the result of inflam- 
matory exudation bursting through from the inside, or 
traumatic puncture that has been uncared for. A puncture 
may not impair the hearing to any serious extent. Suppura- 
tion of the ear in any part should be the subject of surgical 
treatment at once, without regard to the whims or prejudices Personal History and Examination of the Special Senses. 
65 
of the persons possessing an otorrhoea. The discharge is 
often looked upon as a necessary affliction and relief from 
other woes, but in reality it is a source of debility and impair- 
ment of health to the person himself, and a nuisance to 
others. Cases of impaction require treatment, and the same 
may be said of the convex drum. The convex drum may be 
due to catarrh, and if so, that should be treated. All these 
cases are to be referred to physicians. 
An organ may work correctly but slowly. The eye of one 
person sees at a glance what the eye of a second person would 
require seconds to reveal, and yet the eye of the latter may 
be perfect according to every test of the oculist.' It is so 
with hearing. The time required between hearing and 
perceiving sounds and giving a signal is .12 to .18 of a 
second. Higher tones require slightly less time than deeper 
ones. Noises are heard quickest. 
A distinguished teacher recently told me that he had 
called a certain boy stupid until he discovered that the boy 
was merely slow in his sense of hearing. Since that time he 
has studied boys whose perceptive faculties seemed dull and 
has found that a large percentage of them are deficient 
mainly in hearing a question that is put rapidly to them. A 
device that will test the speed of the action of the eye and 
ear correctly within moderate limits of accuracy will be of 
great practical importance in an educational as well as 
scientific aspect. Physical education must bring up to a 
higher plane of activity each physical function that is found 
to be deficient. To do this the examiner must be ever alert 
to discover undeveloped functions and inventive ability will 
be frequently required to solve the problems presented. 
In this connection it may be well to speak of nasal catarrh 
and its influence on health. The disease may be considered 
as a condition of mal-nutrition of the part affected, due to 
irritation of the trophic nerves. It may appear as an inflam- 
mation of the upper air passages with an increased secretion 
of mucous fluid; or there may be atrophy of the mucous 
surfaces and of the harder tissues beneath; or there may be 
extensive ulceration, and decomposition of secretions. 
The first form is due to the action of irritants on a 
supersensitive membrane. The condition can be produced 
almost instantaneously by the inhalation into the nasal 66 
Personal History and Examination of the Special Senses. 
openings of snuff from pulverized tobacco, acrid fumes, dust, 
etc., but the hyperaemia is temporary if the irritation is not 
repeated. Sudden changes from a warm to a cold atmos- 
phere do not give the system time for the nice adjustment to 
environment that enables men to live in every climate where 
food can be found. The result is a continued irritation of 
the mucous surfaces of the air passages and a resulting 
inflammation with thickening of the superficial tissues until 
the normal nutrition of the part is lost, and disease becomes 
seated. This swelling may close the opening^ of the 
eustachian tubes, and impaired hearing is the result. Treat- 
ment is usually successful, and hence the importance of 
examining the nasal chambers if the history discloses any 
suspicion of defect in this locality. The other forms of 
catarrh are often quite as distressing without as favorable a 
prognosis, but relief will not be sought in vain. 
The sense of smell in the atrophic and erosive forms of 
catarrh is often entirely lost, and in all cases is deranged. 
This sense may be tested by inhaling odors that are bland 
and unconnected with articles of food, as musk, attar of 
roses, etc.* 
The olfactory nerve is perhaps more intimately connected 
with the brain tissue than any other, being apparently a pro- 
longation of the brain through the cribriform plate to the 
nasal walls. As many cases of headache are due to a bad 
condition of the surfaces where this nerve is spread out we 
should examine such cases for ulcerations, tumors, mal- 
formations and displacements that may cause occlusion or 
pressure. 
The sense of taste is closely allied with that of smell, but 
is not so important an indication of the condition of the 
organs with which it is connected. It is a sense with great 
capacity for education, as it was the boast of Roman epicures 
that they could tell by the taste of a fish whether it was 
caught above the Bridge or below. A taste may be acquired 
for the most nauseating substances. Children have been 
known to cry for cod-liver oil. But while the sense of taste 
is not important in its relation to health, the condition of the 
mouth may well occupy our attention in discovering those 
facts in a man's condition that make for health or debility. 
♦Scripture-Thinking. Feeling, Doing, p. 124. Personal History and Examination of the Special Senses. 
67 
A clean tongue indicates good digestion; while a coating 
indicates some abnormal condition of the stomach or liver or 
pharynx. A cracked tongue means dyspepsia. The tonsils 
should not protrude beyond the pillars of the fauces; the 
general surface of the pharynx should be smooth and clean 
and of light pink color; the teeth should be sound or filled 
and clean; the vocal cords should be a light pinkish yellow, 
and the tracheal rings below look like white bands between 
which pink tissue can be faintly discerned. 
The temperature should be taken with the bulb of the 
thermometer placed under the subject's tongue for two 
minutes. This should be a record of 98.4° F. without a 
variation of half a degree. If the temperature is below 
normal note carefully the general conditions and repeat the 
test at some future time. About one or two per cent of cases 
have a subnormal temperature. The instrument should be 
carefully washed in an antiseptic fluid after using and it is 
well to have a cup of saturated solution of boracic acid into 
which the mouthpiece of spirometers, etc., can be placed 
after taking records with them. 
The tests of urine for albumen and sugar should be prac- 
ticed until the examiner is sure of his ability. The chemicals 
now prepared by leading manufacturing chemists and drug- 
gists leave little except skillful manipulation to the examiner. 
The record should be repeated if any abnormality is found 
and the subject placed under the advice of a physician. 
The director of a gymnasium should always recommend 
some other physician to cases needing medical care. 68 
Test of Strength. 
CHAPTER V. 
TESTS OF STRENGTH. 
The importance of strength tests as a department of 
anthropometry demands that special attention be given to it 
at present. The earlier tests that were applied in anthro- 
pometrical investigations related to the size or mass of the 
various parts of the body, and it was supposed that high 
record, coupled with a good proportion, constituted a highly 
desirable condition and that exercise might be prescribed on 
this basis. Practical experience, however, soon demon- 
strated the absolute need of other data than those relating 
to bulk and proportion if exercise were to be prescribed 
appropriate to the capacity of the individual. The large 
man is not always the strong man, and with equal truth it 
may be said that the strong man is not always the man of 
high endurance. The working muscle is a machine that 
depends upon two factors for its efficiency. First, it must 
have size, or an adequate aggregation of cells, each one of 
which is involved in the activity of the whole, as the total 
strength of the muscle is made up of the sum of the strengths 
of the individual cells composing it. Second, it must have 
adequate innervation in order to set up the metabolism that 
sets free the stored energy. If continued exertion is to be 
considered, a third important factor . appears, namely, 
sufficient circulatory activity to bring fuel to the cells and to 
sweep away combustion products. The variety in the girths 
of different individuals, especially in the first half of life, 
may be attributed in some degree to the difference in the 
size of the muscles, but the modifications may be largely due 
to the presence of storage tissue that has no immediate rela- 
tion to the muscular ability. The girth of the head, on the 
other hand, bears no direct relation that has yet been deter- 
mined to the nerve force that may be applied as a stimulus 
to muscular contraction. We must, therefore, in estimating 
the muscular ability of a person, have other data than the Test of Strength. 
69 
record of size. Since muscular activity is externally mani- 
fested in forms of strength acting against resistance, it would 
seem plausible that a series of strength tests that should at 
least include the principle groups of muscles would be a 
safer guide in determining the amount of work that may be 
advantageously done, than any other data that can be 
secured. To secure such tests of strength has taxed the 
ingenuity of physical directors in times past, and with some 
the extensor power of the legs in lifting has been considered 
a fair test of the person's muscular power and preparation 
for work. Others, more devoted to that form of exercise 
ordinarily classified as heavy gymnastics, have considered the 
strength of the extensors of the arm as a similar indication. 
Medical men have relied particularly on a test of the con- 
tratile power of the flexor muscles of the hand. With the 
advance of anthropometric science the inadequacy of local 
strength tests has been demonstrated, and gradually methods 
of testing with fair accuracy all the general groups of 
muscles have been established. The earliest forms of dyna- 
mometers that have been found fairly efficient in securing 
local tests are shown in the accompanying cuts (Figs, u, 12, 
15). The general type of these instruments has been that 
of the elliptic spring. The variation of its contour being 
accomplished by pressure or by tension, and recorded by an 
index that is moved forward by the moving side of the 
spring. These instruments have been of French design and 
have been applicable only to a very limited range of use. 
About ten years ago Dr. J. H. Kellogg, the medical superin- 
tendent of the extensive sanitarium at Battle Creek, Mich., 
began to apply strength tests as a preliminary to the exercise 
which was prescribed extensively as a therapeutic means in 
his institution. The small number of muscular groups that 
could be measured in this way led him to study the possi- 
bilities of a mechanical device that should be capable by 
proper adjustment to record the acting power of all the 
skeletal groups with a fair degree of precision. The first 
result of his investigation was the instrument described in a 
previous edition of this book. His instrument as now com- 
pleted is shown in Fig. 32, and consists essentially of a frame 
made of two upright rods, which serve as a support to the 
testing mechanism. This mechanism balanced by a counter- 70 
Test of Strength. 
weight can be readily moved up or down to any position, and 
there fixed by four set screws to the frame. The mechanism 
consists of a lever arm terminating in a handle, which is 
always the point of application of the force. This lever can 
be moved upon its fulcrum through 
ninety degrees so as to' receive force 
applied in a horizontal or in a per- 
pendicular direction. A coupling pin 
transfers this force to a perpendicu- 
lar lever arm which acts against the 
resistance. This resistance is secured 
by the following mechanism: A 
plunger is immersed in a cup con- 
taining mercury by the pressure on 
the handle and the mercury rises 
until a balance is reached by its 
buoyancy. To the plunger is attached 
a bar with cogs that mash into the 
cogs of a wheel that moves a pointer 
around a graduated circle to indi- 
cate the power applied. The capacity 
of this instrument is 
sufficient to record a 
pressure as light as one- 
fourth of a kilogram and 
it has been repeatedly 
subjected to a strain of 
■ 800 kilograms without injury. In 
connection with Dr. W. A. George, 
Dr. Kellogg has prepared percentile 
charts from the records of the 
strength tests of 600 men and 600 
women that may serve us as a basis 
for the graphic representation of 
the strength of any person. 
I can testify from personal ob- 
servation to the facility and ac- 
curacy with which exercises may be 
indicated for a person when his strength record is graphi- 
cally presented on one of these charts. The general theory 
and method of the prescription cannot be better described 
Fig. 36. Test of Strength, 
71 
than in Dr. Kellogg's own words which are taken from the 
book entitled, " The Art of Massage." 
''The data afforded furnish exact information concerning 
the capacity of each of the principal muscles in the body. 
Knowing the capacity of each muscle, it is easy to propor- 
tion the work in such a manner as to secure symmetry of 
development. My plan for accomplishing this is as follows: 
''Take 300,000 foot pounds, one-sixth of a full day's work, 
as the proper daily amount of exercise for a man whose total 
strength capacity is 10,000 pounds, corresponding very 
nearly to the greatest capacity shown upon my table, pre- 
pared from six hundred men in good health (page 72). I 
have undertaken to establish a definite relation between the 
strength capacity and the total amount of work to be per- 
formed. This is accomplished by simply dividing the total 
amount of work done by the total capacity of the muscles; 
that is, 1,800,000 is divided by 10,000, giving 180. In other 
words, for each pound of capacity the muscles are capable 
of doing 180 foot pounds of work daily, an interesting 
physiological fact thus for the first time determined. One- 
sixth of 180 is 30. Hence it is clear that in a symmetrically 
developed man, with a total strength capacity of 10,000 
pounds, each muscle, in order to do its proportion of the 
300,000 foot pounds prescribed, must do work to the amount 
of thirty times its lifting capacity represented in foot pounds. 
''It is only necessary, then, in order to ascertain the exact 
amount of work to be done by each group of muscles at each 
level, to multiply by thirty the figures of each column of the 
chart. 
''I have made a careful approximate calculation of the 
amount of work done in each exercise or set of exercises, 
with each apparatus in the gymnasium under my supervision. 
It is necessary to know the strength of the medicine, as well 
as the needs of the patient. Knowing the amount of work 
required for each individual and for each set of muscles, and 
also the result obtained from each exercise, it is easy to 
construct tables of exercises exactly adapted to any capacity. 
I have arranged ten series of such tables, or day's orders, 
five for each of the two charts. 
''In making a prescription for exercises, I first note the 
total capacity of the individual, and then write down a 
number indicating the day's order which would secure for 
an individual of the given capacity the proper amount of 
work. Then glancing over the chart I note the low point, 
and check or underscore each of these, which indicates to the 
assistant who superintends the exercise in the gymnasium, 
that the work is to be doubled on all such points, so as to 
secure to the weak muscles such rapid development and  
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11 
12 
9 
12 
10 
<) 
•10 
11 
15 
18 
17 
14 
13 
11 
21 
16 
89 
78 
23 
18 
26 
24 
35 
38 
3S 
37 
26 
29 
29 
27 
3° 
82 
34 
44 
5 
15 
9 
10 
27 
31 
.3 
1. 
41 
127 
115 
118 
233 
287 
267 
554 
231 
59 
1077 
1 
□ 
J' Test of Strength. 
73 
growth as will enable them to overtake the rest of the 
muscles and thus restore muscular symmetry. In practice, I 
find that this method never results in giving to a muscle more 
than a full day's work and consequently there is no danger 
of injury resulting from this doubling ot the amount of work 
to be done by the weak muscles. In case of complete paraly- 
sis of the muscle, it is of course necessary, at the beginning, 
to administer the exercise by electrical or mechanical means. 
"As a rule I find it sufficient for practical purposes to 
divide the series of total capacities represented upon my 
table into five groups, instead of making a distinct schedule 
of work at each of the levels indicated by the several quanti- 
ties representing total muscular capacity. 
"The ratio which I have established between the muscu- 
lar capacity and the day's work is probably too small for 
those in vigorous health; but I find it well suited for the 
class of persons coming under my observation who are, for 
the most part, invalids or semi-invalids. The man who is 
training and desired to develop his whole body to its highest 
capacity, should be required to execute a full day's work- 
1,800.000 foot pounds or even more. In arranging a day's 
order of exercise, due account is of course taken of the work 
done in walking, running and similar exercises, which may 
be made part of the program. 
"The patient does not undertake the first day to do all the 
exercise prescribed in the series, but gradually takes them 
up from day to day, as he learns them and becomes able to 
do them, and by the end of two or three weeks he is expected 
to have thoroughly mastered all the exercises given him, and 
to have become able to take each time all that is directed in 
his prescription. At the end of another month another 
chart is made, the changes noted and a new prescription 
prepared according to the requirements. It is a matter of 
frequent observation that the points which at the first exam- 
ination are lowest on the chart, are so improved by the 
specific exercise directed to these particularly weak muscles 
that they become the highest one upon the second chart." 
A study of proportional strength tests and the increase 
during one year among women in their twentieth year, 
representing the records of 100 Smith College students, is 
presented in the following table prepared by Miss Berenson. 
The number 1 and 2 placed after the items indicate the 
first and second measurements respectively, the second being 
taken after an interval of nine months. The figures repre- 
sent kilograms and liters. It is interesting to note that the 
absolute increase for the students strong at the beginning of GRAPHIC I.-A Graphic Representation of the Actual and Comparative Strength of Each of the Principal Groups of Muscles nt 
the Average Man and the Average Woman. Man : Woman---. Test of Strength. 
75 
the year is essentially the same as for the weaker students, 
and for those of medium grade, although the proportional 
increase for the weaker students is greater. It would be a 
great help to the more complete study of methods of physical 
education, if such records as this from. Smith College could 
be secured for the whole group of students, and for every 
year during the college course. Somewhat similar reports 
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have been issued from Wellesley and Oberlin colleges, but 
here the whole group is included (see page 97). 
Foster states that the strength of men and women bear the 
relation of 9 to 5. A more complete comparison is make by 
Dr. Kellogg in the graphic plate (page 74) which shows the 
average strength values for the various muscular groups of 
both men and women. 
It would appear from tests made in secondary schools that 
the strengths of boys in the period of growth, from ten to six- 
teen years of age, show a different rate of increase according 
to the use to which the muscles are called. At this age the 
boy is on his feet most of the time and his principal exercise is 
locomotion. The strength of his legs as shown on the dynamo- 
meter develops much faster than the strength of his arms or 
back. This may be explained partly on the ground that the 
leg length develops more rapidly than the trunk length but it 
is more likely that the increase is due to heredity that has 
stamped an ambulatory power as of more value in the pre- 
servation of the race than prehensile power that was of the 76 
Test of Strength. 
highest value in the first months of life and that has been 
handed down as a heritage from a remote past, even when the 
power is no longer used. 
Another point that should be remembered when considering 
the subject of strength and that is the fact that muscular 
action is the product of two factors, the quality and size of 
the muscle mass and the nerve force that calls it into action 
and determines the degree of its efficiency in contraction. A 
large muscle may be so poorly innervated as to be inefficient 
and a small muscle may be stimulated to greater effort than its 
fibres are able to bear and a rupture will result. 
In a person of high nervous temperament there is usually 
ability to overstimulate the muscles and there is a correspond- 
ing tendency to overdo, while in the phlegmatic there is 
inability to compel the best effort of which the muscle mass is 
capable and the person is never strained by effort. The latter 
class is able to work for prolonged periods without exhaustion 
and the former is able to use all his strength in a few seconds 
and then requires a period of recuperation. The test of en- 
durance as well as momentary strength should demand our 
attention in determining the physical qualities of the individual. Special Instruments. 
77 
CHAPTER VI. 
SPECIAL INSTRUMENTS. 
The number of instruments that have been invented to 
demonstrate anatomical and physiological facts within the 
past ten years bears witness to the extent and earnestness of 
the study of the human body. Only the principal ones can 
be described here, and that 
briefly. 
An instrument for meas- 
uring the obliquity of the 
pelvis has been invented by 
Dr. Mosher which is of 
especial value to those ex- 
aminers who are working 
with women. It has been 
demonstrated by gynecolo- 
gists that the position of the 
brim of the pelvis as regards 
perpendicularity has a very 
important bearing on the 
health of the pelvic organs. 
The mechanical reason for 
this is apparent to all. To 
measure and determine 
what may be considered the 
normal position and what 
limits may be considered 
safe variations from this 
normal is the province of 
those who have charge of 
the hygiene and physical 
training of women. The ob- 
liquimeter enables the ex- 
aminer to determine the angle of pelvic tip with accuracy and 
at small cost of time and effort. The instrument as shown 
in Fig. 37 consists essentially of a fixed arm that can be 
adjusted to the height of the individual. A second arm A, 
Fig. 37. 78 
Special Instruments. 
movable upon a pivot, carries a pointer that sweeps over a 
graduated semicircle. The person to be tested stands in an 
ordinary posture, the fixed arm of the instrument is placed at 
the junction of the sacrum and the last dorsal vertebra. The 
movable arm is then swung down until it rests upon the 
pubic symphysis. The reading is then made in degrees as 
indicated by the pointer. A similar instrument has been 
invented by Dr. J. H. Kellogg (Fig. 38). It is based on 
similar mechanical principles, but is somewhat simpler in its 
mechanism. Probably 
the amount of pelvic 
tip is of less impor- 
tance in men, although 
its relation to conges- 
tive conditions, hem- 
orrhoids, etc., may 
yet be demonstrated. 
The measurement 
and abnormalities of 
the spinal contour has 
been for many years a 
somewhat perplexing 
study, and the various 
devices that have been 
originated have nearly 
all been laid aside as 
too inaccurate in their 
results or too compli- 
cated in their manage- 
ment to be of high 
utility. An instrument 
was devised by G. 
D e m e n y of Paris, 
which he called a thoracometer, for showing the exact con- 
tour of the chest at any level. This instrument is made in 
two segments that can be clasped firmly together around the 
trunk. Running through the band and supported by it are 
many little rods that are pressed forward, each by a spring, 
and that are held in any position by a single clamp that acts 
on all at the same time. The instrument is mounted on a 
stand so that it can be raised or lowered to be'accommodated 
Fig. 38. Special Instruments. 
79 
to any height. The rods are all pushed backward and 
clamped. The instrument is then placed upon the chest, the 
clamp is released and the springs carry the rods forward 
until the tips rest against the surface of the thorax. The 
clamp is now applied and the instrument removed,laid over a 
sheet of paper and the position of the points of the rods 
marked with a pencil. These dots are then connected, and 
the exact contour of the chest is shown. The thoracometer 
described above is made on the same mechanical principle 
as a more elaborate machine, invented by Zander of Stock- 
holm, for making an outline of the body at any level. It is, 
however, much simpler and equalljr efficient. 
A second instrument was subsequently devised by the 
same person for tracing the antero-posterior depths at all 
points of the trunk. This instrument consists essentially of 
two small wheels that pass one along the spinous processes 
while the other passes down the median line in front. These 
wheels are mounted upon a frame work that carries pencils 
that mark the outline traversed by the wheels. Obviously 
this instrument can be used for demonstrating changes in 
outline during respiration. 
Instruments for recording outlines of the body have been 
devised by Drs. J. H. Kellogg,* C. L. Scudder,f and the 
author. The former secured a full-size outline of the body 
by placing the person in a framework for support, while on 
this framework slides, carrying pencils on arms movable in 
one direction, were made to travel up and down keeping one 
extremity in contact with the body. Some very satisfactory 
results have been obtained by the use of this instrument, as 
shown by the series of outline drawings of the human form 
issued by Dr. Kellogg. The device of the author was pre- 
pared in 1892 and was exhibited at the meeting of the Ameri- 
can Association for the Advancement of Physical Education 
in Philadelphia, in April of the same year, as a means of 
giving a reduced and exact outline of spinal curves both 
lateral and antero-posterior. 
The instrument is based upon the principle of the panto- 
graph. The form is that of a double trapezium (Fig. 39)- 
* See "Transactions of American Association of Obstetrics and Gyne- 
cology," 1890. 
f Boston Medical and Surgical Journal, 1891. 80 
Special Instruments. 
one extremity carrying a marker and the other a pointer for 
following the surface to be outlined. The proportional rela- 
tions are such that the instrument produces a drawing one- 
third the size of the object that is outlined. This being a 
convenient size for reference and preservation. The panto- 
graph is hung upon a swinging tablet that is placed at'such 
a height as to make it available for receiving the outline of 
any part of the body. -The person to be outlined is placed in 
a frame and movable supports are brought against him, at 
shoulders and hips, so that he may not move while the out- 
line is being made, which requires only a few seconds. The 
instrument will be found useful in making records of the 
special cases of deformity that may be under observation. 
Fig. 3g. 
Improvements on the instruments there shown have been 
made by W. S. Jackson and the author. The instrument 
may now be said to have some utility in securing outlines of 
the trunk and of the spinal column. 
A method of recording abnormalities of spinal curvature 
has been invented by Thomas Elkinton of Philadelphia (Fig. 
40). It consists of a frame the length of the spinal column. 
This frame carries a series of rods that are freely movable 
back and forth. The frame is supported by an adjustable 
stand so that it may be adapted to the height of any indi- 
vidual. The person stands in customary attitude and is 
supported there by a fork-shaped support that is applied to Special Instruments. 
81 
the shoulders. The rods are then pushed forward until 
their ends strike against the spinous processes throughout 
the entire spinal column. The other ends of the rods play 
over a sheet of paper and their 
position is marked by a pencil, 
thus giving a series of dots that 
may be connected and an outline 
of the antero-posterior curves se- 
cured. If at any particular level 
there be any lateral deviation this 
may be measured horizontally and 
indicated by a figure on the chart 
at the level where the deviation 
occurs, and these may then be laid 
off to the right and left of a perpen- 
dicular line and the displacement 
shown graphically. An instrument 
somewhat similar has been made by 
the author to demonstrate chest 
movements during respiration, 
three rods only being used, and 
these being pushed forward by a 
spring so that they follow the move- 
ment of the wall to which they are 
applied. The other end of each rod 
carries a marker that indicates the 
excursion of the rod. 
In connection with instruments 
for recording abnormal deviations 
of the spinal column it will be well 
to call attention to such instruments 
as have been designed 
to give us subsidiary 
information in regard 
to the possible cause 
of the curvature. It 
has been noted by ex- 
aminers that in about 
three fourths of the 
cases of curvature of the spine there is a decided difference 
in the elevation of the iliac crests. This difference may be 
Fig. 40. 82 
Special Instruments. 
readily noticed by observation of the difference in waist curve 
on the two sides, the greater projection of one hip, and the 
difference in level of the superior spinous processes, both 
anterior and posterior. 
It may be stated in this connection that apparent de- 
partures of the pelvis from the normal level do not always 
indicate a difference in the lengths of the two legs, as it 
may be caused by pelvic distocia or even by prolonged abnor- 
mal posture. However, so far as scoliotic curves are con- 
cerned they may properly be attributed to the uneven base 
of support that is furnished by the laterally tilted pelvis 
when there is a difference in the height in the two sides of the 
pelvis. It becomes, then, the duty of the examiner to recog- 
nize any failure in lateral symmetry of bone lengths and to 
record as far as possible his observations, for if the scoliosis 
be occasioned mechanically a mechanical remedy will prove 
efficient and will be, in most cases, the only one indicated. 
To measure the exact length of the two lower extremities is 
not an easy matter, and different methods have been sug- 
gested to accomplish this end; that employed by surgeons 
has been to measure with a tape line from the anterior 
superior spinous process of the ilium to the internal mal- 
leolus; also to measure to the external malleolus and from 
the umbilicus to the internal malleolus on either side. 
It is essential in taking these measurements that the exam- 
iner do not retain a position on the tape in passing from one 
side to the other, and also that he do not look at the reading of 
the tape until the exact position is determined and the tape 
removed. To discover the spinous process the finger should 
be pressed well down to the lower edge of the prominence, 
where a well-defined point or hook-like projection will be 
found. In no other way can a true landmark be found. 
The point to which measurements are to be taken should first 
be marked with ink or an aniline pencil. 
A test of the accuracy of the ordinary surgical method of 
measuring the length of leg from the spinous process to the 
malleolus has been made by Professor Thomas Dwight, M.D., 
of the Harvard Medical School.* The measurements were 
made on the cadaver and after dissection the actual length of 
the bones was determined. He found that the error was less 
* Boston Medical and Surgical Journal, Vol. CXXXII, No. 18. Special Instruments 
83 
than j mm. in 41 per cent of the cases, and that ah error as 
large as 1 cm was made in only 7 per cent of the cases. 
The probable error is, therefore, very small when the exam- 
iner is careful and expert in locating the exact points of 
measurement. 
A landmark to which attention has been called by 
anatomists is the comparative height of the gluteal folds on 
the two sides. The value of this record is suggestive rather 
than accurate, for it is found that there is not absolute uni- 
formity of the folds in persons where no pelvic tip can be 
demonstrated, but it may be stated that in all cases where 
there is an inequality in the length of legs there will be an 
unevenness in the heights of the folds. A simple instru- 
ment for measuring this unevenness has been devised by 
Thomas Elkinton. It consists of a ruler with a level 
attached to it and having a parallel ruler of half the length 
Fig. 41. 
attached to it, as seen in Fig. 41. The ruler is held horizon- 
tally so that the upper surface touches the lower gluteal 
fold. The parallel portion is then moved upward until it 
touches the higher fold, and the difference in the heights of 
the two portions may be readily measured and recorded. 
The same person has also suggested a simple means of 
measuring the comparative length of the legs by having the 
subject lie carefully upon a line so that it shall pass between 
heels and along the spinous processes to the middle of the 
occiput. Two light box-like supports are then placed under 
the legs and are pressed firmly against the sole of each foot 
with equal pressure on either side. A difference in the 
length of the extremities will be indicated by a projection of 
the support on the longer side, and can readily be measured 
by a ruler. The method is simple but will not record 
accurately the total difference in length, probably because of 
the partial fixation- of the pelvis in a somewhat tilted posi- 84 
Special /nstrumenti. 
tion by the long continued posture that has been necessi- 
tated. 
The author has found that a difference in the height of 
the pelvic crests may usually be determined by having an 
assistant press two narrow rulers inward and downward upon 
the sides of the person just above the iliac bones and then 
measure to the under surfaces of the rulers. 
It is not claimed that this gives a true indication of the 
absolute amount of elevation that will be required under the 
low side to render the support of the spinal column hori- 
zontal. A second method that is suggested is a ruler carry- 
ing a level that is affixed to the caliper section of the measur- 
ing pole used by the author as shown in Fig. 42. The 
caliper is applied by pressing its arms firmly upon the tops 
of the iliac crests while the person stands in normal position 
bearing the weight equally on each leg. The free end of the 
ruler is now elevated until it is horizontal, and is then 
fastened by a thumb screw, 
The pelvic tip can then be 
read in terms of an angle, 
or in terms of linear units 
marked on the upright 
guide to which the movable 
arm is fastened by the thumb screw and that slides along the 
fixed arm to fit the breadth of the pelvis. Probably all that 
can be claimed for this latter method as an advantage over 
other methods is the ease with which the record is taken, 
both for the examiner and the subject. 
Dr. Wilson has made a platform easily adjustable in 
height by a screw and is accustomed to place the subject 
with the foot of the low side resting on this platform. He 
then raises the platform until the pelvis is horizontal. The 
elevation of the platform gives an indication of the amount of 
artificial elevation that should be applied to overcome the 
scoliosis. 
An instrument for recording the bilateral movement of 
the chest in ordinary or forced respiration has been invented 
by Richard Hogner, M.D.* The instrument is applied 
somewhat like an ordinary tape at the level at which the 
movements of the chest are to be recorded. The onlv 
Fig. 42. 
*New York Medical Record, Vol. XI, No. 9. Special Instruments. 
85 
advantage of the instrument, over the thoracometer of 
Demeny, lies in its adjustability to a higher region of the 
thorax, but the circuitous route that the tapes traverse in 
reaching the upper thorax invalidates the records made so 
that the instrument has not come into general use. 
A simple device for measuring lateral inequalities of the 
pelvis is shown in Fig. 43, which consists of two sliding arms 
that are moved against the iliac crests after the central pointer 
is placed over the spinous process of the sacrum. 
There is no advantage, however, in this instrument over 
the rod for length, breadth, etc., which can be placed upon the 
pelvis, as for taking breadth of hips at any desirable point and 
then noting if the half of the total breadth falls exactly over 
the spinous process, which should first be marked. 
Some more or less complicated instruments have been made 
for measuring the inclination of the pelvis by Dr. Compton 
Reilly and others, buttheir utility remains to be demonstrated. 
Fig. 43. 86 
Graphic Anthropometry. 
CHAPTER VII. 
GRAPHIC ANTHROPOMETRY. 
Within the last twenty years various devices for applying 
the principles of graphic mathematics to the measures and 
tests of men have been invented. These have been the out- 
growth of the graphic method of Quetelet for showing the 
mean of any part, as chest girth or height, and the tables of 
averages and means published from time to time during the 
last twenty-five years by Dr. Hitchcock of Amherst, and 
the tables of percentages published by Francis Galton and 
other students of anthropology. 
The oldest record of anthropometrical data in any col- 
lege in the country is to be found at Amherst, where from 
1861-2 to this date the students have had the advantage of a 
physical examination, and advice regarding exercise, and a 
record of their general size has been secured. 
In 1867 W. T. Brigham of Boston made a study of the 
proportions of Mongolian emigrants.* In 1869 he began to 
take the measurements of American young men, and for this 
purpose used a list of measurements and records that was 
later adopted in essential form as the list of the American 
Physical Education Association. He measured several 
hundred Harvard students and other men, but never pub- 
lished his data. 
The items given in Dr. Hitchcock's list are extended in 
the record book of Yale by the addition of age, breadth of chest, 
development, condition, exercise, vision, hearing, color of 
hair and eyes, pulse rate, and use of tobacco. The horizontal 
length is omitted. It may be said that at Amherst the 
record of each student is transcribed for him on a table that 
is compiled from the measurements of men of the same 
height. The table here shown on the opposite page gives 
the averages obtained from five colleges, the material having 
been obtained by one man in each institution. 
In 1880 Dr. D. A. Sargent of Harvard began a systematic 
* Proc. Boston Natural History Society, 1867. Graphic Anthropometry. 
87 
AVERAGES OF COLLEGE STUDENTS. 
AGE 
Amherst. Cornell.Wisconsin. Yale. 
W. & J. 
. 20.8 
- 
20. I 
20.3 
WEIGHT 
6l .2 
6l . 2 
63-3 
63- 
63.1 
HEIGHT 
1725 
1725 
1726 
1724 
1730 
" Sternum 
. 1410 
1406 
1415 
1416 
- 
" Navel 
1030 
1030 
1030 
1033 
-- 
" Pubis 
860 
859 
864 
860 
- 
" Sitting 
903 
9O4 
9°3 
9°3 
895 
" Knee 
478 
424 
45i 
448 
- 
LENGTH, Shoulder, Elbow 
369 
373 
370 
372' 
- 
" Elbow to Tip 
460 
461 
462 
461 
- 
" Arm reach. 
1780 
1782 
1792 
179° 
- 
" Right Foot 
260 
258 
260- 
258 
- 
" Left Foot 
259 
258 
260 
258 
- 
GIRTH, Head 
572 
570 
346 
575 
570 
-- 
" Neck 
353 
357 
350 
346 
" Chest, dep 
. 
- 
839 
846 
846 
" " inf. 
026 
929 
934 
924 
910 
" " normal 
880 
884 
878 
875 
- 
" "at gth Rib, full . ... 
- 
- 
- 
887 
- 
" " " " " dep. . . . 
- 
- 
- 
824 
- 
" Waist 
723 
726 
731 
725 
719 
" Hips 
893 
895 
904 
888 
888 
" Right Biceps 
295 
298 
300 
293 
293 
" Left Biceps 
. 
- 
292 
283 
285 
" Right Arm 
260 
258 
259 
256 
256 
" Left Arm • • 
' 258 
251 
256 
248 
250 
" Right Elbow 
251 
251 
231 
229 
- 
" Left Elbow 
247 
246 
229 
224 
- 
" Right Forearm 
267 
258 
265 
264 
265 
" Left Forearm ; 
261 
258 
259 
258 
258 
" Right Wrist 
166 
165 
169 
i65 
165 
" Left Wrist 
164 
164 
167 
164 
" Right Thigh 
520 
513 
524 
515 
507 
" Left Thigh 
517 
511 
522 
513 
501 
" Right Knee 
361 
359 
362 
357 
- 
" Left Knee 
359 
357 
359 
359 
- 
" Right Calf 
349 
354 
352 
350 
339 
" Left Calf 
349 
348 
350 
350 
339 
" Right Instep 
241 
242 
240 
233 
- 
" Left Instep 
239 
240 
239 
234 
- 
BREADTH, Head 
155 
154 
156 
155 
- 
" Neck 
108 
107 
107 
107 
- 
" Shoulders 
430 
434 
435 
410 
415 
" Chest 
- 
- 
279 
273 
270 
" Waist 
254 
252 
251 
253 
- 
" Hips : 
323 
323 
325 
323 
319 
DEPTH, Chest 
- 
- 
187 
186' 
184 
" Abdomen 
- 
- 
181 
182 
- 
CAPACITY, Lungs 
3-78 
4-24 
4-05 
4.00 
4-05 
STRENGTH of Back 
138 
- 
- 
150 
- 
" Legs 
164 
- 
181 
- 
" Right Forearm 
40 
- 
56.8 
54 
57-3 
" Left Forearm 
37 
- 
54-5 
47 
50.4 
" Pull up 
9-5 
- 
- 
- 
- 
" Push up 
6. 
- 
- 
- 
- 
DEVELOPMENT, 
CONDITION, 
EXERCISE, 
VISION, Right Eye, 
VISION, Left Eye, 
HEARING, 
COLOR of Hair, 
COLOR of Eyes, 
PULSE, 
TOBACCO. SEAVER CHART. Graphic Anthropometry. 
89 
record of measurements of students examined by himself. 
He has endeavored to determine a physical standard for 
American college students that should be derived from a 
tabulation of all the measurements that could be secured. 
The work was very comprehensive in scope and the main 
results have not yet been given to the public, but a partial 
result has been seen in the graphic chart that was pre- 
pared in 1886 by which he was able to give a person an 
idea of how he compared with the whole body of students 
whose measures had been tabulated. A second result was 
seen in the July and November numbers of Scribner's 
Magazine for 1887, where, in an article on "The Physical 
Characteristics of the Athlete,'' certain well-known men were 
pictured graphically as well as literally, and thus the appli- 
cation of the method was more clearly impressed on the 
minds of persons engaged in physical education.- In 1893 
he presented, at the Columbian Exposition at Chicago, 
graphic charts showing the curves of each item for the final 
period of growth for both men and women. 
Meanwhile Dr. Hitchcock of Amherst College, who had 
published tables of average measurements of Amherst 
students of all ages, from fifteen up to twenty-eight years, 
and tables of averages where height instead of age was the 
basis of tabulation, issued a table in which the latter averages 
were arranged on a sheet in order from shortest to tallest, by 
gradation, of one centimeter, and the records of an ordinary 
person could be indicated on this new table in a graphic 
way. In 1887 an "adjusted averages" table was prepared as 
a simple acknowledgment that the tables were compiled 
from so few records in many cases that there was consid- 
erable irregularity, and therefore after determining the 
apparent law of variation, the table was made to conform 
more or less closely to this law, and a better sheet for 
graphic illustration was produced. The numerical compari- 
son method that has been in use at Amherst for over thirty 
years has given us the most extensive study of young men 
from sixteen to twenty-five years of age that we have. 
(See pages 90-91). 
In 1888 the measurements of Yale students for five years, 
that had been taken by the author and that included every 
man in the undergraduate departments for three years and of • » 
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PILO$ITY, 92 
Graphic Anthi opometry. 
two other academical classes, except three men, for four 
years, altogether the records of over 2,200 men, were com- 
piled and arranged in tabular form according to the method 
of percentile grades used by Mr. Galton (see page 88). 
This has furnished a table for graphic illustration and 
personal information that is fairly complete. In graphic use 
it combines (a) the comparison of a man's records with those 
of the whole mass of students; (b) a comparison with the 
mean; (^) the statement of the actual numerical size of each 
part of an individual, and (^) its relation to every other part. 
The general form of this table has been found to be more 
satisfactory than any other that has been devised, and it has 
been followed in form by Dr. Hitchcock, Miss Wood and Dr. 
Hanna and, with slight modifications, by Dr. Gulick (page 
93), Dr. Garland and Dr. Pfister. Dr. Baker of Washington 
and Jefferson College has also slightly modified the form, 
while maintaining its general features. 
This percentile table of the measurements of Yale men 
was followed in 1891 by a similar table compiled from an 
almost equal number of men by Dr. Hitchcock of Amherst 
College (page 94). This table gives an opportunity of com- 
paring the average or mean Amherst student with the mean 
Yale student, as each table includes all of the group at each 
college. 
It should be remarked that in recording certain dimen- 
sions the method varies so as to invalidate the comparison 
for these items. For instance, the height of knee in the Yale 
table is the height to the top of the head of the fibula, while 
in the Amherst table it represents the height to the tendons 
of the hamstring muscles. The girth of elbows represents 
in the one case the smallest measurements taken above the 
condyles of the humerus, while in the other it represents a 
measurement taken over the condyles. And in breadth of 
shoulders the record in the one case is bi-acromial, while in 
the other it is bi-deltoid. It should also be noted that the 
strength records are taken with entirely different instru- 
ments, and therefore do not represent so close a comparison 
as do the other records in the table. 
In the strength of forearm on the Yale table the upper 
figures represent the readings on the dynamometer, which 
were supposed to be kilograms and were so marked; while the Per Cents 
1 
2 
5 
10 
15 
20 
25 
30 
35 
40 
45 
50 
55 
60 
65 
70 
75 
80 
85 
^0 
85 
98 
09 
Weight . 
1033 
107.5 
115.9 
nas 
123.3 
126.4 
129. 
131.3 
1336 
135.5 
137.5 
139.5 
141.5 
1415 
145.4 
147.7 
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1757 
62.6 
63.1 
63.3 
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68. 
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12.7 
13. 
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14. 
14.1 
14.2 
14.4 
14.5 
14.6 
14.7 
14.9 
15.1 
15.4 
15.7 
15.9 
Chat Contracted 
29.9 
30.4 
31.2 
319 
323 
327 
33. 
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33.5 
33.8 
34 
342 
345 
34.7 
35. 
35.2 
35.5 
35.8 
36.2 
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37.3 
38.1 
38.6 
C/?estEx|>&n de A 
32.3 
32.3 
33.8 
34.6 
35.2 
3&6 
36 
36.3 
366 
36.9 
37.2 
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378 
38.1 
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38.7 
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39.4 
39.8 
40.3 
41.2 
42.1 
423 
/ 
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248 
25.3 
26.2 
26.9 
27.4 
27.8 
28.2 
28.5 
28.8 
29.1 
29.3 
296 
293 
30.1 
30.4 
30.7 
31. 
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32.3 
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RiaJitFore<\rnt 
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9.2 
9.4 
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10.1 
10.2 
10.3 
10.4 
10.5 
10.5 
10.6 
10.7 
10.8 
10.9^ II. 
1 
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11.2 
11.4 
11.6 
11.9 
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8.6 
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10. 
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10.3 
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10.6 
10.7 
10.8 
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11.1 
11.2 
114 
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11.3 
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11.8 
11.9 
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12.5 
12.6 
12.8 
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13.4 
13.8 
14.1 
14.4 
Left forearm. 
9. 
9.2 
9.4 
9.7 
9.8 
10. 
10.1 
10.2 
10.3 
104 
10.5 
10.5 
106 
10.7 
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11.3 
11.5 
11.6 
11.8 
11.9 
12. 
12.1 
12.3 
124 
12.5 
72.6 
12.8 
13. 
13.1 
73.4 
73.8 
74.7 
144 
1 hi^,h 
17. 
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17.9 
18.4 
18.8 
19.1 
19.3 
19.5 
19.7 
19.9 
20.1 
20.2 
204 
206 
20.8 
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21.2 
21.4 
21.7 
22. 
22.6 
23.1 
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fwr eJj 
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12.3 
12.6 
12.8 
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13.3 
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137 
13.8 
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14.2 
14.3 
14.5 
14.7 
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15.1 
15.4 
15.8 
16 1 
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17. 
17.3 
17.9 
18.4 
18.8 
191 
19.3 
19.5 
19.7 
199 
20.1 
202 
20/1 
20.6 
20.8 
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21.2 
21.4 
21.7 
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22.6 
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11.9 
12.3 
12.6 
12.8 
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J 3.3 
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13.6 
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13.8 
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14.3 
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14.7 
14.8 
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154 
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7.9 
8.7 
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11.8 
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17.2 
18.6 
20.8 
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9.6 
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10.7 
11.3 
12. 
12.7 
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147 
16.3 
18.1' 
; 9.3 
Percentlie Chart compueu num me mea.bUiemenu> ot men who had taken systematic gymnastic exercise for 
at least two years and between 25 and 35 years of age by Luther Gulick.  
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929 542 539 373 372 3G4 3G2 255 253 315 277 270 262 259 275 2G9 171 170 158:113 451 266 338 209 888 387 478 476 270 270 1850 1789 1.7 IGO 10 ' 12 j 
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948 559 55G 380 380 374 371 2G0 2G0 327 280 280 2G9 2G4 281 275 J75 174 $ 1G1 UG 461 274 345 217 397 395 48G 485 275 275 1886 1820 2.0 >178 ! 12 14 
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962 571 569 388 388 381 380 267 265 335 292 288 274 270 289 280'179 177 c 163 119 4G8 281 352 222 403 402 494 492 279 279 1910 1841 2.2 194 14 16 1 
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CAPACITY OF 
. LUNGS. 
lower figures in the 
square represent the 
actual value of these 
records in pounds, as 
determined by a test of 
the instrument. This 
instrument was of stand- 
ard make, and illustrates 
the unreliability o f 
spring instruments, that 
have been used hereto- 
fore in securing records. 
The double sets of fig- 
ures in the various 
squares in all these 
tables represent kilo- 
grams, millimeters and 
liters and their respec- 
tive equivalents in 
English units. 
In the last four months 
a percentile study of the 
records of the Yale stu- 
dents who were in their 
twentieth year of life 
has been made and the 
result is shown on the 
chart inserted on page 
95. A noticeable fea- 
ture of the results is 
that this tabulation 
seems to show a decided 
tendency to increase in 
height of students in 
recent years. This has 
also been noted in the 
average tables that have 
been made at Yale from 
the records of the fresh- 
men. Another point that 
is unexpected is that the PERCENTILE ANTHROPOMETRIC TABLE 
Compiled from the Measurements of 2,700 Yale Students in their 2Oth Year of Age and Expressed in Metric Units 
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Compiled and copyrighted 1905 by Jay W. Seaver. 
ERRATA : In girth of wrists read one instead of two in hundreds column. Graphic Anthropometry. 
97 
50 per cent record in height of the table representing men 
a year younger is the same as that for the 20th year and this 
would seem to show a period of quiescence in growth of 
height at about this period. 
In 1893 Miss M. Anna Wood of Wellesley College tabu- 
lated the measurements of 1,500 students, and issued the 
table in percentile form like that of the author. This was 
followed in 1894 by a similar table (page 98) compiled from 
the records of 1,600 female students of Oberlin College, taken 
and compiled by Dr. Delphine Hanna, a professor in the col- 
lege. The order of items follows the Wellesley form. In 
both of these cases the tables are of high value as represent- 
ing the whole of a group, and we may therefore fairly con- 
sider that the fifty per cent lines represents the average 
of the students of Wellesley and Oberlin. 
An interesting study of the physical type represented in 
the two institutions may be made by plotting the fifty per 
cent line, the twenty-five per cent line above the mean and 
the twenty-five per cent line below the mean of one college 
upon the table representing the records of the other. In 
general it will be seen that the Wellesley student is some- 
what larger in general dimensions, while the Oberlin 
student represents more nearly the type that has been 
popularly attributed to the Yankee. A comparison of these 
tables suggests a possible influence of environment in pro- 
ducing a racial or local type, for in general the ancestry of 
the Ohio pupil is the same as that of the Wellesley pupil. 
It is possible also that the early occupations of these 
students have differed so widely, as also their food supply, 
as to produce the modifications noticed. It should also be 
borne in mind that the personal equation or method in 
taking the records is marked in the results seen. 
In 1899 Mrs. Anne Barr Clapp of the University of 
Nebraska tabulated and published a chart of the anthropo- 
metric records of 1,500 women of that university who had 
been measured by her. The table consists of the arithmetical 
means, for the various items measured, in groups of height 
varying by a centimeter from 149 cm. to 173 cm. (see page 
99) Appended is a sheet ruled in squares for plotting the 
size of an individual according to the standard set by the line 
of figures representing the average for women of her height,  
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Capacity of 
Lungs 100 
Graphic Anthropometry. 
the same as in the Kellogg chart described below. The 
record of the person is divided by the record for the same 
item in the standard line and the resulting percentage 
valuation is marked in the proper square, by a dot or cross, 
and then these are connected by a line giving a graphic 
picture of the items that are above, below or equal to the 
standard. Thus the chart has a capacity for expressing all 
possible sizes in terms of the averages of women of the same 
height. A comparison of the record at 160 cm. with the 
50 per cent line on the Oberlin or Wellesley table shows 
some interesting divergences in physical type. 
In 1893 Dr. Hitchcock of Amherst issued a table made 
up of a determination of averages on the basis of heights; 
that is, he grouped the records of 1,322 students between the 
ages of seventeen and twenty-six years, according to the 
height of the individuals, separating the groups according to 
a gradation of one centimeter. His records varied from 160 
to 183 centimeters. He found the average for each one of 
these groups and arranged them as seen in pages 90 and 91. 
The nearest approximation to the general college average 
is found to be the grade representing the averages of men 
from 172 to 173 centimeters in height. It may be said that 
this table gives us the best standard of the various dimen- 
sions that are characteristic of American young men between 
the ages of seventeen and twenty-six. The arrangement of 
the figures in the squares is the same as that used in the 
percentile table. This table cannot be used for graphic 
illustration so successfully as can the percentile table, 
although for men of nearly the mean dimensions the table is 
satisfactory for this purpose. In the use of this table it is 
suggested that the method used by Dr. Kellogg in a chart 
(see page 101) issued in 1895 could be used to advantage, for 
it combines a high value for graphic purposes, with the 
reliable standard afforded by an arithmetical mean deter- 
mined for men on the basis of their varying height. The 
fallacy of the supposition that a percentile grade repre- 
sented a standard for an individual, as claimed by some, has 
been pointed out by Dr. Gulick, Dr. Boas and others.* 
Here, however, we have the standard determined by mathe- 
matical treatment of the records of persons of the same 
*Papers on Anthropometry published by American Statistical Society. ^.PMYSICAL CHARTS 
Claeeltled Arranged According to Heights from 04 to 72 Inches. 
Arranged from the results obtained in testing the strength of the Individual groups of muscles in 1600 MEM, by means of the Universal Dynamometer. The figures given represent the mean-average for 
each group of muscles respectively. Made and compiled under the direction of J. H. KELIX1GG, M. D.. Superintendent of the Sanitarium and Hospital. Battle Credit, MJflt. 
txcapt when Otherwlee Indicated, Quantltlee ere Expressed In Pound® Avoirdupois. Graphic Anthropometry. 
102 
height, and the person may then be graphically represented 
in the same way that he could be represented on a percentile 
chart made up from the measurements of persons of his own 
height. This introduces a new and important feature into 
graphic anthropometry, and one table becomes available for 
representing any individual within the limits of the tabu- 
lation in height. 
"It is a recognized law that the strength increases in pro-, 
portion to the square of the height, whereas height increases 
in simple arithmetical ratio. In order to furnish a basis for a 
more just comparison, two charts have been prepared upon 
the basis of height, including such heights as fall within the 
limits of 58 and 67 inches for women and 63 and 72 inches 
for men. Provision is made for a graphic percentage repre- 
sentation in the diagram occupying the lower half of the 
chart, upon which per cents may be written at any level from 
o to 250. To obtain the percentage relation of the person 
examined to the mean-average person of the same height, it 
is only necessary to divide the number found for any item by 
the corresponding number shown in the proper columns for 
the mean-average person of the given height. Having 
found the percentage in this manner, a dot is made with a 
pencil in the proper column, and at the level corresponding 
with the percentage shown by the quotient obtained. If the 
quotient is 1, the dot will be made opposite, or in line with 
100, and the meaning is that the strength of the group of 
muscles tested is equal to that of the mean-average person of 
the same height. If the amount obtained by dividing the 
number found by the number representing the strength of 
the same group of muscles in the average person of the same 
height is less than 1, as .50 for example, this represents that 
the strength of the group of muscles examined is only one- 
half, or 50 per cent, that of the mean-average person of the 
same height. A dot is accordingly located opposite to, or in 
line with, the number 50 in the per cent column. In like 
manner, points may be located for each group of muscles. 
Connecting the points by lines, we have a graphic repre- 
sentation in which the relation of the individual examined 
to the mean-average person of the same height is accurately 
shown (Page 101). All the points in the chart which fall 
below 100 indicate relative inferiority of strength; all the 
points above the 100-line represent relative superiority in 
strength. " 
In considering these percentile tables taken from the 
records of college students, it is well to bear in mind several 
points. First-that the percentile table does not furnish us a Graphic Anthropometry. 
103 
working type or model of proportions in its fifty per cent 
line, but it is rather a statement of the actual physical size 
of the college community at the time these records were 
gathered. Very few of the records entering into the com- 
pilation represent physical maturity, although this is more 
nearly true of the tables for Women than for men. It is a 
notorious fact that a large percentage of college students 
have received no adequate physical training or exercise 
before reaching college. Their lives have been abnormal 
and unnatural in that, during the playing period of their 
lives, they have been closely confined to a line of mental 
processes that dealt largely with abstract subjects and that 
deprived them oE physical activity. As a result of this 
method of life, muscular sizes must be abnormally small in 
the great majority of cases, and a table constructed from 
such measurements will show a man that is truly "mean." 
To determine so far as possible the variation of the fifty per 
cent line on the table of Yale measurement from what might 
be expected in a similar table constructed from the measure- 
ments of men of a like age but who had taken a large amount 
of physical exercise, and who could be considered in perfect 
health, I selected five hundred individuals from two thousand 
and grouped their measurements according to the percentile 
method. The results are shown by the lines representing 
the twenty-five per cent grades, as well as the mean, that are 
plotted on the regular table as shown on page 88. It is 
believed that this new fifty per cent line represents a much 
more reliable standard of physical excellence than the line 
representing the mean of the whole college community. 
A glance at these lines shows us several facts: First- 
That the relation between bone size and muscle size varies in 
different tvpes of men, viz., in the short person the muscles 
have a much large proportional size than in the tall person. 
This has been demonstrated before in other ways and formu- 
lated into a law that the working power of a muscle varies as 
its cubical contents. Second-That there is a direct ratio 
between exercise and bone growth. The lengths of leg in all 
these cases plot higher than length of trunk. Third-A high 
development seems to declare itself in more increase of 
depths than of breadths. Fourth-That there is a direct 
ratio between size of muscles and capacity of lungs. Fifth- ENEBUSKE CHART. Graphic Anthrcpometry. 
105 
That girth of waist increases with chest and hips but not in 
the same proportion. Sixth-That high nutrition power is 
essential to high development. Seventh-That muscular 
and nervous strength increases in greater proportion than 
other items; so we may infer that high strength tests 
indicate physical welfare. Eighth-That exercise gives a 
measurable increase in stamina and tends to produce a dis- 
tinguishable type of man. 
Dr. Enebuske has developed into a new form the more 
important indices as a basis for graphic use in showing the 
physical condition of a person (page 104). In this graphic 
diagram Dr. Enebuske presents a curve, a, representing an 
individual who was too weak to be admitted to class work in 
the school; curve b representing the weakest student who 
was admitted to the normal class of the school; curves 
representing the average working capacity of 1,100 female 
students of Wellesley College, from data furnished by Miss 
M. A. Wood of Wellesley; curve d. on the chart shows the 
average of the students entering the school before the begin- 
ning of their gymnastic training; curve e shows the average 
of forty-two graduates of the school of an average age of 
twenty-three years; curve /represents a record of a student 
whose working capacity corresponded most closely to the 
average working capacity of the graduates; curve g repre- 
sents the highest record made by all female students up to 
the date of the paper; curve h' represents the average 
Amherst student; curve i represents a male student of the 
Normal School of Gymnastics; curve / represents a Yale 
student of the fifty per cent grade. This curve represents 
also the average of fifty naval cadets of the United States 
Navy. Curve k represents the record of a male student of 
the Normal School of Gymnastics, as does also the curve I. 
This form of chart is used in the Boston Normal School of 
Gymnastics as a test of the physical condition of the students, 
who are examined monthly, and if the curve at any time 
falls below what may be expected from the previous record 
the conditions of work are examined, and so far as possible 
errors of method are corrected, or, failing to find such 
errors, the pupil is relieved of part or all of the work until a 
physiological condition is reached that will bear the severe 
work of the school. 106 
Graphic Anthropometry. 
With the invention of the Kellogg dynamometer and the 
consequent ability to test more accurately special groups of 
muscles, we have put at our disposal a means of extending 
the study of ratios between the size of various parts and their 
working ability, and this ratio may obviously be expressed 
in the form of an index or coefficient; and thus it is believed 
that the graphic chart of the future that is to give an indi- 
vidual a clear conception of his standing as a member of the 
community must show him his relation to others, not only in 
size but in working capacity. And a closer study of method 
will give us coefficients that shall-also indicate the quality of 
work, as well as its quantity. Not until this point is reach 
can anthropometry be said to have fulfilled its mission. 
In connection with the arrangement of the percentile 
charts of strength tests there has been a study of the relation 
of strength to weight and to height, and for the mean the 
strength weight index, as determined by Dr. Kellogg, is 
37.34 for men and 23 42 for women. This index as deter- 
mined by Dr. Enebuske is 7.5 for men and 5 for women. 
The difference being due to the larger number of tests used 
by the former. The ratio is essentially the same, thus estab- 
lishing the comprehensive character of the ratio. It is inter- 
esting to note the nearly similar ratio of 10 to 8 in the 
foods required for men and women, as determined by Dr. 
Atwater and published in several bulletins issued by the 
Department of Agriculture as dietary studies. 
The relation between weight and lung capacity is probably 
more definite than the relation between height and lung 
capacity, because weight is a definite statement of the 
amount of tissue to be supplied with oxygen, while height 
relates simply to the arrangement of the mass, rather than 
to its amount. . 
The statement that for each increase in height of 25 mm. 
we should expect an increase in weight of one kilogram 
relates only to the general proportions existing among men, 
whereas the average weight of a transverse section of 25 
mm. would undoubtedly be greater than this amount. But 
respiration is physiologically a measure of the cellular 
activity of the body, rather than of the number of its cells, 
and therefore we should expect those cells thathrndergo rapid 
metabolism, and that consequently tax the respiratory func- Graphic Anthropometry. 
107 
tion for both the supply of oxygen and the elimination of 
their carbonic oxide, to bear a closer relation to lung 
capacity than would total weight. Muscular tissue stands 
at the head of all cellular structure in the vigor and con- 
tinuity of its activity, glandular structure being the only 
tissue that compares with it in the violence of its metabolism. 
But glandular activity is periodical and fairly uniform 
among all persons, the processes being primary and vital, 
while muscular activity is secondary and voluntary. It 
would seem, then, that muscular size must be the measure 
of lung capacity. Now strength is the expression of muscular 
size and activity (z>., nerve stimulation), and therefore the 
relation between strength and lung capacity must be a 
definite and measureable one. 
The relation between strength and height cannot be 
direct, although some coefficient may be determined that 
shall express it with a fair degree of accuracy; but the mere 
expression of height, without relation to weight or girth 
records, tells nothing of the muscular size, and, as we have 
seen, this and its related nerve influence is the determining 
factor of strength. That tall people are on the average 
stronger than short people does not refute the argument 
already stated, because in general tall people are also heavier 
and larger in girth than short people, and consequently their 
muscle mass must be larger. 
The relation between strength and girth would seem to 
give a coefficient that would be fairly reliable and constant, 
especially if we include in the girths only the girths of the 
limbs. The reason for this exclusion will be obvious if we 
consider for a moment the fact that limb development cannot 
be secured without a simultaneous development of the 
muscles of the trunk, as the muscles of the limbs are directly 
connected with the trunk, and any phase of their activity 
is accompanied by a responsive contraction of some group of 
muscles to steady the trunk for the support of the force that 
is to be exerted by the movement of the limb-the trunk 
being a fulcrum, as it were, for the lever constituted by the 
limb. Yet the trunk girths may be large from accumulated 
adipose tissue and the limb girths be comparatively small, 
owing to habits of inactivity and scant muscular exercise. 
In other words, we may have large trunk girths and poor 108 
Graphic Anthropometry. 
limb girths, but not the reverse. The limb girths, then, are 
a fair measure of the muscular activity of the individual, and 
consequently may be truly said to bear a definite relation to 
the strength of the individual. It has been noted as an 
anthropological fact that in the more highly developed races 
of men the increased size and development of the legs is a 
characteristic feature. 
If we consider a ratio of height to weight we have an 
indication of the excess of storage tissue or of the scant 
development of the soft tissues and therefore have a 
coefficient that must bear a fairly close relation to strength. 
This relationship could be expressed by another line on the 
chart of Dr. Enebuske and wide divergence from the normal 
would lead to anticipation of poor condition for work. 
A breadth-strength coefficient, or a depth-strength co- 
efficient, would apparently be unreliable for the same reasons 
that operate against a strength-height coefficient. That is, 
we may have breadth representing a possibility for muscular 
attachments, and still these muscles may not be properly 
developed, while in the case of depths, the large upper 
trunk depth would indicate an approximation to the round 
type of chest, which is primitive and not compatible with 
large lung capacity; while large depth of the lower trunk is 
indicative of muscular weakness or insufficient oxidative 
power. On the other hand, small depth of chest may be 
coincident with excessively poor muscular development or 
with a fair degree of muscular development and large 
respiratory power. It would seem, then, that neither of 
these measurements could be depended upon as a basis for 
determining coefficients. 
In 1889 Dr. W. L. Savage devised a chart for use in 
plotting the measures of boys and youths. The scheme is 
very ingenious and will be found generally useful when the 
table on which it is based is placed in the hands of instruc- 
tors. The chart can be used for any age and gives absolute 
record of averages rather than comparative. These aver- 
ages are computed for all ages from one to twenty years and 
arranged in concentric circles. 
In 1890 the most completely graphic method that has yet 
been devised was completed by Dr. E. Hitchcock, Jr. It is 
based on the tabulation of 15,000 sets of measurements-all Graphic Anthropometry. 
109 
made by physicians who were experienced in the work. The 
figure is drawn from the average of the various measures, 
and lines to right and left show in a perfect manner the rela- 
tion of girths as they are actually found to exist. The rela- 
tion in size of limb girths to semi-girths of the trunk have 
never been so clearly demonstrated before, and therefore the 
chart is an important contribution to artistic anatomy. 
The numerical method of comparison has been the one 
in most general use because the data necessary for making a 
graphic picture of a person's anatomical proportions has only 
recently been made public. The advantage of a graphic 
illustration of physical proportions is as great as the advantage 
of that method in any department of scientific work. It dis- 
closes at a glance what is discovered only after considerable 
time spent in study of figures. It would seem that the union 
of the graphic and numerical methods of stating the propor- 
tions of an individual must be more comprehensive than 
either method alone, and more satisfactory to both instructor 
and student. 
The percentile tables of Dr. W. W. Hastings, that were pub- 
lished in his Manual for Physical Measurements in 1902, are 
the most comprehensive exposition of the sizes of the various 
years of growth from five to twenty years for both girls and 
boys that have been attempted. But the material is not to be 
considered as an actual percentile tabulation but a determina- 
tion of the mean or 50% and then a calculation of the 25^ 
records by the method of "Probable Deviation". The Pro- 
bable Deviation has been defined to be the deviation from the 
middle value which in a large series of observations, is as often 
exceeded as attained. This will be the difference between the 
mean and the 25^ record. 
This may be computed by adding all the deviations from the 
mean or middle value and dividing this sums by the number of 
observations and multiplying the quotient by the decimal,. 8453. 
This product is plus if above the mean or minus if below. 
But in the practical working out of this method the minus devi- 
ation is not the same as the plus because the growth is not 
uniform and the material is not homogeneous. However the 
computed values are more reliable for comparison than an 
actual tabulation would be, unless the data were to be very 
extensive. ANTHROPOMETRIC TABLE 
for BOYS FIVE TO SIXTEEN (5-16) YEARS OF AGE 
PHYSICAL TYPE FOR EACH AGE, AND VITALITY COEFFICIENTS 
(Compiled from the measurements of five thousand four hundred and seventy-six school children) 
0.2 
b § 
so 
d 
cu 
Weight 
(K i los- Pounds) 
LENGTHS 
(cent.- inches') 
BREADTHS 
(cent.- inches) 
DEPTH 
(cent.- 
-inches) 
- inches) 
strengths 
COEFFICIENTS 
Height 
Height 
Sitting 
Span of 
£ 
O 
£ 
fl 
60 
Chest 
Expansion 
Lung 
Capacity 
(Litres- 
Cub. Inches') 
Strength of 
Forearm, R 
(Kilos- 
Pounds') 
Strength of 
Forearm, L 
(Kilos- 
Pounds') 
R H C - Respiratory 
Height Coefficient 
V C-Vitality Coefficient 
OSH C - Organic Strength 
Height Coefficient 
6 
75 
58 20 
428 os 
169 20 
66 bo 
88 50 
34 83 
174 82 
b8 83 
15 57 
6 ro 
26 39 
ro 40 
24 70 
9 75 
18 15 
7 15 
55 68 
2t 95 
10 47 
4 ro 
3 G4 
222 03 
40 96 
go ro 
36 52 
80 3b 
169 
K H C 
16 
218 
M 
52 90 
ub 38 
163 73 
b4 45 
85 21 
33 55 
168 21 
66 25 
15 14 
5 95 
25 04 
9 83 
23 19 
9 15 
16 80 
b bo 
54 73 
2r 55 
8 80 
3 45 
3 14 
rgr 40 
33 31 
73 28 
29 64 
bs 22 
35 58 
V c 
25 
M 60 
104 73 
158 26 
b2 30 
81 92 
32 25 
161 60 
b3 bs 
14 71 
5 80 
23 69 
9 30 
21 68 
8 55 
15 45 
b 03 
53 78 
2r rs 
7 13 
2 80 
2 G4 
rbo 77 
25 66 
5b 4b 
22 76 
50 08 
210 84 
O S H C 
■■ 
75 
53 97 
"8 73 
104 99 
b4 go 
85 56 
33 70 
167 55 
66 00 
15 35 
b 03 
24 95 
9 80 
23 41 
g 20 
17 48 
b 83 
55 G3 
2t go 
10 25 
4 00 
3 07 
r8b gs 
35 09 
77 24 
29 25 
b4 34 
141 
R H C 
15 
324 
M 
46 95 
103 29 
158 18 
b2 23 
81 68 
32 rs 
160 33 
b3 15 
15 00 
5 90 
23 68 
9 30 
22 00 
8 bs 
16 07 
0 SO 
54 55 
2r 45 
8 44 
3 30 
2 64 
rbr 00 
28 85 
bS 47 
24 68 
54 30 
26 09 
V c 
25 
39 93 
8785 
151 37 
59 bo 
77 80 
31 bo 
153 11 
60 30 
14 65 
5 75 
22 41 
8 80 
20 59 
8 10 
14 66 
5 75 
53 47 
2r 00 
6 63 
2 bo 
2 21 
r35 03 
22 61 
49 73 
20 11 
44 2b 
185 22 
O S H C 
75 
44 4G 
97 Sr 
br 70 
80 78 
34 75 
159 33 
b2 70 
15 25 
6 00 
23 87 
9 40 
22 38 
8 83 
16 33 
b 45 
55 18 
2t 70 
9 98 
3 95 
2 G5 
rbr bo 
29 19 
b4 24 
27 19 
59 84 
129 
X H C 
14 
435 
M 
39 73 
87 4i 
151 02 
59 45 
78 06 
30 70 
\ '8 
! B2 
1 
14 89 
5 83 
22 78 
8 93 
21 OO 
8 23 
15 07 
5 95 
54 19 
21 30 
8 46 
3 35 
2 30 
r 10 42 
25 37 
55 84 
23 05 
50 70 
21 97 
V c 
25 
35 00 
77 or 
145 29 
57 20 
75 34 
29 bs 
145 53 
57 30 
14 53 
5 70 
21 69 
8 30 
19 62 
7 75 
13 81 
5 45 
53 20 
20 go 
G 94 
2 75 
1 95 
rr8 b4 
21 55 
47 44 
18 91 
44 59 
170 51 
O S H C 
75 
39 15 
85 90 
149 90 
59 00 
77 56 
30 50 
151 08 
59 50 
15 11 
5 95 
23 07 
9 ro 
20 95 
8 23 
b 00 
54 4G 
24 45 
9 83 
3 85 
2 29 
439 35 
26 28 
57 84 
23 22 
51 08 
116 
R H C 
13 
515 
M 
35 60 
7S 32 
145 09 
57 40 
75 21 
29 bo 
146 02 
57 50 
14 78 
5 80 
22 11 
8 70 
20 18 
7 93 
14 38 
5 bs 
53 58 
2r ro 
8 29 
3 23 
2 03 
423 58 
22 59 
49 bg 
20 49 
45 07 
IS 28 
V c 
25 
32 15 
70 74 
140 28 
55 20 
72 8G 
28 70 
140 96 
55 50 
14 45 
5 bs 
21 15 
8 30 
19 41 
7 bs 
13 41 
5 30 
52 70 
20 75 
6 75 
2 bs 
1 77 
407 84 
18 90 
4i 57 
17 76 
39 ob 
157 62 
O S H C 
75 
35 82 
7* 79 
144 97 
57 ro 
75 70 
2g So 
145 GG 
57 35 
15 04 
5 95 
22 44 
8 83 
20 C2 
8 ro 
15 20 
6 GO 
54 12 
2T 30 
9 22 
3 bo 
2 05 
424 b7 
22 37 
49 21 
21 34 
4b 93 
102 
R H C 
18 
559 
M 
32 98 
72 55 
140 29 
55 25 
73 59 
2 3 93 
140 42 
55 30 
14 69 
5 80 
21 57 
8 30 
19 56 
7 70 
14 17 
5 bo 
53 34 
2r 00 
7 80 
3 03 
1 83 
itr 33 
19 68 
43 2g 
18 44 
40 5b 
15 55 
V c 
25 
30 14 
66 sr 
135 61 
53 30 
71 48 
28 10 
135 18 
53 23 
14 34 
5 bs 
20 70 
8 15 
18 50 
7 30 
13 14 
5 20 
20 70 
6 38 
2 30 
1 G1 
97 99 
16 99 
37 37 
15 54 
34 49 
152 86 
O S H C 
75 
70 03 
133 83 
54 bs 
73 60 
28 go 
140 24 
55 20 
14 95 
5 90 
21 70 
8 30 
19 90 
7 80 
14 80 
5 83 
53 96 
2r 25 
8 70 
3 40 
1 87 
412 72 
20 40 
43 8b 
18 41 
bg 
091 
R H C 
11 
660 
M 
29 P6 
b4 89 
134 90 
53 ro 
71 64 
28 20 
135 64 
53 40 
14 58 
5 75 
20 98 
8 23 
18 92 
7 45 
13 89 
5 45 
52 92 
20 83 
1 36 
2 go 
1 66 
400 74 
18 02 
39 og 
16 11 
3b 30 
13 33 
V c 
25 
27 49 
59 75 
130 97 
54 55 
69 78 
27 30 
131 04 
34 bo 
14 21 
5 bo 
20 26 
8 00 
17 94 
7 ro 
12 98 
5 13 
51 88 
20 43 
6 02 
2 40 
4 76 
15 64 
34 32 
13 81 
'30 94 
147 16 
O S H C 
75 
29 96 
b5 93 
135 11 
53 20 
72 26 
28 45 
134 61 
53 00 
14 90 
5 90 
21 01 
8 30 
19 24 
7 55 
14 04 
5 53 
53 29 
2t 00 
8 24 
3 25 
1 71 
403 gj 
17 24 
37 93 
16 39 
56 ob 
079 
R H C 
10 
498 
M 
21 85 
Or 28 
130 95 
5i 55 
70 04 
27 bo 
130 06 
54 20 
14 53 
5 75 
20 26 
8 00 
18 29 
7 20 
13 29 
5 23 
52 35 
20 bo 
7 00 
2 73 
1 QC $ 
: 0 
14 74 
32 42 
14 06 
30 94 
10 84 
V O 
25 
25 74 
5b bs 
126 79 
49 80 
67 82 
2b 75 
125 51 
49 40 
14 1G 
5 bo 
19 51 
7 70 
17 34 
6 83 
12 54 
4 93 
51 41 
20 20 
5 76 
2 23 
1 25 
7b 44 
12 24 
2b gi 
11 73 
25 82 
137 01 
O S H C  
75 
27 03 
39 45 
129 G4 
5( 05 
70 01 
27 bo 
128 85 
50 75 
14 88 
5 85 
|£ 
19 OG 
7 50 
13 96 
5 50 
53 46 
21 00 
7 69 
3 00 
1 52 
92 34 
15 34 
33 7b 
13 14 
28 or 
13 71 
30 18 
0G£ 
K >1 C 
9 
546 
M 
25 07 
55 15 
125 86 
49 55 
08 00 
2b 80 
124 76 
49 ro 
I 14 51 
5 70 
19 78 
7 80 
18 04 
7 JO 
13 21 
5 20 
52 49 
20 65 
6 55 
2 55 
1 33 
8 j oj 
11 77 
25 90 
9 34 
V c 
25 
23 11 
50 85 
122 08 
48 05 
65 99 
120 55 
47 45 
14 14 
5 55 
19 04 
7 50 
17 02 
b 70 
12 4G 
4 go 
51 52 
20 JO 
5 41 
2 JQ 
1 14 
bg 72 
1 ss 
■« 
9 A3 
135 97 
0 S H C 
1 
■ 
- 
_____ 
1 
75 
25 00 
54 98 
124 85 
49 15 
68 02 
2 b 80 
123 49 
48 b5 
14 7G 
5 75 
20 11 
7 80 
18 59 
7 30 
13 55 
53 2G 
20 qs 
7 01 
2 80 
1 35 
82 S3 
12 CO 
27 7J 
11 07 
24 34 
05G 
K H C 
8 
565 
M 
23 14 
50 90 
121 31 
47 75 
00 00 
2b 00 
119 34 
47 00 
14 44 
5 bs 
19 44 
7 b5 
17 66 
b 95 
12 89 
5 ro 
52 20 
20 55 
IS 95 
2 35 
1 15 
70 43 
10 63 
23 38 
9 53 
20 gb 
7 99 
r7 58 
7 34 
: v v © 
25 
21 28 
4b 82 
117 77 
4b 35 
G3 98 
25 20 
115 19 
45 35 
14 12 
5 55 
18 77 
7 40 
1G 73 
b bo 
12 23 
485 
51 14 
20 J 5 
4 86 
j go 
95 
58 S3 
8 66 
jg 05 
130 09 
O S » C 
- 
- 
75 
22 30 
_ 49 Of 
119 19 
4b go 
2b <0 
118 29 
4b bo 
14 G8 
5 80 
19 G4 
7 75 
18 03 
7 ro 
13 50 
52 86 
20 80 
5 57 
2 20 
1 17 
7/ 57 
10 77 
23 b8 
10 44 
23 00 
039 
R H C 
7 
544 
M 
21 30 
4b 85 
115 69 
45 55 
04 C8 
25 20 
114 28 
45 00 
14 33 
5 bs 
18 92 
7 45 
17 14 
b 75 
12 91 
5 ro 
51 94 
20 45 
4 58 
1 80 
99 
bo 48 
9 18 
20 jg 
8 53 
18 78 
5 05 
V C 
25 
20 30 
44 Ob 
112 19 
44 20 
62 10 
24 40 
110 27 
43 40 
13 98 
5 50 
18 20 
7 >5 
1G 25 
b 40 
12 32 
4 85 
51 02 
20 JO 
3 59 
j 40 
81 
49 39 
7 59 
Jb 70 
6 62 
r4 Sb 
128 93 
O S H C 
75 
20 68 
45 jo 
114 34 
45 00 
63 35 
25 00 
112 01 
44 ro 
14 57 
5 75 
19 09 
7 50 
17 61 
b go 
13 38 
5 25 
52 49 
20 bs 
5 16 
2 03 
1 00 
br or 
8 88 
r9 54- 
7 50 
Jb 4b 
032 
R H C 
6 
410 
31 
19 37 
42 0.2 
11007 
43 55 
61 35 
24 20 
108 18 
42 bo | 
14 24 
5 bo 
18 43 
7 25 
16 69 
b 55 
12 83 
5 05 
51 56 
20 25 
4 29 
r bs 
83 
50 8g 
6 98 
15 3b 
5 70 
r2 S3 
4 02 
VC * 
25 
18 OG 
39 74 | 
107 00 
42 JO 
59 35 
23 40 
104 35 
41 JO | 
13 91 
5 45 
17 77 
7 00 
15 77 
b 20 
12 28 
4 85 
50 63 
19 95 
3 42 
r 30 
66 
40 77 
5 08 
Ji 18 
3 90 
8 bo 
124 89 
0 S H C 
1 
76 
19 01 
4' 81 
108 87 
42 80 
61 15 
24 JO 
105 32 
4> 50 
14 57 
18 71 
7 40 
17 39 
b 85 
12 92 
5 10 
52 03 
20 so 
4 07 
r 55 
83 
50 3b 
5 56 
12^23 
5 14 
rr 3' 
022 
x h c 
5 
202 
M 
17 80 
39 29 
105 78 
4r bo 
59 32 
23 30 
102 44 
40 35 
14 21 
5 bo 
18 10 
7 rs 
16 53 
b 50 
12 39 
4 90 
51 20 
20 j s 
3 42 
67 
40 bo 
4 89 
jo 76 
4 72 
Jo 38 
2 61 
V c 
Toal 
5476 
25 
16 71 
3b 77 
102 69 
40 40 
57 49 
22 bo 
99 56 
39 20 1 
13 85 
5 45 
17 49 
b go 
15 67 
b J5 
11 86 
4 70 
50 37 
jg 80 
2 77 
r 05 
51 
30 84 
4 22 
9 2g 
4 30 
9 45 
120 31 
0 S H C 
Copyrighted by Wm. W. Hastings, Pli.D., The International Young Men's Christian Association Training School, Springfield, Mass. 
All measurements are given in both the Common and the Metric Sys- 
tem. The figures in italics represent inches and pounds. To transpose 
centimetres to inches, multiply by .393; kilogrammes to pounds, multiply 
by 2.2; litres to cubic inches, multiply by 61. 
These tables are sumarized in the age charts on pages no to 
113, but a much more complete exhibit of the sizes of the 
various items of measurement is presented in his tables that 
correlate age and height and that give a standard for graphic 
use that is available for all school ages. 
The use of photography is a legitimate application of 
graphic principles and it will soon be employed in all gymna- 
siums where scientific study and accurate work is accom- 
plished. It gives an idea of the form of a man that cannot be 
derived from figures or graphic lines, and will therefore show 
results of exercise that figures cannot express. ANTHROPOMETRIC TABLE 
for GIRLS FIVE TO SIXTEEN (5-16) YEARS OF AGE 
PHYSICAL TYPE FOR EACH AGE, AND VITALITY COEFFICIENTS 
(Compiled from the measurements of five thousand five hundred and seventy school children) 
M 
K 
to 
co 
* 
© 
© 
Age 
M 
ex 
§ 
5 
a 
4» 
© 
© 
© 
Number of 
Observations 
g 
K 
a 
8 
s 
Ol 
8 . 
s 
a 
8 
s 
s 
8 
s 
X 
8 
© 
8 
a 
a 
Per Cent. 
is 8 
S3 
1 6g 6C 
91 AC 
88 
S§ 
5,8 
S3 
e§ 
*8 
31 68 
bg 86 
Ce Pg 
03 63 
co 
•g« 
aS 
53 
33 49 
73 66 
37 94 
83 46 
as 
as 
«S 
(O 
£§g 
42 35 
93 18 
§ ® 
32 
51 07 
H2 36 
46 09 
for 38 
5 © 
eg 
§£ 
Weight 
(Kilos) 
s! 
s ® 
is § 
'-6 
^8 
'3 
H w 
© 
© 
a § 
°£ 
136 70 
S3 So 
& § 
«g 
%s 
88 
16.8 
as 
*s 
8£ 
£8 
147 67 
58 '5 
153 17 
60 30 
158 67 
62 45 
88 
88 
156 79 
61 75 
161 29 
t>3 50 
5 3 
8^3 
5!g 
161 98 
63 80 
Height 
LENGTHS 
(CENT.) 
Si-S 
^® 
*8 
&s 
"3 
38 
8,3 
§ 
88 
"s 
71 74 
28 25 
a * 
b co 
10 
•0 X 
is 
0 
as 
X X 
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u> co 
w 
88 
80.93 
3i 90 
83 30 
32 80 
;-. 00 
U, Ci 
as 
a? 
b: © 
PC 
Hi 98 
Height 
Sitting 
52 
*3 
129 01 
30 8 
as 
°°8 
5 § 
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as 
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as 
& X 
aS 
38 
a 5 
8- 
8S 
0 s 
147 48 
58 05 
?§ 
ftg 
88 
52 
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s>© 
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at 
8-2 
as 
8g 
162 37 
63 95 
Span of 
Arms 
8" X 
o © 
a 
8g 
M © 
x 
88 
K 
aS 
88 
as 
K 
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83 
0 s 
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Head 
H 
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*8 
82 
a3 
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8S 
0.2 
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08 
8S 
10 
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8g 
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OoS 
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23 03 
8 70 
0 s 
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52 
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83 
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53 
17 14 
6 73 
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83 
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14 75 
5 80 
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58 
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as 
88 
5S 
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'eg 
as 
82 
5S 
as 
58 
0 X 
58 
83 
© 
O © 
58 
82 
58 
Sg iz 
00 90 
58 
63 
Girth 
of Head 
GIRTHS 
(CENT.) 
£8 
w © 
* © 
6 Ci 
£8 
b or 
O £ 
kJ® 
62 
8$ 
aS 
83 
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8 £ 
83 
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88 
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83 
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00 I 
1 27 
77 to 
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38 
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1 85 
j/2 6 g 
'c X 
8« 
0 
8° 
20 2 
0 to 
as 
■0 w 
3 •** 
Lung 
Capacity 
(Litres) 
W 
z 
0 
X 
ft = 
&s 
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<58 
58 
S3 
aS 
eC qf 
99 91 
<i £ 
3 
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18 48 
4Q 65 
%® 
M © 
*. 10 
5,2 
as 
82 
21 73 
47 80 
as 
as 
&8 
as 
ql 
Tt 1Z 
28 29 
62 25 
19 62 
43 f6 
b, 
S> W 
82 
Strength of 
Forearm, R 
(Kilos) 
o co 
Cq Ce 
69 TT 
58 
11 71 
2J 82 
14 42 
31 8o 
17 13 
37 78 
iP ge 
10 31 
5g 
17 29 
38 03 
17 60 
38 86 
20 71 
45 58 
16 20 
35 64 
t = 
<2 
0 t3 
S3 
ass 
t ** 
'S « 
27 13 
59 <>7 
s 
t 
'S » 
b, © 
0 © 
5 3 
Strength of 
Forearm, L 
(Kilos) 
§ 
2 
-i 
s 
a 
£ 
» 
8 
£ 
5 
£ 
co 
X 
•4 
§ 
§ 
2 
►* 
© 
§ 
8 
8 
w 
w 
© 
i 
3 
£ 
2 
8 
8 
w 
« 
S 
CT 
R H C - Respiratory- 
Height Coefficient 
VC - Vitality Coefficient 
O S H C - Organic Strength- 
Height Coefficient 
n 
0 
w 
z 
X 
o 
O 
X 
n 
o 
IB 
X 
n 
4 
X 
X 
o 
X 
o 
X 
0 
X 
n 
0 
« 
X 
0 
X 
0 
X 
X 
0 
< 
X 
X 
0 
< 
X 
X  
76 
27 08 
59 72 
129 90 
53 / 
68 90 
*7 r 
127 71 
50 3 
14 70 
585 
20 14 
8 00 
18 48 
7 25 
13 80 
5 40 
52 85 
20 80 
* 6 73 
2 bs 
1 32 
80 52 
12 13 
2b 77 
11 27 
24 87 
051 
R H C 
9 
834 
M 
24 90 
54 90 
126 17 
49 7 
67 08 
2b 4 
"g 
14 39 
5 70 
19 30 
7 bo 
17 65 
b 95 
13 11 
51 94 
20 45 
5 62 
2 20 
1 14 
b9 75 
10 05 
22 17 
9 68 
23 35 
6 56 
V c 
25 
22 72 
50 08 
122 44 
48 3 
65 26 
25 7 
118 79 
& 7 
14 08 
5 55 
18 16 
7 20 
16 82 
b bs 
12 42 
4 90 
51 03 
20 IO 
4 51 
3 75 
97 
58 98 
7 97 
37 57 
8 00 
37 83 
128 77 
0 S H C 
75 
23 93 
53 ?b 
123 70 
48 7 
68 12 
2b 8 
121 66 
47 9 
14 60 
5 70 
19 C2 
7 75 
18 05 
7 10 
13 19 
5 20 
52 17 
20 55 
6 21 
2 45 
1 16 
70 b3 
10 90 
24 04 
10 11 
22 30 
041 
H H C 
8 
831 
M 
22 17 
48 88 
120 16 
47 3 
66 06 
2b 
117 44 
4b 2 
14 29 
5 bo 
18 90 
7 45 
17 78 
b 75 
12 60 
4 95 
51 27 
20 20 
5 05 
2 00 
99 
60 18 
9 26 
20 42 
8 81 
39 43 
5 12 
V c 
25 
20 41 
45 00 
116 62 
45 9 
M 00 
23 2 
113 22 
13 98 
5 50 
18 18 
7 35 
16 31 
b 40 
12 01 
4 70 
50 37 
39 85 
3 89 
3 55 
82 
49 b8 
7 62 
i b 80 
7 51 
3b 5b 
124 94 
0 3 H C 
75 
22 47 
49 55 
118 29 
4b 5 
65 62 
25 9 
115 66 
45 b 
14 54 
5 70 
19 12 
7 50 
■ i 
17 55 
b go 
13 07 
51 79 
20 40 
5 68 
2 25 
99 
bo 8 J 
9 49 
20 gs 
8 48 
18 bg 
035 
R H C 
7 
814 
M 
20 70 
45 ^4 
114 95 
45 7 
63 71 
25 / 
112 01 
44 r 
14 22 
5 bo 
18 42 
7 V 
16 68 
b 55 
12 55 
4 95 
50 93 
20 os 
4 70 
3 85 
83 
50 77 
7 48 
3b so 
6 60 
34 55 
4 27 
VO 
25 
18 93 
4i 73 
111 61 
43 9 
61 80 
24 3 
108 36 
42 b 
13 90 
5 50 
17 72 
7 00 
15 81 
b 20 
12 03 
4 75 
50 07 
39 70 
3 72 
3 45 
67 
40 73 
5 47 
.32 07 
4 72 
10 41 
122 07 
O S H C 
75 
19 96 
44 02 
113 36 
44 5 
63 35 
24 8 
110 72 
43 b 
14 43 
5 bs 
18 45 
7 30 
17 28 
b 80 
12 93 
5 io 
51 38 
20 20 
4 84 
1 go 
85 
53 84 
6 40 
14 11 
5 CO 
32 34 
025 
R H C 
6 
3S2 
M 
18 50 
40 80 
109 90 
43 2 
61 35 
24 1 
107 16 
42 2 
14 06 
5 50 
17 75 
7 00 
16 31 
b 40 
12 38 
4 90 
50 37 
3g 80 
3 87 
3 50 
71 
43 30 
5 17 
it 40 
4 83 
10 b4 
2 94 
V C 
25 
17 04 
37 58 
106 44 
g 
59 35 
23 4 
103 60 
40 8 
13 69 
5 35 
17 05 
b 70 
15 34 
b 00 
11 83 
4 70 
49 36 
39 40 
2 90 
I IO 
57 
34 7b 
3 94 
8 bg 
4 06 
8 g4 
117 69 
O S H C 
75 
18 78 
4' 42 
108 96 
42 9 
61 47 
24 2 
106 16 
4' 7 
14 41 
5 70 
18 44 
7 30 
17 10 
6 70 
12 48 
5 05 
51 15 
20 IO 
4 43 
3 25 
67 
40 go 
5 13 
11 30 
5 07 
11 18 
020 
R H C 
8 
183 
M 
17 32 
38 rg 
105 38 
4i 5 
59 31 
23 3 
102 25 
40 3 
13 99 
5 50 
17 71 
7 00 
16 17 
b 35 
12 35 
4 85 
50 23 
39 75 
3 59 
1 40 
53 
35 50 
4 72 
10 41 
4 56 
10 06 
2 33 
V 0 
Total 
5561 
25 
15 86 
34 9b 
101 80 
40 1 
57 15 
22 4 
98 34 
39 9 
13 57 
5 30 
16 98 
b 70 
15 24 
b 00 
11 86 
4 bs 
49 31 
39 40 
2 75 
3 05 
49 
30 30 
4 31 
9 52 
4 05 
8 94 
117 75 
O 3 H C 
Copyrighted by 
Wm. W 
Hastings, Ph.D., 
The International Young Men's Christian Association Training School, Springfield, Mas?. 
All measurements are given in both the Common and the Metric Sys- 
tem. The figures in italic represent inches and pounds. To transpose 
centimetres to inches multiply by .393; kilogrammes to pounds, multiply 
by 2.2; litres to cubic inches, multiply by 6r. The Law of Growth. 
114 
CHAPTER VIII. 
THE LAW OF GROWTH. 
The presentation of the law of growth has been accom- 
plished in various ways. The underlying principle, how- 
ever, in most of these methods, depends upon the approxi- 
mation of any group of measurements to the binomial curve, 
as first demonstrated by Quetelet. The measurements may 
be grouped into symmetrical grades according to the per- 
centile form, or they may be grouped into gradations or 
series according to some common unit; as, for instance, the 
weights may be grouped according to the grades represent- 
ing kilogram or other variations, from birth to maturity, and 
heights may be graded by using the centimeter, etc., as the 
unit, and all the measurements graded from the shortest 
number at birth to the highest number found at maturity. 
This latter method has been followed by Dr. Beyer in his 
comprehensive brochure on the growth of the United States 
naval cadets, where he also combines it with the percentile 
method. Records may also be grouped according to their 
relation to some particular part that may be taken as a unit 
or modulus for the other measurements. This method has 
recently been followed by Dr. W. S. Hall in a paper* on 
"The Changes in the Proportions of the Human Body During 
the Period of Growth," where he considers the total height 
of the body as the modulus, and gives the sizes of the other 
parts in fractions of the total height. This method also may 
be combined with the percentile method, as shown by Dr. 
Hall. The scientific value of this latter method depends on 
the proportional contrasts that it presents between parts at 
various stages of growth, as it has long ago been proved that 
there is no fixed relation between the proportions of the 
various parts of the body. Finally we may have the method 
of arithmetical means or averages. This method is applica- 
ble to a wide range of investigation and gives us a result 
* Journal of the Anthropological Institute of Great Britain and 
Ireland, August, 1895. The Lalv of Growth. 
115 
which is essentially the same as the fifty per cent line in the 
"percentile" method, and the mean in the method of "proba- 
bilities" and the "most frequent value," if the material con- 
sidered is homogeneous. 
As shown by Quetelet, the method of averages can be 
applied to material that is small in amount and that is not 
uniform, while the method of means can only be applied to 
uniform material. The material represented by a group of 
men in an American college cannot be considered homo- 
geneous and for this reason certain men like Dr. Hitchcock 
of Amherst have preferred to use the average methods in 
tabulating their data. A selection of material according to 
ages in these groups of college statistics is still open to the 
objection that the individuals represent mixed racial types, 
and consequently the curve showing the frequency of occur- 
rence of values will not conform to a true binomial type. 
It has been shown by Gould in his report of the sanitary 
commission that the men from certain regions, notably 
Tennessee, Kentucky and Indiana, are of taller type than 
were found in other sections, notably New York, New 
Jersey and Pennsylvania. Obviously a college that contained 
a large number of students from any one of these localities 
would have the height curve seriously modified, and the 
height of most frequent occurrence might be changed with- 
out changing the average appreciably. The average height 
of students in the various colleges illustrates the fact that 
there is a difference in type in different parts of our country. 
This may be seen by reference to the percentile charts of 
Oberlin and University of Nebraska women (pages 98 and 
99), and by Fig. 44, showing the height and weight of boys. 
The upper group of lines represent heights and the lower 
weights. The solid line is from Bowditch; the dotted line 
Peckham; the dot and dash Gilbert, while the two dots and 
dash show the median values for New Haven boys. 
When, however, the measurements are arranged in per- 
centile grades as suggested by Galton, while the fifty per 
cent line does not have the authority of the average, it is not 
the only feature of the compilation. This fifty per cent 
line, as before stated, is found to be essentially the same as 
the average, where the group considered is homogeneous, 
and in addition to the determination of this value we know 116 
The Law of Growth. 
Fig. 44. 
how all the records are distributed. xA.s, for instance, we 
may say that one per cent of all the records in any given 
item were as large as the number found in the corresponding 
grade at top of the table, or as small as the number in the 
grade at the bottom of the chart. It also enables us to 
trace the variation in the group and discover by the departure 
from the binomial curve the presence of any material that is 
not homogeneous, it being assumed and fairly well demon- 
strated that there is a mean around which all human propor- 
tions are grouped in symmetrical forms. 
The so-called binomial curve depends for its determina- 
tion upon the coefficients of a binomial quantity, as x+y The . Law of Growth. 
117 
raised to any given power. The numerical value of the 
coefficients may be represented by lines (Fig. 45), and if 
these lines be arranged parallel to each other on a common 
base and a line drawn connecting the tops of the adjacent 
lines, we shall have an approximation to a curve, and this 
approximation will be rendered more complete the higher 
the power to which the binomial quantity is raised. For 
instance, if we raise x+y to the tenth power, we shall have 
for coefficients 1, 10, 45, 120, 210, 252, 210, 120, 45, 10, 1. 
The middle line is the mean around which the others are 
grouped in symmetrical order. This form of distribution is 
found in the arrangement by chance of all quantities of 
similar objects. For instance, if an equal number of black 
Fig. 45. 
and white balls be placed in a box, thoroughly mixed, and 
drawn by chance, in groups of ten, 1024 times, which is the 
sum of the preceding coefficients, it will be found that once 
all ten balls will be black, once all will be white, and the 
various coefficients in the expanded binomial will represent 
the number of times that the balls would be drawn in the 
relative proportion of black and white that is indicated by 
the relation of the exponents of the two quantities in each 
term of the expanded binomial. The sizes of men in the 
community who have a common ancestry and a common 
environment tend to group themselves in exactly this same 
order about a common type or mean. 
If, now, we group any number of measurements of a 
dimension, as of height, weight, etc., in order from the 118 
The Law of Growth. 
smallest up to the largest, dividing them into as many equal 
divisions of size as our expanded binomial has terms, we 
shall find that the numbers'in these groups are represented 
graphically by the height of the lines, as in Fig. 45. It is 
obvious to any one that instead of dividing into these eleven 
arbitrary divisions we might divide them into twenty 
divisions, or a hundred, according to the gradations of size. 
If one hundred were made the basis of the division we 
should then have the records grouped according to per- 
centages, as was suggested by Galton. This grouping has 
been found the most convenient that has yet been discovered, 
for it determines not only the mean, which in any uniform 
data will be the same as the average or arithmetical mean, 
but it determines the mathematical relation of any point in 
the curve to the mass of material represented by the balance 
of the curve. 
Dr. Boas has called attention in a paper published in the 
report of the American Statistical Association, 1893, to some 
of the causes that prevent the distribution of physical meas- 
urements according to the strict law of chance. He men- 
tions the failure in the uniformity of ancestral type with a 
multiplicity of type in the offspring represented by the data; 
in other words, there is a lack of homogeneity in the data to 
be tabulated. He also mentions the lack of uniformity in 
growth at the various periods, and such material must evi- 
dently be considered by some calculus of variables rather 
than by the simple binomial law. He prefers the method of 
mean variation for statistical purposes. In the percentile 
grade system of tabulation we have certain misleading 
features that should be noted by all persons who make use of 
it for graphic purposes. For instance, it is often assumed 
that the line of any percentile grade represents an individual 
or what an individual ought to be. This fallacy results from 
the association together of data that have no relation to each 
other, each column of figures being arranged solely with 
relation to one dimension. If, for instance, we consider the 
column representing total height, and then compare with it 
two other columns which bear a tabular relation to it that is 
constant, namely, the height sitting and the height of pubis, 
which gives the length of legs, we would find that if the 
measurement of any individual be applied to this percentile The Law of Growth. 
119 
chart and the total height fall upon the thirty per cent line 
we would have no right to assume that the height sitting 
would fall upon the same grade, for it may fall on the fifty 
per cent grade or on the ten per cent, etc., the total height, 
being made up essentially of the two records considered, may 
be the sum of one short and one long element so that if the 
height sitting fell upon a higher grade than the total height 
the length of legs would fall upon a lower grade and vice 
versa. In fact, the probability of the two height elements 
falling on one grade is strongly against its occurrence. 
The inter-relation of other proportions may be even less 
distinct than the case mentioned. In studying the growth of 
different individuals, it would seem that a general law of 
growth cannot apply to all cases; and that even the applica- 
tion of a law determined for any type as suggested by Dr. 
Porter, has wide limitations, for the relation between the 
bone growth and muscular growth of tall boys is not the 
same as between the bone and the muscle growth of short 
boys. In the period of accelerated growth from twelve to 
fifteen years of age the increase of bone lengths is markedly 
greater than the increase in muscular tissue* (this will be 
seen by reference to the tables of Dr. Bowditch, Dr. Porter 
and others, if we assume that weight is a fair index of the 
growth of the muscular parts), while the period from sixteen 
to twenty-three is a period of comparatively slow bone 
growth and of rapid muscular growth, just as in the 
decennial period from forty to fifty the marked increase in 
weight must be attributed to storage tissue rather than to 
either bone or muscle growth. It would seem to be impor- 
tant then that some investigation should be made to 
classify the data according to the general type of individual 
that they represent, and from this classified data determine 
anew the law of growth. 
It should also be borne in mind that the rapidity of 
growth varies in the different sections of the country, appar- 
ently according to climatic and telluric conditions. Another 
factor to be considered in the study of anthropometric data 
*This observation has been formulated by Dr. W. S. Hall as follows: 
"When the vertical dimension of the body is undergoing an acceleration 
of its rate of growth the horizontal dimensions undergo a retardation of 
their rate of growth, and conversely." The Law of Growth. 
120 
is the personal equation that is characteristic of each indi- 
vidual when working with more or less plastic material. 
This will be especially noticeable in the records of girths and 
breadths, where slight variation in tension occasions a wide 
divergence in records. Attention should also be given to the 
important matter of having a record of all of the group in 
order to make the records reliable for tabulation purposes. 
If, for instance, a percentile chart be arranged from the 
measurements of such students as offer themselves for exam- 
ination in a college where the examination is optional with 
the students, the grades will not conform with any fair 
degree of regularity to the binomial curve, because in general 
two sets of men will offer themselves for examination. First 
the athletic group of men who are well developed and are 
proud of the physical record that they can make, and who 
may wish suggestion as to further improvement. The second 
group will be made up of physical wrecks who find them- 
selves unable to do the college work without much physical 
hardship and who are in hopes of receiving such hygienic sug- 
gestions as shall enable them to continue their work. 
Between the two groups will come a few men who more 
truly represent the ordinary student and whose influence on 
the chart should be the dominating one. If, then, we are to 
tabulate by the generalizing method we must have a large 
mass of material that shall have been gathered in such a way 
as to have the errors and the omissions of one group 
balanced by the data supplied by another group, and in the 
final tabulation it will probably be found necessary to treat 
the resulting curve mathematically in order to establish the 
true values for any given grades. When, however, the 
whole of any group is measured, and by one person, a com- 
paratively small number of persons will be found to exhibit 
the type and the general distribution of the records for all 
such persons. Thus it is found that percentile table made 
from the records of five hundred college men of the same age 
(within the limits of one year) that includes all the men of 
that age in college at one time, will represent a closer 
approximation to the binomial curve than will the record 
of 2,500 men of similar ages gathered from year to year 
under the optional system of physical examination. 
In studying the law of growth, attention is called to the The Law of Growth. 
121 
chart prepared by Schuyler B. Moon of McDonogh, Md., as 
shown on page 122. This table is made by grouping the 
measurements of one hundred and fifteen boys between the 
ages of thirteen and fourteen years according to Galton's 
percentile method. The fifty per cent column represents 
what we may call the mean, and for the sake of comparison 
the fifty per cent lines from four other charts, prepared by 
the same author, are graphically represented on this one. 
The first line beginning at the left represents the mean of 
boys between eleven and twelve years of age. We notice 
that the items of height and length, the two being similar 
dimensions, diverge farther from the fifty per cent line of this 
chart than do the girth or breadth measurements, which 
shows a tendency in the growth of boys to increase in girth 
proportions more rapidly in early life than they do in length 
proportions, while at a later period the reverse is true-the 
lengths increase more rapidly than girths. This demon- 
strates fully the law that while girth measurements are 
accelerated length measurements are retarded, and vice versa. 
The next point to which attention is called is the large 
girth of head, it approximating more closely to the standard 
of a boy in his fourteenth year than any other measurement, 
showing that this tissue is developed comparatively early in 
life, and that its percentage of future increase must be 
small as compared with that of any other measured organ. 
The breadth of head rising to essentially the same percentile 
grade as girth shows that the form or shape of head does not 
essentially change during the period of growth. Physiology 
has taught us the early growth of the brain that reaches a 
fair approximation to its final size in the eighth year. At 
birth it is 14.34 per cent of the total weight while in the 
adult it is only 2.37 per cent. The muscles grow from 23.4 
per cent of the weight at birth to 43.1 per cent of the weight 
in adult life, while the skeleton keeps at about the same pro- 
portional part of the total weight throughout active life, 
ranging from 16.7 per cent at birth to 15.4 per cent at 
maturity. 
The next point to which attention is called is the large 
depth of abdomen and comparatively large girth of waist. 
This represents the infantile type and is followed, as will be 
seen by reference to the two lines upon the right of the McDONOGH SCHOOL, McDONOGH, MARYLAND. 
Compiled from the Measurements oi 1x5 Boys between the Ages of 13 and 14 years. 
By Schuyler B.' Moon; 
Arranged according to the Percentages indicated at the top. Units: Years, Kilograms, Millimetres, and Litres. 
ANTHROPOMETRIC TABLE. The Law of Growth. 
123 
chart, by a period of retardation in growth. The chest, to 
some extent, partakes of the same change in type, and shows 
that the "round chest,'' that is, the deep chest, is a primitive 
or infantile type. 
It may also be well to note that in girth and breadth of 
neck we have illustrated what will be found true in studying 
the measurements of mature people, namely, that a large 
neck is usually found under a large head, and vice versa-the 
neck developing as a support to the superimposed mass. 
In strength we see the arm developed more rapidly than 
the legs-this again pointing to the rudimentary type, as 
demonstrated by Louis Robinson. 
In studying the second line (boys 12-13 years) in relation 
to the first and the central straight line, we may note an 
acceleration in the development of lengths as compared with 
the first line and a retardation in other records as compared 
with the straight line. The strength tests show symmetrical 
but comparatively small increase, except in forearm. The 
girth and breadth of head show a slight advance, but com- 
paratively the least increase of all the measurements. If, 
now, we study the fourth (14-15 years) line upon the chart 
and compare it with our central line, we see that it diverges 
more widely at all points than does the second line, while 
the fifth line (15-16 years) bears much the same relation to 
the fourth that the second bears to the first. The lengths 
have now outstripped the girths and breadths, while the girth 
of head and waist show a comparative retardation, which 
indicates an approximation to their completed growth. What 
is true of the head seems to be also true of the strength 
tests of the arm, while the strength tests of legs and trunk 
show marked acceleration, until they slightly outstrip the 
standard that might be expected from the girths. The depths 
show a retardation, like the head, and we see our boy evolv- 
ing from the round, primitive type, into the broad form of 
the erect animal. 
Let us now glance at these lines, bearing in mind the 
ages that they represent, for here they show in most unmis- 
takable manner the law of growth, as first demonstrated in 
this country by Dr. Bowditch in his classic paper. The 
period of the fourteenth year is a period of retarded growth, 
and is immediately followed in the fifteenth year by a period 124 
The Law of Growth. 
of greatly accelerated growth, this being the period of pre- 
pubertal acceleration, while the retardation is seen to be 
fully as marked as the acceleration and corresponds in its 
mathematical value closely to it. In other words, if we were 
to draw a line midway between the second and the fourth 
line it would represent on either side a year of what may be 
considered average growth, according to the standard set by 
the space between the first and second lines and by that 
between the fourth and fifth. In other words, the accelera- 
tion of the fifteenth year is sufficient to at least make up 
for the retardation of the fourteenth. 
The question has often been raised as to the value of the 
percentile method in grouping small numbers of measure- 
ments, and much doubt has been expressed as to its value by 
prominent anthropometrists. The presentation of this table 
is an unanswerable argument in favor of the position taken 
Fig. 46. The Lazu of Growth. 
125 
by the author and others, that a small number of measure- 
ments is sufficient, when the group considered is complete, 
to produce a percentile chart that shall represent definitely 
the type of the group considered and that shall not vary 
more from the true type of the group than the probable error 
of the examiner, and consequently for practical graphic use 
will be as serviceable as a chart prepared from large num- 
bers of measurements, especially where these measurements 
are collected by different individuals and from different 
groups, being subject to the personal equation of the exam- 
iner and the^variationsjof'the local types. 
Fig. 47. 126 
The Law of Growth. 
The growth of the male and female child correspond very 
closely until the eleventh year in both weight and height. 
The boy is heavier at birth by one-fourth 
kilogram and taller by a centimeter. During 
the first week of life there is a loss in weight, 
but after that epoch of adjustment to a new 
source of nutrition is passed the increment of 
weight is fairly steady until the eleventh year, 
when the girl begins to grow more rapidly in 
both weight and height and outstrips 
the boy, remaining both heavier 
and taller until the fourteenth year, 
when the boy again becomes taller 
than the girl and in his next year 
he surpasses her in weight. This 
is shown graphically in Fig. 46, 
Fig. 48. 
where the line AA represents the height of boys and BB the 
height of girls; the line CC represents the weight of boys and 
DD the weight of girls. The line EE shows the percentage 
of growth in height for the various years and emphasizes the 
poriod of retardation and acceleration more than the lines 
representing the actual increment. 
An interesting and valuable physiological fact is demon- 
strated in the growth of lung capacity as shown in Fig. 47.* 
* Studies from the Yale Psychological Laboratory, Vol. II. The Law of Growth. 
127 
The dotted line shows the capacity of lungs of boys at the 
various years of life indicated at the bottom of the cut; the 
dash and dot shows the same for girls and the smooth line 
shows the same for both; this varying with weight and finally 
distributing the curves so as to represent essentially the 
proportions demostrated by Kellogg as actually occurring 
in strength tests, and by Foster, Atwater and others, as 
theoretically possible from the metabolism represented by 
the waste eliminated. 
The variations in nerve ability are found to bear a close 
relation to the periods of abrupt variations in the curve of 
growth. This is shown in Fig. 48* where the dotted line 
represents the voluntary motor ability of boys, the broken 
line that of girls, and the solid line both boys and girls. 
* Gilbert. Researches on the mental and physical development of 
school children. 128 
The Percentile Method. 
CHAPTER IX. 
THE PERCENTILE METHOD. 
In studying the distribution of individuals in a group 
there is a tendency to think of some one item of measure- 
ment-usually Height or weight-that fixes the status of the 
individual for all other items of measurement, as girth of 
head, breadth of hips, etc. This overlooks the tact of 
different types in form: as the long body with comparatively 
short legs, the long legs with short body, the broad and flat 
chest, and the narrow and deep chest, etc. In the use of a 
percentile table this fallacy is especially likely to occur, for 
in graphic tracings the easy conception of a straight line as 
showing perfect form is likely to obscure the fact that the 
standard set by a line of figures in any grade is determined 
by an unrelated tabulation of data covering each item. For 
instance, the standard in girth of head is in no way related 
to the standard for breadth of chest. We may eventually 
secure a coordination of items in tabulation throughout the 
entire list as we now have a coordination between height and 
weight, etc., but at present this refinement of tabulation has 
not been carried out because of the expense involved. 
We may then only consider the grade in which the record 
of any item of an individual falls as expressing his relation 
in that one respect to the whole group, and that the low or 
high value is of consequence as an indication of heredity 
expressing its type, or of possibility in the way of future 
development. 
The preparation of a percentile table is carried out as 
follows: The records available are arranged in order from 
the smallest to largest in convenient groups. If height is 
the item being tabulated, the records are grouped so that 
those varying by less than a centimeter are put together, 
viz., the records from 1600 mm. to 1610 mm. are put in one 
group; those from 1610 to 1620 in another, etc., or the groups 
may be made smaller by massing by themselves the records 
within gradation of 5 min., as from 1600 to 1605, 1605 to 
1610, etc ; or they may be made larger by including the 
records that are within limits of 2 cm., as from 1600 to 1620 
mm , etc. The groups by centimeter grades are found to 
be convenient for this item of height while for some items 
like breadth of head, height of knee, etc., grades as low as 
1 mm will be more satisfactory. 
In using centimeter groups for height, or other items, it 
will be well to use a decimal as the center of the group, so The Percentile Method. 
129 
that in a fairly exact way we may speak of the average height 
of the group as being the decimal around which the group is 
arranged. We therefore would make the groups run from 
*595 to 1605 mm., 1605 to 1615 mm., etc., so that we could 
speak of the first group as having an average height of 1600 
mm., and the second as having an average of 1610 mm., 
etc. This would obviously not be strictly true of any group 
except the one that included the mean or 50 per cent record 
of the series, as the number of individuals is large the nearer 
we come to the mean or center of the whole group; but it 
would be near enough for ordinary calculations. 
If, now, we take the 2643 height records of the Yale 
students who were in their nineteenth year of age, as found 
on the books in a period of twenty years, and arrange them 
in the various grades as indicated above, we would have the 
following actual groups: 
Height Groups, 
No. of men. 
Percentile 
No. of men. 
required for 
Record required 
to secure the 
number of men. 
for required 
per cent. 
in millimeters. 
in these groups. 
Grade. 
indicated 
per cent. 
under 1565 m.m. 
7 
13 
1575 
1565 to 1575 
6 
1575 to 1585 
11 
^0 
26 
1587 
1585 to 1595 
9 
2> 
66 
1614 
1595 to 1605 
14 
1605 to 1615 
22 
5 
132 
1630 
1615 to 1625 
37 
IO 
264 
1652 
1625 to 1635 
51 
1635 to 1645 
61 
15 
396 
1668 
1645 to 1655 
67 
20 
529 
1680 
1655 to 1665 
80 
1690 
1665 to 1675 
107 
25 
660 
1675 to 1685 
120 
30 
793 
1699 
1685 to 1695 
137 
1695 to 1705 
163 
35 
925 
1707 
1705 to 1715 
168 
40 
1057 
1715 
1715 to 1725 
171 
1725 to 1735 
181 
45 
1189 
1723 
1735 to 1745 
169 
5o 
1321 
1730 
1745 to 1755 
155 
1189 
1755 to 1765 
145 
45 
1737 
1765 to 1775 
140 
40 
1057 
1745 
1775 to 1785 
121 
1785 to 1795 
in 
35 
925 
1754 
1795 to 1805 
98 
30 
793 
1763 
1805 to 1815 
68 
18r5 to 1825 
52 
25 
660 
1772 
1825 to 1835 
49 
20 
529 
1783 
1835 to 1845 
33 
1845 to 1855 
26 
15 
396 
1796 
1855 to 1865 
15 
IO 
264 
1809 
1865 to 1875 
17 
1833 
1875 to 1885 
12 
5 
132 
1885 to 1895 
4 
21 
66 
1854 
189s to 1905 
8 
over 1905 
8 
I 
26 
1880 
Total 
2643 
1$ 
13 
0119 130 
The Percentile Method. 
The question will arise as to how the various numbers in 
the last two columns are determined. If we wish to find a 
group at either extreme of the records that should include 
i per cent of 2,643 men, we would take the first twenty-six 
men, and if 5 per cent the first 132 men, etc., the group 
always being computed from the extremes toward the mean 
record, or that record below which 50 per cent of the men 
are found and above which the other half of the group is 
found. In the present case of 2,643 men, the 50 per cent 
record would obviously be the record of the 1322nd man in the 
line if the men had been placed in line with the tallest man 
at one end and the shortest at the other, and the others 
arranged in regular graduations between, these extremes 
from tallest to shortest. Of course, in a practical way, there 
would be a considerable number of men of the same height 
near the center of the line, but there must be, theoretically, 
a m in who would stand in the center of the line whose height 
would be such that half of the men would be taller and half 
shorter than his height, if the unit of measurement was 
small enough. 
In order to arrange these in percentile grades, we first 
determine the number of men who would constitute the 
various percentile groups by calculation. The 1 per cent 
groups would include the first twenty-six men. counting from 
either extreme. The 2^ per cent groups would include the 
first sixty-six men from either extreme. The 5 per cent 
group would include the first 132 men, etc., and a complete 
table would be as follows for 5 per cent grades: 
1# = 26 men. 
5# = 132 men. 
10# = 264 men. 
15# = 396 men, etc., as seen on the previous page. 
Now, beginning with the top of the column on the pre- 
vious page, we see there were seven men below 1565 mm. 
in height, and six between that record and 1575 mm., and 
eleven between 1575 and 1585 mm. In other words, there 
are twenty-four records below 1585 mm. But we must have 
twenty-six men in our first group and the question arises as 
to how computation may determine how large a record must 
be used in order to take in two more men. This is easily 
answered by inquiring as to the number of men in the next The Percentile Method. 
131 
group that includes the men between 1585 and 1595 mm. 
and finding that there are nine. As the group includes those 
varying within 10 mm., it is a fair presumption that the nine 
men are evenly distributed in it and for each millimeter 
there is nine-tenths of a man. But we need to include 
enough of the group to make two men and as each milli- 
meter represents nine-tenths of a man, we would have to 
advance into this group as far as is represented by the 
quotient of 2+^=2. We therefore add two to the number 
at which we closed the addition, and this gives us 1587 mm. 
as the record below which 1 per cent of the group is found. 
If we wish to discover next the record for the 5 per cent 
grade, or below which 5 per cent of the men would be found, 
we add the numbers in the various groups until we get a sum 
nearest 132, as, 5 per cent of 2643 is 132,-viz.: 7 + 6+11 + 9 + 
14 + 22 + 37 + 51 = 157, which is twenty-five too many; but if 
we do not add the last group we shall have twenty-six men 
too few. We find that the desired record must be some- 
where between 1625 mm. and 1635 mm , and as in this 
range of 10 mm. there are fifty-one men, we may 
assume that there are five men for each millimeter, and we 
must return from the record of 1635 mm. to get twenty-five 
men less, as far as is indicated by the quotient of 254-5 = 5. 
The 5 per cent record will therefore be 1630 mm. below 
which 132 men would be found. 
In a similar way we find the 10 per cent record: 
157 + 61 + 67 = 285, which is more than 10 per cent of the 
group by twenty-one men. The last group added contained 
sixty-seven men in the variation of 10 mm., or 6.7 men to a 
millimeter, and we would have to return from the record of 
1655 mm. so far as is indicated by the quotient of 214-6.7 = 
3. The 10 per cent record is therefore 1652. 
We may follow this method through the whole column, 
but it will be much more convenient to perform the computa- 
tions if, after we have found the 50 per cent record, we begin 
at the bottom of the column and determine the records above 
which the various percentages are found. We shall also 
have a general check on the accuracy of our work by this 
method, for obviously the 50 per cent record will be the same 
when computed from either extreme, because if we discover 
a record below which half of the men are found and above The Percentile Method. 
132 
which half are found we have the height of the middle man 
in the whole group if these 2643 men were arranged in line 
in regular gradation from the shortest to the tallest. 
Let us see how the computation will proceed from the 
other end of the column. Beginning at the bottom we add 
8 + 8 + 4=20, which is too small by six men. In the next 
group of ten millimeters there are twelve men, or 1.2 men to 
a millimeter, and to get six men more we would have to 
enter this group to the extent indicated by the quotient 
6 + 1.2 = 5. If we remember that we are proceeding from the 
larger records toward the smaller, we will see that we must 
subtract this 5 mm. from the limit of the group that we last 
added, which was 1885, and our 1 per cent record becomes 
1880 mm. This record could be found just as easily by 
adding the group from 1875 to 1885 mm., and having, then, 
too many men by six, the 5 mm. would be added to the 
1875. The 5 per cent record is readily found by adding, as 
before, the groups until the sum is nearest 132 men. This 
sum we find to be 123 at the 1835 mm. limit which is too few 
by nine men, so we must advance into the next group which 
contains forty-nine men, or 4.9 men to a millimeter, to the 
extent indicated by 9 + 4.9= 2, and this subtracted from 1835 
m m., the upper limit of the next group gives us 1833 mm., 
as the record above which 5 per cent of the men are found. 
In this way we proceed, using as small percentile grades 
as is desired. I have illustrated this gradation of one-half per 
cent in the previous table (page 129). 
The interpretation that should be given to the deviation 
from the symmetry of the binomial curve where we have a 
curve representing any group of individuals in any item of 
measurement has been attempted by some writers on anthro- 
pometry by assigning it to the presence of sub-groups with 
well-marked peculiarities and with such numbers as to 
modify the mathematical picture of the mass. This may be 
readily seen if we were studying the height of 1,000 men- 
the records representing all the men in five American 
college classes, and one of the college classes in the Uni- 
versity of Tokio, where the average height of the men was 
only 5 feet 3 inches. This group of, say 200 Japanese 
records, would cause an asymmetry in the line representing 
the total group and would even disturb the mean, or 50 per The Percentile Method. 
133 
cent line, to a very appreciable degree, as compared with the 
mean of a group made up entirely of American students. 
But aside from the lack of homogeneity in the material that 
is studied there is found to be a disturbing factor in the 
curve of human proportions, as seen in western races, and 
that causes a deviation from symmetry at the extremity of 
the curve representing the larger persons of any group. 
For instance, in the matter of weight the mean of Ameri- 
can college men in their twentieth year of age is essentially 
140 pounds and one per cent of the men are as light as 102 
pounds-a difference of thirty-eight pounds. Now, if 
the curve of proportions is to be symmetrical there should be 
1 per cent of the men as heavy as 178 pounds, but in fact we 
find that portion of the men as heavy as 190 pounds. 
In other words, the large persons in any group vary more 
from the mean than do the smaller ones. There would be 
found a fair proportion of healthy men who were 50 pounds 
above the mean but none who were 50 pounds under it. 
It is suggested that this fact points to a tendency in the 
human animal to push toward a larger type and that this 
variation points to a biological law that is still potent in pro- 
ducing change and that may evolve a different type for the 
race. It would seem to be a fact that the American people 
are taller and heavier than the standard for any of the races 
that have peopled the country by emigration. 
The percentile table inserted here shows a method of 
coordinating the various groups for percentile study of 
growth, although it is only a single step in the direction that 
may be followed almost indefinitely, viz., the age groups 
may be each subdivided into height groups, and these again 
subdivided into weight groups, etc., etc. It will thus be 
seen that the possibilities of this method of studying the 
relations of the various proportions of the human body have 
only been slightly realized. It seems not to have been 
noticed by many compilers of this form of statistics that the 
percentile analysis of a group gives information in a specific 
and exact form that can only be determined otherwise by 
more elaborate calculus, as is well illustrated by the 25 per 
cent line showing the "Probable Deviation'' that is of high 
value in demonstrating the variation of measurements from 
the "mean'' or "type" or "average." It demonstrates also 134 
The Percentile Method. 
that the plus value of this deviation is not the same as the mi- 
nus value, at least among college men. It would seem that the 
time is near at hand when more attention must be given to 
the study of anthropometric data and when new information 
will be obtained regarding physical capacity, and possibly 
mental correlations, that are not now imagined. Examination by Inspection. 
135 
CHAPTER X. 
EXAMINATION BY INSPECTION. 
After the measurements of a person have been taken, the 
work of examination and physical diagnosis should begin. 
The measurement is mechanical and could be done correctly 
by any person after a little practice, but a physical examina- 
tion requires the highest product of scientific training 
backed by sound judgment in order to discover the true con- 
dition of organs and determine the real cause of the dis- 
ordered function or disturbed growth. It may require only 
a mechanical eye to discover a curved spine, but it must be 
the mechanical eye, backed by a thorough knowledge of 
physiology and anatomy, that can discern the fact and the 
cause. 
Inspection should be made with the subject entirely nude 
and standing easily. If a military attitude is assumed, try 
to get relaxation into the ordinary positions. This can often 
be done by calling the attention to some trivial matter, as 
any peculiarity of the hands or feet, or by having the sub- 
ject step forward or backward a few steps, when he will 
forget his strained position. From the front, notice (i) the 
general contour or relative breadth, (2) the position of the 
head, (3) the position of the shoulders and arms, (4) the 
curves of the trunk and linea alba, (5) the muscular condi- 
tion of chest, abdomen and legs, (6) any malformation, such 
as asymmetry, tumors, cicatrices, etc. 
From the side notice (7) the antero-posterior or normal 
spinal curves, (8) the depth and mobility of the chest and 
abdomen, (9) the position of the shoulders, (10) the relation 
of the hips to the loins, or the pelvic tip, (11) the relation of 
the neck to the trunk, (12) the general attitude of the sub- 
ject. or the poise. 
From the rear notice (13) any lateral or spiral curvature 
of the spine and prominence of spinous processes, (14) the 
condition of the shoulders and scapulae, (15) the waist curves, 
(16) any tipping of the iliac crests due to one leg being 136 
Examination by Inspection, 
shorter than the other or imperfect bone development, (17) 
the outline and position of the legs, as in knock-knees, bow 
legs, etc., (18) the muscular condition, (19) the condition of 
the skin, and (20) any tumor or malformation, varicose veins 
and cyanosis. 
Of course the examiner will not look up each one of these 
points in regular order, but he should study each one and 
after an examination go over this list and see how many 
points there are on which he has no clear, definite knowledge, 
and then try on the next case to make the list smaller, until 
he will take in everything at a glance, as it were. There are 
many other matters to which attention might be called, but 
they are mostly amplifications of the above list. 
We include in (1) the breadth of head as giving some idea 
of the temperament and vitality of the subject. A broad 
head at the base is believed to indicate a greater vitality 
than is found when the head is long and "top-heavy." 
There is greater power of resisting disease and less liability 
to nervous irritability of a pathological character. A thin, 
weak neck means a bad curve forward at the cervical portion 
of the spine, and a consequent flat chest in a large majority 
of the cases. The voice will be uncertain and the throat 
suffer from catarrhal diseases on the slightest provocation. 
The circulation of the head will be poor and congestive head- 
aches common. 
Narrow shoulders mean compression of the upper part of 
the thorax, and less activity of respiration in the apices of 
the lungs. This, with a history of tuberculosis is unfor- 
tunate, because tubercular degeneration usually begins at 
the apex of the lungs and an inactive part is an unhealthy 
part. This fact has led Dr. T. J. Mays to claim, in an article 
published in the Therapeutic Gazette, May, 1887,* that the 
wearing of corsets by ladies may be a protection against 
phthisis, because by compressing the abdomen and lower 
part of the thorax costal breathing with a freer use of the 
apices of the lungs was necessitated and a consequent 
immunity from tubercular degeneration was the result. 
The fallacy of this theory has been repeatedly shown but by 
no one so completely demonstrated as by Dr. J. H. Kellogg, 
*See Medical News, November 27, 1886. Examination by Inspection. 
137 
whose investigations regarding normal respiration are com- 
plete and original.* 
The breadth of chest is one of the three factors in making 
up the "Vital Capacity,'' and its relation to the breadth of 
waist and hips will give a better idea of the natural strength 
than the size of the biceps. Any depression of the ribs or 
sternum should be noted. I have seen a case of severe 
hepatic disturbance that had resisted medical treatment for 
many months recover more than ordinary health under a 
series of exercises that tended to lift two depressed ribs over 
the liver into a more arched and natural position. 
Notice any elevation of the chest wall in the cardiac 
region, and any transverse depression at about the sixth rib. 
The elevation may be due to enlargement of heart or peri- 
cardiac effusion. The depression is due to faulty habits of 
sitting-the person sliding forward in his chair and sitting on 
the sacrum, instead of on the ischiae. This depression 
causes a pressure on the heart and interferes with the circu- 
lation and also causes indigestion quicker than plum pudding 
by restraining the muscular activity of the stomach which, is 
very marked during digestion. This "creased chest" is a 
postural deformity. 
Under (2) we should note any position of the head that 
might denote a shortness of the sternomastoid muscles. A 
shortness on one side tends to tip the head toward that side 
and turn the face to the other; if both muscles are short they 
tend to draw the neck forward and tip the face up. This is 
a frequent condition and if well marked gives a very awk- 
ward poise, especially if in (7) we find the cervical curve 
very deep, or the neck slanting forward because of poor sup- 
port from weak muscles. A strong neck is very desirable. 
It not only holds important organs in place and insures good 
circulation in the brain by making the channels direct, but it 
gives an aggressive carriage, and indicates determination 
and pluck. In (3) we observe the slope of the shoulders and 
the relation of the acromions to the sternum. If a line be 
drawn from the tip of the acromion to the base of the neck 
and continued to the spine, it will make an angle with the 
line of the spine which should approximate to 80 degrees. If 
the muscles that support the shoulder be weak, they permit 
* Transactions of the Michigan State Medical Society, 1888. 138 
Examination by Inspection. 
the acromial tips to sink, making the angle less, while if 
these muscles be over-developed they draw the tips up and 
give a stiff, hunched appearance that is ungraceful. If the 
muscles in front be better developed than those behind, the 
shoulder will be drawn forward and down, giving an appar- 
ently flat chest with sloping shoulders, which is a mark of 
slack habits and lack of all exercise of a natural character. 
This form is sometimes seen among gymnasts who devote 
themselves to one kind of exercise, as horizontal bar practice, 
etc. The effect of this posture on respiration will be evident 
to every person with a knowledge of the elements of 
anatomy. The person has no energy or "sand" because his 
blood is not properly aerated. The arms hang forward, 
giving the feeble, helpless attitude assigned by caricaturists 
to the innocent "dude." 
By (4) we mean the outline curves of the waist which show 
something of the strength of trunk that may be expected, 
and the outlines of muscles that give the beautiful curves 
seen on the athlete. These lines may not be clearly cut in 
some cases of well-developed muscles on account of the 
adipose tissue immediately under the skin, but in every 
heathy person they give character to the anterior wall which 
otherwise bee mes as expressionless as a bag of meal. This 
last point will help us in estimating muscular condition (5) 
which cannot be judged altogether by size. 
It is well to remember that, in (6), we must not only decide 
as to the character of the malformation but know what the 
prognosis or probable development will be-what inter- 
ference with exercise will be caused and what exercises are 
contra-indicated-what will be the influence on health-what 
does it indicate as to the physical stamina or constitutional 
strength. For instance, varicose veins may never have given 
any trouble and may never have been noticed. How long 
could this condition exist unnoticed and what may be 
expected from it now? What exercises should be avoided, 
etc., etc.? 
In surgery the word tumor means any abnormal enlarge- 
ment of an organ or tissue. Perhaps the most frequent form 
of tumor that will be found is due to rupture or hernia. A 
hernia is a tumor caused by the passage of a portion of an 
organ through the bony, muscular or tendonous wall that Examination by Inspection. 
139 
normally confines it. It may be produced suddenly by a 
severe strain or bruise, or it may be the result of a gradual 
distension of one of the natural openings of the wall. Cases 
of intestinal hernia are frequently found, and among young 
men will affect two or three per cent of all, while among 
those past middle life it will affect as high as six per cent. 
Among females it is much less frequent. This is due to the 
less patulous inguinal openings in the female and to less 
exposure in the daily avocations of life. Abdominal hernias 
are classed as inguinal, femoral, umbilical, diaphragmatic, 
etc., according to the place where the viscus forces its way 
through its natural support. The small intestine or the 
omentum is the tissue that usually protrudes. 
An inguinal hernia may appear at the external inguinal 
ring as a round tumor of greater or less extent and is then 
called "direct," while if it appears first at the internal ring 
and passes down the canal it is called "oblique." The latter 
form is much more frequent and tends to develop rapidly 
downward, giving the tumor an elongated form with higher 
origin than the direct. 
In femoral or crural hernia the intestine passes down 
through the crural ring under Pouparts' ligament where it 
causes a protrusion of the anterior wall of the thigh in a 
round tumor that lies in the groin just below the fold at the 
saphenous opening. It is situated farther externally from the 
median line than the direct inguinal and if large will have its 
axis in a horizontal rather than perpendicular direction. A 
hernial tumor gives a marked impact to the finger of the 
examiner if firm pressure is made while the subject coughs. 
These three forms of tumor must be readily differentiated 
from cystic tumors, varices, glandular enlargements, etc. 
Cysts have a well-marked fluctuation. Varices have fixed 
relations to the venous trunks and subside on the subject 
assuming a horizontal position and fill again on rising even 
if the inguinal rings are supported. Glandular swellings are 
due to some attendant local irritation and are painful and 
unyielding to pressure. Each case of hernia should be 
referred to the family physician or to a surgeon for advice 
and treatment. No gymnastic instructor should take the 
responsibility of prescribing exercise for such cases without 
advice. The same may be said of all tumors. Examination by Inspection. 
140 
The antero-posterior curves of the spine (7) are a con- 
cavity in the cervical and lumbar regions and a convexity in 
the dorsal and pelvic. These curves may all be exaggerated 
by disease or occupation or muscular development. Any 
increase in the curves must shorten the total height. Any 
weakness of muscles at the back of the neck will permit the 
head to hang forward, thus increasing the dorsal convexity, 
producing round shoulders, or kyphosis. An over-develop- 
ment of the lumbar muscles as compared with those of the 
abdomen will increase the lumbar concavity, causing lordosis. 
The strong back is the straight back in men. 
The gymnastic treatment of lordosis, or abnormal anterior 
curvature, is the only satisfactory one where there is no 
caries or breaking down of bone. The same is true of 
kyphosis, of which Dr. Stedman writes:* "A cure of 
adolescent kyphosis, when of slight degree, may be obtained 
by exercise alone, without mechanical support, but it will be 
found advantgeous to aid the patient in maintaining an erect 
posture by suitable apparatus. The treatment by exercises 
in this form of kyphosis should never be omitted, since the 
fault lies chiefly in a want of tonicity of the muscular and 
ligamentous tissues." 
If there is exaggerated curve at any part of the spine, 
there will be more or less compensatory curve in the opposite 
direction at other parts; and, in prescribing exercise, great 
care must be used in deciding which is the primary and 
which the compensatory curve, for an error would make 
matters worse from the development of parts already strong, 
and the neglect of parts that are weak. 
In observing the depth of chest and abdomen (8) and the 
movement of each under respiration, we have a clue to the 
activity of the person. If the chest is deep at the sixth rib, 
but thin at the second, the sternum will usually be found 
unsupported by the muscles of the neck; those behind being 
weak and letting the spine slope forward at the upper part 
so that the sterno-mastoid and the scaleni muscles cannot 
raise the chest. This throws all the work of respiration on 
the diaphragm, and the person is unfitted for any athletic 
exercise, and would have a cramp in his side if he were to 
* Wood's Medical Reference Handbook. See, also, Lagrange's "La 
Medication par 1'Exercise." Examination by Inspection. 
141 
run an eighth of a mile. It is said that a round chest of 
equal girth with a flat one will not show as great a lung 
capacity on the spirometer and my experience corroborates 
the statement if the extreme types are taken. 
If the abdomen protrudes or sags so that the intestines 
seem to be held just above the pubic arch, especially if there 
be a history of hernia, or excessive corpulence, or indiges- 
tion, the matter is of such import as to call for thorough 
instruction and earnest advice. Much discomfort, ill health 
and physical suffering will be saved such cases, if the 
abdominal muscles be developed by persistent exercise-the 
abdominal cavity contains quite as important organs of 
health as the thorax, and the competent instructor will not 
spend all his time and efforts in developing the chest. 
In (9) (10) (n) (12) we have some of the points that go to 
make up the carriage or general appearance of the subject, 
and they constitute the difference in physique between a West 
Point cadet and a slouching loafer. 
Our rear view of the subject will disclose any lateral 
curvatures (13) of the spine, or scoliosis, and we should not 
only see any deformity of this character but should be able 
to judge of its nature, and determine its causation. The 
curve may be simple and confined to one part of the spine, 
or it may be multiple. In the latter case one of the curves is 
usually the primary lesion, and the others compensatory. 
The reason for the compensatory curve is found in the natural 
effort to maintain an erect carriage. If there be a slight 
curvature to the left in the lumbar region it would tend to 
tip the shoulders to the right, but the natural effort to 
straighten the spine has most success where the muscle is 
stronger, and not at the point of greatest weakness, toward 
which the convexity lies. The result is the bending of the 
upper part into such a position that the weight is in equilib- 
rium, and the shoulders fairly level. This effort to bend a 
higher portion of the spine to produce a balance of weight 
usually is the cause of a slighter curve higher up in the 
cervical portion, that restores the head to the erect position. 
Thus a curve to the left in lumbar region may cause another 
higher up to the right, in dorsal region, and another still 
higher to the left in the cervical portion of the spine. If this 
explanation is correct it is plain that the predisposing cause 142 
Examination by Inspection. 
of scoliosis must be due, in a large majority of the cases, to 
the weakness or uneven development of the muscles and 
ligaments that support the spine. If the muscular strength 
and activity of one side be greatly in excess of that of the 
other, the spine must of necessity be drawn to that side 
which will throw the convexity toward the weaker side. If 
this principle obtains in all the anatomical relations-and its 
influence cannot be denied-no better argument could be 
used in favor of training for bilateral symmetry. In con- 
nection with scoliosis or lateral curvature of the spine there 
is nearly always a twist of the spinal column on its long axis 
producing a backward protrusion of one side while the other is 
pushed forward. This deformity is called rotation and its 
importance is quite as great as the amount of lateral displace- 
ment. The rotation is seen more readily when the subject 
bends forward-one side then appearing higher than the 
other. 
The fact that girls are affected by spinal curvature more 
often than boys (the proportion being four to one) would 
seem to indicate a need of more robust exercise out of doors 
or in gymnasiums that shall give such a development of the 
erector spinae mass, and all the muscles above the hips, as 
shall compare favorably with that of boys. The influence of 
corsets and stays has been repeatedly shown to be the cause 
of great muscular debility in the parts constricted, and all 
medical authorities assign a large part of responsibility for 
curvatures to their use. The lumbar muscles of the female 
have a comparatively larger field of origin at the pelvis and 
should be correspondingly strong, but under the differentia- 
tion of civilization and the corset, the female waist has 
degenerated into a backache. 
Pressure on a muscle tends to drive the blood out, and if 
it be continuous, the circulation is impaired. This condition 
means bad nutrition of the muscle, and that leads to imper- 
fect development or to actual atrophy. Is it any wonder then 
that a physician hears from his female clients one long com- 
plaint of weak backs, backaches and general debility! 
The remedial exercises for curvatures need only be sug- 
gested here, as the only treatment, is forcible straightening 
and proper exercises. The care should be exercised on the 
weakest spot, which, in some way, "must stand the strain.'' Examination by Inspection. 
143 
Suspension, as on the rings and bars, and the direct exer- 
cise, either active or passive, of the degenerate muscle, is the 
general plan of treatment. 
The prominence of the spinous processes are of diagnostic 
value in locating weak spots. If the interspinous ligaments 
have been strained and stretched by lack of muscular sup- 
port or bad habits of posture, as sitting back on the hips, and 
letting the weight of the trunk press the lumbar vertebrae, or 
a pernicious habit of letting the head hang forward, the 
saw-toothed appearance of the spine, as the subject bends 
well over, will disclose the fact. Notice the alignment of 
these processes as the subject is bent over and straightens 
up. A failure of one or two, here and there, to stand in the 
line, is not an indication of disease, but is due to a slight 
bend in the process, as will be seen on examining almost 
any skeleton. The spinal curvature will be indicated by a 
number of them assuming a general curved outline. 
The mobility of the scapulae (14) varies greatly in different 
people. A more beautiful contour exists when the trapezius 
and rhomboidei are strong and short, holding the scapulae 
down and well back to the spine, but the range of arm move- 
ment is not great. A good development of these muscles is 
very desirable as they prevent the shoulders from rolling 
forward and flattening the chest. 
In (15) notice the size of the lumbar muscles, with the 
subject bent over. 
It should be borne in mind that a shortness of one (16) 
leg is comparatively frequent and this deficiency causes the 
pelvis to tip with resulting spinal curvature. Distocia, or 
deformity of the pelvis may have the same effect. It is well 
to notice the comparative height of the dimples that mark 
the posterior superior spinous processes of the ilii, as they 
indicate to some extent the position of the base on which is 
erected the bony column of the spine. This base should be 
perfectly horizontal. 
The bone of the legs (17) cannot be greatly changed by 
exercise, but something can be done in early life to relieve 
one of the burden of bow legs or knock knees. Therefore, 
in the examination of children do not overlook this point, nor 
needlessly turn the attention of the subject to it when there 
is no relief, but occupy his mind with matters that can be 
improved and modified. In observing the legs notice any 144 
Examination by Inspection. 
cyanosis about the ankles, and varicose condition of the 
veins, especially of the lower leg. In some persons the skin 
is firm and seems to fit the underlying tissues very closely, 
thus giving support to the venous walls, while in other cases 
the skin is relaxed and thin, furnishing poor support to the 
superficial vessels. If we recall the fact that the hydrostatic 
pressure alone in a person of ordinary height, while stand- 
ing, would be a trifle over one kilogram in the vessels of the 
foot, and that the friction of the current along the vessel 
wall, the impediment from construction of clothing and 
speed of the current, all add to this pressure we can readily 
see why certain classes of people are specially liable to dila- 
tion of the veins, and suffer accordingly. Persons obliged 
to stand much of the time without great change of position 
(as clerks, book-keepers, bench mechanics, etc.), and very fat 
people, who stand a considerable part of the time, are most 
often affected. The pressure on the external iliac vein in cor- 
pulent people is a predisposing cause, as it prevents the free re- 
return of the blood into the trunk, and the same may be said of 
garters, tight clothing on the thighs, or elastic thigh bands, 
tight belts around the waist, corsets, and any garment or device 
that prevents normal respiration (see illustrations, Chapter 
XIV). The proper advice in these cases is clear. Restric- 
tion should be placed on all exercises like jumping, where 
the feet strike the ground hard; running on pavement, 
floors, etc., bicycle riding, because the pressure of the saddle 
falls on the femoral and saphenous veins; violent exercises, 
like football, etc., etc. Light exercise should be encouraged, 
for the better the tone of the tissues, the less giving way 
will there be to pressure. Exercise of the skin to keep it 
healthy and firm-such as massage and cold water baths, to 
stimulate the contraction of the tissues-will be of assistance. 
In this condition "forewarned is forearmed." Cyanosis is a 
varicose condition of capillary veins and indicates poor circu- 
lation. In cyanosis about the trunk search carefully for 
some heart lesion. 
The condition of the skin (19) will signify much to the 
careful examiner. Not that every subject with acne should 
be set down as dyspeptic, but in an almost intuitive way 
the careful observer will learn to diagnose many internal 
ailments and judge of vices that might otherwise be Examination by Inspection. 
145 
unknown. There is something that cannot be described in 
the healthy, firm, velvety skin of an athlete. It must not 
only be seen, but felt, in order to be appreciated. It is 
better to be rolled in the dust by a hearty, healthy wrestler 
than to shake the flabby, moist hand that is placed in yours 
by some advocate of moral suasion and intellectual top- 
heaviness. The skin, like the eye, is the mirror of the bodily 
health, if we only know how to see the image clearly. Its 
firmness, its elasticity, its smoothness, its moisture, its odor, 
its color, its warmth, all are full of meaning. Physicians 
often read the complaint in the countenance of the patient 
before his mouth has uttered it. We have in observation not 
only the facial countenance but the expression of the whole 
body. How much, then, should we rightly judge of the inner 
man! The delicate tint seen on the skin of the woman who 
has exercised in the open air, until every tissue proclaims 
her the type of health, is as superior to the rusty covering 
of the dyspeptic house plant as that is superior to the hide 
of a pachyderm. Local diseases may deform the skin, but 
the indications of general health will be found, if it exists. 
The following table will present in compact form some of 
the more prominent points observed by inspection: 
GENERAL ASPECT. 
Flat. 
Round. 
Bilateral asymmetry. 
Sternum depressed. 
Pectoral muscles. 
Aspect of chest 
Front View. 
" " waist. 
Breadth. 
Muscles. 
Bow-legs. 
Knock-knees. 
Muscles. 
" " legs. 
(i) Form. 
" " neck. 
Sterno-mastoid. 
Lateral muscles. 
Poise of head. 
" " thorax. 
" " loins and belly. 
" " hips. 
Side View. 
Breadth. 
Neck. 
Shoulders. 
Waist. 
Hips. 
Rear View. 
Height of acromions. 
Line of spinous processes. 
Scapulae. 
L Pelvic crests. 146 
Examination by Inspection. 
Unduly thin. 
Sickly aspect 
Healthy " 
Atrophy. 
(2) Nutrition. 
Evenly distributed and firm. 
Unevenly " " soft. 
Fatty degeneration. 
" fat. 
Acne, furuncles, etc. 
Eczema. 
Psoriasis. 
Eruptions. 
Tinea. 
Circinatus. 
Versicolor. 
Tricophytosis. 
Ulcerations. 
Erysipelas. 
Bruises. 
Burns. 
Cuts. 
Lacerations 
Cicatrices. 
Traumatisms. 
Carbuncles, variola, etc. 
Abscesses. 
Free. 
Bone. 
Sebaceous. 
Comedones, 
Seborrhoea. 
Sebaceous cysts. 
(3) The Skin. 
Hypertrophy. 
Ichthyosis. 
Goiter. 
Condylomata, callus, etc. 
Tumors. 
Malformation. 
Chicken breast, 
Retained testis. 
Funnel chest, etc. 
Varicocele. 
Hydrocele. 
Hernia. 
Abscess. 
Cysts. 
Lentigo. 
Chloasma. 
Jaundice. 
Erythema. 
Purpura. 
Cyanosis. 
Bruises. 
Discolorations. Examination by Palpation. 
147 
CHAPTER XI. 
EXAMINATION BY PALPATION. 
The use of the sense of touch, or palpation, is of great 
importance in locating tumors and determining chest move- 
ments, viz.: frequency of respiration, vocal fremitus, ronchi, 
frictions, etc. By the eye you can only imperfectly judge of 
size and consistency. An arm may be large, but, if soft and 
flabby, it does not indicate health or strength; while if it 
meets our hand with a proper resistance-not too hard nor 
too soft-we know that it is capable of good things, be it 
large or small. Palpation enables us to say how much fatty 
tissue underlies the skin, and how firm the muscle is under 
the fat. It is a mistake to set every person with abundant 
adipose tissue in the list of "muscles undeveloped.'' Nor is 
fat a substance of no worth to the physical economy and to 
be avoided. In certain quantities it is of the greatest 
advantage to health, and is an indication of high nutrition. 
It is so much physiological capital stored up, and is so located 
as to prevent loss of heat by radiation, especially over the 
more sensitive organs, and therefore saves the energy that 
would be lost in heat. This is nature's way of protecting 
her children from the increased severities of the season for, 
as autumn brings presages of winter by her cooler nights, 
every animal, in health, grows fat, and those that are 
exposed to continued low temperatures, like whales, seals, 
bears, etc., lay up enormous stores of it underneath the skin, 
where it will do the most good, and over the abdominal 
organs and heart. If the supply of food is cut off, the fat is 
consumed to provide vital force for long periods of time. 
The same is true of man, but to a less extent. As civiliza- 
tion has relieved him of many of the exigencies of nature, it 
has modified his requirements, restricting them in some 
directions, and enlarging them in others. The modern 
civilized man needs much less fat than the Esquimaux, 
because he has a milder climate and better facilities for 
heating his house, but he needs some fat to prevent the irri- 148 
Examination by Palpation. 
tation of the nervous tissues during the adjustments of heat 
production that are so rapid in a well-balanced body, when 
we pass from a cold to a warm atmosphere and the reverse. 
This strain is thrown on the involuntary or sympathetic 
nervous system, and this is the part that breaks down in the 
so-called "nervous exhaustion'' or "neurasthenia," which is 
so common. Not that lack of fat stands in causative relation 
to this disease, but that one source of strain is found here. 
Such persons bear the cold badly and seek warmth, their 
treatment is warmth and nutrition. The argument, then, is 
that a fair amount of fat is conducive to health of the nervous 
system. The same may be said of all the other organs. 
The lean man has no extra physiological resource to fall 
back upon, if irregularities are forced upon him, either in 
the way of lessened food supply or sleep or greater demand 
on his energy, either physical or mental, and his comfort 
and health soon suffer. 
By palpation we may also judge of the temperature and 
moisture of the skin, and thus estimate its activity in 
excretion. A healthy skin should be firm and velvety, even 
in texture and activity, slightly moist under ordinary circum- 
stances but not wet, colored a delicate shade of pink, without 
being flushed or having dilated capillary vessels, as will be 
found common in the clavicular or scapular region. If the 
skin is hot and flushed, it indicates the presence of fever, or 
a local disturbance of circulation, due to deranged nerve 
activity. If the skin be dry, and tends to form scales, the 
superficial circulation is insufficient, and bad digestion is a 
common accompaniment. Free exercise, shower bathing, 
massage and friction will set things to rights if persistently 
employed, unless the skin be affected by ichthyosis, which 
"is a congenital, chronic, hypertrophic disease," and hence 
will be but little benefited. Profuse perspiration is found 
frequently, and seems injurious only in prolonging bronchial 
inflammations and general catarrhal conditions, by keeping 
the clothing damp a large part of the time. There is also an 
increased liability to Bright's disease from high concentra- 
tion of urine and chilling of the surface on slight exposure. 
Hyperidrosis will be favorably influenced by active exer- 
cise, as the circulatory system will at that time be depleted 
by the free sweating, and will give up less moisture in a state Examination by Palpation. 
149 
of rest. After exercise the damp clothes removed, the sweat 
washed off in the shower bath, and the skin dried by proper 
massage, leave slight liability of "colds." Local hyperi- 
drosis may'seriously impair the health by keeping the feet 
damp and cold and thus induce catarrhal, pneumonic and 
rheumatic conditions. Medical advice is to be recommended 
in such cases, if hygienic precautions-such as cold baths, 
frequent change of clothing, sensible shoes with cloth tops, 
proper diet and regular exercise-do not avail. At times the 
under and inner surfaces of the toes and the outside margin 
of the foot from the little toe back to the instep will appear 
white and swollen in these cases.* This condition closely 
resembles large blisters from scalds, but is only a water- 
soaked, "parboiled," state of the epidermal layer, like that 
seen on the hands of washer-women after they have been in 
hot soap-suds for a half-hour. The advantage of a cloth-top 
shoe in these cases is apparent when we think of the com- 
parative ease with which moisture passes through woolen 
fabrics as compared with difficulty of evaporation through 
leather. 
A condition of anidrosis, or too scanty perspiration, is 
frequent without evident impairment of health. The skin is 
apt to get very dry and harsh, especially in cold weather, 
and eczema of the hands result. In many of these cases 
there is no general sweating, even in extremely hot weather, 
and perspiration is not copious. 
It may be well to explain that "perspiration" is the term 
applied to the insensible exudation from the sweat glands 
that is evaporated as fast as secreted, while "sweating" is 
the appreciable collection of this exudation in drops of 
greater or less abundance. (See Foster's Physiology.) 
In addition to what we learn of the integument and 
muscle by palpation, we detect by it certain movements that 
characterize health or disease. If we place the hands firmly 
on the walls of the chest, letting the fingers press the inter- 
costal regions, there will be felt a movement of the chest on 
each inspiration and expiration, if respiration be normal. 
Any failure in expansion is noticed if there be interference 
with the chest action, from muscular or mechanical cause, 
that is unilateral. There should be bilateral symmetry of 
movement, but this may be hindered by muscular soreness 150 
Examination by Palpation. 
from rheumatism, neuralgia, traumatis, etc. ; paresis of a 
muscle, or group of muscles; intrapleural effusions; new 
growths; or by solidification of the lung or any considerable 
part of it. Malformations may also interfere with bilateral 
symmetry of movement. 
If the subject be asked to repeat some word such as 
"ninety-nine," or to count aloud, one, two, three, while the 
hands are on the chest, as above described, a peculiar vibra- 
tion will be felt, which is known as the "vocal fremitus." 
This thrill, or vibration, is much more prominent in persons 
with thin chest walls and low pitched voices, than where the 
wall is thickly padded with fat and the voice in high key, 
on the same principle that the low bass strings of a piano, 
when struck, impart vibration to solid articles in the room in 
an appreciable degree, while the high notes have a less per- 
ceptible effect. The "vocal fremitus" is somewhat plainer 
on the right side, on account of the larger size of the right 
bronchial tube. A fremitus may be caused by other sources 
of vibration than the voice, as by a cough, by mucous rales, 
by pleuritic friction, and the splashing of liquid, when the 
chest contains liquid and air. 
The "ronchial fremitus," due to mucous in the bronchial 
tubes, is frequently very marked in bronchitis, and felt by 
the subject himself; but the area is circumscribed in mosts 
cases. The friction fremitus of pleuritic inflammation is 
faint and local in character. In general, those diseases that 
produce solidification of the air cells of the lungs, without 
obstruction of the bronchial tubes, increase the vocal 
fremitus; while those that interpose more air, like 
emphysema, decrease it. Liquids diminish or check it alto- 
gether. The scapulae interfere with the fremitus, as does 
the liver, the latter not conveying the vibrations, and, if 
pressing firmly against it, preventing the chest wall from 
doing so below the margin of the lung. 
Palpation is of great service in the diagnosis of tumors. 
The fingers are to be placed on one side of the swelling, and 
gentle but firm pressure made on the opposite side of it with 
the fingers of the other hand, by a quick movement of the 
wrist. If the contents of the tumor are liquid a bulging will 
be felt under the fingers, caused by the displacement of the 
fluid, that passes as a wave through the tumor, distending Examination by Palpation. 
151 
the sac at one part to accommodate the liquid depressed at 
another. This peculiar wave-like motion, called fluctuation, 
can be well studied by examination of a rubber water-bag 
under varied thicknesses of covering, having the bag dis- 
tended hard, and again with less water in it, but no air. In 
cases of ascites the wave impulse is readily felt across the 
abdominal cavity-a light tap with the end of the finger 
against the side being sufficient to start the wave. A close 
estimate of the amount of fluid can be formed in this way, as 
the wave simply continues through the liquid part, and is 
not propagated by the intestines or general tissues. 
The apex beat of the heart may also be located by 
palpation in a large majority of cases. In many subjects 
the chest wall is thin, and the heart action strong, so that 
inspection can determine the apex impulse with tolerable 
precision; but if it fail to fall in an intercostal space, or the 
chest wall be thick, or the heart-beat feeble, palpation must 
be used. In this connection it may be said that for this 
purpose the ear may be the organ of tactile, as well as of 
auditory impressions. 
The character of acute or chronic inflammatory action 
can often be determined by palpation, as in swellings about 
joints. Tumors and impactions in the abdominal cavity can 
be diagnosed by this process and their general character 
determined. 152 
Examination by Auscultation and Percussion. 
CHAPTER XII. 
EXAMINATION BY AUSCULTATION AND PERCUSSION. 
The condition of the internal organs is determined in 
several ways. Among the most frequently employed, 
because most satisfactory in results, is by listening to the 
passive and active sounds so far as they can be secured to 
the ear. The passive sounds are obtained by percussion, 
or striking the surface over an organ, either with the tips of 
the fingers or a rubber mallet directly, or by laying a solid 
surface, or the finger, firmly against the surface, and striking 
this. The first method is called immediate percussion, and 
is seldom used, except for hard, bony surfaces. The second 
is called mediate percussion, and is applicable to all parts. 
The sounds obtained by percussion vary in quality, 
intensity and pitch. The quality of the sound obtained over 
the various organs can only be rudely described, but practice 
will give skill in distinguishing it. The intensity will vary 
according to the surrounding medium, and the pitch will 
vary largely through change in the organs that produce the 
sound. 
The region of the body most frequently examined by 
percussion is the thorax. The abdomen, especially in condi- 
tions of disease, is often examined by this method (in con- 
nection with palpation), but without the satisfactory accuracy 
that is to be secured over the chest, although it enables one 
to distinguish the outline of solid tumors of hepatic, splenic 
or intestinal origin and the area covered by cystic enlarge- 
ments. 
The method of employing percussion is generally with 
the fingers, although, if many examinations are made daily, 
it is well to use a pleximeter and percussor (see Figs. 20, 21). 
It seems to the writer that the appreciation of vibrations 
by the finger is of considerable importance in assisting the 
ear and, therefore, that digital percussion is better than 
instrumental. The act is easily performed by laying the 
fingers of one hand firmly over the part to be examined and, Examination by Auscultation and Percussion. 
153 
with the tips of the first two or three fingers of the other 
hand, or the middle finger alone, striking against one of the 
fingers imposed on the part with a firm blow, accomplished 
by a wrist movement of flection. The force of the blow 
may be varied to perceive the difference in resonance, 
quality and pitch of the sound under the conditions, as this 
may have an important bearing on our determination of the 
case. Forcible percussion sets in vibration deeper tissues 
and, if their condition varies greatly from the superficial 
Showing the normal outlines and positions of the heart, lungs, liver 
and stomach. The light dotted line shows the outline of the lung at inspi- 
ration, b d, at expiration,//?, and also to lobar divisions at i k I. The heavy 
continuous line shows the outline of the liver. The light line shows the 
location and divisions of the heart. The heavy broken line indicates the 
outline of the stomach. Luschka. 
Fig. 49. 
tissues, there will be a mixed quality to the sound that aids 
in identifying healthy activity, or disease or abnormal posi- 
tion. For instance, if we begin at the right clavicle and 
percuss downward, until we reach the lower edge of the liver, 
we shall pass over lung tissue at first where the sound 
elicited under mild or forcible percussion is essentially the 
same; lower down we reach a part of the lung that contains 
the large bronchial tubes when the pitch is lower and 154 
Examination by Auscultation and Percussion. 
resonance good, then still lower to a part that is backed by 
the upper convexity of the liver with only the solid dia- 
phragm and lung between it and the chest wall. Here under 
mild percussion, the resonance is unimpaired; but under a 
firmer stroke the resonance is found to lose its clearness and 
become duller, and this dullness increases as we percuss to 
the very edge of the lung, where the sound is flat (see Fig. 
49). The term "flat," as applied to percussion sounds, is 
such a quality of tone as is produced when an organ contain- 
ing no free gaseous element is set in vibration by an impact. 
The word "dullness" is comparative only and denotes less 
resonance than should be expected under normal conditions. 
In using the pleximeter, we press it firmly against the 
surface, and strike upon it with the rubber percussor. The 
resonance of the instrument is slightly confusing to the 
person who has been accustomed only to digital percussion, 
but practice soon enables us to eliminate this sound, as one 
does the sounds of mercantile life while listening to a voice 
in the telephone. Practice alone will give skill in the deter- 
mination of normal or abnormal sounds. It may be remem- 
bered that for any individual the resonance of the chest is 
fairly constant in health, but that of the abdomen varies 
continually; again, the resonance of the abdomen is always 
tympanitic or flat, while that of the healthy chest is neither. 
In making a physical examination, percussion of the abdo- 
men is useless, unless there be a history of abdominal dis- 
order, or inspection and palpation indicate something 
abnormal. 
For convenience in describing any location on the anterior 
aspect of the trunk there has been a long-continued custom 
of dividing the body into a right and left half by a median 
perpendicular line and then designating the portion on 
either side above the clavicle as the superclavicular region, 
right or left. The portion below the clavicle as far down as 
the third rib is called the infra-clavicular region and the part 
covered by the clavicle is called the subclavian region. The 
mammary region extends from the third rib to the sixth. 
Below the sixth rib is the infra-mammary region, extending 
to the margins of the ribs. The lower sternal region extends 
from the ensiform cartilage to the third costal cartilage, and 
from this point to the sternal notch is called the upper sternal Examination by Auscultation and Percussion. 
155 
region. From the top of the stermine to the cricoid cartilage 
is the suprasternal region. The limits on the right and left 
are perpendicular lines drawn from the tips of the acromions. 
At the side the axillary region extends from the summit of 
the axilla to the sixth rib, and below this is the infra- 
axillary space, extending to the bottom of the chest. 
The abdomen is divided into nine regions for purposes 
of description, as follows (Fig. 50): Draw a horizontal line 
across at the level of the narrowest part of the waist and a 
second line at the level of the iliac crests. Draw a perpen- 
dicular line from the middle of Poupart's ligament, on each 
side, extending up to the chest. On the outside of these 
lines will be found, above, the right and left hypochondriac 
regions extending down to 
the first horizontal line. 
Between the horizontal 
lines will be; the lumbar 
regions and below these the 
iliac regions bounded by 
Poupart's ligament. The 
central portion is called the 
umbilical region. Above 
this is the epigastric and 
below the hypogastric re- 
gions. 
In examining a subject 
by percussion it is well to 
begin on the supra-clavicu- 
lar region and percuss 
lightly and then forcibly on each side, and press the fingers 
well against the intercostal muscle rather than over the 
ribs, while proceeding to the lower edge of the chest; then 
percuss the right axillary region; then the posterior thoracic, 
from top to bottom, striking on alternate sides in order to 
discover any difference in sound that may exist, and then the 
left axillary space. There should be equal resonance of 
sound on each side behind, unless there be extreme uneven- 
ness of muscular development, which will slightly dull the 
sound on the strong side; but in front the location of the 
heart to the left of the sternum, and the liver to the right of 
it, and lower down gives a wide variation in sound for 
Fig. 50. 156 
Examination by Auscultation and Percussion. 
similar locations on the two sides. On the right we usually 
find the point of liver dullness beginning about 2 cm. below 
the nipple, while the line of flatness is about 6 cm. below 
it-the flat area extending about the breadth of the hand, or 
to the edge of the ribs, and around to the spine (see Fig. 51). 
On the left the area of heart dullness begins at about the 
third intercostal space, near the sternum, and extends out to 
a point nearly an inch above the nipple, and down for 3 cm., 
shading off into the flat heart area-that is circular above 
Showing the areas of percussion dullness and flatness over heart, liver 
and stomach, i k line of beginning dullness around the heart, ad b c area 
of flat sound or without pulmonary resonance, p q line of dull area over 
the liver, ecml area of flatness over liver, m n 0 area of varying reso- 
nance over the stomach. Weil. 
Fig. 51. 
about 5 cm. in diameter and having its center at a point 
half way between the nipple and the center of the sternum, 
and reaching downward to the sixth rib, where it is merged 
in the stomachic resonance (see Fig. 49). 
The line of stomach dullness is of'variable location and 
may not be perceptible at all. Examination by Auscultation and Percussion. 
157 
The percussion sound of the abdomen is tympanitic or 
flat, according to the existence of gas in the intestinal canal. 
In case of ascites, a peculiar wave impulse is started by 
immediate percussion that is readily felt by the other hand 
held against the abdominal wall opposite the point of 
impact. The same is true of cystic tumors in other locations, 
where the walls are protected only by soft tissues, as in 
effusion into the synovial cavity of the knee and other joints, 
as a result of inflammation or hemorrhage. This wave 
impulse corresponds to the fluctuation of palpation (see page 
i5i)- 
The area of liver dullness should not extend below the 
lower edge of the ribs, on the right side, while the spleen is 
found well around to the left side, extending from the line of 
dullness at ninth rib, downward about 8 cm., the breadth 
being about half this distance (Fig. 51). In ordinary cases 
the spleen is not to be sought, as its function is not fully 
known, and its recognized abnormalities are confined to 
malarial and congestive fevers, with occasional malignant 
growths. The length of the thorax will be found to vary 
greatly in different people, and, where the ribs come well 
toward the umbilicus, the liver should hardly reach to the 
lower edge of the ribs, except in front, while in the cases of 
short chest it may extend five or more centimeters below the 
free margin. The left lobe extends across the median line for 
about 6 or 8 cm. (Fig. 51), where its limits are not readily dis- 
covered by percussion, on account of the area of heart dull- 
ness. At the right side the liver extends down to the tenth 
intercostal space, and behind it reaches to the last rib (Fig. 52). 
It should be remembered that the lower limits of the 
liver may vary greatly without its being an indication of 
enlargement or disease. In examining this organ, there- 
fore, it is well, if any apparent malformation exists, to 
determine by percussion, and mark with a flesh pencil the 
outline of the organ. The exact measurements can then 
be made and malposition differentiated from hypertrophy. 
Some of the more common causes of malposition are tight 
lacing, pleuritic effusion, congenital and traumatic malforma- 
tions, pericarditis with effusion, and certain abdominal tumors. 
For convenience in treating the normal positions of certain 
organs, the following points should be fixed in mind. 158 
Examination by Auscultation and Percussion. 
The sternal notch is on a level with top of the second 
dorsal vertebra or tip of seventh cervical spine. 
The spine of the scapula is on a level with the third dorsal 
spine. 
The lower angle of the scapula is on a level with the seventh 
dorsal spine. 
The base of the heart lies at the fourth dorsal spine. 
The apex of the heart lies at the level of the eighth dorsal 
spine. 
Fig. 52. 
Showing the positions of the kidneys, j k, and spleen, h; margin of 
liver, I. The dotted line, ef g, shows the lobar divisions of the lungs. 
Scheube. 
The apex of the lung lies opposite the seventh cervical spine 
and vertebra, and from two to four cm. above the top of the 
sternum. 
The base of the lung is on the level of the tenth dorsal 
spine. 
The spleen lies on the level of the ninth and eleventh dor- 
sal spines. Examination by Auscultation and Percussion. 
159 
The upper convexity of the liver lies on a level with the 
eighth dorsal spine or slightly above the lower end of the 
sternum. 
The nipple usually covers the fourth intercostal space at 
level of sixth spinous process. 
These locations are all referred to the spinous processes of 
the vertebra as fixed points that can always be found. If we 
rub the ball of the thumb firmly down the furrow between the 
erector spinae muscles, the tips of the spinous processes will 
show as pink spots on the skin. This method is recommended 
by Dr. Holden to determine the existence of lateral curvatures. 
In auscultation we have the method of most precise knowl- 
edge in diagnosis. By other methods of examination we may 
learn that there is something wrong, but the ear is the 
supreme court to decide the case and tell what that "some- 
thing" is. For purposes of auscultation several instruments 
have been devised, but none better for general use than the 
binaural stethoscope of Dr. Camman, Fig. 17, with its im- 
provements for clasping into the ears, without undue pressure. 
The unassisted ear is able to do all that is required in most 
cases, as the sounds are equally distinct, but the ear cannot be 
readily applied to all parts of the chest, and to attempt it in 
some cases would be to affect other parts of the sensorium with 
more profound salutations. 
The stethoscope also enables us to localize sounds closely 
by making a direct course of travel for sound waves. Con- 
sequently, it readily transmits those waves that pass directly 
into its bell or tube, while those waves that are not thrown 
directly in, are either lost or become obscure, so that our 
attention is centered on the sounds produced directly beneath. 
The pressure of the aural tips closes the external meatus of the 
ear, so that foreign sounds are entirely eliminated. 
The following points in the use of the instrument should be 
borne in mind: 
1. Apply the intrument to the ears so that the aural tips 
will point downward and inward, thus following the direction of 
the meatus of the ears. 
2. Have just sufficient pressure in the ears to hold the 
instrument steady and make the tips fit perfectly. 
3. Let no foreign material touch against the stethoscope 
at any part of it during use, as friction-vibrations will be set 
up. 160 
Examination by Auscultation and Percussion. 
4. Press the bell firmly over the spot to be auscultated, so 
that it fits the integument perfectly all around. If the surface 
is uneven the soft rubber bell should be used. 
5. Do not let the fingers move on the instrument while 
holding it in place. 
6. Always apply directly to the skin, as nothing satis- 
factory can be heard through even a thin layer of cloth. 
7. The examiner should keep his own head as nearly erect 
as possible to avoid cerebral congestion from venous constric- 
tion. 
Where the naked ear is used a soft cloth can be interposed 
between it and the subject. 
In listening to the sounds of the mitral and tricuspid valves 
with a stethoscope, it is well, should there be doubt in 
diagnosis, to place a thin cloth, like a napkin, on the chest, and 
auscultate through it. The only sound heard through this will 
be the valvular click-the first sound becoming short and un- 
complicated like the second sound. 
In auscultation continued practice must be given to learn- 
ing normal sounds and their relations. If the examiner knows 
every healthy sound with its variations, he will instantly 
recognize an abnormal one, even if he is not able to clearly 
state or even understand the existing lesion. Some sounds 
are so complicated as to defy experienced surgeons in reading 
their significance. 
The following points are to be studied: 
(«) Muscle-sounds, by placing the stethoscope over a 
muscle like the biceps, during its contraction and relaxation. 
(£) Heart-sounds, by studying the sound at each location 
in the precordial region and along the large arteries. 
(r) Lung-sounds, in every region of the chest. 
(^) Intestinal-sounds, that are caused by the gases of 
fermentation. 
(^) Succession or splashing sounds of fluid in the stomach 
(or chest), while it contains free gas. 
(/) The "bruit" or hum heard in many cases over the 
large venous trunks, especially of the neck and upper chest 
and over aneurismal sacs. 
A muscle sound is of low pitch and vibratory quality-a 
rapid throbbing as it were. Its character is represented in 
exaggerated form by moistening the end of the thumb and Examination by Auscultation and Percussion. 
161 
then rubbing it along the surface of a wooden table with a 
fairly rapid movement. The thumb will jump along the 
surface giving a low vibration to the wood. The muscle sound 
is the cause of the peculiar, prolonged "booming" sound of 
the heart during its contraction, and it modifies the valve 
sound of closing to some extent; therefore the directions on 
page 28 should be followed if there is an apparent systolic 
murmur. 
The valve sounds are brief in duration, of high pitch and 
clicking or non-resonant quality. These sounds are confused 
more or less by the muscle sound, by respiration sounds and 
by the vibrations of blood currents both normal and abnormal. 
These abonormal sounds are generally of blowing quality and 
are called murmurs. They will be studied more at length in 
Chapter XIII. The sounds of the normal heart must be 
patiently studied with the stethoscope until its every peculiar- 
ity is familiar; its rhythm, its force, its various valve sounds, 
its points of clearest differentiation of complex sounds and its 
transmission of sounds, the relation of the pulse in various 
localities to heart inpact, etc. It is only by a thorough 
acquaintance with normal conditions that the abnormal can be 
recognized. 
There will be found frequent cases of arterial and venous 
murmurs or humming sounds that will be likely to be mistaken 
for heart murmurs. These have a location over the larger 
blood vessels and the sound is continuous rather than inter- 
mittent, if of venous origin, and if arterial, the sound is usually 
not heard at the heart, but at some point where a large trunk 
makes a sharp turn or is narrowed by pressure of adjacent 
structures, as in the subclavian artery. The venous murmur 
may vary from a low hum to a whistling sound. The jugular 
vein is the spot where the venous hum is most frequently 
heajd, and in many cases a hum can be produced by an uneven 
pressure of the stethoscope, making a slight constriction in the 
calibre of the vessel. Turning the face of the subject to one 
side will sometimes produce a hum on the opposite side. This 
sound has been called by some writers an anaemic hum, but 
its cause can hardly be assigned directly to the quality or 
quantity of the blood. Anaemia might be a factor in the pro- 
duction of the sound by causing a softening of the tissues 
supporting the vessel, and the watery venous blood may be 162 
Examination by Auscultation and Percussion. 
sonorous to a larger extent than arterial blood, as taught by 
Walshe, but the direct cause must be the unevenness of the 
calibre of vessels, through which bood must be flowing at a 
speed bearing some relation to the size of their lumena. 
Arterial murmurs may be due to roughness of the inner 
coat due to inflammations or vegetations, sacculations, or 
pressures. These causes would produce systolic murmurs that 
would be loudest over the site where they are produced. 
From similar causes murmurs may be produced in the cavity 
of the heart itself. Another class of murmurs is found in 
extremely nervous people, excessive tobacco users and over- 
trained athletes. It is due to irregular muscular action of the 
heart, with consequent imperfect closing of the valves, and is 
therefore systolic and heard more commonly over the base of the 
heart These murmurs are not constant, and do not frequently, 
if ever, exist with benign hypertrophy. 
Heart murmurs due to dilatation of the cavities from 
anaemia do occur, and in those cases it is difficult to decide 
whether there is aortic obstruction or a simple dynamic 
murmur. In the first case, however, we would find a power- 
ful heart impulse from hypertrophy, while in the second there 
would be a feeble impulse from the imperfect contractions. 
At times the respiratory sounds may confuse the heart sounds 
by the air being driven out of a portion of the lung by the heart 
impulse, giving rise to a sound that may be mistaken for a 
heart murmur. This sound would be systolic and not heard at 
the apex. 
It is well, then, in examination, to apply the stethoscope to 
the apex of the heart first and then over the base, listening 
carefully to the valvular sounds and asking the subject to 
suspend respiration in expiration for a moment if any abnor- 
mal sound is heard. Then listen over the carotid and sub- 
clavian arteries an each side. If a humming sound is heard 
that cannot be understood, let the subject take some of the 
gentler strength tests, and after a slight acceleration of the 
pulse listen again, and so proceed until he understands the 
case. The case may not be one to be determined in a few 
minutes or days. The Significance of Certain Physical Signs. 
163 
CHAPTER XIII. 
THE SIGNIFICANCE OF CERTAIN PHYSICAL SIGNS. 
In listening to the sounds of the lungs we must also have a 
fixed idea of the normal before endeavoring to study abnormal 
sounds. In perfect health the normal vesicular murmur of the 
lungs varies within quite wide limits of force, pitch, quality 
and duration, due to the difference in thickness of the chest 
wall and the activity of respiration in different individuals, but 
the general character of the sounds remains the same. 
This sound has been likened to the faint rustling of dry 
leaves or straw, but the only description that is of help to a 
student is the one that he makes to himself by continuous use 
of the stethoscope and naked ear applied to the chest. 
The following point may be borne in mind as helpful in 
examination: 
ist. The murmur is shorter in expiration than inspiration, 
and in some cases the murmur is entirely suspended during 
expiration. 
2d. The murmur is harsher over the region of the larger 
bronchial tubes, becoming milder as we pass downward to the 
base. 
3d. The heart sounds will tend to confuse the lung sounds 
in the front of the left lung, but only in a few cases is it diffi- 
cult to hear only the sounds you search for. 
4th. The sounds of bronchial breathing are heard in simple, 
uncomplicated form, over the trachea and upper sternal region. 
5th. The quality of bronchial respiration sound is tubular 
and harsh ; the pitch is high. 
6th. The expiration sound is longer than inspiration in the 
region of pure bronchial breathing. 
7th. Vesicular or fine respiratory murmur is heard to the 
lower margin of the lung tissue. 
8th. If the murmur ends abruptly at any point above the 
natural border of the lung, and the murmur is normal, suspect 
an effusion into the chest cavity. 164 
The Significance of Certain Physical Signs. 
9th. Normal flatness may begin as high as the sixth rib on 
the right side, and at the seventh on the left. 
The abnormal respiratory sounds are called rales. They 
are in general of the bronchial type rather than the vesicular. 
The sounds may be dry and rasping as when the tubes are 
contracted by an inflammation at the initial stage or a spasm 
of the muscular fibres of their walls or by local pressure. The 
sounds are called moist when the tubes are obstructed by more 
or less fluid. These rales may be so loud as to obscure the 
vesicular murmur. 
The crepitant rale is a fine dry, crackling sound, heard in 
the last part of inspiration in pneumonia and phthisis, and has 
been compared to "the sound produced by rubbing a small 
wisp of hair between the thumb and finger near the ear," 
" pulling postage stamps apart," etc. 
The subcrepitant rale 'is heard in bronchitis, pneumonia, 
oedema of the lungs, phthisis, etc. It is a fine, moist, bubbling 
sound, heard in both inspiration and expiration. 
Coarse bronchial rales are heard in bronchitis, phthisis, etc., 
and are caused by mucous interrupting the flow of air. These 
rales may be so loud as to be heard without applying the ear to 
the chest and if the mucous is very dry a whistling sound will 
be produced. 
Gurgling rales are sometimes heard, especially if the subject 
is very weak and cannot expel thin mucous from the larger 
tubes or if there is a cavity in the lung from tubercular de- 
generation. 
Aside from the respiratory sounds the vocal resonance is of 
importance in determining the condition of the lungs. 
i. The laryngeal voice is heard over the trachea and large 
bronchial passages, while in the general area of the chest the 
sound is modified and softened until the vocal expression is lost 
except over the right bronchus, and, in thin persons, the left. 
2. This tone with "far-away " quality is known as the 
pulmonary resonance. It corresponds to the vocal fremitus of 
palpation. 
3. Increased resonance indicates some consolidation of the 
lung without closure of the bronchial tubes, cavities, pleuritic 
adhesions or compressed lung tissues from effusions. 
4. Diminished resonance is due to obstruction of the 
bronchi or a layer of fluid between the lung and chest wall. The Significance of Certain Physical Signs 
165 
5. Suppressed resonance is caused by large effusion in the 
pleural sac, with compression of the lung or new growths. 
6. Broncophony or a development of the bronchial type 
of resonance in unusual locations indicates a condensation or 
hardening of lung tissue or cavities. 
7. Amphoric resonance indicates very large cavities or 
pneumohydrothorax. The quality of the sound is musical and 
metallic; the pitch and the resonance hollow and without 
articulation. 
8. Whispered resonance is found in as many forms as 
vocal resonance, and its modifications are due to the same 
causes. It is a more delicate test of slight consolidation and 
hence should be thoroughly studied. In normal cases it pre- 
sents a soft blowing sound at the upper part of the chest only, 
where consolidation usually begins. 
9. A cough resonance is helpful at times in securing cumu- 
lative evidence of a condition suspected from other sources of 
information. This is specially true of the diagnosis of cavities. 
In considering the sounds of the heart it is well to bear in 
mind the anatomical features of the heart and the course of 
the blood as it passes into the heart and through it to the 
aorta. The blood from the lower parts of the body is con- 
ducted by the inferior vena cava to a point near the heart 
where it meets the current brought from the upper parts by 
the superior vena cava, and unites with it to form the innomi- 
nate vein which empties into the right auricle after a length of 
30 to 40 mm. There is no valve at the mouth of this vein, but 
blood can flow backward through it under pressure. The 
right auricle is a pouch-like sac with only a small amount of 
muscular fibre in its wall. This auricle acts as a reservoir of 
a fairly steady current whose contents are discharged at inter- 
vals into the ventricle or muscular compartment directly below 
it. This act of discharge is easy during the period of diastole 
or relaxation of the ventricular muscle, and is accomplished by 
gravity and the contraction of the auricular walls. When the 
ventricle is distended with blood the muscular walls begin to 
contract, and the blood is forced toward the two openings, the 
pulmonary artery and the auriculo-ventricular passage, but 
this latter is fringed by the tricuspid valve which is quickly 
closed by the current and the blood sent on to the lungs. At 
the opening of the ventricle into the pulmonary artery there is 166 
The Significance of Certain Physical Signs. 
a valve composed of three semi-lunar flaps of pocket shape, 
which prevents a return current after the contraction or systole 
has ceased. 
After passing through the pulmonary tissue the blood comes 
back to the left side of the heart and enters the left auricle by 
the pulmonary veins which are unguarded by valves to prevent 
regurgitation. The right auricle is very similar to the left in 
function and anatomical character. From it the blood passes 
down into the left ventricle during its period of diastole, and 
is prevented from flowing back during the powerful contrac- 
tion of the ventricle by the mitral or bicuspid valve. This 
closure of the auricular orifice leaves only the opening of the 
aorta by which the blood must be driven out, and which then 
conducts it to the general circulation. At the aortic opening 
are located semilunar valves to retain the blood that has once 
passed into the arterial trunk, so that it cannot flow back and 
refill the ventricle during its period of receptivity. 
It is clear, then, that in normal heart action we must have 
four valvular sounds, and these must all originate at points at 
no great distance from each other. In fact a circle of 25 mm. 
radius drawn from a center at the sternal end of the fourth 
costal cartilage on the left will cover the four valves. There 
are points, however, where each sound is heard more plainly, 
and these are for the mitral valve at the apex of heart; for the 
aortic valves at second intercostal space just at the right of 
the sternum, and over the right common carotid artery; for 
the tricuspid valve at middle of the sternum at the level of the 
nipple; for the pulmonary valve at the left of the sternum in 
the second intercostal space. The mitral and tricuspid sounds 
must be at the beginning of the systole, and are called the first 
sound of the heart, while the semilunar closings will be at the 
end of the systole, and are called the second sound of the heart. 
The first two sounds are synchronous and also the last two. 
The first sounds are prolonged by the muscle vibration into 
a full booming sound, while the second sounds are short and 
clicking. Foster illustrates the difference by pronouncing the 
words loob-diib in the same relative time at the heart sounds. 
Between the second and first sounds is an interval that is 
essentially two-fifths of the time required for a complete cycle 
of heart action. This is called the period of rest. The follow- 
ing table is a summary of normal heart sounds. The Significance of Certain Physical Signs. 
167 
NORMAL HEART-SOUNDS. 
Sounds. 
Location. 
Where Heard. 
i. Muscular. 
Within boundary limits of 
heart or precordial area. 
Heard best at apex and 
just above. 
2. Mitral 
valve. 
Behind the 3rd left intercos- 
tal space and 4th costal 
cartilage about 20 mm. 
from sternum. 
Just above apex beat 
and at 3rd intercostal 
space on left of ster- 
num. 
3. Aortic 
valve. 
Behind the left edge of the 
sternum at the level of the 
3rd intercostal space. 
At 2nd intercostal space 
on right of sternum, 
and over the common 
carotid arteries. 
4. Tricuspid 
valve. 
Behind the sternum at the 
level of the 4th costal car- 
tilages. 
At lower end of the 
sternum above the 
ensiform cartilage. 
5. Pulmonary 
valve. 
Behind the junction of the 3rd 
costal cartilage with the 
sternum on the left. Above 
in front of the aortic valve. 
At 2nd intercostal space 
to left of the sternum. 
The boundary limits of the heart as given by Holden are 
as follows: 
For the base draw a horizontal line over the third costal 
cartilages extending 12 mm. to the right and 25 mm. to the 
left of the sternum. For the apex draw a perpendicular line 
50 mm. long downward from the left nipple and from its lower 
extremity draw a horizontal line 25 mm. to the right, which 
will bring the pencil over the apex to the heart in the fifth 
intercostal space. The nipple is usually located over the fourth 
intercostal space. From the apex draw a curve to the end of 
the sternum, and continue it up more sharply to the right edge 
of the sternum, and continue it upward to the right end of the 
base line by a gentle curve. The left side will be marked by 
a curve of about 200 mm. radius extending from the left end 
of the base line to the apex (see Fig. 49). 
The part of the heart not covered by lung tissue is incon- 
siderable, and is described by Dr. Latham as being outlined 
roughly by a circle of 25 mm. radius drawn from a center half 
way between the nipple and lower end of the sternum (see 
Fig- 5 4 
Abnormal heart sounds are usually called murmurs, and 
result from four causes: 
1. The failure of valves to perfectly hold the blood from 
leaking through. 168 
The Significance of Certain Physical Signs. 
2. The narrowness of the opening through which the blood 
is forced into a tube of larger caliber. 
3. Friction of the external surface of the heart against an 
inflamed pericardium. 
4. Friction on endocardium from vegetations. 
The first cause may be due to active inflammation of the 
valves from endocarditis, etc., that produces vegetations or 
uneven thickening of the valves and therefore imperfect 
closure, or the walls of the heart may become so distended as 
to prevent perfect coaptation of the valves. Other causes also 
may produce imperfect closure. 
The second cause usually depends on inflammation that has 
caused a deposit of fibrous tissue around the orifice affected. 
The third cause is more often the result of an injury or 
strain, and is found in some cases after violent exercise. 
The fourth is found after fevers, rheumatism, etc. 
The character of these abnormal endocardial sounds is hiss- 
ing or blowing, and for this reason they are called by some 
writers "bellows murmurs," while the friction sound is more 
squeaking or grazing in its quality, and can frequently be 
diagnosed by the fremitus discovered by palpation. 
The pitch varies in all the sounds from a low, gentle mur- 
mur to a high whistling note -the pitch giving us some idea as 
to the size of the opening ; for if the sound be caused by a 
stream forced through a small aperture the pitch will be higher 
-the surfaces set in vibration being much shorter than in the 
large opening. 
The most common heart lesion is a failure of the mitral 
valve to perfectly close the left auriculo-ventricular passage. 
This is called mitral insufficiency. It is plain that any fault in 
the closing of this valve would permit the blood to flow back 
into the left auricle during systole, and that this would cause 
increased pressure in the auricle and pulmonary veins, thus 
interfering with respiration and distending the auricle. As 
the heart contraction forces blood into the aortic arch, there is 
an effort toward straightening the aorta from the pressure, and 
this brings the apex of the heart against the chest wall at about 
the fifth intercostal space. This brings a continuous vibratory 
medium of solid tissue from the point of vibration to the exter- 
nal surface where we may receive it by the ear or stethoscope. 
We also find that the sound is carried to the left axillary region 
along the fifth or sixth rib. The sound is heard over the val- The Significance of Certain Physical Signs. 
169 
vular region at the base of the heart but without characteristic 
qualities. The time of the murmur is during the systole, and 
hence it begins with the valvular click of the first sound and 
ends with the second valve closing at the aorta which gives the 
second sound. 
If the heart sounds are so deranged that it is difficult to 
decide which is the first sound, it may be determined by 
remembering that it is synchronous with the impact of the 
apex against the chest wall, and also with the pulse wave in 
the carotid arteries. The following sphygmogram shows the 
typical disturbance of arterial pressure in mitral regurgitation 
(see Fig. 53). 
The curve is not abrupt in the systole, 
and the pressure is not sustained to the 
dicrotic wave. If the systole is very ener- 
getic the pulse would be large but soft. 
The rhythm is irregular. Fig. 54 shows 
mitral regurgitation with slight aortic in- 
sufficiency. In order to un- 
derstand the meaning of 
these curves, let us study 
briefly the normal pulse trac- 
ing (Fig. 55). " All scien- 
tific investigators agree that the line A represents tne cardiac 
contraction, the impulse being conveyed to the 
needle through the arteries, in the same manner 
that the impulse is given to the last marble in 
a row of marbles by striking the first marble 
in the row a quick blow, the difference being 
that the row of marbles does not advance, while the blood 
current does. This ascent we will call the systolic wave. 
" The arteries thus suddenly filled begin immediately by 
virtue of their elasticity to contract and the needle descends 
to the point B. Next we have a wave, the cause of which is 
not definitely settled. It is generally believed that the wave 
B-C, called the tidal wave, is due to a rebound of the blood 
from the terminal vessels or capillaries, for the following 
reasons: 
" The tidal wave is more perceptible nearer the capillaries. 
" The base of tidal wave approaches the systolic line and 
systolic apex the farther the tracing is taken from the heart, 
Fig 53- 
Fig. 54. 
Fig. 55- 170 
The Significance of Certain Physical Signs. 
"Sweating renders the tidal wave less perceptible and the 
base nearer the dicrotic notch. 
" From C the artery again contracts till the needle reaches 
point D. The rise at D. is generally conceded to be due to the 
rebound of blood from the closed aortic valves and is usually 
termed the dicrotic wave. The remainder of the cycle repre- 
sents the diastole or rest of the heart." * 
Fig. 56 shows a normal pulse of 
high tension and Fig. 57 a normal 
pulse of low tension. The lesion 
that stands second in frequency. is obstruction at the aortic 
orifice -any narrowing of this opening that makes its caliber 
less than that of the aorta will produce a murmur and tend to 
increase the work of the ventricle with resulting hypertrophy. 
It obviously does not menace life and health to the same extent 
as mitral insufficiency. The sound being produced by the 
current forced out by the contraction of the ventricle it must 
be synchronous with the systole and end with the second sound 
of the heart. Its location being at the base of the heart, we 
would expect to find the sound clearest at the beginning of the 
aorta. It is in fact heard most distinctly over the sternum at 
level of the second rib or just to the right of the sternum, and 
is also heard over all the large arterial trunks of the upper 
thorax and neck. It is called aortic stenosis. 
Fig. 58 illustrates the typical pulse tracing 
in this lesion. The systolic curve is not abrupt 
nor high, but the pressure is well sustained past 
the dicrotic notch. The pulse is small and usually regular. 
The third lesion in frecpiency is a regurgitation of blood 
through the semilunar valves from the aorta into the left ven- 
tricle. Evidently this can only occur during the diastole of 
the heart. It should be heard in the same locations as the 
murmur of aortic stenosis, and also down along the sternum. 
The lesion is termed aortic insufficiency. 
The interference with the pulse is shown by Fig. 
59. Its characteristics are marked. The systolic 
curve is high and abrupt. The fall is abrupt. The 
dicrotic wave is small. The pulse is quick and 
strong-the " bullet " pulse. 
Fig- 57- 
Fig. 56. 
Fig. 58. 
Fig- 59- 
* See an article on "Use of the Sphygmograph," by Dr. J. G. Smith, 
in Annual Report of the American Association for Advancement of Physi- 
cal Education, 1888. The Significance of Certain Physical Signs. 
171 
The fourth lesion producing a characteristic sound is mitral 
obstruction due to stenosis of the left auriculo-ventricular 
passage. This would interfere with the passage of blood from 
the auricle to the ventricle in the period of diastole. The 
murmur being started during the stage of auricular contrac- 
tion and ending with the beginning of the first sound; it is 
called presystolic. It is heard over the mitral valve and at the 
apex of the heart, but is not transmitted over a large area. 
This lesion leads to much pulmonary disturbance on account 
of the increased blood pressure in the lungs. 
The fifth lesion is obstruction of the pulmonary orifice from 
stenois. This would place extra work on the right ventricle, 
which hypertrophies by natural accommodation. The murmur 
must be systolic and heard over the second cartilage to left of 
the sternum. It is prolonged upward and to left of the ster- 
num for only a short distance as the artery soon divides into 
small branches to ramify through the lungs. 
The sixth lesion is a regurgitation through the tricuspid 
valves due to insufficiency of the closure. It is systolic and 
causes great increase of venous pressure by the current forced 
back into the auricle and through it into the venous trunks 
causing a venous pulse. It is heard at junction of ensiform 
cartilage with the sternum and to the apex. 
The seventh lesion is an obstruction of the right auriculo- 
ventricular opening by narrowing, and hence the murmur 
must be presystolic. 
It is heard over the middle of the sternum at level of fourth 
cartilage, and is not transmitted except to a slight extent down- 
ward to the end of sternum. It is called tricuspid stenosis. 
The eighth lesion is a regurgitation through the valves 
(semilunar) at the opening of the pulmonary artery, and is 
termed pulmonary insufficiency. It tends to enlargement of 
the right ventricle, and interferes with the pulmonary circu- 
lation and aeration of blood. In time it must be diastolic, and 
is heard at the region of the second left costal cartilage. The 
sound is carried along the sternum faintly. 
A murmur is transmitted, in general, by the blood and 
hence in the direction of the current. The Significance of Certain Physical Signs. 
172 
TABLE OF ABNORMAL HEART SOUNDS. 
Condition. 
Heart Sound. 
Heart Action. 
Where Heard. 
Transmitted. 
Les ion. 
i. Mitral regurg. 
1st, sound. 
Systolic. 
Mitral area and 
apex. 
Along 6th rib to 
axilla. 
Mitral insuf- 
ficiency. 
2. Aortic obstruct. 
Il ll 
Il 
2d. rt. cost, car- 
til. at sternum. 
To top of ster- 
num and ar- 
terial trunks. 
Aortic 
stenosis. 
a 
g 
3. " regurg. 
After 2d sound. 
Diastolic. 
2d. rt. cost, car- 
til. at sternum. 
Down along ster- 
num. 
Aortic 
insufficiency 
£ 
4. Mitral obstruct. 
44 41 ll 
Il 
Mitral area and 
apex. 
Not transmitted 
Mitral 
stenosis. 
d 
O 
o 
C 
w 
5. Pulmon obstruct. 
6. Tricusp, regurg. 
1st. sound. 
Il ll 
Systolic. 
2d. left cost, car- 
tilage. 
Just above ensi- 
form cart. 
Up a short dist., 
ends abruptly. 
Down a short 
distance. 
Pulmonary 
stenosis 
Tricuspid 
insufficiency 
7. " obstruct. 
After 2! sound. 
Diastolic. 
Sternum at head 
of 4th rib. 
Not transmitted 
Tricuspid 
stenosis. 
8. Pulmon. regurg, 
With 2d sound. 
2d left costal car- 
tilage. 
Up a short dis- 
tance. 
Pulmonary 
insufficiency 
If these lesions be tabulated in the order of their frequency 
it will be observed at once that the left side of the heart is 
most frequently affected-all possible abnormalities having 
representation before the most frequent murmur of the right 
side. The reason for this is clear when we consider the vastly 
greater extent of tissues to be supplied by the left side of the 
heart compared with the pulmonary circulation supplied by the 
right. 
The exocardial murmur is due to the movement of the 
heart rubbing two inflamed and roughened surfaces together. 
The pitch is usually high and quality squeaking. It has no 
connection with the valve sounds in time or location-is not 
transmitted in any particular direction and if loud, may be felt 
as a fremitus at the apex beat. It has no influence on the pulse 
curve. 
The Pulse of Mitral regurgitation: 
{a) Compensated, is soft and often large. 
(£) Uncompensated, is soft and short (celer). 
" " " " stenosis is small and soft (sometimes frequent and often 
irregular). 
" " " Aortic regurgitation is quick, large, "shotty pulse" (and 
regular). 
" " " " stenosis is small and long (tardus). 
" *• " Tricuspid regurgitation is venous. The Significance of Certain Physical Signs. 
173 
There is a normal venous pulse. In time it precedes the 
arterial pulse, and may he said to alternate with it. It is 
caused by the auricular systole and the consequent stopping of 
the free current toward the heart. 
The abnormal venous pulse is discovered most easily at the 
lower part of the jugular vein, and is synchronous with the 
arterial pulse, being due to the same cause, namely, the systole 
of the ventricles. This indirect current can be forced into the 
veins only when there is insufficiency of the tricuspid valve. Prescription of Exercise. 
174 
CHAPTER XIV. 
PRESCRIPTION OF EXERCISE. 
The main object of a physical examination is to learn as 
many facts concerning the physical needs and tendencies of the 
subject as possible in order to be able to advise him properly 
regarding his exercise and personal hygiene. Without being 
able to give exactly the measures of a perfect man or woman 
we must have a standard of form and development that is 
derived from a knowledge of anatomy and experience in obser- 
ing the individuals that present the highest evidence of perfect 
health and power. We learn also in a negative way by a study 
of pathological cases. The persons of impaired health can 
usually be so classified in groups with common symptoms that 
certain physical signs will be found common to nearly all in the 
group. Then by a study of the history of these cases we can 
judge with some correctness whether the physical sign stands 
in the relation of cause or effect to the abnormal symptoms. 
For instance, if we group together all cases of organic lung 
diseases such as tuberculosis, chronic bronchitis, recurrent 
attacks of pneumonia, pulmonary congestion, emphysema, etc., 
and find that a very large per cent of the cases have in common 
poorly developed respiratory muscles, flat chests, sagging 
shoulders, etc., with no other common feature, we may 
properly conclude that a chest of this type is not favorable for 
the healthy activity of lung tissue and in no sense is it a model 
toward which we should endeavor to conform the flexible chests 
of our people. 
But our inference might be very far from truth and untrust- 
worthy if we did not also approach the subject from a different 
line of study and reach the opinion in a positive way. We do 
this by grouping the individuals that have proved their ability 
for enduring prolonged mental and physical strain, the superior 
individuals of society, like Bismarck, Gladstone, Greeley, 
Webster, etc. If we find in this group the physical comform- 
ity of chest exactly opposite to our other group, we have added Prescription of Exercise. 
175 
to our knowledge of what should be avoided, a type that may 
wisely be followed. 
It is often a question how far the aesthetic sense may guide 
us in deciding as to a physical standard. The eye will ordina- 
rily be pleased with the form that has scientific perfection. A 
well rounded and developed body is more pleasing than a lax, 
untrained one, but there may be sentimental and unjust stand- 
ards of criticism, the result of faulty training in youth, that 
bias even our judgments of beauty. 
This is seen everywhere in the world of fashion. A head 
of hair that is considered beautiful and becoming one season 
must be bleached or dyed to some other color in order to be 
"perfectly lovely" the next. This depraved taste that ap- 
proves of a pale face and crooked spine in a student, and a 
narrow waist with constricted chest and pelvic displacements 
in a woman, must be educated up to the scientific and artistic 
standard. We must show in the gymnasiums that increased 
health means not only increased ability, but increased beauty, 
and that health is only a correct balance of functional activities. 
It cannot exist in perfection if one part is under-developed or 
over-developed 
This brings us to the first point in prescription. If we dis- 
cover an abnormality of shape due to extraneous causes we 
should first prescribe there moval of these causes when pos- 
sible. To forget this would be to give medicine to counteract 
a poison while permitting the patient to ingest more of the 
deadly substance. In work with both sexes the matter of dress 
should be inquired into where we find any suspicious abnormal- 
ity of shape. This is especially true of constrictions of the 
trunk. Boys will often wear a belt in imitation of some noted 
"slugger" or local " tough," or for other reasons known only 
to themselves. The injurious effects are the same as those 
seen in the case of corset-afflicted women-weak lumbar mus- 
cles, narrow loins, pendent abdomen, varicose veins, costal 
respiration, digestive ailments, etc. 
The muscular weakness cannot be cured while circulation 
is impeded by pressure on the fibres; the narrow waist cannot 
be brought out into correct outline, to give room for a proper 
location of the digestive organs, that would relieve the supra 
pubic distention, while every force is crowding them down into 
the pelvis. 176 
Prescription of Exercise. 
The respiratory act should be unimpeded or imperfect 
oxidation will result and this means virtually an enforced 
vitiated atmosphere. A reduction of waist-girth by 50 mm. is 
shown by Dr. Sargent to reduce the lung capacity twenty per 
cent. A number of persons with an average lung capacity of 
2.70 litres, and waist girth of 710 mm. were found to have a 
lung capacity of only 2.15 litres when the waist girth was re- 
duced to 660 mm. 
A reduction of the oxygen in the air by diluting it with 
nitrogen or carbon dioxide to the extent of twenty per cent 
would soon be disastrous to active life. Again, constriction of 
the waist calls for an entirely artificial method of respiration, 
as has been conclusively shown by Dr. Kellogg, through whose 
courtesy the following illustrations of normal and abnormal 
respiration are given 011 page 177. 
After looking at these illustrations, that explain themselves, 
two questions might be suggested by any person not fully 
acquainted with Anatomy and Physiology: First, Does not the 
amplification of the costal curves during compression show that 
the respiration act is faily complete-one set of muscles acting 
when the other is impeded? This view has been presented in 
articles by Dr. Mays, to which reference has already been made, 
who attempts to show that this method of breathing may tend 
to prevent tuberculosis by causing a better action of the apices 
of the lungs where the disease usually locates. The only sup- 
port brought to this theory was the fact that more men than 
women die of pulmonary tuberculosis, but when we remember 
that this disease is largely due to climatic influences of which 
wide and sudden variations are the chief features, and that 
men are more exposed to these variations than women, the 
argument seems worthless. 
But even if we concede a possible safeguard against tuber- 
culosis in tight lacing we must still look upon it as a case where 
the remedy is worse than the disease, or a disguised blessing 
of the kind described by " Josh Billings," who remarked that 
"tight boots are a blessing, inasmuch as they cause a man to 
forget all his other miseries. " 
Second, If costal respiration is prejudicial to health why do 
we not have a larger death-rate from acute lung diseases and 
other diseases directly traceable to interference with respira- 
tion ? Plate I. 
Costal. Abdominal. 
Fig. 1. Man. 
Costal. Abdominal. 
Fig. 2. Civilized Woman (Unmarried, age 33 years). 
Costal. Abdominal. 
Fig. 3. Chinese Woman. 
Costal. Abdominal. 
Fig. 4. Indian Man (Chickasaw). 
Costal. Abdominal. 
Fig. 5. Indian Woman (Chickasaw). 
Costal. Abdominal. 
Fig. 6. ' Chippeway Indian Woman. 178 
Prescription of Exercise. 
The reply is ready that the impaired activity of one organ 
rarely gives evidence in physical signs of its abnormality. 
Even as sensitive an organ as the brain may disclose its dis- 
ordered function, not by pain in the head, but by the abnor- 
mal secretion in some remote organ; or a disease of the kidney 
be discovered by its causing an organic change in the heart. 
The lungs are ordinarily capable of enduring great hardship. 
Their flexibility enables them to conform to any shape of the 
thorax or to be compressed for a long time by a pleuritic effu- 
sion, or other cause, without permanent injury as is frequently 
seen in cases of extreme kyphosis. According to the statistics 
of the New York Mutual Life Insurance Co., consumptives 
average one and a half inches less in chest girth than non- 
consumptives. 
But meanwhile how fare the organs that are dependent on 
good blood? The brain cannot act well from the instant un- 
oxidized blood flows in to supply it. Lowered vitality is the 
result with a yielding to acute diseases of every kind. Many 
a death is recorded as due to typhoid fever, peritonitis, malaria, 
etc., that is really due to a deficient respiration when the 
system requires the most active oxidation. The respiratory 
power is recognized as of the highest importance in all acute 
diseases. 
The same care must be exercised in judging whether or not 
a bad form is due to faulty habits of posture. If the respira- 
tion is checked by a position that brings a bend in the trunk 
with a depression across the upper part of the abdomen, as is 
the case when one slides forward in his seat until the sacrum 
instead of the ischia bears the weight of the body, the same ill 
results will be found that are noticed in tight lacing. The 
horizontal depression due to the above cause will sometimes be 
found as high as the fifth rib, causing the "creased chest," 
and we can readily understand the interference with circulation 
that must exist in such cases. In all there will be more or less 
distrubance of the hepatic function, impaired digestion, consti- 
pation and atrophy of the lumbar muscles. Correct "form" 
while exercising is of special importance in these cases. 
Attention was many years ago directed to the importance 
of the pelvic position, but comparatively few have undertaken 
a thorough study of what may be considered a normal tipping. 
If we take as the original position the horizontal, we may mea- Prescription of Exercise. 
179 
sure by degrees of an angle the departure of the pelvis from 
this initial position, and thus record what is called the obliqui- 
ty of the pelvis. An instrument, Fig. 37, for this purpose 
was first devised by Dr. Mosher and put into practical use.* 
In the article quoted she gives the results of measuring forty- 
one cases, twenty-three of which represented abnormal condi- 
;ions, while eighteen represented perfectly 
lealthy women. The table here reproduced 
>hows that in every abnormal case the angle 
if obliquity was as small as thirty-four de- 
crees, and in only one case was it over thirty- 
me degrees; while among the healthy women 
examined in no case was the angle less than 
:hirty-seven degrees, and in nine it was as 
arge as forty degrees. The averages were 
28.3° and 40. i°, a suggestive variation. 
Dr. R. L. Dickinson of Brooklyn has 
studied the obliquity of the pelvis and his 
records coincide very closely with those taken 
oy Dr. Mosher. Dr. J. H. Kellogg has also 
studied the importance of the pelvic obliqu- 
ty, and has for many years laid great stress 
rpon the necessity of such posture as shall 
secure a large obliquity. The outline of Fig. 
5o is taken from a drawing made by him to 
illustrate normal healthy poise. The author 
has applied the lines representing the angu- 
lar tip of the pelvis. 
In early life the spine is essentially straight, the vertebrae 
being so related to each other that they represent a slight 
curve with a concavity toward the anterior of the body. At 
this time the pelvis has its brim located essentially at right 
angles to the line of the vertebrae, the legs are drawn up and 
a comparative shortness of the muscles running from the anter- 
ior trunk to the thigh results. When the child begins to stand 
erect the leg must be extended from the trunk, which causes a 
stretching of the anterior groups of muscles, with a consequent 
increased pull upon the other attachments. The rectus femoris 
muscles, attached to the anterior superior spinous process of 
the ilium will tend to powerfully tilt the pelvis down in front, 
Fig. 60. 
* New York Journal of Gynecology and Obstetrics, Nov., 1893. 180 
Prescription of Exercise. 
while the iliacus internus and the psoas magnus will act in the 
same manner, both running over the ramus of the pubic bone. 
While the young animal is creeping the weight of the abdomi- 
nal organs is supported by the mesentery and the abdominal 
wall. When it assumes the erect position the weight is no lon- 
ger largely supported by the abdominal wall, but must depend 
upon the mesentery and the floor of the abdominal cavity which 
will now be formed by the bony structure forming the pubic 
arch. If now the normal process in development of tilting the 
pelvis downward so as to form this solid support for the abdom- 
inal organs is arrested by any process, either rachitic or postu- 
ral, the result will be that the floor of the abdomen will be the 
soft organs contained within the true pelvis, the pubic arch 
taking a position corresponding more nearly to the soft abdom- 
inal wall and forming a lateral support rather than a foundation. 
The hygienic result of this abnormal position will be obvious, 
and if we bear in mind that the haemorrhoidal veins are not 
supplied with valves, we will understand that the position of 
the pelvic bones is of high importance in both men and women. 
The muscular condition of the loins and abdominal wall can 
tell us much about the digestion and nutritive powers. If these 
muscles are weak we must point out the fact with emphasis 
and order such exercises as shall tend to give strength and 
activity to them. The small size of a man's biceps or gastroc- 
nemius often troubles him when his real anxiety should be re- 
garding his erector spinae or rectus abdominalis. A person's 
arm will always be large enough for the ordinary demands of 
life upon it-his heart may not be; his leg will always be strong 
enough to fill every requirement-his stomach may fail utterly. 
A man tmay have life and fair health with complete loss of 
some muscles, while others act at the seat of life itself. 
A class of cases will come under the care of the instructors 
in the gymnasiums of schools and colleges that will be rarely 
met by the directors of other gymnasiums; a set of boys and 
girls who have been overworked mentally and underworked 
physically, until the nervous side of their lives is far in the 
ascendant. The whole idea of their physical exercise has 
become repulsive to them because their muscular tissue is so 
weak that any fair activity begets great weariness, and some- 
times even lameness. Brain work is easy for them because it 
has become the habit of their lives; they can generally accom- Prescription of Exercise. 
181 
plish great feats in the way of bearing severe strains of short 
duration, both mental and physical. They can sit up all night 
preparing for an examination, and the next day are bright and 
ready for good work, or, at the time of physical examination 
they show a surprisingly high record in strength tests, but 
come in the next day to tell of a strained back or lame shoulder 
as the result of their lifting. They make good athletes, but 
are continually getting over-trained. They invariably do too 
much. 
Is gymnastic work advisable for such persons? An affirma- 
tive answer can only be given when there is to be personal 
supervision of the work. The boy of high nervous organiza- 
tion needs exercise quite as much as one who has no tendency 
to abnormal nerve activity, but it must be of a different char- 
acter, for the results sought are dissimilar. The nervous per- 
son does not live enough in his muscles. His habit is to make 
excursions out into his extremities, and after stirring them 
up and making every tissue tingle he retires, to leave every 
muscle exhausted and every energy depleted. The exercise 
prescribed for these cases, and enforced by personal supervi- 
sion, must be light and continued over a long period of each 
day. To satisfy the mental requirement of the case the work 
must be made attractive, either as a game or a personal con- 
test between individuals. In a few cases such an interest in 
the physical welfare can be excited in the subject as to take 
the place of this mental interest that is stimulated by games, 
and a person will do routine work that is laid out simply from 
the enjoyment that he gets from visible improvement. 
Athletic work, on the other hand, is too stimulating to the 
nerve centers to be advisable for such cases. The excitement 
of contests will leave a person exhausted, for it will continu- 
ally lead him to over-exertion. This objection does not apply 
to those contests where skill rather than great strength is the 
source of excellence. 
Many of these persons, if uncared for in the gymnasium, 
would shortly fall into the hands of a physician as typical cases 
of neurasthenia, and rest must often be prescribed instead of 
exercise. The effect of sunlight on these neurasthenic cases 
is almost always favorable, and consequently outdoor work 
should be prescribed in preference to indoor work. 
In marked contrast to the cases mentioned the athlete may 182 
Prescription of Pxercise. 
be placed. Advice in regard to exercise will be sought, and 
such exercise must be prescribed as will tend to secure a 
development of the muscles that are least used in the par- 
ticular form of exercise in which the athlete engages. Again, 
after a severe course of training for any athletic event, many 
cases will find discomfort from local congestions on account 
of an over-activity of the heart during the period when there 
is no great physiological "wear and tear" to require a Very 
active circulation. To meet these cases a course of training 
must be laid out that shall be graduated from heavy work 
down to light, so that the person may slowly accustom him- 
self to the new conditions under which he must live. The 
heart of an athlete, who has been properly trained, is usually 
in good condition, and a very small percentage develop any 
heart lesion during their training, but a large over-strong 
heart may be an actual disadvantage to a man leading a sed- 
entary life, as a puny, feeble heart surely is. 
The examiner will find many cases of nutritive debility and 
irritability. Among men a large per cent of these cases will 
be inordinate users of tobacco. The very first glance will 
betray to the experienced eye the "something wrong," but we 
must always remember that some of the most persistent users 
of tobacco are strong and hearty while a few of those who do 
not use it are weak and nervous. How, then, shall we say to 
a person who asks our advice whether he is suffering from 
nicotine poisoning or not? 
In the first place the heart action under continued influence 
of nicotine is peculiar and attention is called to the sphygmo- 
gram (Fig. 61) of 
a typical pulse of 
a "tobacco heart," 
from the "Refer- 
ence Handbook of the Medical Sciences." It will be noticed 
that the first two beats are essentially normal with the tidal 
wave as marked as the dicrotic. The interval between the 
second and third waves is longer than the first, which may be 
considered the normal for this case. The third interval is 
short and the dicrotic notch deep while the systolic wave is not 
high. The fourth interval is normal; the fifth longer and 
followed by a very faint impulse after which the heart again 
rallies, and so on. 
Fig. 6i. Prescription op Exercise. 
183 
The character of this pulse as felt at the wrist is irregular 
and tremulous. A beat or two of high tension followed by one 
of low, or there may be no rhythm discoverable. 
These cases should be studied carefully and repeatedly to 
distinguish them from the frequent pulse of nervous excite- 
ment or the palpitation and irregularity of chronic indigestion. 
In perhaps three-fourths of the cases there will be some ner- 
vous excitement attendant on the new experiences of a 
thorough examination but this influence on the pulse may be 
either quickening or depressing, and these changes come dur- 
ing cycles covering many pulsations. 
An intermittent pulse may not be an indication of serious 
interference with health or longevity and may not be due to 
any appreciable cause. The omission is then usually found at 
stated intervals not very short, but from ten to a hundred 
beats apart. It is not a condition to safely endure the hard- 
ships of athletic training but vigorous exercise may be pre- 
scribed. 
Of course the examiner's duty is clear in each discov- 
ered case of smoker's irritable heart, and it is only sug- 
gested that other narcotic stimulants, like tea and coffee, will 
produce effects that are nearly similar. In these cases the 
exercise recommended must be light, and such as tends to 
relieve-the circulation. 
In studying the growth of a class in Yale, it appeared 
that if this growth be expressed in the form of percentage 
the weight of the non-users increased 10.4 per cent more 
than the regular users, and 6.6 per cent more than the 
occasional users. In the growth of height, the non-user 
increased 24 per cent more than the regular user and 12 per 
cent more than the occasional user. In growth of chest girth 
the non-user has an advantage over the regular user of 26.7 
per cent and over the occasional user of 22 per cent, but in 
capacity of lungs, the growth is in favor of the non-user by 
77.5 per cent when compared with regular users, and 49.5 per 
cent when compared with the irregular users. 
The matter of tobacco smoking as an influence upon the 
physical development of Amherst students has been studied 
in the history of the class of '91. Of this class, 71 per cent 
had increased in their measurements and tests during their 
whole course, while 29 per cent had remained stationary or 
had fallen off. 184 
Prescription of Exercise. 
In separating the smokers from the non-smokers, it 
appears that in the item of weight the non-smokers have 
increased 24 per cent more than the smokers; in height they 
have surpassed them 37 per cent, and in chest girth, 42 per 
cent. And in lung capacity there is a difference of 8.36 
cubic inches (this is about 75 per cent) in favor of the non- 
smokers, which is 3 per cent of the total average lung 
capacity of the class. 
It has long been recognized by the ablest medical authori- 
ties that the use of tobacco is injurious to the respiratory 
tract, but the extent of its influence in checking growth in 
this and in other direction has, I believe, been widely under- 
estimated. The Examiner Himself. 
185 
CHAPTER XV. 
THE EXAMINER HIMSELF. 
And now a word in regard to the examiner himself: It is 
obvious that a medical training is of very great advantage to 
the person who is to make such physical diagnosis and meas- 
urement as shall be strictly scientific and accurate. If the 
examiner has not a medical education, let him always err on 
the safe side in a doubtful case and require a certificate from 
a physician before entering on a course of advanced exercise, 
or athletic work. But first let him study the case, using all 
the light that can be thrown on it from books and the history 
that can be obtained. The examiner must be a student, he 
must learn, he must study, examining not only the client but 
books, papers, periodicals. Anything bearing on his subject 
should be studied and questioned, but not criticised until he 
is sure of some error; then let him correct the error by show- 
ing its inaccuracy of fact or logic. 
The examiner must have a thorough . knowledge of 
anatomy and physiology, for in no other way can he become 
competent to advise a person regarding either health or 
exercise. To prescribe the same exercise for a person whose 
system is starved by malnutrition that we would for a person 
suffering from plethora would obviously be productive of 
unsatisfactory results both to the pupil and to the teacher. 
It must be remembered that malnutrition may be due to any 
one of several causes, and that while some of these will be 
removed or alleviated by exercise, other's might be seriously 
aggravated. We must know how the machine is constructed 
and under what conditions it can work most favorably before 
we can rightly attempt to adjust its mechanism or interfere 
with its ordinary working. 
It is no longer a question of understanding Physiology 
that we may be able to care for the sick-we must know it, 
that we may understand the law of normal action for every 
organ and that harmonious inter-relation of all that consti- 
tutes health. Health is of more consequence than sickness, 
for it should be the constant condition of life varied only by 
the accidents to which all are subject. 186 
The Examiner Himself. 
Science has taught us that in living organisms functional 
activity must be kept no or there will be no development. 
A group of organs unused will atrophy and become useless. 
Heredity soon stamps a deformity, that has been developed 
in two or three generations, as a type, and succeeding gen- 
erations that do not possess that peculiarity are looked upon 
almost as new varieties. This is especially true of physical 
defects that impair the vitality of the parents. Notice the 
stress laid upon this law by life insurance companies where 
business interests have no bias from sentiment. The excel- 
lent health of the applicant is not enough if there be a record 
going back two or three generations of degenerative diseases 
that have proved fatal, or if the constitutional vigor has been 
so weak as to let the life go out at about forty-five or fifty 
years of age from any immediate cause. 
The .first lesson that we must learn from this truth is that 
health cannot exist if vital organs are seriously undeveloped. 
Health is the condition of harmonious adjustment of all 
the functional activities. For instance: a normal pulse rate 
is from 72 to 76 beats per minute under ordinary conditions 
of rest, but a pulse-rate of 72 after a half-mile run might be 
considered abnormal and the ground for solicitude-for 
health would demand an increased activity of the heart muscle 
to supply increased blood currents to the active muscles, that 
waste products may be eliminated and restorative elements 
supplied. But further: an adjustment of the pulse rate is 
not all that is to be required in the case cited, for there must 
be a corresponding increase of respiration for elimination 
and oxidation. And so the perfect activity of any organ- 
even the brain-may be shown to be dependent on the 
healthy activity of other organs, while the converse may be 
stated as a physiological truth, viz.: that the imperfect action 
of any organ impairs the function of all others to some 
extent. A healthy muscle is, then, dependent on a healthy 
stomach, heart and brain, no less than on good food, air, etc., 
while the more refined intellectual processes are also based 
on a normal condition of the physical organs. 
So practical ajbusiness man as the Hon. Thomas G. Shear- 
man says: "I do not underrate the value of pure mental 
training, especially as that is nearly all which I have myself 
received; but my very lack of training in physical labor has The Examiner Himself. 
187 
led me to observe the great value which it has not merely 
with reference to bodily health and strength, but for the very 
purpose of enlarging the mental faculties."* 
A system of education that has in view the symmetrical 
relations of mental and physical qualities, cannot ignore the 
necessity of beginning physical training with the mental. 
The child should come under the care of an experienced 
instructor in physical training from the day of entrance to 
regular school life. A physical examination should be made 
that should determine the condition of heart, lungs, spine, 
muscles, skin, eyes and ears. Many a case of incipient dis- 
ease that eventuates in disaster, would be discovered, and 
put in the care of a physician, if necessary,' or a correct 
regimen inaugurated with the aid of the parents, that would 
counteract the tendency to disease or deformity and save the 
child as a useful member of society. 
To undertake this important duty will be the function of 
the physical director and the preparation should be careful 
and constant. Let no teacher look upon his position as a 
sinecure. There is work to be done in every field. 
Do not permit the self-satisfaction of conceit to spoil your 
ability for work. 
Do not take the statement of anybody as infallible. If it 
clashes with your own idea, examine it and decide who is 
wrong. 
Do not run after everything new and think that the new 
apparatus will make exercise a pleasure and relieve you of 
your work, or the new idea will save you the trouble of 
thinking. 
Do not go through your work in a perfunctory sort of a 
way, but be enthusiastic and full of interest in those with 
whom you come into the relationship of adviser and 
instructor. 
Be earnest, careful and exact, filled with the spirit of hard 
work, or move on to some less onerous occupation. 
Do not try to find some fault with each person who comes 
under your care, nor continually decry habits that you 
believe to be bad. If you believe, as I do, that the use of 
tobacco is injurious to the majority of smokers, do not tell 
* Report of third annual meeting of American Economic Association, 
Philadelphia, 1889. 188 
The Examiner Himself. 
every person whose breath, "gives him away,'' that he is 
"killing himself'' by smoking, or that he has the "smoker's 
heart'' and must reform at once if he wishes to rob the grave 
of an early victim; for in every such case either you will be 
informed that the smoker has no desire to go into the busi- 
ness of robbing graves or you will be set down as a bigot 
whose opinion is good for nothing, and whose advice is 
worth still less. If a person asks you if you think tobacco 
has hurt him, and you find no indication of injury, be honest 
enough to tell him so, and your candor will so establish his 
confidence in you that the subsequently expressed opinion, 
that tobacco has done him no good, will be likely to set him 
to thinking. At times you are expected to express yourself 
freely, as when lecturing on any subject, but do not try to 
pour a lecture into the unwilling ears of every one who may 
chance to fall into your hands. You do no goo.d but make 
yourself ridiculous. 
Establish a record for honesty and ability and your advice 
will be sought. Integrity is the largest factor in influence. 
Endeavor to find out the actual condition of each organ 
and do not be too quick to decide on the cause of any abnor- 
mality. If the heart action is imperfect and the person uses 
tobacco, remember that there are occasionally "bad'' hearts 
in those who have never "used the weed.'' A lateral curva- 
ture of the spine also may be due to no muscular inefficiency 
or weakness but may indicate good muscular action, as in 
case of a shorter leg on one side. 
Do not be boastful and proudly claim to have discovered 
a new "system''or a "natural'' system of exercise because 
you have by a certain method of life acquired a large biceps 
or general good physique. Your size of arm may have as 
little relation to any system as your size of hat. Because Dr. 
Tanner lived forty days without food he did not establish a 
system of living without food, and because some "Prof.'' can 
live comfortably by breathing only three times a minute it 
does not follow that he has a "system'' all his own; a turtle 
can live all winter on one breath. 
Be conservative and at the same time progressive. Ex- 
amine all that is new, but before you adopt it test it by 
every standard that you can bring into comparison with it. 
Remember that you will probably not discover a great num- The Examiner Himself. 
189 
ber of new truths, nor will you undermine and overthrow 
many of the commonly accepted theories and doctrines that 
have been enunciated in the past. 
Be modest, then, and learn much from others, claiming 
very little as entirely new and your own. At the same time 
it is well to remember that this science and art of Physical 
Education or Training is in its infancy, in this country at 
least, and' there is much work that is experimental and 
tentative. 
Perhaps in no field of scientific research bearing directly 
on practical medicine is more to be discovered and demon- 
strated than in kinetic physiology. The influence of exercise 
on muscle, bone, nerve and connective tissue is not fully 
understood-in fact we are only working at the alphabet of 
the science as it will be developed. Much injury to progress 
has been caused by superficial observation and extravagant 
claims for "systems" and methods that had produced fair 
results apparently with a select few and were then loudly 
proclaimed as a complete scientific exposition of the whole 
subject when they barely rested on a single correct principle 
or physiological truth. When the enthusiasm of the origina- 
tor had died out the illumination was found to be meteoric 
and a general distrust was established. 
A quack in a community injures the reputation of every 
honest practitioner in it. Be content, then, to work a great 
deal and claim very little. Have a scientific theory as a basis 
of your work, but be ready to amend it at any time. Study 
your material and you will find so many facts to be classified 
and arranged that you will have little time to electrify the 
world by some universal specific. If you have no material 
and do not work you will have all the more time to invent 
some startling method that shall make you rich with the 
money of fools but leave science the poorer by a filching of 
her name and reputation. 
Remember that you owe something to your profession. 
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