"The Negro race is characterized by an abnormally high amount of venereal disease and its sequelae, such as valvular heart disease, arthritis and ankylosis, by hemorrhoids, by poor emotional control, including tachycardia, hysteria, and psychasthenia, by relatively little otitis media, deafness, or defect of vision (though by much blindness of one eye), by little diabetes, spinal curvature, cryptorchidism, flat foot, and by many bullet and other wounds.

"The Scandinavians are characterized by a slight amount of venereal disease, by relative freedom from hallux valgus, but by much flat foot and by a tendency to hernia. The German groups are characterized by neurasthenia, psychoneuroses, and various psychoses, but by relatively little mental deficiency; by an excess of myopia and curvature of the spine. The French Canadian group shows an extraordinary excess of defects in various important respects, such as tuberculosis, spinal curvature, deaf-mutism, mental deficiency and psychoses, refractive errors, otitis media, defective hearing, asthma, bad teeth, hernia, deficient size of chest, and height and underweight. The sections of which the French Canadians form a predominant factor are among the poorest from the military standpoint.

"The groups occupied largely by Indians and Mexicans are characterized by a large amount of tuberculosis, by venereal diseases, by ankylosis, cleft palate, and harelip. There is an intermediate amount of hernia and a low rate of valvular diseases of the heart and deformities of the hand.

"The mountain whites constitute a sub-race of the whites occupying the southern Allegheny mountains. They are characterized by an exceptionally high proportion of mental defect and mental disease, by varicose veins, by numerous deformities of the extremities and by underweight."

A broad view of this matter may be obtained by comparing the number of defectives per thousand in each state, which shows a variation of eight hundred in Rhode Island to 420 in Kansas. The government summarises this part by stating:

'........the northeastern part of the country appears to be characterized by congenital defects, and those of city life. The northwest is characterized by deformities due to accidents, by goiter, and by flat foot. The southeast is characterized by venereal diseases, hookworm, and similar other complications, including blindness of one eye, arthritis and anklylosis, underweight, mental defect, emotional disturbances, pellagra, hernia, loss of upper extremity, and bullet or other wounds. The southwest is characterized by tuberculosis, drug addiction, hypertrophied tonsils and hernia. The northern central area is contrasted with the southern central by having more goiter, less tuberculosis, much less venereal disease, more varicocele and more varicose veins, more valvular disease of the heart and cardiac hypertrophy and dilatation, more deficient teeth, more psychasthenia and constitutional psychopathic states. It is characterized by more otitis media, errors of re

fraction, diabetes, curvature of the spine, defects of genitalia and weak feet, but less epilepsy, blindness of one eye, pellagra, loss of upper extremity, bullet and other recent wounds, underweight, and deficient chest measurement.”

Reviewing the figures in relation to our future, it is first desirable to observe that a certain proportion of the seriously defective are afflicted with conditions that could be eliminated. Thus the eleven per cent of the tubercular and syphilitic divisions might be led to largely disappear. There remains, however, a residium consisting of the heart-kidney group, and mental deficiency cases, that other statistical inquiries show to be increasing in our midst, and that seem to be inherent in the nature of our civilization. Fundamentally all these cases are due to nervous strain; this, when acting on the body, causes contraction of the arteries, overwork of the heart, involvement of the kidneys and final breakdown, a picture that our business men constantly illustrate, or the brain itself directly fails with an increasing proportion of mental disease. It is very doubtful whether the figures given by the draft examination tell the whole story. Thus Dr. William House, writing on the results of the examination at Camp Devons, says that:

"It may be pointed out that the total number of subnormal and defective people in the United States is estimated at about three per cent. My own estimates are that there are almost exactly three in every thousand confined in insane asylums, two in every thousand who are epileptic, fully as many as both of these together are borderliners or easily recognized feeble-minded, and the entire number thus made. can be doubled, if all the constitutionally inferior are added. This does not include the host of people who get along well enough, provided they are not subjected to strain or stress, but if one includes all the great criminal, pauper and semi-pauper classes, the total number neuro or psychologically deficient will approximate ten per cent of the total population. It will be seen that the diseases of the nervous system play a large part in our national life.

"I believe that from three to five per cent of the conscripts even as they pass the exemption board, will eventually be weeded out because of affections of the brain and nervous system or of constitutional inferiority which renders them unfit to serve as soldiers. If this number seems large, bear in mind that not much more than half the male population in the conscription age is physically fit for soldiers, if all causes for exclusion be considered."

This is probably the most ugly picture that the investigation presents. Unless we can change the mode of life that modern civilization has brought with it, which nothing but a profound alteration of our

economic system can effect, the proportion of mental and physical failures must increase.

Another factor to be borne in mind is the biological complexion of the years to come. The statement already made that certain sections of the community, with occupational or racial peculiarities, show vastly different proportions of defectiveness, and that in this relation some of the oldest elements of our population have the highest defectives, is food for thought. Some of these elements, such as the Anglo-Saxon colonial type, have been shown by other statistics to be slowly disappearing as the result of a deficient birth rate; others, such as the French Canadian group, have a high birth rate and an equally high defective rate, the total result being an increase in the total proportion of defectives, and it is worthy of note that in this particular group, consanguinity is the probable source of the defects from which they suffer. The whole subject needs most careful further statistical inquiries, with the likelihood that it would point to a fundamental alteration in the racial character of the coming populations of the United States, some of the elements whereof are of very sinister omen. The black problem, viewed in the light of these statistics, is blacker than ever. The Southern States, with a large negro population, showing the largest number of defectives with the largest number of vice defectives. Finally I must refer to the State of California, which is unfortunately placed in the list of States, ranking with the worst in the percentage of its defectives, in the percentage of its rejections; and in the latter case the figures are made worse by its standard for rejection being amongst the lowest. But California is the State of refuge for the health failures of the other States and were all the imported tuberculosis and other wrecks eliminated the report would tell another story.

Taken all in all, the figures show a very serious condition of the present health, with equally serious warnings for the future; but there is no evidence to show that the United States is materially worse off in these respects than other countries of a similar grade of industrial organization. (Applause.)

Remarks by President Boardman

THE PRESIDENT: When the Section on Public Health was organized some years ago, Doctor William Palmer Lucas was made vicechairman. He directed, in part, the activities of the section until his leaving, I believe, for Europe where he and Mrs. Lucas contributed most excellent work during the war. It is my pleasure to introduce Doctor William Palmer Lucas who will speak on the subject, "Lessons to be Drawn from the Draft Board Findings."

Lessons From the Draft

By William Palmer Lucas, M. D.

University of California Medical School and Hospitals

DR. LUCAS: You have heard Dr. D'Arcy Power's admirable analysis of the findings of the draft board as related to the men of this country. As he very forcefully stated, it is a question whether there is to be any nation at all in the future if conditions which were found by the draft board are allowed to continue. In health matters it is much the same as in business, if the tendency is downward, this is likely to increase rather than decrease by its own momentum unless something is done to check it. In business when such conditions are found, one of the first steps taken is to make an inventory, take stock of the business assets and liabilities and see whether the assets can not be increased and liabilities decreased.

As Dr. D'Arcy Power told you, forty-seven per cent of the defects. found were serious ones. There were fifty-six per cent of multiple defects, making an average of fifty per cent of serious defects. Of these, fifty per cent were military defects and did not necessarily handicap the individual for civil life, but fifty per cent were social or racial defects and very likely to affect their future.

Among these defects the most important were those connected with heart and kidney diseases. These conditions have been showing a marked increase, which is undoubtedly due to the type of nervous strain which is inherent in our modern civilization, but much of which could be obviated if proper living and hygiene could be adopted. Mental deficiency and nervous disorders showed up in alarming proportions. The analysis of the venereal diseases showed that these conditions were more prevalent among civilians than among soldiers. The defects. which are most common and which show definite effects on the efficiency of individuals are those connected with eye conditions, throat conditions and with the teeth.

One of the most important results of this analysis shows that for every 100,000 men examined in this country there are 3,500 more defects in aliens than in native born Americans. This should emphasize the importance of more strict regulations in admitting aliens to this country. The defects found in aliens are not only physical ones but mental and nervous ones as well. Although there is wide variation in the regional distribution of defects in this country, California with all that nature has bestowed upon her shows a very high percentage of serious defects.

During the draft period it was possible to examine our recruits most carefully and to study the effect of enforced rules of hygiene. The improvement which was shown in the men after they had been in the army for several months was very marked. The periodic examinations which the men had to undergo demonstrated the beneficial results of the army life and routine. Such a routine is of course impossible in civil life, but a certain approach to it could be developed if the defects which are preventable could be cared for early. This can be achieved only by constant supervision. I think that the repeated and constant medical supervision of men in the army has demonstrated to many thousand of men the need of this.

An analysis of the defects shows that most of these must have occurred during childhood. At least the seeds for these defects must have been present many years before the draft age. If we are to benefit from the findings of the draft board we must have more complete physical examinations in our schools so as to detect the preventable defects. Not only are physical examinations necessary but also mental and psychological examinations should be more generally adopted, combined with a study of the home environment, and opportunities for health recreation and for the correction of defects should be found. It does very little good to enumerate physical or mental defects without having some rational means of correcting these defects.

We are, of course, very much more interested in our own local conditions than we are in general statistics. For this reason I have collected some of the San Francisco statistics relating to conditions which might have been prevented. In the list of deaths which occurred in San Francisco in 1919-1920, there were 6,426 deaths which can be placed in the preventable list. If for the sake of argument we say that at least fifty per cent of these might reasonably have been prevented, we have a figure of 3,213 deaths occurring during that year which might have been prevented.

The mortality of these preventable diseases is as follows:

Diseases of the circulatory system, 1,429 deaths; diseases of the respiratory system, 766 (not including tuberculosis) and 166 of these deaths occurred among children. Deaths due to diseases of the digestive system number 454, and 117 of these were in children under fourteen years of age. The genito-urinary system claimed 546 deaths. Under the group of the general diseases including tuberculosis and the contagious diseases there were 2,525 deaths, and 314 of these were in