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| _ STATISTICS
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By
FREDERICK IL. HOFFMAN, LL. D.
Third Vice President and Statistician The Prudential Insurance Company
of America, Member of the Committee on Anthropology and
Chairman of the Sub-Committee on Race in Relation
to Disease (Civilian Records) of the National
Research Council, etc.
A | a Sian leek OF PAPERS
read before the
- National sy of Science, Philadelphia, November 21, 1917
and the American Statistical Association
Philadelphia, December 28, 1917
thoroughly revised and brought down to date
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ARMY ANTHROPOMETRY
AND MEDICAL REJECTION
STATISTICS
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"e.. - BY
ees
FREDERICK L. HOFFMAN, LL. D.
Third Vice President and Statistician The Prudential Insurance Company
of America, Member of the Committee on Anthropology and
Chairman of the Sub-Committee on Race in Relation
to Disease (Civilian Records) of the National
Research Council, etc.
A consolidation of papers read before the
National Academy of Science, Philadelphia, November 21, 1917
and the American Statistical Association
Philadelphia, December 28, 1917
thoroughly revised and brought down to date
LA\BRARy
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fAsity oF 18
* 1918
PRUDENTIAL PRESS
NEWARK, N. J.
Ui SAe
TO
THE COMMITTEE ON ANTHROPOLOGY OF
THE NATIONAL RESEARCH COUNCIL
LIST OF SCIENTIFIC PUBLICATIONS
| OF
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
AVAILABLE ON REQUEST
By the Hon. John F. Dryden:
(1) The American Type of Isthmian Canal, 1906.
(2) Addresses and Papers on Life Insurance and Other Subjects, 1909.
(3) Uniform Laws and Legislation on Life Insurance, 1910.
(4) Industrial Insurance, Past and Present, 1912.
By Frederick L. Hoffman:
(6) Rural Health and Welfare, 1912.
(7) Exhibits of The Prudential Insurance Company of America, International Con-
gress of Hygiene and Demography, 1912.
(7a) Seventy-five Years of American Economic Progress, 1914.
(8) The Significance of a Declining Death Rate, 1914.
(10) Practical Statistics of Public Health Nursing, 1914.
(11) Industrial Accidents in Different Occupations, 1914.
(13) American Public Health Problems, 1915.
(14) The Documentary History of Insurance, 1915.
(15) The Mortality from Cancer Throughout the World, 1916.
(16) The Sanitary Progress and Vital Statistics of Hawaii, 1916.
(17) A Plea and a Plan for the Eradication of Malaria, 1917.
(18) Facts and Fallacies of Compulsory Health Insurance, 1917.
(19) Weekly Index Numbers of National Health and Well-being, 1917.
(20) The Mortality from Degenerative Diseases, 1918.
(21) The Malaria Problem in Peace and War, 1918.
(22) The Tuberculosis Death Rate in 1917, 1918.
(23) The Typhoid Fever Death Rate in 1917, 1918.
(24) Army Anthropometry and Medical Rejection Statistics, 1918.
By,Frederick S. Crum:
(1a) A Statistical Study of Measles, 1913.
(2a) A Statistical Study of Whooping Cough, 1914.
(3a) Medical Inspection of Schools—a Factor in Disease-Control, 1915.
(4a) Anthropometric Table; Children Aged Six to Forty-eight Months, 1916.
(5a) The Mortality from Diseases of the Lungs in American Industry, 1916.
CHARTS (514x8} inches)
I Mortality from Cancer (21 charts).
II Mortality from Tuberculosis (21 charts).
III Mortality from Measles (6 charts).
IV Mortality from Whooping Cough (4 charts).
V Mortality from Accidents (24 charts).
VI Mortality from Typhoid Fever (1 chart).
VII Mortality from Infantile Paralysis (1 chart).
VIII Mortality from Diphtheria (5 charts).
IX Mortality from Malaria (15 charts).
X Mortality of United States and Germany (3 charts).
XI Army Anthropometry (4 charts).
CONTENTS
PART I
GENERAL ARMY ANTHROPOMETRY
Urgency of better standards of physical examinations
The examination of recruits by officers of the line
The sphere and function of physical anthropology
Recommendations of the Committee on /ntheopolagy of the Na-
tional Research Council
The need for a national anthropometric survey
Rules for the preliminary physical examination
Inadequacy of examinations by officers of the line
Obscure evidences of physical maturity
Stigmata of degeneracy....
Limitation of army rejection experience
Recruiting experience under voluntary enlistments
Inconclusive statistics of physical deterioration
Conflict of medical and non-medical considerations in recruiting........
A decade of United States recruiting statistics
Important changes in recruiting standards
Changes recommended by the Committee on Anthropology of the
National Research Council
Race in relation to normal stature
Statistical and mathematical considerations of frequency distribu-
tion in physical proportions
Standard methods of anthropometric measurements
Stature of accepted United States recruits under the voluntary sys-
tem of enlistment
Race in relation to frequency distribution of stature
Race in relation to weight
Race in relation to chest measurements
Standard of physical proportions adopted May 18, 1917
Analysis of foreign recruiting statistics
Index of vital resistance
Limited value of recruiting data
Race in relation to physical proportions
Recruiting statistics of Prussia
Stature of German conscripts
Inconclusive army rejection data
Rejection data of the German army
Geographical variations in the causes of rejections
5
11
13
14
15
16
17
18
19
20
21
“Ze
23
24
26
27
28
29
31
33
35
38
39
4]
46
46
47
48
49
50
51
32
53
55
CONTENTS—Continued
Recruiting statistics of Austro-Hungary
Recruiting statistics of France
Variations of stature of European armies
Recruiting statistics of Italy
Medical causes of rejection in the Italian Army
Recruiting statistics of Switzerland
Recruiting statistics of Scandinavian countries
Recruiting statistics of Belgium
Recruiting statistics of Holland
Recruiting statistics of Russia and Finland
Recruiting statistics of Great Britain
Recruiting statistics of Japan
Recruiting statistics of the United States
Comparative causes of rejection for military service
Causes of rejection in the German army
Causes of rejection in the Austro-Hungarian army
Causes of rejection in the French army
Causes of rejection in the Swiss army
Causes of rejection in the Italian army
Causes of rejection in the Belgian army
Causes of rejection in the Dutch army
Causes of rejection in the Swedish army
Causes of rejection in the Norwegian army
Causes of rejection in the British army
Causes of rejection in the United States army............
Causes of rejection—white recruits only
Causes of rejection—colored recruits only
Causes of rejection—native and foreign-born recruits
Causes of rejection—Filipino and Porto Rican recruits
Part II
RECENT UNITED STATES ARMY MEDICAL AND REJECTION |
EXPERIENCE DATA
Discretionary powers in physical examinations
Negative evidence of physical deterioration
Important changes in rules and regulations
Examinations by officers of the line
Examinations by civil medical officers of local boards
Army rejection experience in Greater New York
Effects of discretionary powers on the rejection rate
Misleading conclusions regarding physical rejections under the
first selective draft
82
83
84
85
86
88
89
90
CON TENTS—Continued
Misleading use of army rejection experience under the voluntary
_ system 91
Comparative rejection statistics of life insurance experience_......__. 92
Important changes in the rejection rules under the selective draft.. 93
The possible saving in man-power and gain in military efficiency
under the new regulations 95
Results of the army rejection experience in the United Kingdom.... 97
Urgency of a national anthropometric survey and new physical
standards : 98
New standards of physical examination 99
The age period of military service in time of war. 102
APPENDIX A
Examination blank tentatively recommended by the Committee on
Anthropology of the National Research Council........................ 104
APPENDIX B
Anthropological survey recommended by The Royal Anthropological
Institute 105
APPENDIX C
Graduated numbers of the male population of the Continental
United States, ages 18-49, by single years of life and conjugal
condition, estimated for the year 1918 112
APPENDIX D
Two letters on unnecessary rejections on account of deficiency in
stature (New York Sun) 113
CHARTS
Comparative stature of conscripts and recruits 32
Stature of United States recruits, 1906-1915 36
Weight of United States recruits, 1906-1915 42
Chest measures of United States recruits, 1906-1915 44
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Preparation.
(1) Select the best lighted part of the available wall space. If a
choice is possible, select the side in which the light will strike the
recruit from the left side. |
(2) Measure with tape A exactly three feet from the floor, and make
. a horizontal line at that point.
(3) Fasten tape A with a couple of suitable tacks or nails, vertically
on the wall, in such a way that its lower edge coincides with the
three-foot mark. The top of the tape will now be 7 feet from
the ground.
Directions for Measurements.
1, Height—Stand recruit, in bare feet and without coat against the
tape on the wall.
See to it that he stands straight, but without straining or stretch-
ing, touching the wall with his heels, buttocks and shoulders, and
holding his head so that he looks straight forward. The head
may touch the tape on the wall, but does not need to do so.
Apply wooden square horizontally to tape on the wall and bring
it down on the head of the subject, with sufficient pressure
* There is a probable: inconsistency in the recommendation for a three-foot tape-measure
for chest measurements. It would probably be best to furnish the examiner with a standard
tape-measure of not less than forty-eight inches; while for height measurements a measure
of seventy-two inches would probably be preferable to one of forty-eight inches, placed
thirty-six inches above the ground.
34
ripe
to feel the hard calvarium, and carefully note measurement, to
the nearest 4% of an inch.
2. Circumference of Chest—The recruit faces the light as well as
the examiner.
_ The elbows are raised somewhat (about 45 degrees from the
body). Facing the recruit the examiner passes the tape behind
the body. One end held in the left hand is pressed against the
middle of the chest on a level with the nipples while the other
end is brought around by the right hand until the overlapping
permits of correct reading.
Record measurement in utmost expiration and deepest inspira-
tion.
Sources of error to be strictly avoided: Conversation during measur-
ing; interruptions; incortect reading of scale; incorrect record-
ing. ’
(The suggested measurements would not require any very consider-
able degree of scientific skill and as regards cost it was estimated that
the total amount would be less than $1 for each set of instruments as
required for each recruiting station.)
STATURE OF ACCEPTED UNITED STATES RECRUITS
UNDER THE VOLUNTARY SYSTEM OF ENLISTMENT
As a practical illustration of the truly immense opportunity for the
scientific ascertainment of the varying bodily proportions among men
of military age, the following table shows the observed number of
recruits at various ages in the experience of the United States Army
during the period 1906-15. *
OBSERVED NUMBER OF RECRUITS AT VARIOUS AGES
_ UNITED STATES ARMY, 1906-1915
eg 18 19 20 21 22 23 24 25and Over
63 219 i189 = 118 617 345 211 228 1305
64 1453 986 574 3910 2079 1713 1546 8534
65 2487 1626 924 6453 3390 2771 2572 14404
66 3087. 2109 1125 9013 4755 3767 3554 20162
67 3112 2171 1281 10621 5472 4176 3997 22416
68. 2773 «291918 1103 «10298 )3=—s «5461S 4361 = 4095 = 22162
69 1887. 1328 796 8165 4255 3356 3291 17473
70 1064 S33", 517° S408" 2001 2375 2259... 12197
71 477 400 270 3051 1642 1249 1295 6670
Total 16559 11560 6708 57537 30390 23979 22837 125323
*In this computation all the statures below 63 inches and all those above 71 inches have
been omitted. The nine-inch interval was chosen because of the fact that a very few tall
and a very few short recruits would tend to copes any indications of change in stature
among the greater bulk of younger members. The computed frequency curves must there-
fore not be confused with data on page 39 showing the whole range of variation or with
the frequency curve for recruits of all ages.
35
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This table represents the measurement of 294,893 recruits. Unfortu-
nately and in obvious disregard of scientific requirements the results for
the measurements for ages 25 and over are given as a group. Theaverage
for such a group including all ages up to the military limit must neces-
sarily be misleading and utterly inconclusive, since this group includes
125,323 measurements, or 42.5 per cent. of the total measurements,
at all ages. The scientific error of returning the results for ages 25 and
over in the aggregate is of sufficient magnitude to seriously impair the
_ value of the returns as a whole. For the purpose of ascertaining the
frequency distribution of stature in relation to age, the returns should
have been given by single years of life, certainly up to age 40; and if
this had been done, the results would have been much more valuable
in their application to practical uses than as published annually in their
present form in the Surgeon General’s report.
Fitting the above data to frequency curves, Mr. Fisher has
obtained for me the following values for the various statistical
parameters:
FREQUENCY DISTRIBUTION OF STATURE, UNITED STATES
ARMY RECRUITS
1906-1916
Statistical Parameters
Age - Dispersion Skewness Excess
18 66.900" inches 1.855 inches —0.0283 —0.0269
19 66.965 1,898 —0.0235 —0.0275
20 67.024 “ 1.936 “ -0.0018 —0.0290
21 67.329 “ Oe as 0.0009 —0.0303
22 67.341 “ 1545 °"% 0.0024 —0.0310
23 67.329 “ 1939 “ 0.0004 0.0325
24 67.367 “ 1948 “ 0.0027 —0.0321
25andover 67.325 “ 1948 “ 0.0011 —0.0317
The theoretical frequency distribution per 1,000 recruits at single
years of life under age 25 and at ages 25 and over, considered as a
group, is as follows:
FREQUENCY DISTRIBUTION OF STATURE, UNITED STATES
ARMY RECRUITS
1906-1915
(Based on the heights Bes Fila 63 and 71 inches)
Inches 718 20 22 23 24 25 and Over
62 2.9 35 52 24 Bed. 2.4 25 2.4
63 24.2 24.7 26.4 17.9 18.4 18.3 17.9 18.1
64 74.7 73.3 71.1 54.6 55.3 55.9 54.6 56.5
65 142.9')) 135.7)» 127:2): © 109.7)» 109.3 111.5 108.1 111.3
66 pene © 182.7 1725 160.7 .. 158.9. .159.8. 157.6 160.9
67 195.7. 1922 187.7 1860 1838 183.7 182.4 184.6
68 166.9 1678 1728 1810 1799 1789 179.6 179.1
6 116.1 121.2 1294 1459 1470 146.0 = 147.7 145.0
70 61.0 66.7 72.9 91.4 92.2 91.6 94.7 90.6
Moo, 4 200 25.6 28.6 39.7 41.1 40,7 42.8 40.3
~42 4.7 6.2 6.1 10.3 10.7 10.6 11.4 10.5
73 0.1 0.4 0.1 0.4 0.7 0.6 0.7 0.6
37
RACE IN RELATION TO FREQUENCY DISTRIBUTION
OF STATURE
Apparently the intensity of the variation in stature increases with
the age as indicated by the dispersion or standard deviation. ‘The
skewness remains negative up to age 21, but from that age onward it
is positive. According to Mr. Arne Fisher, “The figures seem to
indicate that bodily growth in respect to height to all practical purposes
is completed between the ages of 20 and 21, and that from this period
onward the statistical parameters remain practically constant.” ‘This
conclusion, however, might be modified if the details for single years
of dife subsequent to age 24 were available. The anthropometric values
for adult ages are of a much higher degree of practical utility than has
thus far been recognized. The most notable contribution to the study
of this important aspect of physical anthropology is the results ob-
tained by the Medico-Actuarial Committee from the experience of
American life insurance companies. ‘The scientific value of these results,
however, is materially impaired by the fact that the measurements rep-
resent a heterogeneous group, just as this was thecase with American re-
cruits previously to the present war. Indifference to the factor of race or
racial inheritance of bodily physical proportions impairs aggregate data
representative of widely varying types of mankind. Comparing the
frequency distribution of the heights of American males as ascertained
by the Medico-Actuarial investigation with the heights of United States
Army recruits, it becomes apparent that either the measurements were
wanting in accuracy, or, as is more likely, that the results represent a
compound curve consisting on the one hand of males above average stat-
ure typical of the native United States population, Scotchmen, Scandi-
navians, etc., and males of short stature typical of Southern European
races. A compound frequency curve for such heterogeneous elements
cannot possibly be relied upon as trustworthy for scientific and a variety
of practical purposes unless the relative racial distribution is known
with at least approximate accuracy. A critical examination of the
corresponding curve for Italian recruits exhibits a somewhat similar
phenomenon. Obviously the inclusion of the short-type recruits from
the southern provinces with the relatively tall-type recruits from the
northern part of Italy in one curve yields results practically applicable
to neither group but representative of a non-existing type, which, of
course, is scientifically misleading.
In the United States Army the racial aspects of army recruiting
have been limited to the whites and the negroes, or persons of
African descent, the Indians and the Filipinos. The essential statistical
facts of the recruiting physique of the whites and of the negroes are
presented in the following series of tables:
38
q
4
:
DISTRIBUTION OF STATURE ACCORDING TO AGE OF ACCEPTED
UNITED STATES RECRUITS (WHITE), 1906-1915, PER 1000 -
18 Years 26 All
Height and Under 19 20 21 22 23 24 25 andOver Ages
Under 63 inches 1 1 1 1 1 1 1 1 2 1
63 inches 13 16. 27 10 11 10 9 11 10 10
4. * 86 83 83 65 65 69 64 63 64 67
a 147 137 133 108 106 109 107 += 107 109 112
B61" O82) 377° 162°. 150-149. 352 «A477 «(149 152 154
67. “ 184 182 184 177 172 166 165 167 169 172
6s“ 164 161 159 171 171 170 169 = 168 167 168
iid atl snl Bi4-. 156. °154 “930 ~136- 130 132 131
ao * 63 70 74 90 94 95 94 96 91 .« 89
«tid 28 34 «39 51 52 51 54 54 50 49
_opoceanaorer. “zl 26 o¢ 41° 45°" 47-~"S4-. -54 54 47
Total 1000 1000 1000 1000 1000 1000 1000 1000 1000 1000
No. of men 16931 11910 6953 60104 31872 19477 24171 18544 114151 304113
This table may be compared with the table below for colored recruits
or persons of African descent:
DISTRIBUTION OF STATURE ACCORDING TO AGE OF ACCEPTED
UNITED STATES RECRUITS (COLORED), 1906-1915, PER 1000
18 Years 26 All
Height and Under 19 20 21 22 23 24 25 and Over Ages
Under 63 inches n= ly Pome Pap er 1 ligt n | aie 2 1
63 inches 17 Wy Ge Ba 7 8 10 8 6 9 9
64 112 108 989 72 51 66 64 65 58 65
Bory. “ TE nc MOF p ROL s \) LOS een ad LEO > Miao ee des 113 121
195 172 193 164 174 155 154 168 158 163
ie 189 189 159 164 181 181 161 i171 183 179
| hi A (N40 ee. OWS oT. OIGZ =O 179 169 168
ao. “ 107 (104 :«104. «183«©922 144 ISB I21 125 126
y | iis 59 70 70 80 85 19 82) 87 82
a 19 29 «34 43 47 45 42 37 50 * 45
72 “ andover 8 25 438 30 39 42 #51 = 45 46 41
Total 1000 1000 1000 1000 1000 1000 1000 1000 1000 1000
No. of men 597 518 327 2334 1608 1166 1344 1052 9056 18002
The much lesser number of colored recruits precludes a strict com-
parison, but in the main the data may be relied on as trustworthy. As
will be observed, the total number of white recruits examined was
304,113, against 18,002 colored.
RACE IN RELATION TO WEIGHT
The distribution of white recruits by weight is presented in the table
below. Possibly the grouping of the weights in series of ten pounds
each falls short of the required degree of scientific attainment, omy
five-pound groups would perhaps have been preferable:
39
DISTRIBUTION OF WEIGHT ACCORDING TO AGE OF ACCEPTED
UNITED STATES RECRUITS (WHITE)
1906-1915, PER 1000
18 Years 26 All
Weight and Under 19 20 21 22 23 24 25 and Over Ages
Under 120 lbs. 41 33 26 15 12 12 12 12 16 17
120-129 Ibs. 348 308 270 189 160 141 127+ 128 106 156
130-139 $25, 335- 317.304: -281 270°. 251 248s sign net
140-149 187, 204-217. 265. ..276 278... 273... Bz 208 | 230
150-159 69 80 115 144 164 177 185 = 184 181 161
160-169 21 1) a * AS: 4 72 78 94 98 113 83
170-179 6 8. 13 ee) a 39 63 38
180 and over 3 $-2§ 8 -\ AO 734 | och ee 70 34
Total 1000 1000 1000 1000 1000 1000 1000 1000 1000 1000
No. of men 16931 11910 6953 60104 31872 19477 24171 18544 114151 304133
The corresponding distribution of weight according to age of
accepted colored recruits is presented in the table below:
DISTRIBUTION OF WEIGHT ACCORDING TO AGE OF ACCEPTED
UNITED STATES RECRUITS (COLORED)
1906-1915, PER 1000
18 Years All
Weight and Under 19 20 21 22 23 24 25 26 §6Ages
Under 120 Ibs. i « ire: tar 5; | 12 3 4 7 4 4 7
120-129 230" got ide lee. dio. sau 71 80 63 95
130-139 342 303 339 290 243 220 211 213 177 217
140-149 234 234 248 286 289 281 292 270 242 # 259
150-159 79 117 122 178 #201 208 =#%220 246 «+209 ~ «199
160-169 2 287 16h OR I a TO. COS ee
170-179 5 S 25: Oe ee AS USE ae 77 56
180 and over 2 GG 11 14 24 2i 27 78 47
Total 1000 1000 1000 1000 1000 1000 1000 1000 1000 # 1000
No. of men 597 518 327 2334 1608 1166 1344 1052 9056 18002
Mr. Arne Fisher has also worked out for me the frequency curves
for weight according to age for white recruits, In the analysis of these
curves he points out that on account of the military requirements as to
the minimum permissible weight of recruits there exists a well-defined
lower limit for the range of the curve of a more pronounced character
than in the case of the measurements of stature. On this account the
curves are rather skew in appearance and therefore represented by the
type known as the Poisson-Charlier B Curves. The theoretical frequency
distribution by five-pound groups per 1,000 recruits at single years
of life under age 25 and at ages 25 and over, considered as a group, is
as follows:
40
FREQUENCY DISTRIBUTION OF WEIGHT—UNITED STATES ARMY
RECRUITS AS DETERMINED FROM POISSON-CHARLIER
FREQUENCY CURVES
Pounds 18 19 20 21 22 23 24 25 and Over
Under 120 54.4 43.8 33.7 16.6 11.7 7.8 9.9 6.7
120-124 141.9 123.6 102.1 63.0 51.2 35.7 43.1 32.3
125-129 188.0 1764 158.7 1200 1008 82.8 91.9 75.8
130-134 1770 1765 1700 1560 1423 1302 130.3 115.7
135-139 1479 1479 1490 1596 1564 157.5 141.3 131.3
- 140-144 : 108.4 115.2 1204 1411 1411 1586 130.2 121.7
145-149 78.4 85.4 94.1 1139 1228 136.7 1118 102.6
150-154 51.8 58.8 69.7 859 95.5 1069 94.3 87.5
155-159 30.4 363 47.1 60.3 69.6 75.9 78.1 78.4 .
160-164 15.7 19.9 28.5 38.8 46.6 48.4 61.2 70.4
165-169 7.1 9.6 15.3 22.8 28.7 29.2 44.4 59.5
170-174 2.9 4.2 nS 12.1 16.3 16.0 29.1 45.6
175-179 1.1 1.6 3.2 5.9 8.2 8.1 17.2 31.5
180-184 0.3 0.6 iz 2.6 3.0 3.8 9.3 19.6
185-189 0.0 0.0 0.4 1.1 1.7 1.7 4.6 11.0
190-194 0.0 0.0 0.2 0.4 0.8 0.7 2.1 5.7
eee re | a eo 0.1 0.2 0.3 0.1 1,2 2.7
es, Se ee eet on ae en eee etn we 1.2
A EARS Tee T SS SR: preven eae EUS TEE Os a ey epee 0.5
EEE tet ota Se ores eae Blane Busts.) VE Lowe oe a eens Seu Pha a at 0.2
The frequency curves are shown in graphic form on page 42.
RACE IN RELATION TO CHEST MEASUREMENTS
The third and last physical measurement of United States Army
recruits, as reported upon by the Surgeon General is the chest measure-
ment. Unless the method of measurement employed is carefully defined
and its precise significance is clearly indicated, the results may be quite
considerably at variance with the facts or the inferences drawn there-
from. Methods of chest measurement vary widely.* The difference
between the chest at rest and the maximum expansion and the minimum
deflation is not only quite considerable but not always accurately ascer-
tained without difficulty. What the methods have been in the Army, how
much they have varied from time to time and whether the instructions
have been precisely followed are all matters open to question. ‘The
distribution of chest measurements as obtained for white recruits is
given in the table following:
* The rules regarding chest expansion have undergone more or less important changes.
According to the new standard of physical examination promulgated by the Secretary of
War under date of June 5, 1918, all registrants “‘with a chest measurement of less than
thirty inches and a chest mobility of less than two inches” require to be unconditionally
rejected. The Army rules require “all chest measurements to be taken on a level just above
the nipple.” See “Details of Military Medical Administration,” by qosepn H. Gord, Colonel,
Medical Corps, United States Army, Philadelphia, 1918, #286 493. he chest expansion must
not, of course, be confused with pulmonary capacity. . A. Gould, in his Investigations in
the Military and Anthropological Statistics of American Soldiers, considered this question
at considerable length, including observations on the relation of pulmonary capacity to stature,
to length of body, to circumference of chest, to play of chest, and to age. e refers to the
well-known observations by Hutchinson, according to whom “The vital capacity differs in
man according to height, weight, age and disease.” For these and other reasons, all chest
measurements should be in conformity to thoroughly standardized and well-understood methods
of examination. See, also, Direction No. 2 on page 35
41
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Weight of United States Recruits—1906-1915
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STATISTICIAN’S DEPT., THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
DISTRIBUTION OF CHEST MEASUREMENTS ACCORDING TO AGE
OF ACCEPTED UNITED STATES ARMY RECRUITS (WHITE)
1906-1915, PER 1000
Chest 18 Years All
Measurement and Under 19 20 21 22 23 24 25 26 Ages
Under 31 139 110 91 53 41 33 28 28 20 42
31 201 188 169 118 103 89 79 74 58 95
32 290), Zen Zol = 240. tZee ~ 203: 38). 179 141 197
33 198 213 229 242 241 237 235 233 190 217
34 107 121 142 177 194 208 206 207 196 185
35 40 53 67 98 115° 125 143 142 153 123
36 15 21 32 45 54 66 77° 81 107 72
37 3 5 9 15 9: (B28 34 60 34
38 1 1 2 4 8 10 13 4 36 18
39 and over 0.4 ee 2 o 4 7 8 39 17
Total 1000 1000 1000 1000 1000 1000 1000 1000 1000 #41000
No. of men 16931 11910 6953 60104 31872 19477 24171 18544 114151 304113
The frequency distributions according to chest measurement for
white recruits as determined by Mr. Fisher from the Poisson-Charlier
frequency curves give the following values according to age:
FREQUENCY DISTRIBUTION OF CHEST MEASUREMENTS—UNITED
STATES ARMY RECRUITS AS DETERMINED FROM POISSON-
CHARLIER FREQUENCY CURVES
18 Years
Inches and Under 19
Under 31 Zen5. 935
32 281.4 225.4
33 202.9 267.7
34 131.1 208.9
35 82.2 120.6
36 45.2 54.8
37 20.6 20.5
38 7.8 6.4
39 2.4 1 5
40 0.7 0.4
41 0.1 0.1
Ra aia Bee Soe ge oe
ee ae ee Soe
FOR i takin. & Nacaleias
WO eset stares j2» - Sietpoce
20
75.9
197.1
254.5
217.9
139.1
70.6
29.8
10.7
21
41.5
143.5
232.6
239.2
176.7
100.0
44.8
16.1
22
32.7
122.4
213.9
237.4
189.5
116.0
56.6
22.3
23
26.0
105.3
197.7
234.5
199.2
129.8
67.3
28.2
The frequency curves are shown in graphic form on page 44.
43
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The chest measurements of the colored are as follows:
DISTRIBUTION OF CHEST MEASUREMENTS ACCORDING TO AGE
OF ACCEPTED UNITED STATES RECRUITS (COLORED)
1906-1915, PER 1000
Chest 18 Years 26 All
Measurement and Under 19 20 21 22 23 24 25 and Over Ages
Under 31 178 137 98 72 51 oe vl 31 27 17 40
31 BOs 2210 162 ° T2Z7> 123 72 65 80 55 86
32 291 303 260 241 216 213 200 = 190 140 185
33 196 180 220 224 229 235 240 237 187 206
34 80 95 131 180 204 194 213 210 206 194
35 37 48 80 GeO 119 13S” 132" 334 162 132
36 10 Ze gt 50 44 71 83 76 111 82
37 3 4 9 15 14... 35 22 26 60 39
Sea Danes a 9 5 4 10 8 14 33 20
39 and over ee. Slack 3 2 3 6 6 29 16
Total 1000 1000 1000-1000 1000 1000 1000 1000 1000 1000
No. of men 597. 518 327 2334 1608 1166 1344 1052 9056 18002
Whether these statistics are really useful and conclusive for scientific
purposes is an open question. How far the results are in consequence
of methods of selection cannot, of course, be decided until the data have
been subjected to extended analysis. It is shown, for illustration, that of
the white recruits the proportion with a chest measurement of less than
33 inches was 33.4 per cent., in comparison with 31.1 per cent. for the
colored. General investigations into the comparative anthropometry
of white and colored races, especially Americans of African descent,
disclose more pronounced differences in their vital capacity than are
here indicated. An admirable illustration of such comparative studies
in physical anthropology is the report by Dr. Ales Hrdlicka on One
Thousand White and Colored Children, Inmates of the New York
Juvenile Asylum. It may also be said that the chest measure-
ments in the Army are required to be taken on a level, just above the
nipples, and that the following standard table has been adopted by the
army authorities as a basic regulation governing physical examinations,
under the Selective Service Act of May 18, 1917. Under the revised
regulations (June 5, 1918), however, the minimum permissible height
is 63 inches,* and the weight 116 lbs., excepting registrants from our
insular possessions:
* The minimum height under the regulations of May 18, 1917, has since been again
reduced to 60 inches (July 19, 1918). The importance of the racial aspects. of medical
examinations for military service was brought up by Dr. O. L. Williamson, of. Mariana, Ark.,
at the Conference of Physical Examination under the Selective Service (held in Chicago,
June 13, 1918), who said that “Many physically fit negroes have not a chest mobility. of
two inches and they do not know how to expand the chest.’ The answer made by the
chairman of the meeting was that this was entirely a local question and a problem for
local disposition. The problem, however, can only be solved by a better understanding of
the principles of physical anthropology and the known facts of race pathology.
45
STANDARD OF PHYSICAL PROPORTIONS ADOPTED
MAY 18, 1917
STANDARD TABLE OF HEIGHT, WEIGHT AND CHEST
MEASUREMENTS, UNITED STATES ARMY, 1917
————_HEIGH T—— —-CHEST MEASUREMENT—
WEIGHT At Expiration Mobility
Feet Inches Pounds ; Inches Inches
Sst /i2 61 118 31 2
5 2/12 62 120 31 2
5 -3/1iz 63 124 31 2
5 4/12 64 128 32 Zz
SM29/12 65 130 32 2
5 6/12 66 132 32% 2
5 7/12 67 134 33 2
5 8/12 68 141 33% 2y%
5 9/12 69 148 33% 2%
5 10/12 70 155 34 2%
541/12 71 162 344% 2%
6 72 169 3434 3
6 1/12 73 176 354 ear
6 2/12 74 183 36% 3
6 3/12 75 190 3634 3%
6 4/12 76 197 37% 3%
6 5/12 77 204 37% 334
6 6/12 78 211 3814 4
It requires to be explained that the following variations below the
standard are permissible when the applicant for military service is
active, has firm muscles and is evidently vigorous and healthy.
PERMISSIBLE VARIATIONS IN PHYSICAL PROPORTIONS
UNITED STATES ARMY, 1917
Height, Inches Inches Weight, Pounds
61 and under 64 1 8
64 and under 68 2 10
68 and under 69 4 12
69 and under 70 2 15
70 and under 73 2 20
73 and upward 2 24
It is quite probable that these variations are only tentative and that
further and possibly even radical modifications may be introduced by
the military authorities during the examination of the men called out
in response to the Second Selective Draft. /
ANALYSIS OF FOREIGN RECRUITING STATISTICS
For a considerable number of foreign countries in which the system
of conscription prevails, more or less trustworthy statistics of recruit-
ing are available, although in each and every case extreme care is
required in the use of the data for comparative purposes. The
terminology employed frequently does not permit of precise translation
and occasionally it is impossible to determine whether the rates of
46
acceptance or rejection are based upon the number of conscripts at large
or only those examined subsequently to a preliminary process of elimi-
nation. ‘Ihe most comprehensive treatise on the subject of recruiting sta-
tistics is the fifth volume of the Handbook of Military Hygiene by
Bischoff, Hoffman and Schwiening, published in Berlin, 1913. Of much
additional value is the article on Military Efficiency by Claassen in the
Handbook of Social Hygiene, by Grotjahn-Kaup, published in Leipzig,
1912. The references to foreign statistics in handbooks on military and
naval hygiene by American and English authors are exceedingly frag-
mentary and practically useless for trustworthy comparative scientific
purposes. The whole question of normal physical growth and normal
bodily proportions with a due regard to race, sex and age has been re-
ported upon to best advantage for practical purposes by Dr. S. Weissen-
berg, Stuttgart, 1911. The conclusions arrived at by means of strictly
scientific investigations are much more generally applied in the selec-
tion of recruits in foreign countries than in the United States or
England, at least previously to the adoption of universal conscription.
As observed in a recent contribution to the Scientific American (June
9, 1917): “There is an increased interest everywhere in physical
measurements and the means of improving them when they are below
par.” But it is properly pointed out that “there is another factor besides
height, weight, and girth of trunk or limbs, which is highly important
in determining the military value of a soldier in the field, namely,
endurance, or staying power.”
INDEX OF VITAL RESISTANCE
The correct ascertainment of the degree of disease resistance on the
one hand and of the resistance to physical and physiological fatigue on
the other are as yet a subject unfortunately merely in a preliminary
stage of qualified investigation. The scientific research work of A. F.
Stanley Kent on Industrial Fatigue by physiological methods indicates a
direction which can be followed to much practical advantage in the
more rational development of training methods for new recruits and of
endurance tests for mature men with sufficient military experience to
make such tests relatively non-hazardous to health and life. As
observed in an article in the Scientific American on Human Measure-
ments and “Resistance Formulas,” ‘The various corporal measure-
ments commonly made, such as height, weight, circumference of normal
and of expanded chest, respiratory amplitude, dynamometric force,
girth of arms, legs, hips, etc., taken alone represent merely separate
elements of strength and development.” Among the various formulae
for combining these factors and ascertaining a mathematical in-
dex of comparative robustness the one most generally employed and
likely to yield the best results is said to be the one by Pignet, which is
briefly stated as follows:
47
T—(P-+C), in which T equals height in centimeters, P equals weight in kilo-
grams, and C equals average circumference of chest in centimeters. For a man
1.72 meters tall, weighing 68 kg., and having an average chest measurement of
90 cm. this would give 172—(68+90) equal to 14. (5 ft. 7 in. tall, 149.6 Ibs.,
weight, 35.1 inches, average chest measure.)
This index is used at the present time in Switzerland for the rating
of recruits, the stamina or resistance of which is superior to the average
in proportion as the index is smaller, and the larger the index figures
the poorer is the physical constitution, with a due regard of the
mathematical correlation of the more important anthropometric
measurements. The following table shows the index value and the
physical results, according to the Pignet method, as stated in the
Scientific American previously referred to:
Index Value Result
Low equals 10 Very good
11 to 20 Good
21 to 25 Average
26 to 30 Weak
31 to 35 Very weak
High equals 35 Inadequate
The Pignet index has recently been controlled or re-examined by
individual measurements of more than a thousand young men, made
by Dr. Fr. M. Messerli, in an endeavor to further perfect a system
already apparently of a high degree of intrinsic usefulness. According
to a recent number of the Archives d. Sc. phys. et nat., as stated in the
article referred to in the Scientific American, Messerli has succeeded
“in rendering it more precise by introducing a new element: the average
(B) of the circumference of the two arms (measured in the middle of
the arm while extended), from which he subtracts the original formula
of Pignet. The formula thus reads B—[T—(P-+C)]. Taking the
individual cited above, if he has an average brachial circumference of
25 centimeters, then his numerical index would equal 25—[172—
(68 + 90)]=11. .The numerous measurements made by Dr. Messerli
cause him to conclude that every positive result may be regarded as
good and every negative result as inadequate, the figure 0 being the
limit of the index of the weak individuals (negative) and of that of
the strong individuals (positive) ; the more the result is positive, the
more the individual is resistant; the more negative the result, the
weaker the individual.”
LIMITED VALUE OF RECRUITING DATA
These preliminary observations indicate the very limited practical
value of general recruiting statistics and anthropometric averages of
height, weight and chest expansion for the purpose of ascertaining the
facts of supreme importance as regards the physical stamina or resisting
power of the recruiting material available for military service. All
official statistics are furthermore subject to inherent limitations of
trustworthiness not only on account of the want of uniformity in the
48
Eg PNRM SME
:
.
|
.
“FP
ascertainment of the physical proportions of recruits in different
countries, but also because of the frequent changes in military rules
and regulations, varying widely according to the available recruiting
material and the numbers actually required to meet the exigencies of
military service. Conclusions frequently advanced to the effect that
the physique of any given country has improved or deteriorated on the
basis of recruiting statistics are decidedly misleading and every
authority on military statistics rejects unconditionally the assumption
that the data can be used for the purpose of ascertaining physical
progress or decay. The older recruiting statistics are therefore not
comparable with modern statistics, and even these can be utilized for
only a comparatively short period of time and a few of the more
important countries of the world. For Germany the general statistics
are perhaps the most extensive, but on account of the fact that
the scientific details, especially as regards anthropometric averages, have
not been made public by the Imperial Government they fall measurably
short in practical usefulness of the corresponding statistics for France,
for Scandinavia, for Italy, etc.
RACE IN RELATION TO PHYSICAL PROPORTIONS
Every authority on anthropology and anthropometry concedes the
supreme importance of race as an underlying determining condition or
consideration in the physical proportions or dimensions of the recruit-
ing material under consideration. ‘The term race is not one which
permits of precise definition, for entirely pure races are certainly no
longer met with in European countries. It is generally held that the
average stature or the distribution, or more accurately, perhaps, the
frequency distribution, of height according to age and sex, is more
directly determined by heredity on the basis of racial antecedents than
by any other physical factor excepting color, hair, skin pigmenta-
tion and the shape and size of the skull. Race, in however crude a
sense the term may be used, is largely conditioned by the locality of
birth of the recruiting material examined, and for the purpose of
scientific conclusiveness the ratio of rejections for physical reasons
or the anthropometric data ascertained by precise methods of measur-
ing should be accurately correlated to the place of birth and not to the
place of residence. Still more trustworthy and conclusive would be
statistics of physique according to ancestry, which for practical pur-
poses might be limited to the country of birth of the mother. This
limitation has been found sufficient in mortality investigations, which
exhibit the same definite relationship between disease predisposition or
disease resistance on the basis of inherited ancestral traits as has been
shown to be the case in the inheritance of physical proportions of the
body, chiefly, however, in the average stature and its frequency distri-
bution as determined by modern mathematical statistical processes.
4 49
AN
The ratio of rejections on the ground of unfitness for military service
varies widely for different countries, not so much because of inherent
differences in vitality, physical strength or disease resistance, as on
account of the precise rules and regulations applicable to the recruiting
service, subject to far-reaching changes from time to time, especially
during active military operations. Not only is the ratio of rejection
governed by physical, physiological and pathological considerations, but,
also, by social or economic interests precluding the advisability of using
for military services men who for special reasons may be more useful
to the State in the government service or in industry and private life.
These considerations obviously must vary from time to time, and quite
materially during prolonged periods of active military operations.
In countries where the rule of conscription applies to all alike at a
certain minimum age, the new recruits are, of course, only represented
by a single year of life, for illustration, by age 20, except in so far as
volunteers may be drawn upon from earlier ages or as those temporarily
rejected may require to be re-examined at older ages, limited usually,
however, to only a short period of years. In the United States in the
future, if conscription continues, only the attained age 21 will require
consideration, except in so far as new rules,and regulations may provide
for the re-examination of those rejected or temporarily declined at sub-
sequent years. Since the minimum age of recruits varies for different
countries and since the same conclusion applies to the rules and regula-
tions regarding subsequent re-examinations, the statistics for any two
countries are not strictly comparable and in some cases not at all.
RECRUITING STATISTICS OF PRUSSIA
In Prussia, during the year 1850, out of every 100 recruits examined,
64 were temporarily relieved from duty, while 36 were accepted,
subject to examination. Of those accepted 11.2 per cent. were
rejected as entirely unfit, and 10.8 per cent. as unfit for the
field service, so that of those examined as required for service during
the current year, 22 per cent. were finally declined. Of the
remainder 28.1 per cent. were assigned to the supplementary reserves
and 0.4 per cent. were declined for military service, including reasons
involving personal integrity. An additional 4.6 per cent. of persons
otherwise qualified were for domestic and other reasons assigned to
the supplementary reserves, which with 9.2 per cent. of volunteers and
35.6 per cent. finally accepted, constitute 49.4 per cent. of the recruits
examined as ultimately considered fit and useful for active service in
the field (it is not entirely clear, but apparently the 4.6 per cent. were
considered fit for military service in the field when so required and to be
drawn from the supplementary reserves). When these statistics for 1850
are compared with those for 1860, it appears that profound changes had.
been introduced in the meantime, so that in the aggregate the general
50
results were materially modified. During the entire period 1847-62 the
maximum rate of acceptance for military training was 55.6 per ‘cent. in
1859, and the minimum 42.3 per cent. in 1856. At the beginning of the
period the ratio was 43.8 per cent. and at the end of the period 48.5
per cent. The combined ratio of rejections as entirely unfit, however,
reached the lowest figure in 1862, or only 10.1 per cent., against 20.7
per cent. in 1847. These earlier statistics of the Prussian military
service are, of course, of only historical interest at the present time.
They are not conclusive as regards the physical changes in the
population during the intervening period and do not justify
any conclusions whatever concerning the possible physical progress
or deterioration of the German people. One of the most impor-
tant variables in recruiting experience is the modification in the mini-
mum standard of height, which in a measure depends upon the needs
of the several arms of the service, in that usually a lower height
is permissible for the cavalry than for the infantry and artillery.
In Bavaria between 1853-65 the rejections on account of failure to
conform to the minimum standard varied between 5.1 per cent. in
1855 and 1857 and 3.8 per cent. in 1865. It would obviously be mis-
leading from these statistics to conclude that there had been
a physical decline in the Prussian or Bavarian populations during the
period under review, since the changes in military rules and regulations
as regards the minimum standard of height in part at least explain the
higher rejection ratio during the earlier in comparison with the later
years.
STATURE OF GERMAN CONSCRIPTS
For more recent periods the German statistics are equally interesting,
but far from conclusive. Innumerable changes in the rules and regula-
tions appertaining to the examination of recruits and the acceptance or
rejection of the same for military service make exact comparison of
any one year with another of doubtful intrinsic value. The gen-
eral average rate of acceptance in the German conscript recruit-
ing experience is given by Claassen as 55.5 per cent. In addition,
14.9 per cent. are temporarily rejected but considered subsequently
qualified, and 22.9 per cent. are assigned to the reserve as being of a
restricted degree of ability for military service. No precise information
is available as regards the reasons which govern in the respective
assignments to the temporary or permanent reserves, but it is obvious
that the former are considered more qualified for active military service
than the latter, although both groups, representing a combined percent-
age of 37.8 of those subjected to final examination, are below the
required standard of current army service represented by the 55.5 per
cent. unconditionally accepted. Of the remainder 6.6 per cent. are
considered entirely unfit for military service for physical or reasons
51
other than obvious moral grounds, probably convicts and persons other-
wise undesirable, representing 0.2 per cent. of the conscripts subjected
to final examination. These averages are based upon the returns for
1906-07, which are apparently normal and not influenced by urgent con-
siderations of impending war.
The German rate of acceptance is, however, in a large measure
determined by the number available for military service. That
number naturally bears a direct relation to the’ authorized
effective strength of the army. The rapid growth in the German
population had made it possible to select conscripts with much greater
care than in certain other countries, especially France, where the avail-
able material has rarely if ever within recent years been fully sufficient
to meet the required complement in accordance with the authorized
strength of the French army. For this reason the French statistics
cannot be considered strictly comparable with the German statistics,
and the fact that the average rate of acceptance was 72 per cent. in
France, against 66 per cent. in Germany, is not evidence of the physical
inferiority of the German recruiting material and its unsuitability for
military service. The discussion by Claassen includes the average rate
of acceptance for various countries, but for different periods of time, all,
however, subsequent to 1899. For Russia the rate is given as 85 per
cent.; for Norway, 76 per cent.; for Sweden (Province of Dalarne),
75 per cent.; for France, 72 per cent.; for Switzerland, 58.5 per cent.,
and for Germany, 55.5 per cent.
Another even more important factor which requires consideration
is the question as to how the number finally examined is constituted or
deterinined for military purposes. If, for illustration, those who are
seriously impaired in physique or who are mentally unsound or who
are below height are not required to present themselves at all but are
excused on grounds sufficient to a lay official, then the rate of rejec-
tions on final examinations would, of course, be correspondingly
diminished. It is generally understood that this is the case in France,
although the rate of final rejections as entirely unfit is 10.1 per cent.,
against 6.6 per cent. for Germany. The interpretation of foreign
recruiting statistics is unfortunately further impaired by a strong bias
which precludes to a considerable degree the practical use of the data
available in a summarized form.
INCONCLUSIVE ARMY REJECTION DATA
The causes of rejection in recruiting as in the case of the so-called
causes of death are for statistical purposes limited to assumed primary
or determining causes, while secondary, although possibly equally
important, causes of rejection are obscured in the prevailing method of
statistical tabulation and analysis. If, for illustration, a recruit is
rejected because of deficiency of stature, it does not at all follow that
52
he would not also have been rejected on account of an organic impair-
ment of the heart, or mental deficiency. The causes of rejection,
therefore, as presented in the usual form in army medical reports are
not conclusive evidence as regards the existence or co-existence of
impairments, defects and deficiencies of a physical or pathological
nature. Limited to the crude method of statistical presentation, the
recruiting statistics according to causes of rejection are therefore
merely indicative of the determining causes or reasons sufficient for
military purposes to justify the unconditional rejection of the recruit
as unfit for military service in time of peace or war. For a consider-
able number of specific causes. of rejection, such as goitre, for illustra-
tion, or flatfoot, the available statistics are reasonably conclusive, and
usually in conformity to the known facts of local frequency of special
diseases or special forms of physical disability. In the German experi-
ence for the period 1904-08, out of every 100 recruits subjected to final
medical examination an aggregate of 49 were rejected or de-
clined, or, respectively, 19.3 per cent. on account of general debility,
7.2 per cent. on account of internal diseases, etc., 4.6 per cent. on
account of diseases, or defects or deficiencies of the eyes and ears, 11.9
per cent. on account of external diseases and malformations, 0.8 per
cent. on account of deficiency in stature, and 5.2 per cent.. for other
causes. The details are of exceptional practical importance, but abso-
lute accuracy in the conclusions is precluded by the fact that the term
“general debility,” which in the German experience accounts for 19.3 per
cent. of those permanently rejected on final examination, includes nu-
merous causes and conditions more or less complicating other causes
and conditions specifically referred to as reasons for final rejection, but
chiefly retarded bodily development, general weakness, partly in conse-
quence of previous diseases or injuries, deficiency in bone or muscle
formation, deficiency in chest development, etc. There are reasons for
believing that in a number of cases, sufficient to require special consid-
eration, the apparent unfitness for military service was after all only of
a temporary nature, suggestive of the advantage of special training or
curative processes, etc. In the majority of cases the reasons for de-
clining applicants on the ground stated have probably much to do with
retarded physical or physiological development, not only of the
body as a whole but of the separate organs and parts, subsequently
successfully overcome by the attainment of normal growth and develop-
ment during the remaining years previous to complete physical ma-
turity. .
REJECTION DATA OF THE GERMAN ARMY
In the order of their importance the reasons for final rejection on
the ground of complete and permanent military unfitness in the German
army during the years 1904-08, aside from the rejections on account
53
of general debility, accounting for 19.3 per cent. of the total number
examined, the first cause of importance is rejections on account of
diseases or impairment of the heart and circulatory organs, accounting
for 3 per cent., followed by minor defects but of sufficient military
importance to justify rejection, also equivalent to about 3 per cent., and
recognized defects and deformities of the extremities, equivalent to 2.9
per cent. Of the remainder of principal causes of rejection, flatfoot
accounted for 2.1 per cent., hernia for 2.1 per cent., errors of refrac-
tion for 2.0 per cent., varicose veins, etc., for 1.8 per cent., and physical
deformities, chiefly spinal curvature, for 1.8 per cent. Goitre in the
German experience is of relatively slight importance, accounting for
only 0.4 per cent., varying, however, between a minimum of 0.3 per
cent. in the Prussian army and 1.2 per cent. in the army of Wirttem-
berg. Bad teeth accounted for only 0.21 per cent., rheumatism and gout
for only 0.17 per cent., and corpulence for 0.14.
Of special military significance is the relatively high rate of rejec-
tions on account of flatfoot, which varies from a minimum of 1.1 per
cent. for the Bavarian to a maximum of 2.4 per cent. for the Prussian
army. Disease of the lungs caused a rejection rate of only 1 per cent.,
with but a slight range in variations in the rate for the fundamental
constituent armies of the German Empire, or, respectively, Prussia,
Bavaria, Saxony and Wuirttemberg.
The changes in the rejection rate during recent years in the German
army experience, or specifically during the period 1904-10, are not
suggestive of an improvement in the physical type or the disease resist-
ance of the recruits, since the ratio of the unfit for military service has
gradually increased from 48.7 per cent. in 1904 to 54.3 per cent. in
1910. ‘The increase has chiefly fallen upon the groups of rejections for
genefal debility, from 18.2 to 22.3 per cent., diseases of the heart
and circulatory organs, from 2.7 to 3.8 per cent., and diseases of
the lungs, from 0.9 to 1.4 per cent. The rejections on account of
deficiency in stature declined from 0.73 per cent. to 0.61 per cent.
These changes, however, in the recruiting results can no more, as
elsewhere observed, be relied upon as evidence of physical deterioration
than that, conversely, a declining rate of rejection for specified causes
can be safely utilized for the purpose of proving physical advance.
The rates are governed primarily by military considerations, which vary
with army requirements almost from year to year. The rates are also
affected by improvements in methods of physical diagnosis, in connec-
tion with which to an increasing extent use is made of instruments of
precision, in place of entire reliance upon the objective and subjective
symptoms ascertained by non-instrumental methods in physical and
medical examination.
54
a
;
a
e
|
i
at”
GEOGRAPHICAL VARIATIONS IN THE CAUSES
OF REJECTIONS
Most valuable for practical purposes is the analysis of the German
recruiting statistics according to causes of rejection by army corps,
which broadly correspond to the principal geographical and topo-
graphical divisions of the Empire. These statistics indicate with
approximate accuracy the local excessive incidence of physical or other
impairments sufficiently serious to cause the final rejection of recruits
for military service. Thus, for illustration, in the ratio of rejections
for diseases of the lungs during the period 1904-08 the maximum rate
was 20.8 per 1,000 for the 55th Brigade of the 14th Army Corps,
whereas the minimum rate was only 3.8 per 1,000 for the 21st Brigade
‘of the 6th Army Corps (Prussia). For flatfoot the rejection rate
varied between a maximum of 44.6 per 1,000 in the 33rd Brigade of
the 9th Army Corps to a minimum of only 6.2 per 1,000 for the 45th
Brigade of the 12th Army Corps (Saxony). For goitre the rejection
rate varied between non-occurrence in the 35th Brigade of the 9th
Army Corps to a maximum of 23.2 per 1,000 in the 4th Brigade of the
Ist Army Corps (Bavaria). When shown in graphic form these rates
of rejection according to locality furnish evidence of exceptional value
in the practical furtherance of public health movements, suggestive of
the urgency of highly specialized local inquiries regarding underlying
causative or contributory conditions or circumstances possibly within
the range of prevention and control. To be scientifically conclusive it,
however, is necessary that the rejection rates should be calculated ac-
cording to the place of birth or at least the usual or prolonged residence
of the examined recruit rather than according to the recruiting locality,
which might have no bearing upon the causative conditions or circum-
_ stances responsible for the frequency of certain defects and deficiencies,
such as goitre,. flatfoot, etc. To ignore racial antecedents in recruiting
statistics is as certain as in mortality statistics to lead to seriously
erroneous results; for,broad general averages derived from a hetero-
geneous group of persons examined cannot possibly serve as a standard
properly applicable to widely varying constituent parts.
RECRUITING STATISTICS OF AUSTRO-HUNGARY
No country illustrates the importance of racial consideration more
conclusively than the Austro-Hungarian Monarchy. ‘The statistics
available are neither for very recent years nor in such detail as to
justify their use in comparison with the returns for adjacent European
countries.. The tendency has been apparently towards a diminution in
the proportions rejected on account of deficiency in stature and a
lesser proportion of recruits of short stature and a larger proportion of
those above the average-in height according to age. The rejection rates
by causes are based upon the numbers examined above the minimum
55°
stature, which was 155.4 cm. in 1888, but reduced to 153 cm. in 1889.
Of those examined from 1894 to 1905, some 43 per cent. were declined
on account of general weakness, 3.3 per cent. for varicose veins,
3.1 per cent. for intestinal dislocations (hernia), 2.8 per cent. for
goitre and 2.4 per cent. for flatfoot. The proportion rejected on
account of errors of refraction was 0.7 per cent., and for other
diseases of the eyes 1.4 per cent. Defective dentition caused a re-
jection rate of 0.4 per cent. and valvular affections of the heart
0.24 per cent. It is remarkable that tuberculosis of the lungs caused
a rejection rate of only 0.08 per cent., which may be accepted as
evidence that by some other previous process of selection those pre-
disposed to pulmonary tuberculosis did not come :up for final mil-
itary examination at all. The general rejection rate is relatively ©
high for Austria, but the rules and regulations have so frequently been
changed during the last forty years that no definite conclusions can be |
safely advanced, excepting possibly for certain clearly recognized causes.
Rejections for general debility increased from 27.9 in 1870 to 44.3 per
cent. in 1905. All forms of tuberculosis decreased from 0.61 per cent.
to 0.57 per cent. Flatfloot decreased from 3.4 per cent. to 2.8 per
cent., while goitre decreased from 4.7 per cent. in 1871 to 2.9 per cent.
in 1905. There was a remarkable reduction in the rejection rate on
account of intermittent malarial fever from 0.12 per cent. at the begin-
ning of the period to 0.02 per cent. at the end. Specific rejections for
malaria were highest in the southern province of Zara of Dalmatia (1.15
per cent.), whiie rejections on account of goitre were highest in the
Innsbruck district of Tyrol (9.5 per cent. of the total examined). These
averages are for the decade ending with 1905, and given by regional
divisions of the Austro-Hungarian Empire, but not in such detail as
the German statistics, regardless of equally wide variations in local,
racial and topographical conditions.
The Austro-Hungarian statistics are of special interest as regards
variations in stature according to race, it being shown that per thousand
examined during 1894-1905 in the Zara district of Dalmatia the propor-
tion of conscripts below 153 cm. was only 5 per 1,000, or the lowest on
record, against 60 per 1,000 in the Przemysl district. Conversely the
tallest races were met with in Dalmatia and Croatia, or, respectively,
53.2 and 31.2 per cent. of 171 cm. and over, against a general average
of 22.2 per cent. for the Austro-Hungarian Empire and 14.2 per cent.
for the district of Przemysl. Croatians are the tallest, followed by the
Czechs, Moravians and Slavs. The Germans occupy an average po-
sition, while the Roumanians, Magyars and Ruthenians are distinctly
below the average, returning, in any event, :a lesser proportion of those
171 cm. in stature and over. The Poles show the largest proportion
under 160 cm. and the smallest proportion of 171 cm. and over. The
Austrian statistics do not justify the assumption frequently given
56
utterance to that short and medium sized men are in the main stronger
and more suitable for military service than tall recruits, or at least this
conclusion is not the fact, according to Schwiening, for Germany
and Austro-Hungary.
RECRUITING STATISTICS OF FRANCE
The recruiting statistics for France extend over a long period of
years, but there have been so many changes in rules and regulations
that conclusions require to be arrived at with extreme caution. There
has apparently been a decrease in the proportion of recruits below the
minimum standard, but the available data are of more or less doubtful
intrinsic trustworthiness. The rate of rejections on the ground of
entire unfitness is, as previously stated, relatively low for France com-
pared with Germany, but the difference is probably more attributable to
lax rules and regulations or to the urgent necessity of bringing the
authorized strength of the army to its full quota rather than to a
superior physique or physiological condition. In 1901 the provision as
regards minimum stature was removed and recruits even below 154 cm.
were accepted. It is explained that in consequence of changes in the
rules and regulations by 1902 the proportion of accepted recruits had
increased to 87.3 per cent., and the high rate was obviously indicative of
the urgent demand of the army to make use of the largest possible
proportion of the available recruiting material. During 1906-10 the aver-
age ratio of rejections on account of entire unfitness for military service
was 9.6 per cent. for France, having been as high as 14.8 per cent. for
the military district of Rennes and as low as 7.1 per cent. for the
military district of Nancy.
During the period 1907-10 the ratio of rejections for all causes was
9.8 per cent., of which 3.3 per cent. was on account of general debility ;
1 per cent. on account of diseases of the nervous system; 0.8 per cent.
on account of diseases of the eye; 0.36 per cent. on account of diseases
of the ear and 0.2 per cent. on account of diseases of the respiratory
organs. The data are not in sufficient detail to justify definite conclu-
sions and they are complicated by the fact that the French figures are
given separately for those entirely unfit and those useful for auxiliary
military service, which constitute 4.2 per cent. of those rejected for all
causes. In more detail, it may be said in this connection that combining
the two groups of the entirely and the largely unfit for military service
the rejection rates for the period 1907-10 were as follows: Diseases of
the bones and extremities, 2.4 per cent.; physical weakness or debility,
$9 per cent.’ tuberculosis, 1.2 per cent.; varicose veins, 0.9 per cent. ;
errors of refraction, 0.8 pér cent.; other diseases of the eye, 0.6 per
cent.,'and diseases of the heart, 0.5 per cent. Rejections on account of
hernia amounted to 0.4 per cent. and of goitre 0.1 per cent.
Retrospectively the statistics for France cover the period 1873-1910,
57
but, as stated before, the data require to be used with extreme caution.
In view of the alleged prevalence of tuberculosis among the French
troops during the present war, it is extremely significant to find that the
ratio of rejections for tuberculosis of the lungs increased from 0.23
per cent. in 1885 to 0.59 per cent. in 1905. For more recent years not
all of the details are available. Goitre of all forms decreased from 0.5
per cent. in 1887 to 0.1 per cent. during 1907-10. Hernia decreased
from 2.7 per cent. in 1887 to 0.4 per cent. during 1907-10, while
flatfoot decreased from 0.46 per cent. in 1887 to 0.19 per cent. in 1905.
There was a decided decline in rejections on account of general debility,
from 3.0 per cent. in 1873 to 0.7 per cent. in 1905; but during the
period 1907-10 the rate increased quite considerably, of, specifically,
to 1.6 per cent., a figure not reached before since 1882. ‘There are
reasons for believing that this apparently considerable decline in the
frequency of general debility is more apparent than real, and that in all
probability the increasing demand for the largest possible number of
acceptable recruits accounts for the falling off in the rejection rate,
applying to a group of physical defects difficult of exact diagnosis or
adjudication for recruiting purposes.
The frequency of tuberculosis in France among recruits has been as-
certained for the different army corps according to departments, and a
startling range in the variation of the local incidence has been disclosed,
the accuracy of which has unhappily been confirmed by the experience
during the early part of the present war. The highest ratio of tubercu-
losis is met with throughout the Northern Department, but chiefly in the
Department of the Northwest. In contrast, the frequency of heart dis-
ease or organic heart impairment was decidedly more common in the
more or less mountainous provinces. The proportion of recruits of a
deficient stature was lowest in the Northeastern Department of
France.. And approximately this conclusion holds good for the Middle
Departments, while in the Northwestern section and the West and
South, practically throughout, the percentage of recruits below 162 cm.
was below the general average. Proportionately the largest number of
short recruits came from the Bretagne, as well as from the Southwest,
chiefly Gascogne and Guiene.
VARIATIONS OF STATURE OF EUROPEAN ARMIES
Schwiening gives a table of percentages for four different European
countries, according to which out of every 100 recruits examined the
following were of the proportion of less than 160 cm. in stature:
Wiirttemberg, 11.8 per cent.; Prussia, 13.0 per cent.; Bavaria, 14.7 per
cent., and Austro-Hungary, 22.9 per cent. The proportion of tallest
recruits, or such as had a stature of 170 cm. and over, was highest in
Prussia, 31.1 per cent., followed by Wiirttemberg, with 27.7 per cent.,
Bavaria, 27.1 per cent., and Austro-Hungary, 22.1 per cent.
58
Claassen gives another comparison according to which the proportion
of soldiers or recruits of less than 165 cm. in stature was for
German soldiefs in 1906 29.8 per cent., for German recruits during
1899-1903 40.2 per cent., and for F rench recruits during 1906 43.2 per
cent. The proportion of tall men, or those 170 cm. or over, was largest
among German soldiers, or 35.7 per cent., followed by German recruits,
with 29.6 per cent., and French recruits, with 25.6 per cent. Evidently
such comparative anghtopemetric averages must be used with extreme
caution and upon a thorough understanding that the statistics apply
either to soldiers or to recruits, and if to the latter whether the averages
apply to accepted recruits or to the entire recruiting material sub-
jected to a preliminary physical examination.
RECRUITING STATISTICS OF ITALY
The available recruiting statistics for Italy are for the period 1875-
1909. The rejection rate has varied considerably, between a maximum of
29.7 per cent. of those examined in 1906 and a minimum of 17.7 per
cent. of those examined in 1882. ‘The fluctuations in rates, however, are
such as to make it evident that the results are strongly influenced by re-
cruiting requirements. The rejection rate on account of deficiency in
height has changed from a maximum of 10.2 per cent. in 1876 to 4.2 per
cent. in 1909, which is the lowest rate on record for the period. There
has been an increase in the rate of rejections on account of dis-
ease from a minimum of 10.1 per cent. in 1882 to 24.8 per cent.
in 1906. For the year 1909 the rate, however, was only 20.2 per cent.
The practice prevails in Italy of temporarily declining recruits who
apparently remain subject to further examination and possible accept-
ance. The rate of such rejections for the year 1909 was 28 per cent.
of the total number examined. In this group also the rejections on
account of deficiency in stature during recent years have been con-
siderably below the former average, the rate having been 1.4 per cent. in
1909, against a maximum of 5.3 per cent. in 1882. That these statistics
cannot be relied upon as measurable evidence of physical deterioration
is made clear by the fact that, while in 1881 the rejection rate on
account of deficiency in stature was 3.3 per cent., it was 5.3 per cent.
in 1883, and only 2 per cent. in 1884.
The aggregate rate of acceptance was as high as 63.3 per cent. in
1877, and as low as 41.8 per cent. in 1906; but there was an increase to
44.0 per cent. in 1907, 43.4 per cent. in 1908; and 47.7 per cent. in 1909.
Evidently the rates have no direct bearing upon the question of physical
deterioration or improvement. The Italian statistics are impaired by the
increase in the proportion of those who were absent; accounted for ina
large measure by the enormous Italian emigration. The statistics of defi-
ciency in height are affected by the law of 1882, which fixed the mini-
~ mum stature at from 154 to 156 cm., but the maximum was reduced from
59
. 156 to 155 in 1883. The law of 1889 changed the chest measurements,
and a chest circumference of 75 cm. or less made rejection permanent
and from 75 to 80 cm. temporarily effective. The minimum of 75 cm.
was changed in 1896 to 77 cm. It is held that the increase in the rejection
rate cannot be considered conclusive evidence regarding the physical
deterioration of the Italian recruiting element. ‘The increase is largely
explained by changes in the rules and regulations and more rigid
methods of examination. The rejection rate has varied widely from
an average of 39.6 per cent. for the country as a whole during the
period 1906-08; a minimum of 29 per cent. in the Province of Lazio
and a maximum of 62.9 per cent. in the Province of Sardinia. In a
general way the highest proportion of acceptance was in the middle
and northeast of Italy, and the lowest proportion in southern Italy and
in the northwest Province of Lombardy. The rejections on’ ac-
count of minimum stature were lowest in the Province of Venetia, or
2.5 per cent., and: highest in the Province of Sardinia, or 20.4 per
cent. For all Italy the rejection rate on account of minimum stature
during 1906-08 was 6.7 per cent. of the total number examined.
MEDICAL CAUSES OF REJECTION IN THE ITALIAN ARMY
The medical causes of rejection were as follows: General physical
debility accounted for 5.14 per cent. of examined recruits; deficiency
of chest formation, respiratory function, etc., 4.05 per cent.; and
scrofula, anemia, weakness, etc., 1.96 per cent., a combined aggregate
of 11.15 per cent. Following these general causes, diseases of the eye,
including errors of refraction, accounted for 2.07 per cent., diseases of
the extremities and of the bones, for 1.94 per cent., hernia, for 1.53 per
cent., goitre for 1.23 per cent., and spinal curvature and physical
defects of the chest, for 1.21 per cent.
During the period 1878-1909 there were important changes in
the rejection rates of Italian recruits for specified causes, but the data
require to be interpreted with extreme caution. ‘Thus, for illustration,
the rejections for general physical deficiency were 6.07 per cent. in
1895, 12.57 per cent. in 1896; and 8.61 per cent. in 1897. In 1906 the
rate was 13.2 per cent.; in 1907, 11.4 per cent.; in 1908, 10.6 per cent.,
and in 1909, 9.0 per cent. These rates evidently have no direct bearing
upon a tendency towards physical deterioration or advance, as the case
may be. Goitre, however, shows a distinct rate of increase, from a
minimum of 0.56 per cent. in 1883 to a maximum of 1.42 per cent. 1n
1905. Subsequently to that year the rate is shown to have gradually
declined to 0.89 per cent. in 1909. Lung diseases show a perceptible
decline, but heart diseases show a decided increase. This, however,
may be largely in response to the more thorough examination of
recruits. Hernia has shown a slight increase from 1.46 per cent. in
1878 to 1.64 per cent. in 1909. ‘The conclusion is advanced that the
60
4
% sence jim Ee LN RT SITS SOL MERI, SR IR IE TEI ARP CS ey, aS eye
increase in rejections on account of heart affections from a minimum of
0.08 per cent. in 1881 to a maximum of 0.4 per cent. in 1908 cannot be
evidence of an actual increase, but is more likely the result of more
rigid methods of examination. As regards goitre it appears that the
disease was practically limited to the most northern provinces of Italy,
adjoining those of Switzerland and Austria in which the disease is cor-
respondingly frequent.
RECRUITING STATISTICS OF SWITZERLAND
The recruiting statistics of Switzerland are available only for the
period 1875-1904. The general rejection rate on account of unfitness
for military service has varied between a maximum of 46.6, per cent.
during 1879 and a minimum of 31 per cent. in 1876. For the year
1904 the rate was 40.1 per cent. The opinion is advanced that the
changes are largely in consequence of more rigid methods of examina-
tion and not directly related to material alterations in the physique of
the Swiss population. Comparing thereturns by quinquennial periods for
the last twenty-five years, it appears that there have been changes in the
rejection rate for specified causes, but the data require to be considered
or interpreted with extreme care. General weakness, anemia or
convalescence was the cause of rejection of 6.1 per cent. of those exam-
ined in 1875-84, the rate having gradually declined to 3.3 per cent. in
1901-05. Rejection on account of deficiency in stature decreased from
6.5 per cent. in 1886-90 to 3.7 per cent. in 1901-05. Rejections on
account of tuberculosis of the lungs, however, increased from 0.3
per cent. during 1886-90 to 0.6 per cent. in 1901-05. Rejections on
account of diseases: of the heart and circulatory organs increased
gradually from 0.7 per cent. during 1875-84 to.1.7 per cent. during
1901-05. Rejections on account of goitre increased from 5.8 per cent.
during 1875-84 to 7.1 per cent. during 1886-90, subsequently de-
clining to 6.1 per cent. during 1901-05. The rejection rate for her-
nia remained practically stationary, having been 2.7 per cent. during
the last five years of the period under observation, while re-
jections on account of flatfoot increased from a minimum of 2.3
per cent. during 1886-90 to 4.1 per cent. during 1901-05. The significant
facts about the Swiss recruiting statistics are the high rejection rates
for general weakness, anemia, etc., minimum stature, diseases of the
heart and circulatory organs and, most of all, goitre, which continues
as the leading cause of rejection in Swiss recruiting at the present time.
Errors of refraction accounted for rejections of 5.6 per cent. of the ex-
amined during 1901-05, against a minimum of 1.9 per cent. during 1874- —
84. The increase was probably more the result of improvement in
methods of eye examination than an actual increase, although there are
some reasons for believing that errors of refraction are progressively
on the increase in practically all the leading European countries as a
cause of rejection in recruiting statistics.
61
RECRUITING STATISTICS OF SCANDINAVIAN
COUNTRIES
For the Scandinavian countries the statistics of Denmark are sug-
gestive of an increase in the rate of rejections on account of unfitness
for military service from 29.0 per cent. during 1891-95 to 41.3 per cent.
during 1906-10.* The rejection rate has varied between a maximum of
47.6 per cent. in the First Military District to a minimum of 37.5 in
the Fourth Military District. These rates are for the period 1905-09.
The principal causes of rejection during 1906-10 were 2.95 per
cent. on account of general bodily weakness, 2.22 per cent. for dis-
eases or defects of the eyes, 1.38 per cent. for diseases or defects of
the ears, 1.5 per cent. for diseases of the lungs, 2.7 per cent. for
diseases of the heart and 5.99 per cent. for diseases or physical defects
of the feet. The rejection rate for all causes was 41.3 per cent. for the
period under review. The rejections for deficiency in stature decreased
from a maximum of 0.48 per cent. of those examined during 1891-95
to a minimum of 0.24 per cent. during 1906-10.
For Norway the recruiting statistics from 1878 to 1910 are indica-
tive of conditions quite at variance with those reported upon for
Denmark. The rejection rate during 1910 was 20.7 pef cent., the rate
having changed during the period under review from a maximum of 26.6
per cent. in 1880 to 18.3 per cent. in 1890. The rejection rate was
highest in the Third Military District (Kristianssand), or 22.9 per cent.,
and lowest in the T'romsoe District, or 16.6 per cent. The principal causes
of rejection were as follows: Diseases of the extremities, 7.1 per cent. ;
diseases of the eyes and errors of refraction,.4.4 per cent.; diseases of
the lungs, 2.6 per cent.; diseases of the ears, 2.5 per cent.; diseases of
the heart, 2.3 per cent.; hernia, 2.2 per cent.; bodily weakness, 1.5 per
cent.; spinal curvature, etc., 1.9 per cent.; diseases of the nose and
mouth, 1.1 per cent., and all other diseases and defects and deficiencies,
6.3 per cent. Thé average rate for all causes was 31.1 per cent. for the
period 1904-08. The Norwegian returns, however, are for both the en-
tirely unfit and those temporarily unfit, which makes a comparison with
other recruiting statistics of doubtful validity. The average stature
of Norwegian recruits has been ascertained for a long period of years,
having gradually increased from a minimum of 168.7 cm. during
1878-82 to 170.8 cm. during 1908-09.
For Sweden the recruiting statistics are for the period 1890-1907.
The general rejection rate gradually declined from a maximum of 26.3
per cent. during 1901 to 18.1 per cent. during 1907. These rates do
not include those temporarily rejected, or those whose acceptance for
actual service was postponed. A minimum rate of only 12.4 per cent.
was reported for the Gotland District and a maximum rate of 25.6 per
cent. for the Sodermanland District. These rates apply only to the
* The rate declined, however, again during the period 1911-15 to 29.5 per cent.
62
recruits 21 years of age examined during 1903-07. ‘The principal
causes of rejection during the same period were as follows: Diseases
of organs of circulation, including the heart, 4.37 per cent.; diseases
of bones and extremities, 3.43 per cent.; deafness and diseases of the
ears, 1.58 per cent. ; tuberculosis, 1.57 per cent.; general debility, 1.5 per
cent.; diseases of the eye, 1.36 per cent.; diseases of the mind, 1.07 .
per cent., and deficiency in stature, 0.53 per cent. For all causes the
rate was 18.58 per cent., limited, as previously stated, to those 21 years
of age only. For those examined at older ages the rejection rate for all
causes was 20.12 per cent., and for diseases of the heart and circulatory
organs, 5.05 per cent., and for tuberculosis, 2.86 per cent. The large
group of rejections on account of diseases of the circulatory organs
apparently includes varicose veins, etc.
RECRUITING STATISTICS OF BELGIUM
For Belgium the available recruiting statistics are for the period
1901-09. The general rejection rate having varied between a maximum
of 34.27 per cent. at the beginning of the period to 19.26 per cent.
during 1907, when, however, radically different methods of examina-
tion appear to have been employed. The rate increased to 29.34 per
cent. in 1908, and declined to 25.63 per cent. in 1909. The rejection
rate was highest in the District of Brabant, or 40.7 per cent., during the
period 1902-06, and lowest in the District.of Luxemburg, or 18.3 per
cent., the average for all districts for the period having been 31.7
per cent.
The principal cause of rejection in Belgium during 1902-06 was
general debility, accounting for 7.97 per cent. Diseases or defects of
the extremities caused 5.0 per cent.; deficiency in stature, 2.27 per
cent. ; varicose veins, etc., 1.85 per cent.; hernia, 1.63 per cent. ; flatfoot,
0.27 per cent. ; tuberculosis of lungs, 0.15 per cent., and goitre, 0.13 per
cent. Wide variations in causes of rejection were reported for the differ-
ent provinces. For illustration, physical debility accounted forarejection
of 12.6 per cent. of those examined in the District of Brabant, but for
only 1.97 per cent. in the District of Luxemburg. Rejections on
account of diseases of the heart and circulatory organs accounted for
1.77 per cent. in the District of Hennegau, but for only 0.1 per cent.
in the District of Luxemburg. Goitre accounted for a maximum rate
of 0.53 per cent. in the District of Liege, but for only 0.009 per cent.
in the District of West Flanders. Rejections on account of deficiency
in stature varied from an average of 2.27 per cent. for the entire
kingdom, a maximum of 2.64 per cent. for the Province of Liege and
a minimum of 1.33 per cent. for the Province of Limburg.
RECRUITING STATISTICS OF HOLLAND
For Holland the available recruiting statistics are only for the period
1903-07. The average rejection rate was 19.8 per cent. of the ex-
63
amined, having been as high as 24.9 per cent. in one district and as
low as 15.8 in another. . The principal causes of rejection were diseases
and defects of the eyes, 6.1 per cent.; general debility, including anemia,
etc., 1.9 per cent.; followed by flatfoot and other diseases of the feet,
1.5 per cent.; spinal curvature, etc., 1.5 per cent.; diseases of the ears,
0.95 per cent. ; hernia, 0.9 per cent.; diseases of the heart, 0.6 per cent.;
tuberculosis of the lungs, 0.6 per cent., and goitre, 0.09 per cent.
Aside from diseases of the heart, however, heart murmurs, etc., ac-
counted for 0.3 per cent. of the examined, a total of 0.88 per cent. for
all diseases of the heart, as far as reported. Of special significance
is the relatively high rate of rejection on account of spinal curvature,
which, however, may be explained by special attention to an impair-
ment frequently not recognized by superficial examinations.
Of special interest in the statistics of Holland are the anthropometric
data, which extend over the period 1863-1910 and which indicate a
persistent decline in the proportion of recruits of a stature of less than
155 cm. and an increase in the proportion of those of 170 cm. and over.
At the beginning of the period the proportion of minimum stature was
11.09 per cent. of those examined, against 1.98 per cent. at the end.
The proportion of a stature above 170 cm. was 24 per cent. dur-
ing 1863-67, which by 1906-10 had increased to 54.61 per cent.
Whether this increase, however, is not more apparent than
real is not made clear by the .statistics, which are suggestive of
extreme caution in connection with their use as regards the probable
physical improvement of Dutch recruits. The stature varies considerably
for the different provinces. The proportion below the prescribed mini-
mum of 155 cm. has been as high as 3.74 per cent. in one district and as
low as 0.88 per cent. in another during the last quinquennial period for
which the information is available. The general conclusion, however,
would seem justified that the proportion of recruits below the average
stature is now less in Holland than in former years.
RECRUITING STATISTICS OF RUSSIA AND FINLAND
The recruiting statistics of Russia and of Finland are too fragmen-
tary to permit of definite conclusions. For Finland the ratio of perma-
nently rejected recruits has varied considerably from year to year, hav-
ing been at a minimum of 20.25 per cent. during 1903 and a maximum
of 62.69 per cent. in 1894, The returns indicate the decided influence of
changes in rules and regulations and cannot be accepted without an
analysis in detail, for which the data are at present not available.
RECRUITING STATISTICS OF GREAT BRITAIN
The recruiting statistics for Great Britain are not comparable with
those of the countries thus far examined or discussed, in that they relate
exclusively to volunteers instead of to conscripts, and to a class of vol-
unteers which cannot be considered typical of the British male popula-
64
tion of the recruiting age. During 1910 the rejection rate was 30.9 per
cent., the rate since 1891 having been as high as 42.35 per cent. in
1896 and as low as 28.1 per cent. in 1900. The rates show throughout
the strong influence of recruiting necessities, as, for illustration, during
the years 1900-01, on account of the South African War. During
1906-10 the principal causes of rejection on initial examination were as
follows: Deficiency in chest measurement accounted for 5.3 per cent.
of those examined; dental defects and deficiencies, 5.2 per cent.;
visual defects and deficiencies, 2.8 per cent.; diseases of the
heart, 2.8 per cent.; deficiency in stature, 1.18 per cent.; deficiency in
weight, 1.16 per cent.; flatfoot, 0.88 per cent.; hernia, 0.8 per cent. ;
spinal curvature, 0.53 per cent. (for Holland the corresponding propor-
tion of rejection was 1.48 per cent.).
In the English statistics forty specific causes of rejection are enumer-
ated, some of which, apparently, are not recognized in the recruit-
ing statistics of the Continent. Of special significance is the high rejec-
tion rate on account of deficient chest development or chest measure-
ment, which to a certain extent is explained by the class of recruits
accepted on a basis of voluntary enlistments. There have been pro-
found changes in this respect, however, during recent years, and the
proportion rejected on account of deficiency in chest measurement or
‘chest proportion was as high as 13.98 per cent. in 1896, and as low as
4.96 per cent. during 1906. Equally important changes have occurred
in the rejection on account of underweight, the rate on this account
having been as high as 4.56 per cent. in 1897, and as low as 0.41 per
‘cent. during 1908. The misleading character of these returns as
evidence of physical deterioration is best illustrated by the fact that the
rate of rejections on account of underweight was 2.33 per cent. of
those examined in 1907, only 0.4 per cent. during 1908, 0.46 per cent.
during 1909, but 1.47 per cent. during 1910. In further contrast the
rate was as high as 4.0 per cent. during the year 1893, but during the
preceding year it was only 2.8 per cent. The rejection rate on account
of tuberculosis has also varied considerably, or between a maximum of
0.26 per cent. during 1894 and 0.07 per cent. during the preceding year.
Rejections on account of hernia have remained fairly stationary, the
fluctuation being limited between a maximum of 0.95 per cent. during
1908 and a minimum of 0.71 per cent. during 1895. Of special signifi-
cance is the decline in the rejections on account of syphilis, which
reached a maximum rate of 0.51 per cent. in 1894 and a minimum of
0.18 per cent. during 1908-09.
RECRUITING STATISTICS OF JAPAN
The only other available statistics for foreign countries are those of
Japan, limited to the period 1903-09. As far as it is possible to judge, the
ratio of rejections was 10.8 per cent. of those examined during the
65
period 1905-09. No statistics ate published regarding the causes of re-
jection, but some interesting data are available regarding the distribu-
tion of troops by stature, which seem to indicate a gradual decline in
the proportion of those below 148.5 cm. Comparing the returns for
Japan and those for certain other countries, it appears that the propor-
tion of those of a stature of 160 cm. and over (63 inches) was 87.0 per
cent. for Prussia, 69.9 per cent. for France, 57.0 per cent. for Austro-
Hungary, but only 3.1 per cent. for Japan.
RECRUITING STATISTICS OF THE UNITED STATES
The comparative value of the preceding statistics is very limited.
It is not only difficult to scientifically define the prevailing standards
of military fitness in the different countries for which recruiting
statistics are available, but the standards themselves have varied so
frequently and have been so strongly influenced by military require-
ments that all international conclusions must be arrived at with extreme
caution. Schwiening includes, however, certain statistics for the United
States which may be referred to, since nearly all of the preceding data
are derived from his elaborate work on Recruiting Statistics (Lehrbuch
der Militarhygiene, vol. v.) which, unfortunately, has not been trans-
lated into English. According to Schwiening, the rejection rate for
American recruits, which, of course, represent volunteers, is not
strictly comparable with the returns for conscripts, on the one hand, nor
exactly with the volunteer statistics of England, on the other, for there
are reasons for believing that the English statistics represented previ-
ously to the war a class physically distinctly below, in age and physique;
the corresponding class of applicants for military service examined
and accepted in the United States.
The general (medical) rejection rate for 1906-10, according to this
author, was 13.69 per cent., having been 13.8 per cent. for the white,
and 10.5 per cent. for the colored. The principal.cause of rejectionamong
the white was diseases of the eyes and errors of refraction, or 1.57 per
cent. of those examined, followed by sexual diseases, 1.23 per cent.;
diseases of the ears, 1.07 per cent.; diseases of the heart, 1.03 per cent. ;
underweight, 0.79 per cent.; dental defects, 0.69 per cent.; alcoholism,
0.65 per cent.; flatfoot, 0.57 per cent., and hernia, 0.54 per cent.
It is extremely significant that general debility should be such a
rare cause of rejection in the United States Army, only 0.06 per cent.
for the white and 0.02 per cent. for the colored, when this cause
or group of causes is one of such major importance in the examination
of conscripts on the Continent. The statistics make it clear that they
cannot be used for comparative purposes without extreme caution; in
fact, it may be sefiously questioned whether any comparison can at
the present time be made which does not involve the serious risk of
error in whatever conclusions may be arrived at. The analysis, there-
66
fore, suggests the urgency of radical reforms as regards both
standardized methods of physical and medical examination in recruit-
ing and the subsequent tabulation, classification and publication of the
returns.
COMPARATIVE CAUSES OF REJECTION FOR
MILITARY SERVICE
The questions involved in the practical use of army anthropometry
and medical statistics are of such obvious vital importance, not only
to the military authorities but to the public at large, that unnecessary
delay in the required changes and improvements must be considered
as contrary to public policy and the scientific spirit of the age. It is
difficult to understand how so important a branch of statistics should
have been so conspicuously neglected that not much more than a
beginning has been made toward placing the army anthro-
pomettic and medical statistics upon a thoroughly well-developed
scientific basis and above the serious criticism of inherent un-
trustworthiness and practical uselessness. Even the great work of
Prof. Dr. H. Schwiening fails to meet modern requirements, due
primarily to the inherent limitations of the data in consequence of
the neglect on the part of the military authorities to properly develop
the statistical branch of the army medical and recruiting services. The
statistics for the various foreign countries utilized for the present
purposes and chiefly derived from the work of Schwiening cannot,
therefore, be accepted as conclusive evidence of the physical superiority
or inferiority of the different army groups or of the same group at
different periods of time. \ No two countries, apparently, follow the
same methods of recruiting, of physical examination, the same rules
and regulations in physical and medical rejections and, finally, the ©
same classification and tabulation of returns. The status of the prob-
lem in this respect is much the same as some twenty years ago was
true of general mortality statistics, the reform of which dates from
the now almost universal adoption of the Bertillon or international
classification of causes of death.
These limitations in army medical statistics explain the contradictory
nature of many of the conclusions based upon crude and far-from-
satisfactory returns. Thus, for illustration, it is frequently not entirely
clear whether rejection ratios are derived from recruiting material
subjected to a previous process of the elimination of the obviously
unfit or from the entire material subject to conscription or selective
draft. It is also often doubtful, especially as regards anthropometric
statistics, whether the official data have reference to the recruiting
material previously to medical selection or merely to accepted recruits,
as was the case in the United States Army before the war. Now, of
course, such a selected group cannot be considered typical of the normal
67
stature or weight distribution of the male population of military age,
since those above the maximum and those below the minimum of the
army standard are excluded. In no direction, however, are the statistics
more inconclusive than in the assigned causes of rejection for military
service, especially where the practice prevails of assigning all those
who are generally deficient in physique, health or bodily strength to a
relatively large group designated as “general debility.” It is
true that for Germany the details of this group are reasonably
well understood, but it requires a thorough knowledge of the German
army regulations to determine the significance of numerically unim-
portant but medically suggestive causes and conditions. Unques-
tionably, the difficulties to be overcome are often serious, as, for illus-
tration, in the cases of retarded bodily development and deficien-
cies in consequence of the debilitating effects of previous illness, etc.
In the absence of a thoroughly well-considered international classifica-
tion of causes of rejection, the available statistical material requires
therefore to be used with extreme caution. .
In further illustration of these observations, it seems advisable to
briefly restate the principal causes of rejection in recruiting as officially
assigned in the army experience of representative countries, primarily
for the purpose of emphasizing still more precisely the inherent limita-
tions of army recruiting statistics in their medical aspects and the
more or less inconclusive evidence of the prevailing physical or medi-
cal defects and deficiencies in the recruiting material of the armies
of the different countries under review. Most of the following data
are derived, as a matter of convenience, from the treatise on Military
and Sanitary Statistics by Dr. H. Schwiening.
CAUSES OF REJECTION IN THE GERMAN ARMY
The first table is for the German army and the period 1904-08. In
addition to the six principal causes of rejection, the table shows the
percentage of such rejections in the total number of recruits examined,
which must not be confused with the percentage distribution of all
causes of rejection in the usual form, in which rejections only are con-
sidered and not with reference to the recruiting material from which
they are derived.
PRINCIPAL CAUSES OF REJECTION IN THE GERMAN ARMY
1904-1908 -
Per Cent.
' Examined
1. General Debility 19.3
2. Diseases of Heart and Circulation... 3.0
3. Minor. Medical Defects (as defined by regulations)............ 3.0
4. Defects and Deformities of the Extremities 2.9
5. Flatfoot 2.1
6.
Hernia 2.1
68 .
According to this table, out of every 100 recruits examined in the
German army, 19.3 were rejected for general debility, which includes
retarded bodily development, weakness of the body as a whole or of
any of its parts in consequence of previous illness or injury, and minor
diseases or deformities not likely to result in permanent incapacity for
military service. This group also includes deficient bone or muscular
development, deficient chest development and lung capacity, etc. In the
usage of other countries these defects or deficiencies are separately
enumerated, and the proportion of such rejections in the German army
considered as a group cannot, therefore, be compared or contrasted
with the combined figures for other armies, on account of the absence of
corresponding army rules and regulations governing with approximate
precision the designation or classification, as the case may be. It,
nevertheless, is extremely significant that the proportion of rejections
for this group of causes and conditions should be so large in the
German army regardless of universal physical coy rg co-ordinated
‘to military requirements.
CAUSES OF REJECTION IN THE AUSTRO-
HUNGARIAN ARMY
The next table is for the Austro-Hungarian Empire, and for the
decade 1894-1905. It is limited to the first three age groups of the
attained minimum stature of 153 cm.
_ PRINCIPAL CAUSES OF REJECTION IN THE AUSTRO- HUNGARIAN
ARMY, 1894-1905
Per Cent.
Examined
1. General Bodily Weakness 43.0
2. Varicose Veins 3.3
3. Intestinal Displacement (Hernia) ‘SA
4, Goitre ; 2.8
5. Flatfoot 24
6. Deformities of Skeleton and Skull 2.2
The term “bodily weakness” as used in the Austrian statistics is
obviously a large group of miscellaneous causes and conditions, each
and every one of which should be separately stated to permit of a
definite assignment in a strictly scientific classification. Such a group
of causes or conditions serves no medical and military purpose, but
merely tends to preclude finality of judgment and accuracy in com-
parison. It is alsoa practical certainty that such a grouping permits of
the inclusion of a large number of ill-defined causes or conditions ;
but it justifies, in the main, the assumption that a very considerable
proportion of those examined for service in the Austro-Hungarian army
are ofa sufficient degree of physical inferiorityas tobe unfit for the stress
and strain of military life. It, however, must not be overlooked that in
countries where the military age may begin with 18 in the case of volun-
69
teers, many of the recruits who may be physically underdeveloped at the
time of examination may be assigned to a class subject to re-examination
and may beacceptable for military service on attaining full maturity. The
Austrian statistics illustrate precisely the urgency of a rational and well-
considered international classification of causes and conditions of re-
jection, but in the absence of similarity in other recruiting require-
ments, such as the age and the method of selection, the derived classi-
fication itself may still remain inconclusive and possibly seriously mis-
leading.
CAUSES OF REJECTION IN THE FRENCH ARMY
The following table is for the French army, for the period 1907-10:
PRINCIPAL CAUSES OF REJECTION IN THE FRENCH ARMY
1907-1910
Per Cent.
Examined
1. Diseases of Bones and Extremities
2. General Bodily Debility 19
3. Tuberculosis LZ
4. Ill-defined and Not-designated 1.0
5. Varicose Veins . 0.9
6. Errors of Refraction 0.8
The French statistics clearly emphasize the non-comparability of the
data with those of Germany and Austria. For tuberculosis, which is re-
turned separately for France, is probably included in general debility
in the statistics of Germany and Austria, at least as a predisposing con-
dition or with the disease in its initial stages. The German classifi-
cation, in fact, does not specifically enumerate tuberculosis, but it gives
a separate classification for diseases of the lungs (1.0 per cent.), asthma
(0.04 per cent.) and diseases of the larynx (0.3 per cent.). These
three groups, therefore, constitute a major group of diseases of the
respiratory organs, probably inclusive of a fair proportion of cases of
tuberculosis, at least in its initial stage. In contrast, it is exceedingly
significant that the permanent rejections in the French army on account
of tuberculosis should have been 1.2 per cent., as stated, with a rea-
sonable assumption that cases in the initial stages of the disease were
also included in the second group under bodily weakness or general
debility. The term “tuberculosis” as used in the foregoing group is,
however, exclusive of tuberculosis of other organs or parts, the propor-
tion of rejections on account of which was 0.4 per cent. It is intimated
by Schwiening that the rate of discharges on account of tuberculosis in
the French army previously to the war was relatively high, and that
therefore the examinations in connection with recruiting were either in
many cases superficial or conditions of army life were peculiarly predis-
posing to the development of the disease soon after entry into the mili-
tary service.
70
The French statistics also illustrate clearly the importance of ex-
ceptional causes in their effects upon general recruiting results. Thus,
for illustration, in the Austrian experience, goitre is the fourth im-
portant cause, accounting for 2.8 per cent., but in the French army
this condition accounts for only 0.14 per cent. Equally important are
the differences in rejections for flatfoot. In the German army this
condition accounts for 2.1 per cent. of the examined, in the Austrian
for 2.4 per cent., but in the French army for only 0.34 per cent.
CAUSES OF REJECTION IN THE SWISS
ARMY
The Swiss recruiting statistics are for the period 1901-05, and their
tesults by causes are also on the percentage basis of the examined. The
statistics are even more conclusive than those of Germany and Austria,
for the purpose of illustrating the importance of exceptional causes
or specific conditions, such as goitre, hernia, etc.
PRINCIPAL CAUSES OF REJECTION IN THE SWISS
ARMY, 1901-1905
Per Cent.
Examined
1. Goitre ; 6.1
2. Visual Defects and Errors of Refraction 5.6
3. Flatfoot 4.1
4. Below Minimum Stature 3.7
5. General Bodily Weakness i 3.3
6. Hernia : 2.7
Next to goitre errors of refraction are apparently the principal cause
of military unfitness in the Swiss army. There is probably no condi-
tion which gives rise to more confusion and error than the examina-
tion of the eyes. In some recruiting statistics all visual defects, errors
of refraction, as well as eye diseases and even blindness, are combined.
This, however, is not the case in Switzerland, where other diseases of
the eyes account for 1.7 per cent. of the examined, and blindness of
one or both eyes for 0.02 per cent.
The rejections for failure to attain to the minimum stature in Swit-
zerland are of exceptional importance. They clearly emphasize the
effect of governing rules and regulations rather than of physical in-
feriority, on the one hand, and the actual army necessities on a peace
basis, on the other. In the German army the proportion rejected on
account of failure to attain to the minimum stature was only 0.08 per
cent., against 3.7 for the Swiss army. Evidently either the Swiss re-
quirements as to stature are unnecessarily rigorous or unduly high in
consequence of the sufficiency of recruiting material to maintain the
recruiting strength of the army on a peace basis.
71
CAUSES OF REJECTION IN THE ITALIAN ARMY
The following table for Italy is for the period 1905-09:
PRINCIPAL CAUSES OF REJECTION IN. THE ITALIAN ARMY
1905-1909
Per Cent.
Examined
1. General Weakness
2. Deficient Development of Chest 4.1
3. Diseases of the Eye, including Errors of Refraction.............. on
4. Scrofula, Anemia, Weakness, etc 2.0
5. Diseases of Bones, Extremities, etc 19
6. Hernia LS
In Italy, Austria and Germany general bodily weakness is the pre-
dominating cause of army rejections. For medical and recruiting pur-
poses this term is neither conclusive nor practically useful. Com-
bining general bodily weakness with deficient chest development and
scrofula, anemia, convalescence, etc., the three causes account for 11.2
per cent. of the rejections of the examined in the Italian experience,
- against 19.3 per cent. in the German army and 43.0 per cent. in the
Austrian army. It is exceedingly doubtful whether on the basis of
a thorough medical examination, with a due regard to the necessity
for the ascertainment of all existing impairments, defects and defi-
ciencies and not merely the predominating one sufficient for military
disqualification, the Italian recruits would still hold a position of
superiority in physical development over the recruits of the German
or the Austrian Empire.
CAUSES OF REJECTION IN THE BELGIAN ARMY
The Belgian statistics are for the period 1902-04.
PRINCIPAL CAUSES OF REJECTION IN THE BELGIAN ARMY
1902-1904
Per Cent.
Examined
1. Bodily Weakness
2. Diseases of the Bones and Extremities 5.0
3. Diseases of Eyes, including Blindness and Ophthalmia........ 4.4
4. Below Minimum Stature 2.3
5. Varicose Veins 1.9
6. Hernia 1.6
In all of the recruiting statistics specific rejections for tuberculosis
hold a comparatively unimportant position. In the Belgian army the
rejection rate was only 0.15 per cent., but in addition thereto the rejec-
tions for diseases of the respiratofy organs were 0.8 per cent. The
fact, of course, must not be overlooked that the examinations concern
almost exclusively the recruiting material between 20 and 22 years of
age, at which tuberculosis has rarely developed to a point of sufficient
seriousness to permit of its ascertainment except by thorough methods
72
of examination. In proportion, therefore, as methods of physical and
medical examination are perfected, the rejection ratio is increased, but
the higher percentage is merely evidence of thoroughness and not
necessarily of a higher degree of frequency occurrence.
CAUSES OF REJECTION IN THE DUTCH ARMY
The statistics for Holland are for the period 1903-07.
PRINCIPAL CAUSES OF REJECTION IN THE DUTCH ARMY, 1903- 1907
Per Cent.
Examined
1. Errors of Refraction | 4.2
2. Other Diseases of the Eyes 1.9
3. Bodily Weakness, Anemia, etc 1.9
4. Flatfoot, etc. 1.6
5. Spinal Curvature, etc 1.5
6. Ear Diseases 1.0
The predominating importance of visual impairments, accounting for
rejections of 6.1 per cent. of all the examined and 32.5 per cent. of
all rejections, is not explained by the available information as regards
the military rules and regulations covering army rejections on this
ground, It is difficult to assume that visual defects are proportionately
so very much more common in Holland than in Germany, and the high-
frequency figure is probably governed exclusively by rules and regula-
tions, for in Germany, where errors of refraction are known to be
exceptionally common, and perhaps more so than in any other country,
the proportion of rejections for this cause was only 2.0 per cent., and,
including blindness and all other diseases of the eye, only 3.1 per cent.
Of special importance in the Dutch recruiting statistics is the rela-
tively high rate of rejections on account of flatfoot and related patho-
logical conditions of the feet. No details are provided, but in the Bel-
gian statistics flatfoot accounts for rejections of 0.27 per cent. of the
examined, while other pathological conditions of the feet, such as
excessive Sweating, etc., account for 0.7 per cent.
Finally, the very high figure for rejections on account of spinal cur-
vature, etc., in the Dutch army indicates rather exceptional thorough-
ness in the examinations and particular attention to a condition prob-
ably frequently overlooked or ignored in other countries. In the Ger-
man army experience rejections on account of spinal curvature repre-
sent only 0.3 per cent. of the examined, against 1.5 per cent. in the
Dutch army. The condition is not enumerated at all in the Belgian
statistics, but in French recruiting the proportion of those pStas
on this account was 0.46 per cent.
CAUSES OF REJECTION IN OTHE SWEDISH ARMY
The statistics for Sweden are for the period 1903-07, differentiating
those of the age period 21 and those of older ages. As might be
73
expected, the two groups yield somewhat different results, and as illus-
trating the importance of the age factor, which is almost invariably
ignored in recruiting and army medical statistics, the rejection results
are presented for both groups, and in the first group (age 21) in ‘
the order of their importance.
PRINCIPAL CAUSES OF REJECTION IN THE SWEDISH ARMY
1903-1907
Per Cent. Examined
Age 21 Over 21
1. Diseases of the Heart and Circulatory Organs.... 4.4 5.7
2. Diseases of Bones and Extremities 3.4 3.6
3. Deafness and Other Diseases of the Ears.............. 1.6 1.1
4. Tuberculosis 1.6 2.9
5. Constitutional Weakness 1.5 4.5
6. Diseases of the Eyes 1.4 1.3
The Swedish statistics are of very limited practical value on account
of the grouping of the causes, as best illustrated by the predominating
importance of rejections on account of diseases of the heart and cir-
culatory organs. Rejections for heart impairments require differen-
tiation as to whether functional or organic. Methods of examination
vary widely in the different armies and according to the branch of the
service. In modern armies with a thoroughly developed aviation ser-
vice the rejections for even minor functional heart murmurs are of
coutse very high. A man may be rejected for the aviation service al-
though thoroughly sound and efficient for some other branch of army
work. ‘To group all rejections for diseases of the heart and circula-
tory organs with mere functional defects or deficiencies is therefore
scientifically erroneous. In the German army rejections on account
of diseases of the heart and circulatory organs accounted for 3.0 per
cent. There are no corresponding data for the Austrian army, for
which the information is limited to rejections on account of valvular
heart disease alone, accounting for 0.24 per cent. of the examined.
Equally suggestive in the Swedish statistics is the rather high ratio of
rejections on account of deafness and other diseases of the ear (1.6 per
cent.). Itis scientifically erroneous to combine defects of hearing with
ear diseases and congenital deafness. It is even more misleading to
combine deafness and mutism in one classification, as is the case in the
German statistics, which, however, return defects of speech separately.
The German statistics also return separately diseases of the ear, ac-
counting for rejections of 1.5 per cent. of the examined, in addition,
however, mutism and deaf-mutism combined, accounting for 0.09 per
cent. It would seem, therefore, that deafness and other diseases of
the ear are not necessarily exceptionally common as a cause of rejec-
tion in the Swedish army, especially when compared with the ratio for
Norway of 2.5 per cent. .
74
ay, ae wren
CAUSES OF REJECTION IN THE NORWEGIAN ARMY
‘The statistics for Norway are for the period 1904-08, on the basis
of the examined, but they are unfortunately not available in sufficient
detail to make even an approximately useful comparison possible with
the corresponding statistics for Sweden. ‘The causes of rejection are
given as follows: Diseases of the extremities, 7.1 per cent., diseases
of the eyes, 4.4 per cent., diseases of the lungs, 2.6 per cent., diseases
of the ears, 2.5 per cent., diseases of the heart, 2.3 per cent., and hernia,
2.2 per cent. The statistics for both Norway and Sweden seem to in-
dicate a decidedly lesser proportion of rejections for bodily weakness,
anemia, scrofula, etc., than met with in the recruiting experience of
Germany, Austro-Hungary and Italy.
CAUSES OF REJECTION IN THE BRITISH ARMY
How far the foregoing statistics of causes of rejection in recruiting
under a system of compulsory military service can be compared with
the corresponding statistics of England and of the United States under
a condition of voluntary military service previous to the war is, of
course, an open question. .The great work by Schwiening reflects such
a degree of thoroughness and accuracy that it has seemed best for the
present purposes to utilize the returns included by him for England
and for the United States in the two following tables, rather than to re-
compute the available official statistics, which at best would result in
only minor changes, due to differences in classification, etc. For Eng-
land the statistics are for the period 1906-10, on the basis of the
examined, differentiating, however, those rejected outright on first ex-
amination and those rejected within three months after conditional ac-
ceptance. The latter figures, for the present purpose, are of minor
importance and are therefore omitted.
PRINCIPAL CAUSES OF REJECTION IN THE BRITISH ARMY
1906-1910
Per Cent.
Examined
1. Deficient Chest Measure
2. Dental Defects and Deficiencies 52
3. Visual Defects 2.8
4. Diseases of the Heart 2.8
5. Defects of Lower Extremities 1.7
6. Varicose Veins 1.4
7.. Diseases of Veins 1.2
8. Below Minimum Stature 1.2
9. Below Minimum Weight 12
10. Flatfoot 0.9
On account of their practical importance four additional principal
causes have been included in the preceding table. It is self-evident
that the results cannot be strictly compared with corresponding sta-
tistics concerning rejections in connection with military service on a
75
conscription basis. The high proportion of rejections in the British
army on account of deficient chest measurement is obviously in con-
sequence of a military rule not necessarily governed by necessity or
sound anthropometric considerations. ‘The same conclusion applies to
defects and deficiencies in dental development, as best made evident
by the radical change in the rules governing this matter in the exami-
nations of the United States Army under the Second Selective Draft
compared or contrasted with the methods under the First Selective
Draft. The English statistics are rather evidence of over-refinement
in rules and regulations than of physical inferiority or military unfit-
ness of the recruiting material. This conclusion applies particularly
to the relatively high proportion of rejections on account of dental and
visual defects, minimum stature and minimum weight.
CAUSES OF REJECTION IN THE UNITED
STATES ARMY
The statistics for the United States are for the period 1906-10, with
a differentiation of the white and the colored. ‘The ten principal causes
of rejection are arranged in the order of their importance for the white
recruits.
PRINCIPAL CAUSES OF REJECTION IN THE UNITED STATES ARMY
WHITE AND COLORED, 1906-1910
Per Cent. Examined
White Colored
1. Diseases of the Eyes, and Errors of Refraction 1.6 0.8
2. Venereal Diseases 1.2 1.9
3. Diseases of Ears, including Defects in Hearing 1.1 0.3
4. Diseases of Heart 1.0 0.9
5. Underweight 0.8 0.4
6. Defective Dentition 0.7 0.4
7. Alcoholism SUOF 0.3
8. Flatfoot 0.6 0.7
9. Hernia 0.5 0.5
10. Insufficient Chest Development 0.4 0.2
These results for the United States are so very much at variance
with the corresponding data for foreign countries that the main cause
of the differences must be attributable to methods of selection under
the voluntary system. ‘The three principal causes of rejection are of
relatively minor military importance; as best made evident by the pro-
found changes in examination methods under the Second Selective
Draft. Diseases of the heart, which account for about 1 per cent. of
the examined, cannot be considered relatively important when con-
trasted with a rejection ratio of 3 per cent. in the German army. Under-
weight is largely governed by arbitrary standards and not necessarily
of pathological significance. The relatively high ratio of rejections on
account of defective dentition is largely the result of rules and regu-
lations, which under the Second Selective Draft have been very ma-
terially modified. ‘The same conclusion applies to alcoholism and to
76
> SEOs Se OW 3 og ee
a somewhat lesser degree to flatfoot and hernia. ‘The rejection ratio
on account of insufficient chest development, which is numerically of
the first importance in the British experience, is relatively unimportant
in the American experience, or only 0.4 per cent. of the examined,
against 5.3 per cent. for the British army previously to the war. *
For the colored the rejection ratios are quite different, the most pro-
nounced variation being in the lesser degree of frequency of diseases
of the eye and errors of refraction, and the much higher degree of
_ frequency of venereal diseases. ‘There is also, however, a very marked
difference in the lower rejection ratio for the colored on account of
diseases of the ear and defects of hearing, as well as defective denti-
tion, underweight, alcoholism and insufficient chest development. The
difference in the rejection on account of flatfoot is not as marked as.
generally assumed to be the case, the respective ratios being 0.6 per |
cent. for the white recruits and 0.7 per cent. for the colored.
These results are somewhat modified by more recent statistics for
the period 1910-15, inclusive of the entire United States Army -and
native recruits in the Philippines and Porto Rico. A rather serious
practical difficulty is the relatively large proportion of rejections on
account of causes not physical or medical, chiefly rejections based on
army rules and regulations not bearing directly upon the physical fit-
ness of the examined recruit for military service. For the white and
’ the colored recruits combined the six principal causes of rejection dur-
ing the period under review were as follows:
UNITED STATES ARMY REJECTION EXPERIENCE, 1910-1915
WHITE AND COLORED Per Cent.
Examined
Po Gunsee mer Physical eek. Ae el ae 2.19
2. Venereal Diseases 1.23
3. Heart Diseases 1.03
4. Ear Diseases and Defective Hearing 0.94
5. Eye Diseases and Defects of Vision... Sunn, OLBU
ag OS 8 Ritesh ae eae oer Eo Ee ae SE = aE 0.59
CAUSES OF REJECTION—WHITE RECRUITS ONLY
Considering separately white recruits only, the results were as
follows: :
UNITED STATES ARMY REJECTION EXPERIENCE, 1910-1915
WHITE RECRUITS ONLY Per Cent. .
Examined
1. Causes not Physical 2.20
2. Venereal Diseases 1.11
3. Heart Diseases 1.04
4, Ear Diseases and Defective Hearing 0.97
5. Eye Diseases and Defects of Vision 0.82
6. Flatfoot 0.60
* From this table, derived as stated from German sources, the rejections in the United
States Army for “causes not physical” are omitted. This group of causes, however, has been
included in the tables following, so as to facilitate a more accurate comparison with the
corresponding statistics for foreign armies.
77
The important fact disclosed by this analysis is the relatively low
proportion of rejections for venereal diseases, with regard to which the
examination and rules concerning exclusion in the United States Army
are in all probability much more strict, being even drastic, than those in
use in the armies of continental Europe. As might be expected, the
rejection rate for venereal disease among the colored recruits was
perceptibly higher, as shown by the table following:
CAUSES OF REJECTION—COLORED RECRUITS ONLY
UNITED STATES ARMY REJECTION EXPERIENCE, 1910-1915
COLORED RECRUITS ONLY
Per Cent.
Examined
1. Venereal Diseases
2. Causes not Physical 2.00
3. Ear Diseases and Defective Hearing 0.90
4. Eye Diseases and Defects of Vision 0.52
« 5. Flatfoot 0.49
6. Hernia 0.43
It is rather surprising to find a relatively low rate of rejections on
account of flatfoot among the colored, or 0.49 per cent. of the examined,
against 0.60 per cent. for the white recruits. In the earlier data of
Schwiening for the period 1906-10 the rejections on account of flatfoot
among the white recruits were 0.57 per cent. of the examined, against |
0.70 for the colored. ‘‘he relative frequency of flatfoot among the
colored is in all probability not as pronounced as often assumed to be
the case upon superficial inquiry into the facts. As a general prin-
ciple, however, it is probably safe to assume that flatfoot is more com-
mon among colored males than among white males of corresponding
age.* |
CAUSES OF REJECTION—NATIVE AND FOREIGN-
BORN RECRUITS
A comparison of native-born recruits with those of foreign birth in
the United States Army is more or less misleading, on account of ma-
terial variations in the age distribution of the examined. The foreign-
born, as a general rule, are older and in many cases have had previous
military experience in foreign countries. As an illustration, however,
of the marked difference in the health and physique of the examined
recruiting material, the two following tables show the six principal
causes of rejection in the United States Army experience for the native
and foreign-born white applicants for military service.
* A thoroughly scientific discussion of ‘The Soldier’s Foot as an Important Feature of
an Effective Army,’ originally contributed to American Medicine by Harold D. Corbusier,
M. D., Major, Medical Officers’ Reserve, United States Army, has been reprinted in the
Scientific American Supplement, No. 2172, for August 18, 1917. This discussion includes in
its subdivision, first, the exceptional foot; second, the doubtful foot; and, third, the disqualified
foot, with observations on special pathological conditions and remedial considerations.
78
UNITED STATES ARMY REJECTION EXPERIENCE, 1910-1915
NATIVE WHITES
Per Cent.
Examined
1. Causes not Physical 1.86
2. Venereal Diseases 1.19
3. Heart Diseases 1.06
4. Ear Diseases and Defective Hearing 0.96
5. Eye Diseases and Defects of Vision 0.83
6. Flatfoot 0.58
UNITED STATES ARMY REJECTION EXPERIENCE, 1910-1915
FOREIGN-BORN WHITES
Per Cent.
Examined
1. Causes not Physical 4.08
2. Ear Diseases and Defective Hearing 1.05 ©
3. Heart Diseases 0.91
4. Eye Diseases and Defects of Vision 0.77
5. Venereal Diseases 0.75
6. Flatfoot 0.71
The most important difference met with is the decidedly higher
ratio of rejections among the foreign-born on account of causes not
physical, which in all probability are closely related to age and pre-
vious military experience. The age factor also probably explains the
lower ratio among the foreign-born of rejections on account of vene-
real diseases, while conversely the possibility of previous military ex-
perience has a bearing upon the somewhat higher rejection ratio for
flatfoot.
CAUSES OF REJECTION—FILIPINO AND PORTO
RICAN RECRUITS
Of poe shy interest are the rejection statistics of native Filipinos
and native Porto Ricans, limited, however, for the present purpose to
the period 1912-15. Prior to 1912 only causes responsible for more
than one rejection per annum were reported, so that a consolidation
of the statistics for the earlier period would be misleading.
_UNITED STATES ARMY REJECTION EXPERIENCE, 1912-1915
FILIPINOS
Per Cent.
Examined
1. Eye Diseases and Defects of Vision 0.85
2. Heart Diseases 0.78
3. Tuberculosis 0.72
4. Causes not Physical 0.66
5. Underweight 0.57
6. Ear Diseases and Defective Hearing : 0.41
79
UNITED STATES ARMY REJECTION EXPERIENCE, 1912-1915
PORTO RICANS
Per Cent.
* Examined
1. Underweight ......... 4.73
2. Insufficient Chest Development 1.40
3. Eye Diseases and Defects of Vision 1,22
4. Defective Development 1.13
5. Venereal Diseases 1.05
6. Flatfoot 0.96
Limited in numbers, as these statistics are, for the Filipino and the
Porto Rican recruits, they are nevertheless of exceptional value in
emphasizing the probability that the anthropometric standards ap-
plied to this class of applicants were those used generally for the Army
of the Continental United States, though for racial and other reasons
quite inapplicable in view of material variations in physique. The
results leave no question of doubt as to the fact that many Filipino and
Porto Rican recruits were unnecessarily rejected because of non-con-
formity to anthropometric standards based upon a heterogeneous mass
of recruiting material of totally different racial origins. It requires to be
kept in mind, of course, that undernourishment is probably more com-
mon among Porto Ricans and Filipinos than among white and colored
recruits of the mainland of the United States, and that particularly in
the case of the Porto Ricans, the former excessive frequency of anemia
and of uncinariasis have a direct bearing upon the relatively exception-
ally high rejection ratio for underweight. *
The entire recruiting material is suggestive of the need of decidedly
more qualified consideration of questions of normal physique and ab-
normal departures from rational standards of physical development
and bodily proportions, if serious errors are to be avoided, both in the
direction of accepting recruits really unfit for military service in the
field ahd in the direction of rejecting men thoroughly qualified, except
in possibly minor details, for service demanding even the extraordinary
stress and strain of modern warfare on land and sea.
* The results of Some Anthropometric Measurements of Students of the University of
Porto Rico, by Fred K. Fleagle, Dean of the College of Liberal Arts, have been published
in the Bulletin of the University of. Porto Rico under date of January, 1917. The
measurements include 1,412 students, of whom 616 were males of an average age of 19.59
years. ‘The measurements are of special value in that they are for single years and for
three successive dates, including twenty separate anatomical factors aside from height and
weight. An interesting comparison is made with the corresponding measurements of Chilean
boys by single years of life, 16-20, inclusive.
With special reference to Filipinos, see the Racial Anatomy of the Philippine Islanders,
by R. B. Bean, published by J. B. Lippincott & Company, Philadelphia, 1910.
The physical standards applicable chiefly to the native-born are more or less inapplicable
to Orientals. See in this connection some recent statistics on the height, weight and chest
measurements of healthy Chinese in the China Medical Journal, for May, 1918. See, also,
the tables on the Average Physical Condition of the applicants examined for admission to
the Imperial Japanese Navy, Annual Report, 1909-11, Tokio.
80
PART II
RECENT UNITED STATES ARMY
MEDICAL AND REJECTION
EXPERIENCE DATA
In its theoretical as well as practical aspects the whole problem of
army anthropology has undergone important and far-reaching changes
in consequence of the war. A method of selection for military service
during a prolonged period of peace must necessarily vary considerably
from the method of selection of men for active service in the field, but
much more so when the exhausting effects of a great war upon the man-
power of a nation demand a lesser degree of rigid conformity to theoret-
ical principles of physical fitness for military duty. The experience which
has now been had in the United States with the First Draft under the
Selective Service Act of 1917 is obviously, for our own purposes, at
least, of over-shadowing importance. An extended and admirable
report has been made public by the Provost-Marshal General, which,
however, still leaves many important questions undecided. The vast
extent of our draft experience at this time practically precludes a
qualified statistical analysis of the data, however important the results
would be for the needs of anthropological and medical science. Unfort-
unately, many erroneous conclusions have been advanced upon the basis
of the experience which has thus. far been had, with the result that
many far-reaching misleading arguments are being advanced and left
uncontradicted by an appeal to a statement of the facts. It, for illus-
tration, has been alleged that “War tests show that the nation is in
feeble health,” and that “Ninety-nine per cent. are below par.” No
evidence of a sufficiently trustworthy nature has, however, been forth-
coming from the Provost-Marshal General’s office to substantiate these
conclusions, nor in support of the further exaggeration that “The exact
status of Americans’ physical condition is disclosed by countrywide
examinations of applicants for service, and the verdict is all but alarm-
ing.” Asa matter of fact, the only analysis of the causes of physical
rejection which has thus far been made by the Provost-Marshal Gen-
eral’s cffice concerns 10,258 recruits out of a total of 3,082,949 men
called for examination and hearing, of which 730,756 were examined
and rejected on physical grounds, or 23.7 per cent. Eliminating those
who were merely given a hearing, it appears that 2,510,706 men were
81
physically examined by the Boards and, it is to be assumed in each and
every case, by a qualified medical examiner, and that of this number
730,756, or 29.11 per cent., were rejected. These rejections, however,
were only in the first instance by Local Boards. Subsequently, of
561,000 men examined by Boards of Appeal, of which number 413,384
had arrived in camp by November 20, the number rejected by camp
surgeons, and it may be assumed on the basis of a more rigid ex-
amination made under more satisfactory conditions, was 22,989, or
5.8 per cent. If it is therefore assumed that this percentage would
apply to the entire 730,756 men rejected for so-called “physical”
reasons by Local Boards, it would appear that 34.91 per cent. of the
men physically examined by the Boards were considered totally unfit
for active military service.
DISCRETIONARY POWERS IN PHYSICAL EXAMINATIONS
In the words of the Provost-Marshal General, ‘Doubtless the Local
Boards varied extremely in the strictness of their examinations. But
so also, it seems, did the camp surgeons.” The experience shows
“that the percentage of rejections at camp varied between 0.72 per
cent. and 11.87 per cent.; and as the physical condition of the men
from the different regions cannot entirely account for this, it must be
attributable in part to differences of strictness in the examinations by
the camp surgeons.” As to the important question whether the Surgeon
General’s rules for physical examination, as set forth in the directions
to the Local Boards, were stricter than necessary for securing efficient
fighting men, it is said that on this point “the civilian surgeons have
expressed variant opinions,’ and a large majority “consider that the
physical requirements are not too exacting,” but “a considerable number
deem the requirements too strict in many respects, notably as to the
weight and height relation, teeth, eyes and feet, and contend that the
regulations as strictly applied tend to exclude many capable and effi-
cient men.” If-a tendency towards over-emphasis upon relatively
unimportant physical or other factors concerning health and physique
was at all pronounced in connection with the original examinations
by the civilian surgeons of the Boards and subsequently by the army
surgeons at the camps, it is self-evident that a fairly large proportion
of men must have been rejected on so-called “physical grounds,”
although quite probably of normal physique and average power of
endurance as determined by standards such as would govern in the
acceptance of risks for life insurance. It is therefore most regrettable
that an analysis should only have been made of the causes of
rejection of 10,258 recruits at eight different camps, which would indi-
cate that the rejections were by army surgeons and not by civilian
medical examiners in connection with the examinations made under
the direction of the Boards. ‘The latter, unquestionably, are more
82
lenient than the former, and probably subject to an even larger degree
of variation than the indicated range from 0.72 per cent. for Camp
Riley to 11.87 per cent. for Camp Deven. The table following has
been rearranged so as to show the causes for physical rejection and
their percentage distribution in the order of their importance as given
in the Provost-Marshal General’s report made to the Secretary of War
under date of December 20, 1917.
CAUSES FOR PHYSICAL REJECTION BY CAMP SURGEONS—
NATIONAL ARMY EXPERIENCE UNDER FIRST DRAFT OF
THE SELECTIVE SERVICE ACT OF 1917
Causes for Physical Rejection Number Per Cent.
Eye 2,224 21.68
Teeth 871 8.50
Hernia 766 7.47
Ear 609 5.94
Heart Diseases 602 5.87
Tuberculosis . 551 * SSF
Mentally Deficient 465 4.53
Genito-urinary (Venereal) 438 4.27
Physical Undevelopment 416 4.06
Nervous Disorders (General and Local) 387 3.77
Flatfoot 375 3.65
- Joints 346 3.37
Bones 304 2.96
Blood Vessels 191 1.86
Underweight 163 lea 2S
Respiratory 161 1.56
Genito-urinary (Non-venereal) 142 1.39
Skin 118 5
Ill-defined or Not-specified 93 91
Digestive System 82 80
Alcoholism and Drug Habit 79 7
Muscles 66 64
Not stated 809 7.89
Total number of cases of physical rejections con-
sidered 10,258 100.00
NEGATIVE EVIDENCE OF PHYSICAL DETERIORATION
This table is of exceptional importance. It fails in every way to
sustain the conclusion so frequently advanced by sensational writers
that the medical examinations under the First Selective Draft have
brought to light a truly astonishing amount of physical impairment
and military inefficiency on the part of the men of the draft-age period,
21 to 30, inclusive. The table shows that 21.68 per cent. of the
rejections were for diseases of the eye, followed by a proportion of
8.5 per cent. of the rejections for defective teeth. Since defects of
83
hearing accounted for 5.94 per cent. of the total rejections, it appears
that 36.12 per cent. of all the rejections were due to defects or
deficiencies of the eye, the ear and the teeth. How far these defects
are remediable is, of course, an important question, but certainly no
alarming assertions are justified regarding national physical deteriora-
tion as disclosed by this very limited basis of exact information for
a relatively small proportion of the men examined under the Selective
Service Draft.
A further examination of the details, in fact, affords much ground
for satisfaction and evidence that the physical condition of the young
men examined was indeed in many respects a remarkably satisfactory
one. Out of 10,258 men only 79, or 0.77 per cent., were rejected on
account of alcoholism and drug habits. The proportion rejected for
venereal diseases was 4.27, which is high, but not excessive. Physical
underdevelopment accounted for 4.06 per cent. of the total rejections,
aside from 1.59 per cent. for underweight. More important are the
rejections for tuberculosis, or 5.37 per cent. of the total, and for non-
tuberculous respiratory diseases, or 1.56 per cent. Heart diseases are
represented by 5.87 per cent. and nervous disorders, general and local,
by 3.77 per cent., aside from 4.53 per cent. for mental deficiency.
There is nothing alarming in these figures, which, of course, require
to be used for practical purposes with extreme caution. Erroneous con-
clusions might easily be drawn from the fact, for illustration, that rejec-
tions for hernia are represented by 7.47 per cent. of the total; but under
the new rules and regulations of the Provost-Marshal General’s office
the ratio of rejections on this account will be very much reduced. The
same conclusion applies to flatfoot, which accounts for a rejection
proportion of 3.65 per cent., but which under the revised rules will be
reduced to a much smaller proportion.
In other words, it is largely a question of rules and regulations rather
than of physical facts and conditions. The very term “physical rejec-
tions” as used in the Provost-Marshal General’s report is a rather
misleading one, since there are included a considerable proportion of
causes which are not physical in a strict sense, but pathological, or so
ill-defined or not specified as not to permit of being classified or
precisely stated.
IMPORTANT CHANGES IN RULES AND REGULATIONS
The original rules and regulations governing the physical examina-
tion of recruits or conscripts under the Selective Service Law were
promulgated by the Secretary of War under date of November 8, 1917.
These rules have been materially modified by the revised regulations
of the office of the Provost-Marshal General, made public under date
of January 28, 1918. The modifications have practically all been
decidedly in the direction of a lesser degree of exact conformity to
S4
ee ee, a ae
theoretical principles and a more rational adaptation to practical service
requirements, and if they had been applied in the original examina-
tions and rejections under the First Draft, the proportion of rejections
would unquestionably have been substantially reduced. The general
assumption of a single rule of action as to fitness for military service
has, fortunately, been radically changed, and hereafter the men
accepted will be classified into four groups, as follows:
(A) Acceptable for general military service; (B) acceptable for
general military service after being cured of remediable defect; (C)
acceptable for special or limited military service in a specified capacity
or occupation; (D) rejected and exempted from any military service.
Under this plan of reclassification according to physical condition,
in a restricted sense of the term, provision will be made for the
military utilization of a much larger proportion of conscripts or
recruits than has heretofore been possible. It is stated to be the inten-
tion of the Provost-Marshal General to provide later for further inves-
tigation and reclassification of men acceptable for limited or special
service, so that each and every one may be assigned to the kind of
work least likely to endanger his health.
EXAMINATIONS BY OFFICERS OF THE LINE
The possibilities of a material saving in effective man-power by
means of more careful and rational methods of physical selection are
clearly emphasized by the table following, which has been derived
from the annual reports of the Adjutant General for the five-year
period 1913-17: |
RECRUITING STATISTICS OF THE UNITED STATES ARMY
ADJUTANT GENERAL’S REPORTS
1913-1917
ENLISTMENTS AT RECRUITING STATIONS
Total Number of Number of Accepted and
oe pjeccriendl *Rreted Per Cent. gi gnaeroreap Per Cent. pera chico
1913 123,664 98,927 80.0 24,737 20.0 3,469
1914 168,527 127,317 75.5 41,210 24.5 5,308
1915 168,842 123,731 73.3 45,111 26.7 5,866
1916 133,090 102,097 76.7 30,993 aw 4,194
1917 367,579 187,388 51.0 180,191 49.0 17,256
—
Total 961,702 639,460 66.5 322,242 33.9 36,093
According to this table, out of 961,702 applicants for military serv-
ice, 639,460, or 66.5 per cent., were rejected. All of these rejections
were, as far as known, on the basis of examinations made by non-
medical officers of the line. The rejection ratio, however, varied from
80 per cent. in 1913 to 51.0 per cent. during 1917. The very substantial
85
reduction in the rejection rate during 1917 was naturally in conse-
quence of a lesser degree of severity in the initial examinations by non-
medical officers of the line. It is the practice, however, to re-examine
the recruits at recruiting depots and depot posts, chiefly, it is under-
stood, by medical officers of the Army. Out of 337,599 men thus
subjected to re-examination during the period 1913-17, the number
rejected was 37,938, or 11.2 per cent. No statistics are available to
show what proportion of rejected applicants would have been accept-
able to the army authorities if re-examined by army medical officers
in conformity to the same method which prevails in the case of the
re-examination of accepted applicants. The medical rejection ratio of
the re-examined was 13 per cent. in 1913, 11.6 per cent. in 1914, 11.5
per cent. in 1915, 14.1 per cent. in 1916, but only 10.3 per cent. in 1917.
The lower medical rejection rate in 1917 may therefore be accepted
as evidence that the rejections in a measure were affected by the
necessities of the war. ‘The new method of examination and re-exam-
ination will probably continue for the duration of the war. The new
instructions to examiners are based in a large measure upon the prac-
tical experience which has been had under the First Selective Draft.
EXAMINATIONS BY CIVIL MEDICAL OFFICERS
OF LOCAL BOARDS
Among the numerous contributions which have been made to the
literature of the subject by medical experts of national reputation, a
discussion on “The Examination of Registrants,’ by M. L. Harris,
M. D., Medical Member of the District Appeal Board, Chicago, is of
exceptional importance. According to Dr. Harris,
When the first draft started, it was entirely a new experience to the people
of this country. The rules and regulations were so drawn as to place the
carrying out of the provisions of the act in the hands of the people; in fact,
the act itself forbade any one connected with the military establishment to have
anything to do with the execution of the draft. The personnel of the boards,
local and district, was made up of civilians, both lay and professional, none of
whom had had any experience in the selection of men for the Army. Prac-
tically all of the members of the boards labored under the disadvantage of
having no opportunity to acquaint themselves with the work to be done until
they were appointed to the positions and ordered to proceed at once with the
draft. It is no wonder, then, that things did not go at all times as smoothly
as they should have gone; it is no wonder that there were differences of
opinion and even a lack of harmony between the various boards, which a
better understanding of the work to be done would have avoided.
These observations apply with special force to the question of
height, weight and chest expansion. Even though in the large majority
of cases the results were quite satisfactory, as observed by Dr. Harris,
it requires to be thoroughly understood “that the question which the
physician is to determine when a person presents himself for exami-
nation is not what ailment, if any, he may have, but whether he is fit
86
or unfit to do military service.” For, he continues, “These are not
necessarily synonymous, for there are certain ailments which a person
may have and still be fit for military service; and, on the other hand,
he may be unfit for service without there being any special physical
disability.” It is self-evident that it must often be a most difficult
matter to decide whether or not a certain condition really unfits one
for service, and it is therefore particularly significant, as pointed out
by Dr. Harris, “that the rules and regulations are not definite and
clear on the subject,” and that “therefore much is necessarily left to
the judgment of the examining physician.” ‘These conclusions. were
arrived at, however, before the new rules and regulations of the
Provost-Marshal General’s office were made public. In answer to the
important question whether the rejection statistics are really conclusive
as regards the physical condition of the registrants of merely a statis-
tical enumeration of the principal causes of rejection on the ground
of unfitness for military service, Dr. Harris, on the basis of his own
experience, states (Journal American Medical Association, January
19, 1918) that
When the registrant alleged more than one ailment, which was very common,
he was examined first for the most important one from a disqualifying sense.
For instance, one might complain of bad eyes, trouble with his stomach, and
rheumatism. The eyes would be examined first, and if the vision was found
to be so defective as positively to disqualify the man, no time was spent in
investigating his other complaints. It should be understood that the purpose
of the examination is to determine the fitness or unfitness of the registrant
for military service, not to make a complete clinical diagnosis such as one
would do in practice. Hence, just as soon as a condition is found which under
the rules and regulations positively disqualifies the man for military service,
the examination need not be further extended. This, of course, applies to
examinations on appeal, as it is necessary in all cases for the local board to
make a complete examination and fill out a blank form as required by the
rules and regulations.
It would appear from this statement that a complete examination of
the registrant is made by the Local Board, but that only a single ques-
tion, as a rule, receives consideration with the Board of Appeal. If this
conclusion is entirely correct, the value of the rejection statistics by
causes would be materially enhanced. Unfortunately, it is said
that under the First Draft, at least, “The rules laid down for the
guidance of physicians are quite incomplete and often ambiguous, so
that much was left to the unaided judgment of the examiner,”
since many had “perhaps little or ne experience in selecting men for
the army, errors in judgment are not uncommon.” The greatest number
‘of errors, according to Dr. Harris, was made in the examination of
the eyes. Since, according to the Provost-Marshal General’s analysis,
visual defects accounted for 21.68 per cent. of all the rejections for
physical reasons, this element of error assumes special significance.
In contrast, however, overlooked cases of pulmonary tuberculosis were
ascertained on appeal, even though some of the applicants “had been
87
for some time inmates of the Municipal Tuberculosis Sanatorium of
the city of Chicago.” ‘There were some cases of deficiency in height
or weight, or both combined. Dr. Harris observes in this connection
that “As the regulations prescribe 61 inches as the minimum height,
and as our instructions were to make no concessions below 61 inches,
of course all who fell below that height had to be rejected.” “In the
matter of weight, however,” he remarks, “more discretion is allowed
when the individual is otherwise in good physical condition.” He
makes reference to one rejection on account of underweight where the
actual weight was 1104 pounds at the time of the examination,
whereas the prescribed minimum for applicant’s weight was 112 pounds.
His chest measure was 1% inches in excess of the measurement required
according to his height, and he was otherwise physically sound. ‘This
applicant had tried in every possible way to procure exemption, and
the conclusion was that “he deliberately reduced his weight, as his
general condition was very good.” Evidently cases of this kind cannot
be accepted as evidence of physical inferiority or physical deterioration,
for, quite to the contrary, the lesser weight, under given conditions,
may be an advantage rather than otherwise. The final recommenda-
tion of Dr. Harris is therefore sound: __
As the great majority of the men composing these boards are inexperienced
in this particular kind of work, and as many new questions will come to them
for solution, it would be very advantageous if there were some one of experi-
ence in the Provost-Marshal General’s office to whom they could turn for
advice. Strange as it may seem there is not a physician attached to that office.
ARMY REJECTION EXPERIENCE IN GREATER NEW YORK
Another contribution of real value to the subject matter under
consideration is by Dr. Edward F. Hurd, of New York, based upon
the work done by the examining physicians of the Local Board for
Division 20, Bronx, New York City (J. A. M. A., January 5, 1918).
In this case the medical member of the Board had secured as his asso-
ciates six other physicians of the Bronx, all of whom but one had
for many years been engaged in the genefal practice of medicine.
The exception was a specialist in diseases of the eye, ear, nose and
throat. ‘The men were examined in groups of ten in the gymnasium of
the New York University, and after having been asked a few questions
made mandatory by the Selective Draft Law, the procedure was as
follows:
The man was then told to retire behind the screen. When he stepped, stripped,
from behind the screen, he was taken in charge by the first physician. who
weighed him and took his height and chest measurement. He was then passed
to the second physician, who examined his teeth, nose and throat, and made a
general inspection for deformities and abnormalities, including Hatfoot, hammer-
toe, etc. The third physician examined by stethoscope the heart and the lungs.
The fourth covered hernia, varicocele, hemorrhoids and history as to venereal
disease; if any question elicited a suspicion of diabetes or nephritis, a sample
88
of urine was obtained in the presence of the physician, and a university professor
of chemistry made the examination at once, the result being known before the
man was dressed. The fifth physician was stationed in a small room fitted with
Snellen’s test cards, and there examined the eyes and the ears. The physical
exagination blank was passed from physician to physician, each making a record’
of h® findings.
It is explained by Dr. Hurd that if during the course of the exami-
nation any physician detected a condition which he considered sufficient
to disqualify the registrant, he consulted the sixth physician, who was on
duty for re-examination, These two failing to agree, they appealed to the
board physician: the verdict of the three was final. It is stated that
under the foregoing arrangement it was possible “in a few hours to
examine 175 men with such thoroughness that to date, with 70 per
cent. of the quota in camp, not a man has been returned because
physically deficient.” Before leaving the building, each man was in-
formed as to the result of his physical examination and given an
opportunity to file a claim for exemption or discharge, the chairman
of the Local Board taking charge of this branch of the work.
EFFECTS OF DISCRETIONARY POWERS ON THE
REJECTION RATE
The actual results under this procedure in 1,800 cases were as
follows: The number of rejections for physical reasons was 705, or
39.2 per cent. of the total. It is stated by Dr. Hurd that “This seems
a staggering proportion of unfitness among men between the ages of
21 and 31, a time when physical perfection is most likely to be found;
but when we consider that 232 of these were underweight, a condition
which may not mean any permanent physical defect, the high rate
becomes more readily understandable.” He explains, however, that
“This figure would have been much higher had not the examining
physician departed from the arbitrary dictum of the rules and regula-
tions as to relative weight and height.” “In cases in which the subject,
although underweight, was in all other essentials in good physical
condition, he exercised his personal judgment to the effect that camp
life would probably improve the weight, and accepted the man. Con-
versely, of overweights: none of the latter were rejected unless really
obese.” With reference to the 232 men underweight, the greatest
number were aged 29; the smallest 27. It is therefore evident that
the group under review was not sufficiently large for entirely safe con-
clusions. Out of 477 native-born registrants, 151, or 31.7 per cent.,
were underweight; out of 149 Russians, 66, or 44.3 per cent., were
underweight. Since the army standard is the same for all races, in
disregard of the fact of decided anthropometric variations, conclusions
based upon these percéntages are certain to be misleading.
Other causes of rejection were: flatfoot, 22; varicocele, 15; bad
teeth, 20; tuberculosis, 4;‘bad eyes, 30; deformities, including hammer-
toe, etc., 36; varicose veins, etc., 8; obesity, 22; albuminuria, 11; bad
89
ears, 3; other causes, including insanity, 33. These statistics cannot
be considered evidence of a really serious degree of physical deteriora-
tion, or, in a considerable proportion of cases, as obvious evidence of
unfitness for military service. Nevertheless, the conclusions of Dr.
Hurd are entitled to weight, being in brief, that
The findings of this board show that men of draft age who hold clerical
positions are the poorest physical specimens. We shall waive the question
whether deficient physical equipment impelled these men toward the inactive
occupation of the clerk, or whether the sedentary life of the clerk has resulted
in poor physical condition: there is probably a good deal to be said on both
sides. Undoubtedly chronic constipation, lack of exercise and fresh air, with
the resulting soft flabby muscles, would seem to be the principal causes of under-
weight and hernia. Take these men out of their stuffy offices and put them into
camp, make them live in the open with regular exercise and regular hours, and
they. will soon be brought up to the standard.
The statistical tables included in the report by Dr. Hurd are not in
conformity to standardized methods of statistical analysis. The causes
of rejections according to age are not correlated to the corresponding
numbers of men examined, so that the true rejection ratio for different
causes cannot be determined from the data thus far made available.
It is properly suggested, however, by Dr. Hurd, that “The compilation
of such data from all districts of Greater New York would be of
“enormous statistical value.’ Such statistics would be practically use-
less, unless compiled in a proper manner, for mere data on the subject
of army rejections are certain to be misused by those who are wrong-
fully alarming the public as regards the alleged physical deterioration
of American men of military age.
MISLEADING CONCLUSIONS REGARDING PHYSICAL RE-
JECTIONS UNDER THE FIRST SELECTIVE DRAFT
Among others in authority, Prof. D. A. Sargent, Director of
Physical Training at Harvard, has given public utterance to the view
that “Any one who has read the Provost-Marshal General’s recent
report and noted that from 25 to 75 per cent. of our young men were
exempted from military service on account of physical disability and
preventable disease, cannot help having some misgiving as to the future
of our country.” Elsewhere in the same discussion, on “The Draft’s
Showing Up of Physical Defects of Young Americans and the
Remedy,” Prof. Sargent observes that “Yet this is the condition of
the United States today, where, as we have seen, over 50 per cent. of
our young men have been rejected as unfit for military service, while
the country is spending millions upon millions at the training camps
in trying to get those who have been accepted in fit condition to perform
the duties of a soldier.” Now, as a matter of fact, it is not correct
to say that 50 per cent. of the men have been rejected for physical
reasons, or, in other words, on the ground .of a physical impairment
of a sufficient degree to preclude the immediate or remote possibility
90
of efficient military service in the field. Of all the men examined, at
most 35 per cent. were rejected on this ground and in conformity to
methods of examination more or less antiquated and inadequate to
the present purpose. A careful examination of the causes of rejections
as far as analyzed proves conclusively that probably one-half, if not
more, were not of a sufficiently serious nature to justify the uncon-
ditional rejection of the registrant or conscript as unfit for military
service at home and in the field.
MISLEADING USE OF ARMY REJECTION EXPERIENCE
UNDER THE VOLUNTARY SYSTEM
Even more misleading are the rejection data which have been
utilized by Dr. J. H. Quayle, of Cleveland, Ohio, in connection with
an argument for the “Reclamation of Men Rejected Under the Draft,”
however admirable the suggestion may be otherwise concerning the far-
reaching possibilities of physical rehabilitation. Unquestionably, much
can be done in this respect, and much ought to be done, for the waste
of life and strength because of ignorance and indifference is incal-
culable, but the end in view does not justify the misleading use of
statistics which is certain to unduly alarm the public and lead to
entirely erroneous conclusions on the important question of physical
status and physical deterioration. Dr. Quayle applies the rejection
statistics of the Surgeon General’s report for a single year, 1916, to
the 9,000,000 men called out under the draft, of which it is alleged only
1,800,000 would be physically fit, and 7,200,000 would be rejected. This
conclusion is absolutely grotesque and likely to hinder rather than help
the cause of the rehabilitation of those properly rejected under the
draft. The argument is advanced by Dr. Quayle upon the hypothetical
assumption that if 7,200,000 of the men were rejected, among others,
938,232 would be suffering from venereal diseases, 564,768 from heart
disease, 525,600 from diseases of the ear, including defects of hearing,
421,704 from diseases of the eye, including defects of vision, 346,392 _
from flat feet, and 296,640 from alcoholism. ‘There are no statistics
extant which justify these conclusions, but it may safely be asserted
that they are entirely erroneous and grossly at variance with the facts.
For, as observed in the earlier discussion, the rejection rate experienced
in connection with the selection of volunteers for army service
during a period of peace is not evidence of the physical status of the
nation, and not even of the class of men examined. Furthermore,
recruiting rejection statistics of the Army as reported by the Surgeon
General’s office include ages 18 to 44, whereas the Selective Draft
experience is limited to ages 21 to 31. The fact, also, must be kept
in mind that voluntary applicants for military service during a time
of peace include a disproportionately large number of men who have
lost their employment because of dissipation or immoral conduct, etc.,
and have applied to the Army or Navy as a suitable place for reform.
91
It is only natural that among this element the proportion rejected on
account of venereal disease and alcoholism should be relatively high,
for the statistics of the Surgeon General’s office in this respect are
in marked contrast to the results of the very limited analysis of the
causes of rejections which has thus far been made by the Provost-
Marshal General’s office. *
COMPARATIVE REJECTION STATISTICS OF LIFE INSUR-
ANCE EXPERIENCE
Attempts have been made to compare the ratio of rejections in
ordinary life insurance experience with the rejection rate in the United
States Army previously to the war. All such comparisons are seriously
misleading and absolutely useless for practical purposes. The army
rejections include a large proportion of physical causes which do not
constitute a serious impairment in its relation to life expectancy. Rejec-
tions for life insurance are exceptionally severe with reference to
habits, as best illustrated by the fact that in the experience of The
Prudential during 1911-15 the rejections on account of alcoholism
were 12.7 per 1,000 examined, against 3.7 for the United States Army
during the same period. In contrast, rejections for venereal diseases
are relatively low in life insurance experience, largely, of course, on
account of the fact that the class or element most subject thereto is
not knowingly solicited for life insurance purposes. In the Prudential
experience the rejection rate on account of venereal diseases was only
1.1 per 1,000 examined, against 12.5 for the United States Army. On
account of the exceptional care exercised in life insurance examinations
with reference to the condition of the heart and of the urinary organs
the rejection rate for this group of impairments is much higher. In
the Prudential experience the rejection rate for heart diseases was
25.1 per 1,000, against 10.2 for the United States Army, for respira-
tory diseases 12.7, against 2.9, and for diseases of the genito-urinary
system 18.6, against 2.8. Combining these three groups of organic im-
_ pairments it appears that against a rejection rate of 56.4 per 1,000 on
account of diseases of the heart, the respiratory organs and the urinary
system in the Ordinary experience of The Prudential, the corresponding
rejection rate in the United States Army was only 15.9.
The most important causes of rejection in the United States Army
are relatively uncommon in the experience of a representative life
insurance company. ‘The most important of these causes, with a due
regard to the higher average age of insurance applicants, are as follows:
Weakness of mind, Prudential, 0.4, U. S. Army, 1.7; varicose veins,
Prudential, 0.1, U. S. Army, 1.6; hernia, Prudential, 0.1, U. S. Army,
* This rule would seem to indicate that upon the medical ascertainment of a single mental
or physical disqualification for military service, no further medical examination is made
of the registrant who is unconditionally rejected. The resulting statistics therefore require
to be interpreted with extreme caution, since many important mental and physical defects
would no doubt be ascertained by a complete examination which apparently is made only
in the case of registrants considered eligible for qualified or unconditional acceptance.
92
3.5; skin diseases, Prudential, 0.1, U. S. Army, 2.3; curvature of the
spine, Prudential, none, U. S. Army, 1.1; flatfoot, Prudential, none,
U. S. Army, 6.2; other diseases of organs of locomotion, Prudential,
none, U. S$. Army, 3.1; defective teeth, Prudential, none, U. S. Army,
2.4; defects of development, Prudential, none, U. S. Army, 2.5; dis-
eases of the ear, including defective hearing, Prudential, 0.7, U. S.
Army, 9.6; diseases of the eye, including defects of vision, Prudential,
0.01, U. S. Army, 8.0; injuries, Prudential, none, U. S. Army, 3.7;
abnormal height, Prudential, none, U. S. Army, 0.4. This formidable
group of impairments accounts in the aggregate for 46.1 per 1,000 of
the rejections in the U. S. Army, against only 1.4 in the experience of
The Prudential. But aside therefrom 22.9 per 1,000 were rejected for
causes not physical in the Army for which there are no corresponding
rejections in the experience of The Prudential. Among the physical
causes, however, overweight accounted for only 0.4 per 1,000 of the
rejections in the Army, against 5.1 in the experience of The Prudential.
This difference illustrates precisely the effect of rigid army standards
which practically preclude the application of men obviously over-
weight. The standards of examination are probably more restricted
in life insurance experience, but the examination itself in cases of
obesity is more thorough, in view of the fact that the mortality of
persons overweight is invariably in excess of those of normal weight.
On account of underweight the rejections in the Army accounted
for 2.7 per 1,000, against 2.1 in the experience of The Prudential.
The pathological significance of underweight is considered of less
serious significance at the present time than in former years, especially —
in its relation to a predisposition to tuberculosis. It is probably of
more immediate importance in its relation to physical endurance in
active military service.
IMPORTANT CHANGES IN THE REJECTION RULES UNDER
THE SELECTIVE DRAFT
As stated elsewhere, the ratio of rejections is primarily a question or
the precise army regulations governing the physical examination. The
regulations were materially changed under date of January 28, 1918,
and in a preliminary statement with reference thereto it is said that,
“Physicians on the Local Board are not required to make a complete
examination of every registrant.” The moment the physician on the
Local Board finds a mental or physical defect placing the registrant
within the standards of unconditional rejection the physician on the
Board is required to indicate the fact on the blank and refer the regis-
trant to the Medical Advisory Board. It is explained, however, that
“Registrants cannot be declared physically qualified for general military
service until the complete examination has been made by the physician
on the Local Board, with the finding that the candidate comes in every
93
instance within the standards of unconditional acceptance or without
remediable. defect.” The new regulations provide special examina-
tions and standards for unconditional rejection and for unconditional
acceptance, with or without remediable defects on reference to the Med-
ical Advisory Board. ‘he final classification of the registrant “physi-
cally qualified for special or limited military service,” depends entirely
upon the recommendations of the Medical Advisory Board and not
upon the action of the Local Board. As illustrations of the lesser
degree of rigid conformity to earlier theoretical principles of examina-
tion, the following are of interest:
Chronic alcoholism.—The registrant on examination must show suffused eyes,
prominent superficial blood-vessels of nose and cheek, flabby, bloated face, red
or pale purplish discoloration of the mucous membrane of the pharynx and soft
palate; muscular tremor in the protruded tongue and extended fingers, tremu-
lous hand-writing, emotionalism, prevarication, suspicion, auditory and visual
hallucinations, persecutory ideas. The history or evidence that the registrant has
been frequently or grossly intoxicated is not of itself sufficient for a diagnosis of
chronic alcoholism and rejection.
Skin Conditions —Accept registrants who have skin diseases which run an
acute or temporary course, or are trivial in character, or do not interfere with
the general health, or are not incapacitating. Among the common skin condi-
tions coming in this category are: Acne, Anomalies of Pigmentation, Scars,
Condylomata, Diseases produced by pus infection, Eczemas which have not been
of long duration, all forms of Naevi not producing great disfigurement or
deformity, all forms of Pediculosis, Scabies, Psoriasis, all forms of Ring
Worm, Warts, Callosities.
Syphilis—Accept all registrants with syphilitic lesions of the skin.
Conditions of the Neck—Accept registrants with normal necks, moderate
enlargement of the thyroid with no toxic symptoms. Accept with a few pal-
pable lymph glands with or without healed scars and no sinuses.
Lungs.—Reject no registrants for diseases of the lungs, pleura, mediastinum,
and chest wall, except men with tuberculosis or other diseases of lungs, pleura,
and mediastinum, who are confined to their beds, when verified histories establish
unmistakably the existence and long duration of diseases.
Heart and Blood-vessels—Following specific instructions regarding the exami-
nation to be made by physicians of the Local Boards, the regulations read that
after this examination the Local Board shall accept all registrants who come
within the standard for unconditional acceptance, which is as follows:
Standard for Unconditional Acceptance.—Subjects with apex impulse within
the left nipple-line and not below the fifth interspace, of normal, not heaving
character, with normal sounds, free from murmurs, without pulsation or dullness
above the base of the heart, with regular pulse of normal rate, who have no
unusual thickening of the arteries or evidence of high blood pressure, and who
show a normal response to the exercise test, may be unconditionally accepted.
Abdomen —Accept all registrants who give a history of abdominal trouble
suggesting a chronic appendicitis or gall-bladder disease and who on examination
present no signs of such diseases,
Accept all registrants with small or medium reducible inguinal, femoral,
umbilical, and post-operative hernia.
Accept all registrants with abdominal scars who give a history of operation
for hernia, appendicitis, gall-bladder disease, or for some abdominal injury,
providing there is no large hernia in the scar.
94
Genito-urinary organs and venereal diseases»—Accept all cases with no signs
of disease of the genito-urinary organs, all acute and chronic cases of gonorrhea
and syphilis who have no complications permanently incapacitating.
Lower Extremities—Accept all foot and ankle lesions if they do not interfere
with the wearing of an ordinary shoe and with walking and weight-bearing
power; hammer-toe, hallux valgus, bunion, callosities, the different types of flat-,
club-, and claw-foot are to be accepted if they come within the above
requirements.
This is amplified by a specific rule which reads: “And reject no foot cases.”
Height, weight, and chest measurements——Registrants whose chest measure-
ments do not come within the limits of the table and who have no disqualifying .
defect are referred to the Medica! Advisory Board. :
Accept registrants above 78 inches in height when exceptionally well propor-
tioned. Refer all other such cases to the Medical Advisory Board. Reject
registrants of less than 58 inches in height. Refer to the Medical Advisory
Board registrants whose height is more than 58 inches and less than 60.
Reject registrants whose weight is less than 100 pounds, unless it is plainly
due to some recent illness and otherwise the registrants have no disqualifying
defect.
Registrants whose weight is more than 100 pounds and less than 114 pounds
and who have no other disqualifying defect are to be referred to the Medical
Advisory Board.
Registrants under weight in proportion to their height, unless it is plainly
due to some temporary cause, are referred to the Medical Advisory Board.
_ When this underweight can reasonably be explained and the registrant otherwise
is physically fit, accept.
Registrants with over-weight are to be accepted, unless the obesity interferes
with normal physical activity. Refer all doubtful cases to the Medical Advisory
Board.
The examiner is specifically requested to take the measurements “with the
greatest care.’ (The standard tables in use have been given on page 46.)
THE POSSIBLE SAVING IN MAN-POWER AND GAIN IN
MILITARY EFFICIENCY UNDER THE
NEW REGULATIONS
Under these revised regulations a considerable proportion of men
will hereafter be accepted which under the First Draft were uncondi-
tionally rejected. Practically all the important causes of rejection
have been sufficiently modified to result in a substantial increase in
the number of men hereafter accepted with or without remediable de-
fects. In view of the fact that so large a proportion of men in the past
were rejected for dental defects or deficiencies, the following new rules
regarding dental requirements are of special importance:
Dental Requirements.—Accept registrants who have three serviceable natural
masticating teeth above and three below opposing and three serviceable natural
incisors above and three below opposing. All these teeth must be so opposed
as to serve the purpose of incision and mastication. Therefore, the registrant
shall have a minimum total of six masticating teeth and a minimum total of
six incisor teeth. The needed dental treatment will be performed at the canton-
ment. However, if time permits, a registrant, if he prefers, may have the
necessary work done at home previous to his induction into military service.
95
By way ot contrast, the former rule is given, which reads as follows:
The person must have at least eight serviceable natural masticating teeth,
either bicuspids or molars, four above and four below, opposing, and six service-
able natural incisors or canines, three above and three below, opposing. These
teeth must be so opposed as to serve the purposes of incision and mastication.
There must be one molar above and one below on one side which occlude; the
remaining six opposing masticating teeth may be either bicuspids or molars.
The practical significance of this change is indicated by the fact
that dental defects accounted for 8.5 per cent. of the total rejections,
.according to the special analysis made of 10,258 rejections by the
Provost-Marshal General’s office. Since these rejections were made
by camp surgeons, the proportion of rejections for dental defects by
Local Boards was probably much higher. It is specifically stated in
the new regulations that “No registrants can be rejected on account of
teeth defects.”
Finally, as regards the degree of deficiency for disqualification, on
general grounds it is said in the regulations that |
The standards for unconditional rejection which places the registrant in the
class physically deficient and not physically qualified for military service are
clearly defined. When the Local Board is in any doubt, the registrant should
be referred to the Medical Advisory Board.
This Board is governed by the rule that
If the registrant is held to be physically disqualified by the examining
physician, the Local Board shall, unless it decides by unanimous vote that the
disqualification is so obvious as to leave no room for reasonable doubt, send
the registrant before such Medical Advisory Board in the manner just provided.
This shows, in other words, “that there must be a unanimous vote
of the Local Board to disqualify the registrant and the disqualifica-
tion must be so obvious as to leave no room for reasonable doubt.”
Even as regards temporary defects, it is now provided that
Registrants confined to their homes, or hospitals, or who present themselves
with some temporary defect the result of an acute disease, injury, or operation,
or who are waiting for operation, should be granted a reasonable delay for
completing the physical examination. All of these cases should be thoroughly
investigated by the physician on the Local Board.
The foregoing extracts from the new official regulations make it
sufficiently clear that under the present procedure on the part of the
Local Board and the Medical Advisory Board a much larger propor-
tion of registrants will be accepted for military service than in the
past, and that in so far as minor ailments or physical defects or defi-
ciencies are ascertained by the examination, they will be remedied, if
possible, or the registrant will be placed in a class of service where
the defect or deficiency can not prove injurious to health or life.
Under the new regulations, therefore, the examinations will disclose a
much lesser degree of apparent physical deterioration among men of
96
the draft age than heretofore, and it is to be hoped preclude hereafter
the dissemination of sensational and alarming assertions concerning
the alleged physical decline of American manhood..
RESULTS OF THE ARMY REJECTION EXPERIENCE
IN THE UNITED KINGDOM
The experience of the United Kingdom has been much the same as
in this country. At the time of the South African War three out of
every five men had been originally rejected on the ground of physical
unfitness for active military service. Out of 679,703 recruits examined.
between 1893 and 1902 only 424,651, or 62.5 per cent., were accepted.
As observed in a letter from London, dated March 5, 1918, in the
Journal of the American Medical Association, of April 6, 1918, “An
army of over a quarter of a million had thus to be cast aside because
it was below the military standard of the time.” If the rules and
regulations had been in conformity to the observations of Sir W.
Aitken, Examiner in Medicine for the Military Medical Service, and
Pathologist attached to the Military Hospitals during the Russian War,
and had been adopted by Great Britain at the outset of the present
war, a much larger army would actually have been available and
without any serious risk whatever regarding the physical efficiency of
the men for active duty in the field. The present necessity of replacing
the enormous loss of man-power in consequence of the war is resulting
in the lowering of the qualifications for service: but it is to be appre-
hended that many of the rules and regulations are not in strict con-
formity to scientific principles of anthropology and medicine. The
committee appointed by the British Government in 1903 on the Alleged
Deterioration of the National Physique made a systematic investiga-
tion and an admirable report in 1904, the recommendations of which
were entirely disregarded. The need for an anthropometric survey,
emphasized at the time and repeatedly brought forward by the Royal
Anthropological Institute, has been clearly recognized by those familiar
with the facts. The Conjoint Board of Scientific Societies set up by
the Learned Societies and Corporations of Great Britain has recently
appointed a strong committee to prepare a plan for a new survey, the
committee being of the opinion that “Such a survey is a matter of
national importance and one that can be carried out by machinery
already in existence. All that is now necessary is to set up an Advisory
Council to co-ordinate the work carried on by the varied Government
departments and bureaus to deal with the statistics as they are col-
lected.” Such a survey is not only required for Great Britain and
Ireland, but as much if not more so for the United States. The yzen-
eral principles of such a survey have been brought forward in the
discussions of the Committee on Anthropology of the National Re-
search Council, which, however, has failed to secure the required
governmental support. The lamentable results of ignorance and indif-
97
ference in the medical and physical ¢xamination of recruits are not
even, as yet, as clearly recognized as is necessary to prevent a further
deplorable waste _of man-power, both in the unnecessary rejection of
those fit for military service in the field and in the wrongful acceptance
of men physically or otherwise disqualified for the extraordinary stress
and strain of service on the battle field. The problem, it is true, con-
cerns at most but a fraction of the entire army, for there can be no
question of doubt that the large majority of our young men are not
only as physically fit but in all probability physically superior to any
army that has ever gone out for active service on the battle field. As
properly said in the London letter to the Journal of the American
Medical Association,
The victorious manner in which our national armies* have come through
conditions more severe and more trying than any to which armies of former
times were ever subjected seems to allay any fear that we are not equal
to our forefathers in either vigor of body or strength of will. But every
country in Europe has its contingent of men unfit to bear arms and unfit for
the physical brunt of civil life. Before the war Germany had to reject 16 per
cent. of her young men, because weakness or deformity rendered them useless
as soldiers. We also have our share of the unfit; the size of that share is the
index of our physical deterioration as a nation. Under the present conditions
the need for a physical survey of the people, instead of being merely a matter
of theoretical importance, as it was at a former time, has become a matter of
urgent, practical importance. The total number of our population is not the
most important matter for us at present; it is the number of our fit men and
women, boys and girls, that matters. The medical examinations instituted by
‘tthe Ministry of National Service really constitute a physical census: of our
man-power.
URGENCY OF A NATIONAL ANTHROPOMETRIC SURVEY
AND NEW PHYSICAL STANDARDS
These conclusions apply with even greater force to the men of our
new National Army, which in the cantonments as well as on the western
front has given an excellent account of itself as regards physical endur-
ance, of which the country has every reason to feel proud. If only,
however, one-tenth of the entire Army represents a group below the
ideal standard of physique and capacity for physical endurance in active
military service, the question of their proper physical care and service
classification is one of considerable practical importance. If even as
low a proportion as 15 per cent. of all the registrants are properly
rejected on physical grounds, the question of their rehabilitation is of
equal if not greater concern to the Government and the people at large.
It requires no sensational or alarmist assertions to emphasize an obvious
duty in this respect, however lamentably that duty has been ignored in
the past. All questions of physical growth and development, physical
training, military and industrial service proportionate to physical
* The reference, of course, is to the national armies of Great Britain and the British
Colonies and self-governing Dominions.
98
strength and physical endurance depend primarily for their successful
solution upon a correct ascertainment of physical standards, with a
due regard to race, locality, occupation, etc. A mere heterogeneous
mass Of measurements and general-average conclusions based upon
mere data cannot successfully meet the exacting requirements of the
present time; nor can the methods in use heretofore in connection with
the examination of recruits be utilized to advantage any more than the
methods employed for examination purposes by life insurance com-
panies. New standards are required and these must be derived from
accurate measurements of the registrants, if not in the aggregate, at
least in selected groups, with a due regard to race and the regional
divisions of the country, and, if possible, the previous occupation of
the registrant. There is therefore an obvious urgency for a national
anthropometric survey, in conformity to the preliminary recommenda-
tions of the Royal Anthropological Society of Great Britain, of the plan
of which a copy is reprinted.in Appendix B.
NEW STANDARDS OF PHYSICAL EXAMINATION
New standards of physical examination governing the entrance to
all branches of the Army of the United States for the use of Medical
Officers of the Regular Army, National Army, National Guard, Medi-
cal Reserve Corps, Recruiting Officers of the United States Army and
Local Boards and Medical Advisory Boards under the Selective Service
Regulations were promulgated by the Secretary of War under date of
June 5, 1918. These rules and regulations are in a large measure based
upon actual experience and qualified consideration on the part of those
directly responsible for the best possible results. Of course, some of
the rules are subject to further modifications, but, in the main, the new
regulations will go far to facilitate the fundamental purpose of the
Selective Draft, 7. e., “To procure men who are physically fit, or who
can be made so, for the rigors of field service or for special and limited
service,” but the final determination of these questions is left to the
judgment and discretion of the examining boards appointed under the
authority of the Selective Service Law and to the military examining
surgeons of mobilization camps and other army posts and stations.
The most important qualification, as elsewhere pointed out, which
has practically remained unchanged, is that “Local Boards need not
make a complete physical examination of every registrant. Upon the
discovery of a defect requiring unconditional rejection the physician
of the Local Board need proceed no further; but in all other cases
there must be a complete examination.” ‘To avoid a possible misunder-
standing, it requires to be pointed out with special reference to the
Medical Advisory Boards that they, also, “are not required to make
‘a complete examination of every registrant,” if “at any point in the
99
course of the examination it is found that the registrant is physically
or mentally unfit within the standards of unconditional rejection, then
the examination need proceed no further.” These qualifications or
restrictions obviously preclude the general use of the Selective Draft
experience data as evidence of the true physical status or bodily condi-
tion of the male population of draft age. The data require, therefore,
to be used in all cases.with extreme caution, but especially in their
application to the most important problem of available man-power for
military service.
The order of procedure in the physical examination includes nine-
teen subdivisions, as follows:
REQUIRED ORDER OF PROCEDURE IN PHYSICAL EXAMINATIONS
UNDER THE SELECTIVE DRAFT
1 The eyes 11 Abdomen
2 The ears 12 Neck
3 The mouth, nose, fauces, pharynx, 13 Genito-urinary organs, venereal dis-
larynx, trachea, esophagus eases
4 Dental requirements 14 Mental and nervous diseases
5 Skin 15 Lungs and chest-wall
6 Head 16 Heart and blood-vessels
7 Spine 17 General
8 Scapulae 18 Temporary defects
9 Extremities ' 19 Malingering
10 Height, weight and chest meas-
urement
It is quite evident that this order of arrangement for physical exam-
ination purposes is not in conformity to a thoroughly developed, sys-
tematic method of procedure, particularly with a due regard to the
practical importance of the ascertainment of impairments requiring
unconditional rejection. Since a complete examination of every regis-
trant is not required, it is of the first importance, at least for general
purposes, that the more serious pathological impairments shall be ascer-
tained first, or previously to minor physical defects, though possibly the
latter be of even major military importance. For to the extent that
the medical results of the Selective Draft examinations can be utilized,
for illustration, for the purpose of determining incipient cases of
pulmonary tuberculosis, this object would be defeated by the prompt
rejection on primary examination of men found to suffer from some
serious visual impairment, deafness, dental defects, etc. It would not
seem going too far, therefore, to suggest that the order of procedure
in the examination should be so modified as to materially increase the
assurance that the more serious pathological or physical conditions,
such as tuberculosis, syphilis, hernia, etc., may be first ascertained as
unconditional causes of rejection rather than causes or conditions of
secondary general importance from the point of view of preventive
medicine, public health, etc.
100
It is, however, quite difficult to establish an order of procedure suit-
able to other requirements than those of the military service, but even
for the latter purpose a more systematic anatomical -and osteological
arrangement would no doubt prove in actual practice distinctly more
useful, and possibly less time-consuming than the one provided for
under the revised standards of examination.
SUGGESTED ORDER OF PHYSICAL EXAMINATION
1 The height, weight and chest meas- 10 The extremities
urement 11 Lungs and chest-wall
2 The head 12 The heart and blood-vessels
3 The eyes 13° The abdomen
4 The ears 14 Genito-urinary organs and venereal
5 The mouth, nose, fauces, pharynx, diseases
larynx, trachea, esophagus 15 Mental and nervous diseases
6 Dental requirements 16 Skin
7 Neck 17. General
8 Scapulae 18 Temporary defects
9 Spine 19 Malingering
This suggested order of examination, however, is merely a com-
promise. It fails particularly in the direction of the obviously practical
requirement that the more serious physical impairment should be certain
of first ascertainment, rather than the minor physical defects and
deficiencies which also disqualify for military service. If this point
of view were hereafter to prevail, it would probably be best to examine
the lungs immediately after the chest measurements and to follow with
the examinations of the heart and blood vessels, the abdomen and the
genito-urinary system. ‘This arrangement would give the preference |
to the ascertainment of serious pathological impairments over less
important physical defects, deformities and deficiencies. If followed
more or less in this order, the bodily impairments of general public
importance, especially in connection with public health activities and
preventive medicine, would be ascertained with reasonable thorough-
ness according to their relative significance. Valid objections may, of
course, be raised on practical grounds against a complete examination
in each and every case, for, as has well been said by Major General
Crowder, the object of the Selective Draft examination is to raise an
army and not to furnish information, statistical or otherwise; but
nevertheless it might be considered well worth while on the part of
the nation to subject each and every registrant to a thorough physical
examination and to ascertain all the existing defects, deficiencies and
impairments, with a view to their subsequent treatment, cure or cor-
rection, rather than to abruptly conclude the examination with the
determination of the first disqualification sufficient for unconditional
rejection for military purposes only.
101
The new standards mark an important departure from those else-
where referred to in this discussion, in that the minimum height is
raised to 63 inches from 61 inches under the standards adopted May
18, 1917 (but for recent change, see page 45, and for former stand-
ards, see page 46). This change would, perhaps, be unobjectionable
with regard to registrants of native ancestry, but it must be considered
unfortunate with reference to registrants of foreign-born parentage of
South-European racial origin. There can be no question but that
a considerable proportion of such men will probably be rejected ex-
clusively on the ground of deficiency in stature, but who otherwise
would in every respect be qualified for military service in the field.
If our own physical standard were to be rigorously applied to the
French, Italian and Portuguese armies at the present time, there un-
questionably would be a material reduction in man-power upon purely
theoretical considerations, which, considering the supreme necessities
of the war, might involve truly momentous consequences. It would
seem much more rational, therefore, to apply the recruiting standards
of foreign armies to American registrants of the same type of foreign
origins than to make use of a purely arbitrary general standard pri-
marily applicable to the registrants of the continental United States,
of a racial descent normally subject to a quite different frequency
distribution in height, such as those of English, Scotch, Irish, German
and Scandinavian parentage. The loss in man-power on account of
the rigorous use of this theoretical requirement as to minimum stature
may not, perhaps, be so very serious for this country, but in any
event it is seemingly as unnecessary as it is clearly unscientific.
The new regulations are a notable contribution to a much-neglected
branch of medicine. To an increasing extent medical examinations are
being made of applicants for industrial service, and the practice of life
insurance has become so universal that sooner or later the larger por-
tion of the male population will at one time or another have been
subjected to one or more examinations, though, of course, for purposes
somewhat different from those which apply to the Army in time of
war. All of these examinations, however, have much in common, and
to the extent that the practice is made more scientifically conclusive
as well as generally useful the cause of preventive medicine, health-
conservation and efficiency in man-power will be advanced to a position
never heretofore realized in any country of the world.
THE AGE PERIOD OF MILITARY SERVICE IN TIME
OF WAR
The war demands men, more men, and still more men. The wastage
in modern battles is enormous. The tendency is, therefore, to lower
the draft age as a matter’ of ready convenience, rather than to seek
more intelligently for the physically fit among those who are within
102
:
:
eX et Pe ta. ee
the present age period of military conscription. The proposed lowering
of the draft age for the National Army of the United States would,
however, be a calamity the ultimate consequences of which might be
even more serious than the immediate loss of life, limb and health’ on
the battle field. All the standard authorities on army recruiting who
have thoughtfully and impartially considered the question of age in its
relation to military service are strongly opposed to the inclusion of
mere boys, or what Sir William Aitken has so admirably described as
“growing lads.” If the quotas forthcoming from the present age
period of the Selective Draft, 21 to 31, are insufficient and if improved
and more rational methods of medical examination or remedial physical
training are inadequate, it would in every way be preferable to raise
the draft age even, if necessary, to 50 and over, rather than to lower
the age by a single year or two to 20 or 19. In the words of Sir
William Aitken (sustained by distinguished English, French and Amer-
ican army authorities), in his treatise “On the Growth of the Recruit
and Young Soldier,” which deserves to be much better known in this
country than there are reasons for believing is actually the case:
It has been fully demonstrated that the placing of “growing lads” in the field
who are physically immature has not only been poor economy but has some-
times been fatal to the success of military operations. Such lads have always
been found disqualified and unable to perform the duties or to endure the
hardships incident to the life of a soldier.
Also, according to the late Dr. Parks whose treatise on Public
Hygiene is a standard work of reference throughout the world:
There is no doubt that to send young lads of 18 to 20 into the field is not
only a lamentable waste of material, but is positive cruelty. At that age such
soldiers, as Napoleon said, merely strew the roadsides and fill the hospitals. The
most effective armies have been those in which the youngest soldiers have been
22 years of age.
These are the words of military wisdom, based upon military expe-
rience. They require to be taken to heart by those who in very truth
have the future physical welfare of the nation in their keeping. We
are, it is said, in this war to the last man and the last dollar; but that
very policy precludés the ruthless waste and wrongful sacrifice of the
nation’s boyhood, unless the exigencies of the military, situation are
such as to imperatively demand the lowering of the draft age, which,
considering our vast population, our healthy and resistant manhood of
mature ages must be considered, at this time, at least, a remote
contingency.
103
APPENDIX A
Examination blank tentatively recommended by the Committee on Anthropology
of the National Research Council
SMITHSONIAN INSTITUTION
United States National Museum
Name Age
Occupation
Born in (what state or country)
Birthplace (state or country) :
of father , of mother
of father’s father , of mother’s father
of father’s mother , of mother’s mother
MEASUREMENTS
Bopy : FACE:
Weight Length to nasion
Stature Length to crinion
Height to shoulder (mean)................ Breadth, bizygom
Height sitting MISCELLANEOUS
HEAD: Shoulders:
Deformation of Breadth
Length Chest:
Breadth Mean breadth at nipple height..........
Height Mean depth at nipple height............
; OBSERVATIONS
Color of eyes Lips ;
Color of hair Chin
Nature of hair Body and limbs
Nose fr. hand..........
Dynamometric Pressure {
Nasal septum
Lbs hand icecne
104
APPENDIX B
THE ROYAL ANTHROPOLOGICAL INSTITUTE
50, Great Russell Street,
London, W. C.
To tHE HoNoRARY SECRETARY OF THE
BoarD OF SCIENTIFIC STUDIES.
Dear Sir:
PHYSICAL SURVEY OF THE BRITISH PEOPLE.
We beg to acknowledge receipt of your letter of October 23rd,
1916, in which you inform us that the Board of Scientific Studies in-
vites the Council of the Royal Anthropological Institute to submit a
report to the Executive Committee of the Board, on the “Need of a
Physical Survey of the British People.”
The Council of the Institute has given this matter its serious consid-
eration from time to time during the last twelve years, and has been
steadfastly of opinion that such a survey is necessary.
We have the honour to submit particulars of the conclusions arrived
at by the Council after careful review of the question in the light of
present conditions.
Considerations Bearing on the Need for a Survey.
In 1903 it was stated by the Inspector-General of Recruiting that
in certain areas as many as 40 per cent., or even 60 per cent., of men
who offered themselves for Military Service were rejected because
they were found to be physically unfit. The occurrence of such a
large number of unfit men in the general population gave rise to a
suspicion that a proportion of the British people was undergoing physi-
cal deterioration. Whether such was the case or not could not be
determined, however, since there was no existing standard with which
the measurements made could be compared. At no period in the his-
tory of this country has any attempt been made to obtain an accurate
estimate of the condition of bodily development amongst the. people,
and there can obviously be no basis for comparison until an initial sur-
vey is made of at least a representative part of the population. The
Council feels that it is necessary to lay stress upon the expediency of
placing our knowledge of the men of the heart of the Empire on a
more satisfactory footing.
Previous attempts to institute a Survey—(1) In September, 1903,
largely as a result of representations made by Fellows of this Insti-
tute and members of the Anthropological Section of the British Asso-
105
ciation, the Lord President of the Council—the late Duke of Devon-
shire—appointed an Inter-Departmental Committee “to make a pre-
liminary inquiry into the allegations concerning the deterioration of
certain classes of the population.” ‘The exact Terms of Reference
were: |
(1) To determine, with the aid of such counsel as the medical
profession are able to give, the steps that should be taken to fur-
nish the Government and the nation at large with periodical data
for an accurate comparative estimate of the health and physique of
the people ;
(2) To indicate generally the causes of such physical deteriora-
tion as does exist in certain classes; | |
(3) To point out the means by which it can be most effectually
diminished.
After sifting all the available evidence, and examining a large num-
ber of witnesses, the Committee issued a Report * in the autumn of
1904. Their first and chief recommendation was the institution of
an “Anthropometric Survey,” the recommendation being couched in
the following terms:
“With a view to the collection of definite data bearing upon
the condition of the population, the Committee think that a per-
manent Anthropometric Survey should be organized as speedily as
possible, upon the lines indicated in Part I of this Report.” (Re- .
port, Part I, page 84.)
The Committee were constrained to place this proposal at the head
and front of their recommendations, because they found that, in the
absence of any former standard for comparison, it was impossible to
determine whether any physical change was occurring in the British
population as a whole, or in any particular section of it. The follow-
ing quotation from the Report (Part I, page 92) indicates the views
of the Committee as to the occurrence of deterioration:
“The Committee hope that the facts and opinions they have
collected will have some effect in allaying the apprehensions of
those who, as it appears on insufficient grounds, have made up
their minds that progressive deterioration is to be found among
the people generally.”
The Council of the Royal Anthropological Institute hopes and is
ready to believe that this conclusion was justified, but is nevertheless
of opinion that whether the physique of the population is improving,
remaining stationary, or deteriorating, it is highly important that the
nation should know the true state of affairs, and this can only be
achieved by means of a physical census of representative parts of the
population.
* Report of the Inter-Departmental Committee on Physical Deterioration, 1904.
106
OF ee ste Cpe + hea
In the evidence and in the Recommendations of the Inter-Depart-
mental Committee, the Council finds support for its views as to the
need for a physical survey.
(2) At the meeting of the British Association, held at Cambridge
in 1904, a discussion took place on the “Alleged Physical Deteriora- -
tion of the People.” This discussion, with papers read by the late
Professor D. J. Cunningham, the late Mr. John Gray, and Dr. F. C.
Shrubsall, was published by the Royal Anthropological Institute as
Occasional Paper No. 2 (1905), and a copy is enclosed (Enclosure A).
The urgency of an Anthropometric Survey was conceded by all, and
plans were formulated for carrying out such a survey. Amongst those
who took part in the discussion was Dr. Ridolfo Livi, who had been
entrusted by the Italian Ministry of War with the drawing up of a
report upon measurements made on 300,000 conscripts drawn from all
parts of Italy. Dr. Livi’s report gave Italy an initial basis on which
future comparisons may be founded, and at the same time threw a
flood of light on the physical condition and racial constitution of the
Italian people.
Causes tending to produce physical changes in the population —An-
other reason for urging the necessity for a survey is based on theoret-
ical considefations. The conditions under which the British people
now live differ profoundly from those which prevailed some centuries
ago. Their food has changed, their houses and surroundings are dif-
ferent; their modes: of life and of livelihood are new. At present it
is only possible to speculate as to whether these altered conditions are
effecting a physical change amongst the mass of the population. In
the course of time’ a physical survey would provide the means of
assessing the extent and nature of the changes, if such there are.
Organization and Scope of the Survey.
So far, only the reasons for urging the institution of an anthropomet-
rical survey or physical census have been put forward. The Council
ventures to assume that the Board of Scientific Studies will agree that
such a survey is needed, and that it will be desirous of convincing the
Government that a survey ought to be initiated. The manner in which
it could best be carried out would then have to be determined. This
practical question has already been investigated, and definite sugges-
tions put forward, both in the Report of the Inter-Departmental Com-
mittee and in the papers contributed to the Discussion at Cambridge.
(See Report, Part I, page 8.) 7 ;
Broadly speaking, three preliminary problems have to be solved:
(1) The selection of representative sections of the population.
(See below, “Scope of the Survey.”)
107
(2) The measurements and observations to be made. (See
below “Scope of the Survey.’’)
(3) The organization required for making, collecting, analyzing
and preserving the records.
It will be convenient to consider the last question first in order.
Use of the Military Organization—The Council feels that it is not
desirable to enter into administrative questions in any great detail at
present, especially as many of them can only be settled when the scheme
becomes one of practical politics. It may be pointed out, however,
that a very great change has come about since the Inter-Departmental
Committee issued its Report—a change which makes a survey of the
manhood of the people mofe feasible than it ever was before. The
organization which war has rendered compulsory could provide the
anthropological data as regards the chief constituents of the popula-
tion, without detriment to military service; nay, an accurate survey
should be of military advantage. It is probable that during the assem-
blage of the present armed forces of the country, statistics relating to
the physical condition of the nation’s manhood have been accumulated,
but in view of the hurried conditions under which recruiting had to
be carried on, and the diverse methods employed by medical officers
at the time, it is unlikely that such statistics could serve as a standard
basis. Were, however, some kind of compulsory service to remain in
force, and were medical officers, trained in a uniform system of ob-
servation, placed in charge of the examination of recruits in selected
areas of the country, there could be obtained through the Army organ-
ization such data as are required for an anthropometrical survey.
Use of medical examination in schools—The organization for the
collection of data relating to school children is already more than
foreshadowed. To make the existing arrangements effective for the
purposes of a survey, it would be necessary for the medical officers to
be trained systematically in the employment of uniform methods of
measurement and record.
The Central Organization—A very important and also very diffi-
cult matter is the constitution of a central body, to be responsible for
the manner in which the survey is carried out, for the determination
of its scope, and for the collection, systematization and publication of
the records. The Inter-Departmental Committee recommended the
adoption of a scheme which was formulated by Professor D. J. Cun-
ningham (Report, Part I, p. 8). In that scheme it was proposed that
there should be:
(1) A Consultative Committee, consisting of three leading an-
thropologists, the appointments to be honorary and unsalaried.
They were to be advisers, but their powers were not defined.
108
(2) A Central Bureau, under the control of a paid Director,
with a staff of assistants, including a statistical department.
(3) A staff of trained “surveyors” or “measurers.” It was
also proposed to train teachers as surveyors, paying them a gratu-
ity for their services.
Estimates were given of the cost of such a staff, varying from £4,000
to £10,000 per annum.
It was apparently intended by the Inter-Departmental Committee
that the anthropometric soha should be affiliated to the Local Gov-
ernment Board. —
If the Council is right in its anticipation that some form of general
military service will be maintained throughout the country, then it is
clear that the recommendations which were valid for the conditions
of 1904 do not apply to those which are likely to prevail in coming
years. If, however, there is a reversion to pre-war conditions, then
the scheme proposed by the Inter-Departmental Committee, or a mod-
ification of that scheme, would have to be considered.
In the event of its being decided that the manhood of the nation is
in future to be registered and medically examined for military ser-
vice, it is clearly through the Ministry for War that a physical census
of the adult males would have to be carried out. It is equally clear
that in any case a survey of the school children would be made through
the Ministry of Education. Neither of these Departments of State
would be likely to allow a central bureau, such as is mentioned above,
to use their officers to carry out an anthropometrical survey. Each
Department would, no doubt, set up its own organization, not only
for the collection of data, but also for its treatment and publication. It
would probably, however, be possible to co-ordinate the work by
setting up a small Advisory Board, with powers to advise the respon-
sible Ministers as to the manner in which the survey should be carried
out, and to recommend, from time to time, such changes as might be
necessary. On such a board there would need to be two or three
skilled anthropologists, a statistician, and a representative from the
_ Admiralty, the War Office, the Board of Education, the Local Gov-
ernment Board, and the National Health Insurance Committee, re-
spectively.
Scope of the Survey—The Council feels that it is at present only
possible to touch upon the two other main questions that will have
to be considered, since they are clearly matters which must be finally
settled by the Advisory Board. These questions are:
(1) The selection of sections of the population for examina-
tion, and the proportion which these sections must bear to the
population as a whole; and
109
(2) The number and the nature of the observations to be made
on each individual examined.
It is obvious that the first of these questions is a matter for statis-
ticians rather than for anthropologists, and it may therefore be left
on one side.
As regards the observations to. be made, it is clear that they must
be as few in number as is compatible with the end in view, and that
all of them must deal with characters which are capable of exact meas-
urement. The Council would recommend the following list, which
is essentially that selected by Professor Cunningham (see Report, Part
I, page 9). This includes:
(1) Stature.
(2) Sitting height.
(3) Chest girth (maximum and minimum).
(4) Weight.
(5) Head (length, width, height).
(6) Breadth of shoulders.
(7) Breadth of hips.
(8) Vision tested by Snellen’s type.
(9) Colour vision.
(10) Degree of pigmentation.
Evidence to be obtained from ancient interments—There are already
grounds for supposing that, in comparatively recent centuries, a defi-
nite change has occurred in the physical constitution of a large propor-
tion of the British people. A past President of the Royal Anthropo-
logical Institute, Dr. Arthur Keith, has instituted an elaborate com-
parison between the teeth, jaws, and facial skeleton of 50 men and
women who lived in England prior to the Norman Conquest, and of
50 men and women of the 18th Century, and has come to the conclu-
sion that the differences between them are such as cannot be accounted
for by a difference in racial constitution. In the last thousand years
the facial parts of the English people have altered. The Council men-
tions this circumstance because it points to another source of evidence
supplementary to that to be derived from an anthropometrical survey.
In every district throughout the country ancient burials are from time
to time discovered. In a great number of cases it is possible, with ex-
pert advice, to determine approximately the period at which these in-
terments were made, and the human remains will then provide ac-
curate data relating to the physical condition of the people of the
period. At present, the bones are in most cases neglected and cast
away, valuable records being thus lost for all time. In the opinion of
the Council, it should be compulsory for any one making a discovery
of human remains in an ancient burial to report that discovery to the
110
: NPG OIE OI
7
Coroner of the district, or to a corresponding officer, and such, officer
should be under instructions to see that the remains are preserved and
examined, a report being forwarded to a central bureau. If this were
done over a period of years a basis would be provided on which to
found definite conclusions as to changes affecting the physical constitu-
tion of the people during recent centuries.
The Effects of the War on the Population.
There is another anthropological matter which will require inves-
tigation when the war is over, but it is one which must be regarded as
totally distinct from an anthropometrical survey. It will be necessary
to ascertain how the mortality of the war has affected the manhood of
the nation; the distribution of the loss in its relation to counties and
cities; the percentage of loss as affecting various classes of the com-
munity, and particularly how far the losses have affected the persistence
of family strains. Such an enquiry would fall most naturally on the
Local Government Board, or on the Ministry of Health, were such a
Ministry established.
Fate of the Recommendations of the Inter-Departmental Committee.
In conclusion, the Council thinks it may interest the Board of Scien-
tific Studies to know the fate of the Recommendations issued by the
Inter-Departmental Committee in 1904. In order that these recom-
mendations might not be shelved and forgotten, the Royal Anthro-
pological Institute organized in June, 1905, a powerful deputation to
wait on Lord Londonderry, then Lord President of the Council. The
deputation urged on him the need of carrying out the steps recom-
mended by the Committee. = Y PTT, i.
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