The selective service act of 1917 brought the first opportunity to take an inventory of the health of the American people. Every man of military age was made liable to enrollment in the fighting forces in the war with Germany, and nearly four millions of the young men were brought into the service. To secure this force, a very much larger number was examined as an astonishing proportion of the young men liable to draft was rejected for physical defects which made them unsuitable for service in the army or navy. The facts were so disturbing that medical authorities throughout the country were set to analyzing the situation. The Club's Section on Public Health took up the subject for examination, and after due consideration requested opportunity to report to the Club their findings and recommendations. The investigations of the Section took up the inquiry into the facts and suggestions as to the remedies to be pursued to correct the conditions shown to exist.

The Board of Governors assigned to the Section the Club meeting of August 19, 1921. The program of the meeting was as follows:

"Health Outlook of the United States in the Light of the Draft Revelations," Dr. H. D'Arcy Power.

"Lessons to be Drawn from the Draft Board Findings," Dr. William Palmer Lucas.

Report of the Section on the Sheppard-Towner and Fess-Capper bills.
Minority Report against the Fess- Capper bill, C. C. Boynton.

Owing to the interest of women in the subject and the circumstance that remedial measures must depend on women, the meeting was made Ladies' Night.

Meeting of August 18, 1921

The regular dinner meeting of the Commonwealth Club of California was held at the Hotel St. Francis on Thursday, August 18, 1921. At the conclusion of the recess that followed the business meeting President T. D. Boardman called the meeting to order as follows:

Remarks by President Boardman

THE PRESIDENT: The Club is to have a report tonight from its Public Health Section. This section was organized some six years ago, with Doctor Ray Lyman Wilbur as its Chairman. During this period it has held many meetings, discussing subjects of interest to the medical mind, and on several occasions has reported to this Club. Those reports have formed the basis of very valuable issues among the Club's published proceedings, notably on the State Hospital Problem, the Malaria Problem, the question of Vivisection. Another very interesting topic which has been the subject of their inquiry is the revelations of the draft examinations. It was very disturbing to learn how large a proportion of the youth of the country were found physically unfit, as well as how large a proportion were illiterate. The inquiring mind, particularly of the medical fraternity, was at once interested in seeking the cause of that condition. It is yet to be determined whether the nation will profit by this lesson and other lessons of the war. Its importance is not related merely to the military strength of the nation, but more particularly to its economic welfare.

The first paper will be on the subject "Health Outlook of the United States in the Light of the Draft Revelation." I will call on Doctor H. D'Arcy Power. (Applause.)

The National Health as Revealed by the Draft Examinations

By H. D'Arcy Power

DR. POWER: In the symposium on the national health, the matter consigned to my care, is a presentation of the statistical findings of the examining boards. I feel sure that you will have due pity inasmuch as statistics are stated to be either as dry as dust or on the other hand, that nothing can lie like statistics; but there occurs to me that the great English statesman, William Ewart Gladstone, was in the habit of holding his audiences spellbound in the presentation of the national budget, and that on one occasion I had the pleasure of listening to a famous American Indian great great grandmaster, I believe, of the

Order of Foresters, who really kept us interested for two hours and a half on a presentation of the statistics concerning the merits of his organization. I may therefore hope, without drawing too much on the romance side of statistics, to interest you in what are probably the most valuable of all collected data concerning our present health, and the probable future of the health of the nation. In fact, it is not an exaggeration to state that the very question of whether there is to be any nation at all, is involved in a proper realization of what these figures portend.

In the year 1917, we commenced to examine the young men of America for military service, and after one million had passed the ordeal, the publication of the results led to general consternation and not a little scare literature. We had been priding ourselves on the virility of our manhood, one hundred per cent Americans putting all other nations into the shade, and here were the drill masters, foresooth, telling us that not fifty per cent of our men were fit to carry a gun. Since then we have examined close on three million men, and the results have now been duly sorted and labelled and are at our disposal to draw what deductions we may. The ponderous tomes that contain these findings are not light literature, but I hope to extract therefrom some of the salient features. The material from which I propose to give you excerpts is first the report of Surgeon General Rupert Blue in the American Journal of Public Health, September, 1919; the Public Health Report of the Treasury Department, No. 13, Vol. 34, March 28, 1919; the report of the War Department, Defects found in Drafted Men, Edited by Surgeon General Ireland in 1920; the latter is a very extensive report, and, as being of later date, is the source of most of the statistical information to be given. It deals with 2,750,000 men, from the ages of 18 to 30, with the maximum approaching the latter age. It enumerates both the defectives and the rejects, with their classification. Lastly, I shall quote from the papers of Frederick Hoffman, on Army Anthropometry, published by the Prudential Press, Newark, New Jersey, 1918.

It is first necessary to consider the value of the figures, as there has been variation in their quotation, and in the deductions drawn by different writers, the causes being two-fold: Figures drawn from local sources as against the total results, and secondly, the confusion of defectives with the rejections. Both these troubles are due to carelessness and are eliminated in this report. Real sources of error are, first, variations in the standards of the examiners; but as we are

dealing with nearly three million men, who were passed through the hands of from four to twelve examiners apiece, the inequalities must be fairly well balanced in the immense totals. A second source of error lies in the fact that the maximum age was thirty years; a very large proportion of active manhood is of greater age than this, and between thirty and fifty defective conditions of the constitution latent in the early years become active. It thus appears that in comparing the incidence of heart disease, blood vessel and kidney disease, as recorded by the Prudential Life Insurance Company, in nearly a million cases; the figures are much higher than those found by the draft examiners, the actual numbers being: draft examinations under thirty, 16 per cent; Prudential Insurance examinations, thirty to fifty, 56 per cent. Thirdly, the draft examiners were in a certain class of cases unable to afford the time for the detection of defects actually present. I believe the errors so caused would not materially affect the final results.

I wish at this point to state that the figures hereinafter given will deal not with rejections for military service, but solely with defects found, the reason for the choice being as follows:

Army rejections consider only the possibility of making use of the human material for fighting purposes, and their decisions are not based upon the possible effects of their choice on the individual, but rather upon the military necessities, and as these necessities become more acute, the standard for rejection continually falls. So we find that in times of peace, when men are many, and requirements few, the United States authorities have rejected as much as seventy per cent of the applicants, while with the greater needs consequent on war, the rejections fell to thirty per cent, and a portion of these were accepted only for lighter military duties. As these standards change from time to time, it is impossible to draw any health conclusions therefrom, and we fall back upon the safer ground of considering defects actually found. Of the 2,750,000 men, forty-seven per cent were found to have some serious defect, and if we consider multiple defects, the figure will be fifty-six per cent. It is safe to assume a figure between the two and give fifty per cent as the general average of defectives. When we examine the total enumerated defects, with the view of determining the national health, we shall find it necessary to segregate there from defects which are due to causes common to the whole organism, and having a direct bearing on the duration of life and the character of the coming generation. We shall therefore have to separate the defects into two classes: those that have military

importance and those having social importance. These latter will include the diseases of development, such as defective height, weight and embryonic conditions, diseases of the great vital systems, heart, lungs, blood vessels and brain, and diseases that are dependent upon lowered resistance, such as tuberculosis. Such a group will not include mechanical defects of the limbs or sense organs, and so constituted, will amount to about fifty per cent of the total defects. As these amounted to fifty per cent of all examined, we shall be safe in assuming that twenty-five per cent of the young men of the nation show conditions that are likely materially to affect their future, with another ten per cent to be added to this, if the age limit were extended to fifty years. This seems, and undoubtedly is, a terrible bill of health. The worst auguries have been drawn by different writers, but to consider it in a proper relation, it should be placed in comparison with the results of army examinations in other nations, and with the findings of examining bodies dealing with non-military material. It is a matter of much regret that comparison with foreign countries is made almost valueless by the collectors of such information presenting their statistics solely from the standpoint of military utility. And so we have most varying standards set and no classification of diseases upon any common basis. It is, however, worth while to give some figures which are a little comforting. Thus Alfred Hoffman, in the paper referred to on anthropometry, gives for the German army, fifty-three per cent rejections; for the Austrian army, fifty-one per cent; for the Italian, up to twenty-nine per cent; for Switzerland, forty per cent; for Scandinavia, up to forty per cent; for Belgium, thirty per cent; for Great Britain, from thirty to forty per cent. It does appear that in comparison with other countries our thirty per cent is not excessive. It is most unfortunate that the European statistics as to the causes of rejection are given such a varying classification that it is not possible to compare them with our own or with one another, and still more so that the total defectives are not enumerated at all.

When we turn to our own draft findings with the view of ascertaining the racial distribution of defects, we learn that the analysis of the returns is not completed to the point of allowing of an accurate distribution of defects to each particular race. Something approaching this, however, has been effected by classifying sections of the country according to whether they contain certain proportions of given foreign races. We are thus able to note the total effect on such a section as compared with other sections and the norm. Surgeon-General Ireland's report summarizes these statistics as follows: