U B
333
UC-NRLF
*B 7^7 act
Army Anthropometry
AND Medical Rejection
Statistics
By
PRIED^RICK I<. HOFFMAN, I,!,. 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 (CiviUan Records) of the National
Research Council, etc.
A CONSOI^IDATION OF PAPERS
read before the
National Academy of Science, Philadelphia, November 21,
and the American Statistical Association
Philadelphia, December 28, 1917
thoroughly revised and brought down to date
1917
ARMY ANTHROPOMETRY
AND MEDICAL REJECTION
STATISTICS
BY
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,
and the American Statistical Association
Philadelphia, December 28, 1917
thoroughly revised and brought down to date
917
1918
PRUDENTIAL PRESS
NEWARK, N. J.
U. S. A,
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:
(i) The American Type of Isthmian Canal. 1906.
(2) Addresses and Papers on Life Insurance and Other Subjects, 1909.
(J) Uniform Laws and Legislation on Life Insurance, 1910.
(4) Industrial Insurance, Past and Present, 1912.
By Frederick L. Hoflfman:
(6) Rural Health and Welfare, 1912.
(7) Exhibits of The Prudential Insurance Company of America, International Con-
gress of Hygiene and Demography, 1912.
i7a) Seventy -five Years of American Economic Progress, 1914.
(*) The Significance of a Declining Death Rate, 1914.
(10) Practical Statistics of Public Health Nursing, 1914.
(//) 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) TheTyphoidFever Death Rate in 1917, 1918.
(24) Army Anthropometry and Medical Rejection Statistics, 1918.
By Frederick S. Crum :
(la) 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 (5^x83^ inches)
/ Mortality from Cancer (21 charts).
II Mortality from Tuberculosis (21 charts).
Ill 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 MortaHty 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 1 1
The examination of recruits by officers of the line 13
The sphere and function of physical anthropology 14
Recommendations of the Committee on Anthropology of the Na-
tional Research Council 15
The need for a national anthropometric survey 16
Rules for the preliminary physical examination 17
Inadequacy of examinations by officers of the line 18
Obscure evidences of physical maturity . 19
Stigmata of degeneracy 20
Limitation of army rejection experience 21
Recruiting experience under voluntary enlistments 22
Inconclusive statistics of physical deterioration 23
Conflict of medical and non-medical considerations in recruiting 24
A decade of United States recruiting statistics 26
Important changes in recruiting standards 27
Changes recommended by the Committee on Anthropology of the
National Research Council 28
Race in relation to normal stature 29
Statistical and mathematical considerations of frequency distribu-
tion in physical proportions ^^
Standard methods of anthropometric measurements 33
Stature of accepted United States recruits under the voluntary sys-
tem of enlistment 35
Race in relation to frequency distribution of stature 38
Race in relation to weight 39
Race in relation to chest measurements 41
Standard of physical proportions adopted May 18, 1917 46
Analysis of foreign recruiting statistics 46
Index of vital resistance 47
Limited value of recruiting data 48
Race in relation to physical proportions 49
Recruiting statistics of Prussia -50
Stature of German conscripts "51
Inconclusive army rejection data 52
Rejection data of the German army 53
Geographical variations in the causes of rejections 55
5
415587
CONTENTS— Continued
Recruiting statistics of Austro-Hungary 55
Recruiting statistics of France 57
Variations of stature of European armies 58
Recruiting statistics of Italy 59
Medical causes of rejection in the Italian Army 60
Recruiting statistics of Switzerland 61
Recruiting statistics of Scandinavian countries 62
Recruiting statistics of Belgium 63
Recruiting statistics of Holland 63
Recruiting statistics of Russia and Finland 64
Recruiting statistics of Great Britain '... 64
Recruiting statistics of Japan 65
Recruiting statistics of the United States 66
Comparative causes of rejection for military service 67
Causes of rejection in the German army 68
Causes of rejection in the Austro-Hungarian army 69
Causes of rejection in the French army 70
Causes of rejection in the Swiss army 71
Causes of rejection in the Italian army 72
Causes of rejection in the Belgian army 72
Causes of rejection in the Dutch army 73
Causes of rejection in the Swedish army 73
Causes of rejection in the Norwegian afmy 75
Causes of rejection in the British army 75
Causes of rejection in the United States army 76
Causes of rejection — white recruits only 77
Causes of rejection — colored recruits only 78
Causes of rejection — native and foreign-born recruits 78
Causes of rejection — Filipino and Porto Rican recruits 79
Part II
RECENT UNITED STATES ARMY MEDICAL AND REJECTION
EXPERIENCE DATA
Discretionary powers in physical examinations 82
Negative evidence of physical deterioration 83
Important changes in rules and regulations 84
Examinations by officers of the line 85
Examinations by civil medical officers of local boards 86
Army rejection experience in Greater New York 88
Effects of discretionary powers on the rejection rate 89
Misleading conclusions regarding physical rejections under the
first selective draft 90
6
CONrnNTS— 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
ARMY ANTHROPOMETRY
AND MEDICAL REJECTION
STATISTICS
PART I
GENERAL
ARMY ANTHROPOMETRY
PART II
RECENT UNITED STATES ARMY
MEDICAL AND REJECTION
EXPERIENCE DATA
PART I
GENERAL
ARMY ANTHROPOMETRY
URGENCY OF BETTER STANDARDS OF PHYSICAL
EXAMINATIONS
The science of anthropometry or physical anthropology includes
primarily the systematic examination and precise ascertainment of the
physical characteristics of the human body. As a branch of anthro-
pology, or the science of man in general, anthropometry concerns itself
with the measurable aspects and proportions of the human body and
the divergence from the normal averages according to climate, race,
sex, social condition, etc. Physical anthropology has a literature of its
own and a vast field of eminently practical and increasing application
to social, industrial and military requirements. As observed by Seaver,
"A determination of the laws of physical growth for the human animal
has done more to correct educational methods than any other influence
in pedagogy." Within recent years the physical fitness of men, women
and young persons for highly specialized labor functions has become
clearly recognized by the industrial physician responsible for the main-
tenance of the highest degree of health and efficiency in the operation
of industrial plants. The term "anthropometry" was coined by Quetelet,
but in its broader significance the work of the anthropometrician and the
physical examiner represents rather the field of physical anthropology
than a highly specialized branch of human anatomy and the practice of
medicine as a healing art. Osteology constitutes the major portion of
the basic and measurable material in physical anthropology, chiefly, of
course, the skeleton, the size and relative proportions of which vary
widely according to age, sex, race, etc. * The correlation of skeletal
proportions to the physiological and pathological characteristics of the
human body has not as yet been ascertained to the degree of scientific
exactitude required to justify definite conclusions on many questions of
serious concern to both the physician and the physical anthropologist.
A successful adaptation of the human machine to the always more or
less highly complex requirements of modern social and economic life
* The principal works on general anthropology utilized in connection with this investigation
are the following: Anthropology, by P. Topinard, translated by R. T. H. Bartley, London,
1878; Manual of Anthropometry, by C. Roberts, London, 1878; The Study of Man, by Alfred
C. Haddon, New York, 1898; The Races of "lEurope, by William Z. Ripley, New York, 1899;
Skeletal Remains in North America, by Ales Hrdlicka, Washington, 1907; The Human Spe-
cies, by Ludwig Hopf, London, 1909; Pedagogical Anthropology, by Maria Montessori, New
York, 1913; The Races of Man, by J. Deniker, New York (n. d.).
11
IS plSyiiQiijly' \ai mMiftr. b.f ' the most urgent necesaity in military service,
in which the stress and strain upon organic functions are out of all pro-
portion to the normal degree of endurance demanded by the exigencies
of every-day labor and life. It has properly been observed by
Lieutenant-Colonel Frank R. Keefer, M. D., an authority on military
hygiene and sanitation, that ''Not every man is suitable for a soldier,"
and "A man may be a good insurance risk and yet be entirely unfitted
for military service." His conclusion, however, that only a small
percentage are qualified is not in exact conformity to the facts of
physical anthropology properly applied to the exceedingly complex
requirements of the numerous branches of the military service which
cannot possibly be standardized without a risk of substantial and even
far-reaching errors in the selection of recruits or conscripts, as the case
may be. As stated by Lieutenant-Colonel Keefer, "The number of men
rejected for one reason or another, but chiefly on account of physical
deficiency, greatly exceeds those accepted," and **only one in three or
four is taken by officers on recruiting duty in cities, and this percentage
is still further reduced by a rigid medical scrutiny at recruiting depots
to which provisionally accepted applicants are sent prior to taking the
oath of enlistment." It is the purpose of the present discussion to
emphasize with the required brevity certain fundamental considerations
of army anthropometry as a branch of the army medical service
demanding decidedly higher average technical qualifications on the part
of the examiner and the use of more strictly scientific methods and
standards of measurement, with a due regard to the racial characteris-
tics or inherited physical race traits of the recruit or conscript subject
to examination and the risk of improper acceptance or rejection for
military service, as the case may be. The observations by Keefer
may be referred to as evidence to sustain this conclusion, for his
views require only to be restated to emphasize their inherent limita-
tions when applied to the end in view of the highest attainable ideal
in the physical and medical selection of men for duty in the army and
navy during a time of war. He remarks, "The physical deficiencies
which cause the greatest number of rejections for our army are venereal
diseases, heart abnormalities, defective vision and hearing, foot
deformities and poor physique." Now, venereal diseases, of course,
are pathological impairments, regardless of the fact that they
cause physical deterioration or incapacity for service in much the
same manner as any other diseased condition of the body, whether
tuberculosis, typhoid fever, etc. To confuse venereal diseases
with physical deficiencies of the body is as serious an error as to confuse
organic defects of the lungs or heart with defects of lung capacity or
heart function due to strictly physical and ascertainable causes.
12
THE EXAMINATION OF RECRUITS BY OFFICERS
OF THE LINE
The practice which prevailed of having the preliminary examination
of recruits for voluntary enlistment made by officers of the line tempo-
rarily assigned to recruiting duty cannot be defended as in conformity
to the strictly scientific requirements of physical anthropology, which is
as yet but an imperfectly developed branch of knowledge, a thorough
understanding of which would prove invaluable, especially in the
furtherance of the aims and ideals of preventive medicine. What
represents normal men and normal proportions of bodily development
and growth is neither adequately known nor adequately taught in even
the best medical schools of the present day. Many of the most useful
contributions to the scientific study of physical anthropology have been
made by physicians, but the fundamental theory of anthropometry was
worked out by Quetelet, a statistician and mathematician, and the
largest body of trustworthy data was brought together by an
astronomer, Mr. B. A. Gould, who secured approximately trustworthy
measurements of bodily proportions of over one million of recruits
during the Civil War. * Physical deficiencies and abnormalities are
obviously matters of the utmost medical significance as regards appro-
priate methods of treatment and cure, or of rational adaptation to
highly specialized needs. It would therefore seem unnecessary to re-em-
phasize the suggestion frequently made that the physical measurements
of recruits or conscripts should be made by qualified physicians and
not by laymen, least of all by officers of the line not thoroughly trained
in the fundamental principles and methods of physical anthropology.
From this point of view serious objection must be raised to the conclu-
sion advanced by Lieutenant-Colonel Keefer that "While it is not to
be expected that line officers on recruiting duty shall be able to detect
obscure affections of the internal organs, there are many grosser defects
which are readily apparent to them. Such are: Deformities, skin
eruptions, pallor, emaciation, inebriety, venereal disease, defective
development of parts, lice, dirty person, rupture, piles, stiff joints,
varicose veins, flat feet, indecent tattooing, etc. Furthermore, internal
disease may be suspected from shortness of breath, a thumphig heart,
dimness of vision, or irregular pulse following moderate exertion." It
is only necessary to review this long list of more or less obscure
physical or pathological conditions to emphasize the practical necessity
that they shall be ascertained and passed upon as to their relative
significance by a qualified physician and not by an officer of the line,
* Investigations in the military and anthropological statistics of American soldiers, by
Benjamin Apthorp Gould, published for the U. S. Sanitary Commission, Cambridge, > River-
side Press, 1869. See also Medical Statistics of the Provost-Marshal General's Bureau, com-
piled under the direction of the Secretary of War, by J. H. Baxter, A. M., M. D., Wash-
ington, 1875, 2 vols.; this report includes an elaborate outline of the plan and scope of the
work, the instructions to recruiting surgeons issued by the various governments, an outline
of the history of anthropometry, a review of the tables and their results, a series of charts
and maps, and, finally, a number of special reports of boards of enrollment, and other
documents.
13
however competent he may otherwise be for military duty. The
medical significance of emaciation, venereal disease, rupture and even
flat feet is by no means "readily apparent" in the large majority of
cases. The ascertainment or even suspicion of shortness of breath,
dimness of vision or an irregularity of the pulse is not within the
province of the judgment of the average layman, however conscien-
tiously he may apply himself to the duty of physical and medical
examination assigned to him as a matter of army routine.
, THE SPHERE AND FUNCTION OF PHYSICAL
ANTHROPOLOGY
In the words of Dr. Ales Hrdlicka, in charge of physical anthro-
pology at the Smithsonian Institution, ''Physical, i. e., anatomical,
anthropology is one of the main branches of the extensive science of
mankind. It is that part of anthropology in which are studied varia-
tions in the human body and all its parts, and particularly the
differences of such variations in the races, tribes, families, and other
well-defined groups of humanity. Physical anthropology accumulates
facts concerning these variations in every part of the earth and seeks
their causes and significance. On the basis of such knowledge and with
the help of other sciences it endeavors to trace man's evolution, to
show his biological history, as well as the processes of differentiation
actually going on in him, and to outline the tendencies of his physical
life for the future." The inadequacy of our existing information on
so important a branch of the extensive science of mankind was clearly
brought out by Dr. Hrdlicka in an exhibit on physical anthropology
contributed to the Panama-California Exposition in 1915. The most
important scientific result of this exhibit was the emphasis placed upon
the factor of individual physical variation, which comprises the differ-
ences among normal full-blooded representatives of one race or group,
a difference which is regional as well as local, and extends from
part to part of the body, being relatively limited in such char-
acteristics as the color • of the skin, eye or hair, but al-
most endless in the details of physiognomy and the various pro-
portions of the body. The inadequacy of the existing amount
of information on the physical anthropology of the civiHzed races
is so much the more deplorable because the practical application of the
data to such questions as the normal growth of children, the normal
development of the body during early adolescence, the physical adapta-
tion of workmen to highly organized industrial functions, and last but
not least the physical requirements for military service depends for
its best solution upon the ascertainment and perfection of normal
bodily averages, which at present are wanting in scientific conclusive-
ness to a lamentable degree. * If, therefore, the measurements which
* The principal references, in addition to those previously quoted on general anthropology
and anthropometry, are the following: On the Stature and Bulk of Man in the British Isles,
14
are being made and the physical and pathological facts which are being
secured are deficient in the required degree of inherent accuracy, it is
self-evident that one of the greatest opportunities for securing such
information will be lost, if, in fact, it has not been entirely missed, in
connection with the examination of the manhood of the nation, at ages
21 to 31, under the provisions of the Selective Draft.
RECOMMENDATIONS OF THE COMMITTEE ON ANTHRO-
POLOGY OF THE NATIONAL RESEARCH COUNCIL
The value of the opportunity for securing such information was
clearly recognized by the Committee on Anthropology of the National
Research Council, and repeated efforts were made to induce the army
authorities to adopt a blank for examination purposes which would pro-
vide for all time a trustworthy return of the physical characteristics of
the age period when maturity has been reached and when the resulting
information would be most useful for practical, medical and other
purposes. The blank suggested to the authorities is appended to this
discussion (Appendix A), but it is most regrettable that it should not
have been adopted. The measurements which have been made or
will be made in the case of millions of men will therefore be almost
useless for scientific purposes and, there are reasons for believing,
frequently misleading for the purposes of the Selective Draft to secure
those best fitted for military service in the field. The new data,
therefore, cannot be utilized to best advantage in the ultimate work-
ing out of trustworthy standards of height, weight and chest expan-
sion, which are the three essentials insisted upon by army medical
authorities. Indifference to the racial antecedents of the examined
recruit or conscript, or, in other words, the race or country of birth of
the parents of the person examined, precludes the practical utility of
the new information, since, as presently to be shown, the racial factor,
in height and weight, at least, is invariably of paramount importance.
by John Beddoe, B. A., M. D., &c., London, 1870; Height, Weight and Chest Measurements
of Soldiers, by Dr. H. Busch, Berlin, 1878; The Relation between Growth and Disease, by
H. P. Bowditch, M. D., Philadelphia, 1881; Die naturliche Auslese beim Menschen, by Otto
Ammon, Jena, 1893; The Range and Significance of Variation in the Human Skeleton, by
Thomas Dwight, M. D., LL. D., Boston, 1894; Anthropometry and Physical Examination, by
Jay W. Seaver, A, M., M. D., New Haven, Conn., 1896; Social Anthropological Studies, by
Dr. W. Pfitzner, 1899; A Graphic Standard Table of Heights and Weights, by Oscar H.
Rogers, M, D., 1899; Manual of Physical Measurements, by Wm. W. Hastings, Springfield,
Mass., 1902; Essay on the Stature of Man at Various Epochs, by A. Dastre, from the
Smithsonian Institution Report for 1904; Overweight and tJnderweight Statistically Inves-
tigated by Means of a Card System, by S. W. Carruthers, in Proceedings of the German
Periodical for Insurance Sciences, 1907; Physical Growth and School Progress, by Bird
Thomas Baldwin, Washington, 1914; Physical Anthropology in America, by Ales Hrdlicka,
Panama-California Exposition Edition, Lancaster, Pa., 1914; Socio-Anthropometry, by B. L.
Stevenson, Ph. D., Boston, 1916; Communication from Mr. Francis Galton on International
Anthropometry to Sir Rawson W. Rawson, President of the International Statistical Insti-
tute; Zur Anthropometrie der Menschen Messkunst, by Dr. Engel, Director, Royal Bureau
of Statistics of Prussia (n. d.) ; Meddelelser on Danmarks Antropologi (Communications on
the Anthropology of Denmark), an annual report issued by the Danish Anthropological Com-
mittee on the anthropological survey of Denmark, Copenhagen, 1910-12; Military Anthro-
pology, by Livi; Criminal Anthropology, by Lombroso; General Anthropology, by Enrico
Morselli; Anthropology of Sweden, by Retzius and Fuerst, 1902.
15
THE NEED FOR A NATIONAL ANTHROPOMETRIC
SURVEY
General averages of height, weight and chest expansion for a hetero-
geneous mass of men are as useless as general averages of wages,
prices, etc., which are inapplicable as a rule to individual cases. The in-
vestigations by Gould during the Civil War constitute for this reason an
extremely valuable basis of trustworthy information concerning the
physical characteristics of American manhood with a due regard to
race. If corresponding information could have been obtained in
response to the urgent appeal * of the Committee on Anthropology of
the National Research Council and other interests concerned with the
practical use of such data, there would have been secured a proper basis
for comparison of the past with the present, and extremely important
questions concerning national vitality, physical progress or deterioration,
etc., would have been brought measurably nearer to a successful conclu-
sion than is now likely to be the case for many years to come. The ex-
pense involved would have been slight, the additional labor would have
been of no material significance, the standard instruments required
would have been useful for the future, and the slight amount of pre-
liminary scientific training would have materially increased the ability
of the medical examiner charged with the highly responsible duty to so
measure and examine the recruit or the conscript that no injustice would
be done to the nation or to himself in his wrongful acceptance or rejec-
tion for military service. The practice at the present time in the prelimi-
nary examination of recruits and even in their subsequent examination
by medical men falls often far short of the required high standard de-
manded by urgent military and general considerations. The extensive
literature of the subject bears intrinsic evidence of superficial consider-
ation, with the one important exception of the work by Sir William Ait-
ken, on "The Growth of the Recruit and New Soldier, with a View to a
Judicious Selection of 'Growing Lads' for the Army, and a Regulated
System of Training for the Recruits," published in 1887, which is not
critically referred to by a single American authority on military hygiene
or the army medical service; nor is reference made to the best Amer-
ican authorities on anthropometry, particularly ''Anthropometry and
Physical Examination," by Jay W. Seaver, published in New Haven,
1896, intended for practical use in connection with physical education
and physical examination of college students or men of that period of
adolescence which just precedes early manhood, and upon whom the
heaviest military demands are naturally made, f
* The report had been reprinted from the Proceedings of the National Academy of
Sciences, Vol. Ill, August, 1917.
t Some exceptionally valuable observations on growth and the development of muscle
power, with special reference to physical education and the diseases of adolescence are con-
tained in a brief treatise on "The Adolescent Period," by Louis Starr, M. D., Philadelphia,
1915. See, also, "The Problem of Age, Growth and Death," by Chas. S. Minot, LL. D., New
York, 1908.
16
RULES FOR THE PRELIMINARY PHYSICAL
EXAMINATION
The rules governing in the examination of recruits have been revised
from time to time, but in the main the changes until very recently
have been of relatively slight importance. The preliminary physical
examination of the recruit is generally by a line officer, who is
required to proceed in the following order :
First, test the applicant's vision; second, test his hearing; third, strip him of
all clothing and inspect his general physique and appearance; fourth, take his
height, weight, and chest measurements; fifth, require him to perform the
exercises prescribed in paragraphs 16 to 19, inclusive, of these rules; sixth,
make a special examination of the various parts of the body in the order and
to the extent prescribed in paragraphs 21 to 36, inclusive, of these rules. The
applicant must be entirely nude during the whole of this examination after he
has been subjected to the tests of vision and hearing.
As far as known, the examining officer of the line is not required to
undergo a course of special instruction in methods of physical examina-
tion, so that merely accuracy in observation, good judgment and strict
conformity to thoroughly standardized requirements are relied upon for
satisfactory results. Considering special aspects of the examination,
it must be apparent that in many cases an officer of the line may be far
from qualified to ascertain accurately the visual acuity of an applicant
for military service, or his hearing or his general physical proportions
in so far as they may possibly indicate more or less obscure departures
from accepted standards. The present practice is a survival of the
earlier methods of recruiting, when the main object of the examination
was to exclude applicants obviously unsuitable, often on moral or
intellectual grounds. Considering, for illustration, such a delicate pro-
cedure as chest measurement, it is required, according to the official
instructions, that
The applicant will be made to stand erect with his heels together and to raise
his arms over his head. The measuring tape will be carefully adjusted around
the chest with the upper edge of the tape just below the lower angles of the
shoulder blades behind and the nipples in front. The arms of the applicant
will then be dropped to the sides and he will be directed to take several deep
breaths to verify the maximum and minimum measurements. Care must be
taken not to displace the tape and to avoid muscular contortions. Many men
must be taught how to breathe and to expand the chest before the measurements
are taken, and consequently great care and patience are often necessary in order
to get correct results.
This is merely one of many indications that the functions of the
examining officer of the line conform more to those of a medical
examiner, whose judgment would unquestionably be more conclusive
and trustworthy than that of even the most careful and painstaking
non-medical observer.
17
INADEQUACY OF EXAMINATIONS BY OFFICERS
OF THE LINE
This conclusion adverse to the present practice of preliminary
examination by non-medical officers * applies with special force to the
examination of special parts, such, for illustration, as the examination
of the skin for evidences of disease, ulcers and eruptions, extensive,
deep and adherent scars, extensive or disfiguring birthmarks, hypo-
dermic scars, indicating a drug habit, etc. With reference to the
examination of the eyes, the attention of the non-medical examiner is
directed to possible evidences of chronic inflammations, triangular or
fan-shaped growths on eyeball with the apex encroaching upon the
cornea, marked squint, and drooping of the upper Hd. The nose is
required to be examined for dilated vessels, indicative of alcoholism,
for disfiguring deformities, for offensive discharges, and for inability
to breathe freely through the nose and with the mouth closed. The
neck is required to be examined for goitre, enlarged or suppurating
glands and their resulting scars. The chest is required to be examined
for malformations ; the abdomen for obesity, dropsy, ruptures, and with
collateral questions regarding a possible past history of chronic
dyspepsia or dysentery. Rupture is made a subject of special instruc-
tions, and the applicant is directed "to stand with his feet apart and his
arms raised above his head, while the examiner is required to instruct
him to cough, the examiner placing the tip of his forefinger at the
point of suspected rupture, etc. The back is required to be examined
for deformities and malformations; the groins for enlarged glands;
the hands and arms for deformities, old fractures and dislocations,
stiff joints, etc. ; the feet for flatfoot, deformed toes, etc., and
finally, the appHcant is required to stand ''with the inner borders of his
feet together, arms horizontal, fingers apart, and eyes shut to submit
to an inspection for tremors and instability indicating alcoholism or
nervous disorders."
It is not made entirely clear by the regulations what precise method
of procedure is to be followed by the non-medical officer in the final
rejection of recruits. There is apparently a distinction drawn be-
tween applicants for enlistment who are not acceptable to the recruit-
ing officer before being examined physically and those who are rejected
by him subsequently to their physical examination, more or less in
conformity to the preceding outline, which is largely based upon the
revision of Tripler's Manual by Major and Surgeon Charles R. Green-
leaf, issued in 1890. The Rules for the Bxamination of Recruits as
issued in the form of General Orders No. 66, Washington, April 18,
1910, and re-issued in 1916, proceed with the instructions for the exam-
ination from the non-medical portion as made by the line officer to the
■* These observations, of course, have reference only to the examination of recruits under
the former system of voluntary enlistment and they do not apply, unless otherwise stated,
to the examination of registrants under the Selective Draft.
18
medical portion as made by the medical officer without an explanation
in detail as to the limitations of the" functions of the former and the
full authority of the latter, especially as regards a review of evidence
more or less medical, although obtained by a non-medical officer of the
line. The instructions to the medical officer are merely amplified in
important matters of detail, but in a general way conform to most of
the essential requirements as regards the non-medical physical examina-
tion of the recruit by an officer of the line. With reference to the
medical examiner, however, it is suggested that use be made of "every
possible diagnostic procedure at his disposal, including the use of the
microscope, the X-ray, and other laboratory methods, for the determina-
tion of doubtful cases, and he may admit such cases to a hospital for
study and observation for a reasonable period in order that a definite
conclusion may be reached with regard to them."
Diseases, injuries, malformations and other physical defects dis-
qualifying for military service are briefly enumerated as follows :
A superficial examination of many applicants determines the fact of their
unfitness; they are undersized, underweight, undeveloped, sallow, or pale and
scrawny, poorly nourished, with thin, flabby muscles, and are manifestly lacking
in stamina and resistance to disease. The rejection of such applicants for "poor
physique" is not sufficiently exact, and the medical examiner should record as
the disqualifying cause in each case some specific pathological condition, if
such can be found, or "underweight," "deficient chest measurement," "deficient
muscular development," "deficient nutrition," or such other definite disqualifying
conditions as may be found to exist. Obesity is a cause for rejection when so
marked as to interfere with marching or other military duties.
OBSCURE EVIDENCES OF PHYSICAL MATURITY
The indicated physical evidences of maturity for the guidance of
medical officers are quite superficial and inconclusive. It has been
properly pointed out by Sir William Aitken that "All the parts of the
organization of man are connected or correlated together so that with
the increase or decrease of the whole body, or any particular part of
it, certain organs are also increased or diminished or modified; and
modifications which arise during the earlier stages of growth tend to
cause the subsequent development of the whole man." A much more
qualified and extended review of this important aspect of the medical
examination is given by Munson in his treatise on Military Hygiene,
in part as follows :
From the standpoint of developmental anatomy the soldier should certainly not
be enlisted before the age of twenty-one years, and a delay of an additional
twelve months would not be undesirable. At eighteen years the bones are not
fully formed and their actual growth continues until the twenty-fifth year,
osseous development preserving a distinct and definite sequence. The epiphyses
of the transverse and spinous processes of the vertebrae hardly commence to
ossify before sixteen years of age, and it is not until after twenty years that
the two thin circular plates form on the bodies of the vertebrae, while the
whole process is not completed until the thirtieth year. The sacrum commences
to consolidate at the eighteenth year and the process is completed from the
19
twenty-fifth to the thirtieth year. The fourth and third bones of the sternum
are united between the twentieth and twenty-fifth years, and the second is not
united to the third bone before the thirty-fifth year. The epiphyses of the ribs
commence to grow between the fifteenth and twentieth and are not completely
joined to the bone until the twenty-fifth year. The epiphyses of the scapulae
join between the ages of twenty-one and twenty-five; while the epiphysis of the
clavicle begins to form between the ages of eighteen and twenty years. The
internal condyle of the humerus unites at eighteen, but the upper epiphysis does
not join until the twentieth year. The epiphyses of the radius, femur, tibia and
fibula are all unjoined at eighteen years and are not completely united until the
twenty-fifth year. The epiphyses of the pelvic bones (crest of the ilium and
tuberosity of ischium) begin to form at puberty and are completed by the twenty-
fifth year. The greatest growth of the heart takes place between eighteen and
twenty-five years and even at the latter age has not attained its maximum.
When cardiac development is deficient, heart failure is liable to occur under
unwonted exercise and in emergencies, and irritable heart, unfitting for military
service, is thus favored.
These observations are, broadly speaking, in entire conformity to
modern teachings of anatomy and physiology and to the earlier general
conclusions of Aitken, whose descriptive account of the "progressively
gradual development and growth of the recruit and the young soldier"
continues to the present time as a most reliable guide to the examiner,
whether an officer of the line or a thoroughly qualified officer of the
medical branch of the army service.
STIGMATA OF DEGENERACY
The general rules for the examination of recruits are also somewhat
obscure as regards the precise limitations upon the judgment which is
required to be exercised in medical matters by the recruiting officer of
the line. It is with reference to mental and nervous disorders, for
illustration, that the rules read : "The recruiting officer should use
every effort to exclude the mentally defective and those showing
evidence of serious nervous disorders." It is assumed that the term
"recruiting officer" has reference either to the line officer only or to
the line officer and the medical officer as well. A list of the principal
stigmata of degeneracy is given; but obviously, as made clear by the
following extract, it would be quite out of the question for any one not
thoroughly versed in anatomy or physiology to accurately ascertain and
adjudicate the significance of these so-called "stigmata of degeneracy,"
the importance of which has been denied by so high an authority as
Goring in his report on the Anthropometric Measurements of English
Convicts. * The stigmata of degeneracy enumerated in the Rules for
the Examination of Recruits are as follows:
Anatomical stigmata: Cranial abnormalities in outline, capacity, or dimen-
sions; excessive development of the occipital protuberance and ridges, the
frontal eminences, and the mastoid processes; reduction of the facial angle;
asymmetrical facial development; lower jaw disproportionately large and
* Of special value is the schedule of measurements and general anthropological data on
the English Convict, issued as a supplement to the report by Chas. Goring, M. D., lyOndon,
1913.
prognathic; hard palate sharply vaulted; dental arches narrowed or angular;
teeth defective or misplaced; ears disproportionate in size or malformed;
extremely refractive anomalies and strabismus; deviation of the nose; septal
deformities; harelip; cleft palate; remnants of branchial clefts; spina bifida;
sacral growths of hair; deep sternal furrows and concavities; disproportion
between thorax and abdomen ; upper and lower limbs disproportioned to each
other or to the trunk; abnormality in size of hands or feet; tendency to left sided
overdevelopment; deformities of the fingers; syndactyly; excessive length or
shortness of the fingers; undersize of the ring and little fingers; genitalia
undeveloped; hypospadias; epispadias; scrotal fissure; albinism; melanism;
multiple naevi; defective development of hair and nails.
With reference to these alleged stigmata of degeneracy a supple-
mental ruling reads that "The degenerate physique as a whole is often
marked by diminished stature and inferior vigor; males may present
the general body conformation of the opposite sex, with sloping, narrow
shoulders, broad hips, excessive pectoral and pubic adipose deposits,
with lack of masculine hirsute and muscular marking." In addition
thereto, functional stigmata are defined as "defective mental qualities ;
moral delinquencies, such as wilfulness, deceitfulness, indecency, stam-
mering," etc., but it is properly said with reference to the practice of
estimating the value of the various marks of degeneracy that "the
occurrence of a very few in any individual case would not justify
classification of the case as that of a defective." The notable work
of Goring clearly brings out the danger of blind reliance upon so-called
physical stigmata of degeneracy, criminality or perversion. Referring
to the prevailing notion that "every individual criminal is an anomaly
among mankind by inheritance and can be detected by his physical
malformations and mental eccentricities," Goring concludes that "this
anthropological monster has no existence in fact," and, furthermore,-
that the "physical and mental constitution of both criminal and law-
abiding persons of the same age, stature, class and inteUigence are
identical." Inferior physique and defective intelligence unquestionably
differentiate the criminal from the average normal population; but
such "stigmata of degeneracy" as are referred to in the Rules for the
Examination of Recruits are of very doubtful validity, especially when
practically applied by those not thoroughly trained in psycopathy,
which, as a rule, may safely be assumed not to be the case. There is
therefore the serious danger that a considerable proportion of thorough-
ly eligible recruits may be rejected as unfit for military service for
reasons which cannot possibly have any practical relation whatsoever
to military efificiency.
LIMITATION OF ARMY REJECTION EXPERIENCE "
The rejection statistics of the United States Army are quite difficult
of correct interpretation. The term rejection in army recruiting has
apparently quite a different significance from what it has in life insur-
ance practice or in the physical examination of applicants for official
21
or private employment. A preliminary process of selection seems to
prevail, the results of which are not included in the final sta-
tistics of recruiting as issued by the authority of the Surgeon
General of the Army. Seriously erroneous conclusions are un-
avoidable unless the terminology in use is more precisely de-
fined. According to the Army and Navy Journal, of January
10, 1914, for illustration, the total number of applicants for enlistment
in the Army during 1913 in the Eastern, Middle, Southern and Western
sections of the United States was as follows : In Chicago, 11,920 appli-
cants for enlistment, with 9,342 rejections, or 78.4 per cent. ; in New
York, 17,055 applicants for enlistment, with 13,758 rejections, or 80.6
per cent. ; in Savannah, New Orleans and Little Rock, 3,855 applicants
for enlistment, with 3,011 rejections, or 78.1 per cent. ; in San Francisco,
5,504 applicants for enlistment, with 4,443 rejections, or 80.7 per cent.
The Journal of the American Medical Association, under date of Jan-
uary 31, 1914, in commenting upon these data, remarks that "It will be
seen from these figures that the percentage of rejections was about the
same in New York and San Francisco, and that the percentage for the
Southern section and the Middle West as represented by Chicago was
lower than either the East or the West, with a small fraction in favor
of the more northerly section. The better showing of the Middle West
was rather to be expected, though the margin is quite small; but the
surprising thing about all these figures is the large percentage of rejec-
tions in all sections of the country. It does not argue well for the
physique and the stamina of our young men, or perhaps may be
accounted for by the supposition that the best do not offer themselves
for enlistment. It is said, in England, that the physique of the average
recruit is deteriorating, but in a comparatively new country, like the
United States, the descendants of hardy pioneer stock, reared amid
abundance and under favorable health and climatic conditions, should
make a much better showing." The question therefore arises as to
whether the preceding rejection data have the significance attached to
them or whether they may not be, as they probably are, seriously mis-
leading. The rejection ratio in all probability merely represented the
results of a preliminary process of selection without specific or qualified
reference to the supreme question of physical stamina and disease as
well as fatigue resistance.
RECRUITING EXPERIENCE UNDER VOLUNTARY
ENLISTMENTS
During the period 1913-15 in the recruiting districts of the United
States Army there were thus examined 461,033 applicants for military
service, of whom 349,975, or 75.9 per cent., were declined, while 111,058,
or 24.1 per cent., were provisionally accepted. Of the 111,058 it appears
only 92,667 were subsequently medically examined at recruiting depots,
22
and of this number 13,884, or 15 per cent., were finally rejected and
78,7S3, or 85 per cent., were finally accepted. At depot posts 9,110
applicants were medically examined, and of this number 800, or 8.8
per cent., were rejected, while 8,310, or 91.2 per cent., were finally
accepted. In addition thereto, at other military posts or in the field,
26,422 applicants were examined, and of this number 669, or 2.5 per
cent, were rejected, and 25,753, or 97.5 per cent., were finally accepted.
The initial rejection of 75.9 per cent, of the applicants for military
service in the United States Army by non-medical officers of the line can
therefore not be construed as evidence of deficiency in physical stamina
or lack of resistance to disease or fatigue. Many applicants were
declined, in all probability, for defects or deficiencies, physical, men-
tal or moral, each without a very decided bearing upon the question
of physical strength and power of endurance. All army experience
under a voluntary system proves conclusively that a large number of
young men apply who obviously are not required as long as the
authorized military strength can be easily maintained by means of the
most careful medical selection, as a guarantee that only the best fitted
will be secured. The applicants for voluntary military service in the
recruiting districts are generally without any previous military expe-
rience or training whatever, the applicants examined at depot posts and
other military posts are chiefly, if not exclusively, those who have had
previous military training; those, in other words, who represent a
class eligible for re-enlistment. When the latter two groups are
combined, it appears that of 35,532 such applicants examined only 1,469,
or 4.1 per cent., were rejected, while 34,063, or 95.9 per cent., were
accepted.
INCONCLUSIVE STATISTICS OF PHYSICAL
DETERIORATION
The foregoing observations emphasize the urgency of extreme care
in the use of army recruiting data for other than military purposes.
The misuse of such data is of common occurrence, regardless of the
intimations in practically all the text books or discussions on recruiting
that the experience is governed by military considerations and has no
very definite, if any, relation to possible changes in the physique or
bodily proportions of the population considered. Among other conspic-
uous illustrations of the misuse of the comparative method, appropriate
reference may here be made to the statement of a well-known actuary
before the House Committee on Labor with regard to the eflfects of
social insurance in Germany on the physique of the German adult popu-
lation. The argument was advanced that, according to military sta-
tistics, in consequence of compulsory social insurance there had been a
very substantial improvement in the height and weight of those
conscripted for military service. The foremost German authority on
23
the subject in commenting upon the German recruiting statistics his-
torically reviewed for a long period of years observes more than once
that the changes in the bodily proportions, chiefly as regards height and
the ratio of rejection, must not be accepted as evidence of material phys-
ical alterations, but rather as being governed primarily, if not exclusive-
ly, by changes in standards of selection. In contrast, a well-known Pres-
byterian minister in an address delivered on the occasion of the first
Congress on Race Betterment advanced the conclusion that the British
recruiting statistics for a hundred years indicated a very considerable
diminution in stature and presented otherwise evidence of physical
deterioration. The statement was in conflict with the evidence collected
by the Inter-Departmental Committee on Physical Deterioration, which
drew attention to the opinion of Prof. Cunningham that "perhaps
the most unreliable evidence is that which is obtained from the recruit-
ing statistics," for, it is explained :
The class from which the recruits are derived varies from time to time with
the conditions of the labor market. When trade is good and employment
plentiful it is only from the lowest stratum of the people that the Army receives
its supply of men : when, on the other hand, trade is bad, a better class of
recruits is available. Consequently the records of the recruiting department of
the Army do not deal with a homogeneous sample of the people taken from one
distinct class.
To much the same effect was the evidence of the Director General of
the Army Medical Service, Sir W. Taylor, who, according to the
report, "most emphatically disclaimed any responsibility for the deduc-
tions that had been drawn from the figures published by his depart-
ment," and who "appeared to attach very little value to the figures,"
and in reply to a question calling attention to a passage in the Report
of the Inspector General of Recruiting, where that officer speaks of the
gradual deterioration of the physique of the classes from which recruits
are principally taken, he said, "He is not justified in that. We have no
data on which to form that opinion." Unless, therefore, the strictly
military nature of recruiting statistics is kept in mind, erroneous conclu-
sions are practically unavoidable, for a full understanding of such
statistics requires an exhaustive study of army rules and regulations
extending over a long period of years, and a reasonably thorough
knowledge of the exceptions granted in conformity to the special
authority vested in the Adjutant General.
CONFLICT OF MEDICAL AND NON-MEDICAL CONSIDERA-
TIONS IN RECRUITING
It may also be pointed out that while non-medical officers of the line
employed in connection with the examination of recruits are not
expected to express a medical judgment on such defects as errors of
refraction of the eye, valvular lesions of the heart, tuberculosis of the
lungs, Bright's disease, or other obscure internal affections, they are
24
specifically reminded in the book of Rules for the Examination of
Recruits that these affections usually give rise to signs such as defec-
tive vision, shortness of breath, emaciation, and tumultuous beating
of the heart, which the recruiting officer should detect and which are
causes of rejection. In proportion, therefore, as non-medical officers
are governed by semi-medical instructions and are desirous of avoiding
possible defects disclosed by a subsequent medical examination, the
ratio of primary rejections must vary considerably.
In this connection the observations of Dr. Edward L. Munson * are
of interest. He remarks that:
Of the applicants for enlistment a considerable proportion are summarily
rejected by recruiting officers, prior to any physical examination, by reason of
intoxication, obvious defect of body or mind, or on account of apparently
undesirable personality. Such rejections are not made a matter of official
record. Of those admitted to the physical examination only about one in four
has been found in times past to be qualified for the military service.
He also directs attention to the fact that during the period 1889-93
the total number of applicants physically examined was 101,432, and
that of this number 85,136, or 83.9 per cent, were rejected. In explana-
tion of the excessively high ratio of rejections he observes that during
more recent years "the physical attributes of the classes from which the
recruits were derived appear to have undergone a steady improvement."
And referring to the year 1897 he states that the ratio accepted was
70.2 per cent., or differentiating the two races the ratio of accepted
recruits was 78.7 per cent, for the whites and 69.5 per cent, for the
colored.
The foregoing observations indicate that for practical purposes the
rejection of recruits on primary examination by non-medical officers of
the line is quite inconclusive, the rejections being interdependent with
the technical qualifications of the examiner and his predilection for
special indications of deficiency or unsuitability for military service, on
the one hand, and the specific rules and regulations as well as the
authorized strength of the army, on the other. Munson quotes Marshall
as authority for a grouping of the causes on account of which recruits
are rejected, as follows:
1st. Diseases or deformities which a medical man from his professional
training and acquaintance with the duties of the soldier considers are infirmities
which disqualify men for service in the army.
2nd. Slight blemishes which do not disqualify a man for the army but which
an unwilling soldier may exaggerate, and allege that he is thereby rendered unfit
for military duty.
3rd. Unimportant details or deviations from symmetry, or slight variations
from the usual form or condition of the body — technical or nominal blemishes
which do not incapacitate a man for the army or in the slightest degree impair
his efficiency.
* "The Theory and Practice of Military Hygiene," by E. L. Munson, New York, 1901,
page 30.
25
Munson also refers to Greenleaf as authority for the statement that :
Experienced surgeons will reject all recruits whose defects fall under the
first two headings from a conviction that they render the men unfit or unde-
sirable for the army; but those under the third head are frequently rejected
from fear of responsibility, a dread of official correspondence and to an ultimate
damage of professional character.
It is therefore self-evident that the rules and regulations which
govern in the examination of recruits, whether non-medical or medical
in a time of peace, and chiefly with reference to voluntary enHstment,
yield results of very limited scientific value. In a time of war, accord-
ing to Munson, those coming under the first of the three preceding
groups should be excluded, while those coming under the second and
the third should be as rigidly held in the service. In other words,
widely different points of view prevail in the selection of recruits for
military service during times of peace and during times of war, and un-
less this fact is kept carefully in mind, the statistics extending over a
long period of years are most likely to be seriously misleading.
A DECADE OF UNITED STATES RECRUITING
STATISTICS
Limiting the observations for the time being to medically examined
applicants for military service, subjected to a previous process of
elimination by non-medical officers of the line, the table following is
of interest as illustrating the changes in the rejection rate during the
last decade, for which the information is available in detail :
RECRUITING EXPERIENCE OF THE UNITED STATES ARMY
(White and Colored)
1906-1915
Year
Examined
Rejected
Rate per 1000
1906
25,022
5,625
224.8
1907
33,864
3,110
91.8
1908
54,885
7,434
135.5
1909
23,520
3,356
142.7
1910
25,133
2,378
94.6
1911
50,534
4,576
90.6
1912
32,738
3,960
121.0
1913
36,822
4,952
134.5
1914
57,244
6,102
106.7
1915
37,993
4,781
125.8
1906-1910
162,424
21,903
134.8
1911-1915
215,331
24,371
113.2
According to this table the maximum rejection rate occurred in 1906
or 22.5 per cent., and the minimum in 1911, or 9.1 per cent. Without
an analysis in full detail of the individual causes of rejection a final con-
clusion, of course, would not be justified, even as to the most general
26
reason underlying this wide variation in the non-eligibility of applicants
for military service during a period of peace.*
The army rejection rate is governed not only by physical and medical
considerations but also by the numerical requirements of the service,
primarily the permissible maximum of enlisted strength. The
preceding table is an excellent illustration of the very limited
value of recruiting statistics in efforts to prove that there has been
physical progress or deterioration, as the case may be. For such a
profound range in the rejection rate as is here indicated could not, of
course, have any definite relation whatever to the actual physical con-
ditions of the population concerned.
In amplification of the preceding table for both the white and the
colored troops, combined, the following table is included, exhibiting the
results separately for the two races :
RECRUITING EXPERIENCE OF THE UNITED STATES ARMY
(White and Colored)
WHITE
1906-1915
COT ORFD—
Year
Examined
Rejected
Rate
per 1000
Examined
V.-- V^ i_/ Vy XV 1^ A-'
Rejected
Rate
per 1000
1906
*24,259
5,484
226.1
763
141
184.8
1907
32,199
2,948
91.6
1,665
161
97.3
1908
52,740
7,218
136.9
2,145
216
100.7
1909
22,613
3,243
143.4
907
113
124.6
1910
23,788
2,295
96.5
1,345
83
61.7
1911
47,980
4,382
91.3
2,554
194
76.0
1912
30,374
3,680
121.2
2,364
280
118.4
1913
33,828
4,594
135.8
2,994
358
119.6
1914
53,970
5,717
105.9
3,274
385
117.6
1915
35,533
4,496
126.5
2,460
285
115.9
1906-10
155,599
21,188
136.2
6,825
715
104.8
1911-15
201,685
22,869
113.4
13,646
1,502
110.1
'Figures represent recruits examined up to July 31, 1906.
According to this table the rejection ratio was, as a rule, higher for
the white than for the colored, although, as is well known, the average
American negro is of a distinctly lower degree of physical resistance
to disease than the average white man.
IMPORTANT CHANGES IN RECRUITING STANDARDS
Changes in recruiting standards are, therefore, of the first importance
in connection with the practical use of recruiting statistics. According
to Munson, "The minimum limit of stature for the recruit has varied
greatly in our service. Shortly after the Revolution it was fixed at
* These statistics must not be confused with the corresponding returns of the Adjutant
General of the Army, as given on page 85.
27
5 feet 6 inches, and in 1835 a minimum of 5 feet 8 inches for infantry
was required. In 1838 it was reduced to 5 feet, but this was increased
by 5 inches three years later. Before the end of the Civil War it was
again reduced to 5 feet. At present (1916-17) it is placed at 5 feet
4 inches for all branches of the service, although recruiting officers are
allowed to exercise their discretion as to the enlistment of desirable
recruits (such as band rriusicians, school-teachers, tailors, etc.) vyho
may fall not more than a fraction of an inch below the minimum
standard of height. The above requirement for height is, however,
subject to change, instructions to that effect being issued from the
i\djutant General's office from time to time as the requirements of the
service may dictate." According to the same authority, in foreign
armies about 1900 the minimum height of soldiers was as follows:
MINIMUM HEIGHT OF RECRUITS IN FOREIGN COUNTRIES
(Munson)
Inches Inches
English 63.8 Swiss 61.0
Swedish 63.0 French 60.6
German 61.8 Russian 60.2
Belgian 61.8 Spanish 59.1
Italian 61.4 Portuguese 59.1
Austrian 61.4
These variations in prevailing minimum standards of stature have a
direct bearing upon the more or less important differences in the rejec-
tion .rate of the recruiting service of the different countries.
CHANGES RBCOMMENDBD BY THE COMMITTEE
ON ANTHROPOLOGY OF THE NATIONAL
RESEARCH COUNCIL
In full appreciation of the practical as well as general scientific
importance of precise anthropometric and other measurements of the
men of the new National Army, the Committee on Anthropology of
the National Research Council presented a number of suggestions to
the National Academy of Science and through the National Research
Council to the Council of National Defense. The suggestions con-
sidered (1) the examination of recruits, (2) modification of stature
requirements, (3) further anthropometric work for statistical and
scientific purposes at the concentration camps, and (4) material for
future scientific research. The communication was signed by Prof.
W. H. Holmes, Chairman, and the members of the Committee,
Prof. C. B. Davenport, Dr. Frederick L. Hoffman, Dr. G. M. Kober,
Dr. Ales Hrdlicka, Mr. Madison Grant, Mr. E. A. Hooton, and Dr.
Tom A. Williams. With special reference to modification of stature
requirements, it is first pointed out that the minimum requirements of
stature in any branch of the Army and Navy (at the time the sugges-
28
tions were submitted, August, 1917), was 5 feet 4 inches. In further
explanation of the suggestions it was said that:
The minimum for the English infantry and some other branches of the service
prior to the present war was 5 feet 2 inches, and it has since been reduced. On
the Continent the minimum differs with the nationalities, but is as a rule lower
than that of the United States. In many of these nationalities the average
height of the male does not reach, barely equals, or only slightly surpasses the
minimum requirement for the soldier of the United States. Many of these
nationalities are well represented in this country. They include Italians, Greeks,
French, Mexicans, Spanish, Swiss, the Russian and Austrian Jews, many of the
Slavs, the Magyars, Roumanians, Lithuanians and even Germans. Should the
present minimum in stature for the United States Army and Navy be rigidly
adhered to, from one-fourth to one-half of the men belonging to or descending
from the nationalities mentioned would be excluded by this rule alone, thus
resulting in serious disadvantages, the chief among which would be that of
placing a disproportionate burden in the formation of the army on the naturally
taller native American.
RACK IN RELATION TO NORMAL STATURE
In view of the fact that small stature in a large majority of cases
signifies normal variation and not weakness or degeneration, as
has repeatedly been proved by certain regiments of short stature of
England and other short stature troops of European countries, the
Committee recommended that "the minimum stature requirement for
the new United States Army be reduced, for all branches of the service,
to 60 or at most 62 inches; and that corresponding with this, the
minimum weight requirement be reduced from 128 to 120 pounds."
These recommendations were subsequently adopted by the Chief of
Staff. The practical importance of the adoption of this recommenda-
tion is one of far-reaching significance, on account of the vast immigra-
tion from Southern Europe during the last thirty or forty years and the
fact that the Army will include a considerable number of men of Amer-
ican birth of South-European parentage. Practically all South-Euro-
peans are of a lower stature than the northern races of Europe or the
United States. In forwarding the suggestions and recommendations, these
fundamental facts of physical anthropology were emphasized by Dr.
Hrdlicka and amplified by a table showing approximately the average
height of European nationalities, exhibiting an average stature as low
as 63.7 inches in the case of Magyars, 64.1 inches in the case of Russian
Jews, 64.7 inches in the case of Italians, and 64.8 inches in the case of
Austrian Slavs. All of these racial elements form constituent parts of the
new National Army. Their unnecessary rejection on the basis of the for-
mer minimum stature would have been a foregone conclusion. The aver-
age height for certain races is frequently more or less misleading and
often useless for practical purposes. The typical frequency distribution
of stature is, however, of decidedly greater scientific value; and as a
useful contribution to a better understanding of this important aspect
29
of army recruiting a series of tables and frequency curves has been
prepared for European conscripts and American recruits. A few typical
frequency curves of stature, for the purpose of convenient illustration,
have been worked out for me by Mr. Arne Fisher, the well-known
author of a standard treatise on ''Probabilities. " The point of view that
the mean or average value of a large number of measurements may be
relied upon unconditionally as a measure of comparison is a serious
fallacy common in general statistical practice. The mean at best repre-
sents a norm around which the other values of the variate are grouped.
The mean frequency gives not the slightest clue as to the possible
tendency of the statistical material to cluster around a particular value
which for practical purposes may be of governing importance. As
pointed out to me by Mr. Fisher in his observations on the frequency
curves of recruits that if, for illustration, the mean stature of American
recruits and of Norwegian conscripts are 67.52 inches and 67.49 inches,
respectively, we are by no means justified in assuming that the statures
of the two populations are precisely the same, although the difference be-
tween the means is less than .03 part of an inch. It is quite probable
that in the one we would find 70 per cent, having a stature between
65 and 70 inches, while in the other the percentage distribution
would amount to only 55 per cent. The mean, under such conditions,
is therefore often a fictitious mathematical measure which without
qualification is practically certain to prove misleading. A more satis-
factory method is to determine the possible presence of a clustering
tendency, or a constant known as the dispersion, or the standard devia-
tion around the mean value. If, for. illustration, it is found that the
mean stature of Norwegian conscripts is 67.5 inches and the disper-
sion is 2.33 inches, this means that about 68 per cent, of the Norwegian
conscripts measure between 65.17 and 69.83 inches. * More precise
statistical analysis readily disproves the common error that all statistical
frequency curves are true symmetrical curves. This point of view was
first advanced by the German mathematician Gauss, and unfortunately
widely accepted among statisticians of modern times. As a matter of
fact, however, the symmetrical distribution is the exception rather than
the rule, and the correct ascertainment of frequency distribution
requires in addition to the mean and the dispersion the computation of
at least two additional parameters, the skewness and the excess. As
explained by Mr. Arne Fisher, "These two statistical characteristics are
purely abstract numbers." A positive skewness indicates a tendency to
a heavier clustering of values greater than the mean ; negative skewness
indicates a heavier clustering of values less than the mean. A positive
* The importance of the dispersion (also called the standard deviation) as the best measure
of a clustering tendency about the mean vakie of a variate is emphasized in the formulas of
the mathematical theory of probability. Through a simple application of the Bernoullian
theorem, or the so-called "law of large numbers," it can be shown that a range of six times
the dispersion will include more than 99 per cent, of the bulk of the observations, while two
ordinates drawn both to the right and to the left of the mean at a distance from the mean
equal to the dispersion will include about 68 per cent, of the area of the frequency curve.
30
excess means a tendency to make the frequency curve topheavy around
the mean; a negative excess indicates a flattening tendency. Once
having computed the various statistical parameters represented by the
mean, the dispersion, the skewness and the excess, the frequency distri-
bution is easily ascertained for any value of the varying attributes and
reduced to a common standard of measure. This method has been
followed and is sufficiently explained in the diagrams of frequency
distribution of the conscripts of Norway, Sweden, Denmark, Wiirttem-
berg and Japan, and the corresponding measurements of recruits of
the United States Army previously to the present war. (See diagram
on page 32.) All of the frequency dispersions have been reduced
to English measure. The values of the various statistical parameters
are as follows : *
STATISTICAL AND MATHEMATICAL CONSIDERATIONS OF
FREQUENCY DISTRIBUTION IN PHYSICAL
PROPORTIONS
COMPARATIVE MEASUREMENTS
Values of the Various Statistical Parameters
Country
Mean
Dispersion
Skewness
Excess
Coefficient
of Variability
U S. A. (1906-15)
67.52"
2.198"
-0.0570
-0.0062
3.255
Sweden (1914)
67.66"
2.535"
0.0008
0.0084
3.747
Norway (1913)
67.49"
2.335"
-0.0106
-0.0163
3.460
Denmark (1916)
66.54"
2.573"
0.0062
0.0147
3.867
Wurttemburg (1911)
65.63"
2.313"
0.0293
-O.0064
3.524
Japan (1915)
62.30"
2.262"
0.0124
-0.0091
3.631
According to this table the variation is most pronounced in the
case of the Danes. The Swedes are evidently the tallest of the races
included in the comparison, showing both a positive skewness and a
positive excess. Computing the distribution from the equations of
the frequency curves, Mr. Fisher presents the following comparative
results on the basis of 1,000 standard measurement^ progressing by
one-inch intervals for the six countries for which the data could be
secured.
* For an elementary description of frequency distributions see "Elderton's 'Primer of
Statistics'" (London, 1910), and H. Secrist's "Introduction to Statistical Methods" (New
York, 1917). A more advanced treatment is to be found in Udny Yule's "Theory of Sta-
tistics" (London, 1911). Of special value are the observations by Secrist on the Graphic
Presentation of Simple Frequency Series. He properly directs attention to the common
error of "Taking measurements with extreme accuracy and then grouping them into broad
classes." And he suggests that "Measurements should be so grouped as to show the
variability and at the same time to leave the frequency distribution fairly smooth." "For,"
he remarks in continuation, "in the matter of grouping there are two opposing tendencies
— grouping into too few classes to show variability and grouping into too many classes to
give a smooth distribution." In many cases "the law of distribution is hidden because of
too much detail."
31
m
05
03
m
5>
•^
■^p^
1
II
- p
I —
=z
^A-^
^ " '
i —
-< —
-^^
==s-:
^
!
^ ■
1
^
i
■j
A
B
_^^fl
B
.jaBm
V, m
:8i
*5
/
(
V
^ . ■•v:.,:.'-^^
■ " ■■
\^,^^
X
\
\
1
o o
9 ^
W
I
It
s^^
S^-5
>^.^
^■5^
^f^
s:
b O
32
STATURE OF ARMY CONSCRIPTS AND RECRUITS IN INCHES, AS
DETERMINED BY LAPLACEAN-CHARLIER FREQUENCY CURVES
(By Arne Fisher)
r
a
U. S. Army
Recruits
1906-1915
Norwegian
Conscripts
1913
Swedish
Conscripts
1914
Danish
Conscripts
1916
Warttemberg
Conscripts
1911
Japanese
Conscripts
1915
56
4.7
57
12.5
58
31.6
59
1.3
2.9
1.2
64.0
60
2.2
6.7
7.0
106.5
61
2."i
5.4
15.0
22.7
148.6
62
3.8
9.9
12.9
30.2
53.4
173.0
63
19.2
29.4
27.5
54.0
96.9
169.8
64
53.8
60.1
53.4
92.6
141.7
132.8
65
105.5
100.3
88.6
130.5
167.5
83.9
66
155.7
137.6
127.8
157.7
164.8
44.2
67
182.2
165.2
155.3
160.0
137.2
20.8
68
169.5
163.1
159.7
136.0
97.0
6.4
69
129.4
132.8
138.5
96.9
59.2
1.2
70
86.8
96.4
102.0
59.4
30.9
71
51.0
58.9
63.4
31.7
13.6
72
26.3
28.7
34.6
15.2
5.0
73
11.4
11.3
16.4
6.7
1.5
74
4.2
3.2
7.0
2.8
0.3
75
1.2
0.5
2.7
1.1
76
0.3
1.3
0.4
77
0.2
0.2
This table clearly emphasizes the error which underlies the non-critical
use of the general average and the importance of utilizing the frequency
distribution as a more trustworthy measure of physical types. In the
two diagrams three shades have been adopted, relatively for short,
medium and tall stature. The contrast, for illustration, between the
complete absence of persons of tall stature from the Japanese army and
the preponderance of tall men in the Swedish army is very striking. The
diagrams strongly suggest the urgency of more qualified attention
to questions of physical anthropology and the necessity of the ascer-
tainment of new standards which if available would meet many press-
ing army, medical and other practical requirements.
STANDARD METHODS OF ANTHROPOMETRIC
MEASUREMENTS
The value of the anthropometric statistics of the United States
recruits or enlistments previously to the war is probably more limited
than the scientific use of the corresponding data for European con-
scripts, since no particular value was attached to the importance of
accuracy in such measurement. There are convincing reasons for be-
lieving that in a sufficient proportion both the height and the weight
were rather guessed at than ascertained with the required precision.
33
This element of inherent inaccuracy also underlies the new measure-
ments of the men of the National Army, and the results though truly
colossal in their proportions will be decidedly less in scientific value
than would easily have been the case, if the necessity for accuracy in
measurement and the urgency of a preliminary training for such meas-
urements had been recognized by the army authorities. For the data,
aside from their mihtary use, as observed by the Committee on Anthro-
pology of the National Research Council, could and no doubt would be
utilized for broader scientific purposes. It was therefore considered
imperative that the following directions regarding such measurements
should be followed to the letter. Unfortunately, these recommenda-
tions were not adopted.
SUGGESTED DIRECTIONS FOR ANTHROPOMETRIC
MEASUREMENTS AT RECRUITING STATIONS.
(Committee on Anthropology, National Research Council.)
Instruments.
A. Tape 4 feet long, 1^ inches wide, for measuring height;
B. A wooden square, an adjunct to A ;
C. Tape 3 feet long, ^ inches wide, for measuring chest. *
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
to feel the hard calvarium, and carefully note measurement, to
the nearest ys 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 he strictly avoided: Conversation during measur-
ing; interruptions; incorrect 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 $1 for each" set of instruments as
required for each recruiting station.)
STATURE OF ACCEPTED UNITED STATES RECRUITS
UNDER THE VOLUNTARY SYSTEM OF ENLISTMENT
As a practical illustration of the truly immense opportunity for the
scientific ascertainment of the varying bodily proportions among men
of mihtary age, the following table shows the observed number of
recruits at various ages in the experience of the United States Army
during the period 1906-15. *
OBSERVED NUMBER OF RECRUITS AT VARIOUS AGES
UNITED STATES ARMY, 1906-1915
Inches
62
63
18
19
20
21
22
23
24
25 and Over
"219
"189
"ii8
"617
"345
"211
"228
1305
64
1453
986
574
3910
2079
1713
1546
8534
65
2487
1626
924
6453
3390
2771
2572
14404
66
3087
2109
1125
9013
4755
3767
3554
20162
67
3112
2171
1281
10621
5472
4176
3997
22416
68
2773
1918
1103
10298
5461
4361
4095
22162
69
1887
1328
796
8165
4255
3356
3291
17473
70
1064
833
517
5409
2991
2375
2259
12197
71
477
400
270
6708
3051
1642
1249
1295
6670
Total
16559
11560
57537
30390
23979
22837
125323
* In this computation all the statures below 63 inches and all those above 71 inches have
been omitted. The nine-inch interval was chosen because of the fact that a very few tall
and a very few short recruits would tend to displace any indications of change in stature
among the greater bulk of younger members. The computed frequency curves must there-
fore not be confused with data on page 39 showing the whole range of variation or with
the frequency curve for recruits of all ages.
35
^iD
i
'^^^
CO
(/3
^->
a
P
(4-1
o
<u
u
(/3
'^
1^'
I
I
2S
^
^
i
y^
^
^^^H
.."■^
Kpwpm^iiid
y^'^
"'
\^->.-<'^,>
' ' I
^NJ^';-
''V
-w^
^■""^^V^
^
J«
8 S
C
■"f^
\'
1
1
•<^
-I
?5
^
s
'f!f^9
,.^1
N|?sv
'^??pis
'<i
1
y#C^^ ■
-0
^""^^Siii^
^'''***^|:'i;'::
\
'c>
^
^
_
1
i
A
i
.^ifl
^i
.^f^mmim^
4
■p^* ^^>^v
!'
yfn$
'i:H'^t^^'''''
%
m4,-^m
■■' .^^^'i--
i —
^*^*«-ii
'*" ""'^
m
^'"^■^"'•Ss^
I
N^
1
11
^11
M
^^
^1
- Q)
3
A
i
^
i
^^^
1
^-^
^^B
s-
t"
4
^
v^:.,,.. .. ^ :a
f. —
^•^fj
s^^
1 — '
"^
>
1
^
36
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. The average
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 w^hole. 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 follov^ing values for the various statistical
parameters :
FREQUENCY DISTRIBUTION OF STATURE, UNITED STATES
ARMY RECRUITS
1906-1916
Statistical Parameters
Age
Mean
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 "
1.929
0.0009
-0.0303
22
67.341 "
1.943
0.0024
-O.0310
22,
67.329 "
1.939
0.0004
-0.0325
24
67.367 "
1.948
0.0027
-0.0321
25 and over 67.325
1.948
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 between 63 and 71 inches)
tches
18
19
20
21
22
23
24
25 and Over
62
2.9
3.5
5.2
2.4
2.7
2.4
2.5
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
188.8
182.7
172.5
160.7
158.9
159.8
157.6
160.9
67
195.7
192.2
187.7
186.0
183.8
183.7
182.4
184.6
68
166.9
167.8
172.8
181.0
179.9
178.9
179.6
179.1
69
116.1
121.2
129.4
145.9
147.0
146.0
147.7
145.0
70
61.0
66.7
72.9
91.4
92.2
91.6
94.7
90.6
71
22.0
25.6
28.6
39.7
41.1
40.7
42.8
40.3
72
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
irldicate 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 life 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 the case 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
DIST
RIBUTIO^
I OF S
TATl
JRE
ACCC
)RDI^
IG TC
) 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
and Over
Ages
Under 63 inches
1
1
1
1
1
1
1
1
2
1
63 inches
13
16
17
10
11
10
9
11
10
10
64 '
86
83
83
65
65
69
64
63
64
67
65 '
147
137
133
108
106
109
107
107
109
112
66 •
182
177
162
150
149
152
147
149
152
154
67 '
184
182
184
177
172
166
165
167
169
172
68 '
164
161
159
171
171
170
169
168
167
168
69 '
111
111
114
136
134
130
136
130
132
131
70 '
63
70
74
90
94
95
94
96
91
89
71 '
28
34
39
51
52
51
54
54
50
49
12 '
* and over
21
28
1000
34
1000
41
45
47
54
54
54
47
Total
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
u
Nil
PED S
TATES
REC
Run
^S (C(
3L0R
ED),
1906-1915, PER 1000
18 Years
26 All
Height
and Under 19
20
21
22
23
24
25
and Over Ages
Under 63
inches
5
1
2
1
2 1
63 inches
17
17
15
7
8
10
8
6
9 9
64 '
112
108
89
72
51
66
64
65
58 65
65 '
165
137
131
133
127
116
125
128
113 121
66 '
195
172
193
164
174
155
154
168
158 163
67 '
189
189
159
164
181
181
161
171
183 179
68 '
124
149
162
173
164
162
179
179
169 168
69 '
107
104
104
133
122
144
133
121
125 126
70 '
59
70
70
80
85
79
82
80
87 82
71 '
19
29
34
43
47
45
42
37
50 45
n '
and ov
er 8
25
43
1000
30
39
42
51
45
46 41
Total
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, and
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
Weight
Under 120 lbs.
18 Years
and Under 19
41 33
20
26
21
15
22
12
23
12
24
12
25
12
26
and Over
16
All
Ages
17
120-129 lbs.
348
308
270
189
160
141
127
128
106
156
130-139
325
335
317
304
281
270
251
248
213
261
140-149
150-159
187
69
204
80
217
115
265
144
276
164
278
177
273
185
272
184
238
181
250
161
160-169
21
28
37
57
72
78
94
93
113
83
170-179
6
8
13
18
25
30
37
39
63
38
180 and over
3
4
5
1000
5953 (
8
10
14
21
24
70
34
Total
No. of men
1000
16931 ]
1000
11910 (
1000 1000 1000 1000 1000 1000 1000
50104 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
Weight
18 Years
and Under 19
20
21
22
23
24
25
26
All
Ages
Under 120 lbs.
27
31
21
12
3
4
7
4
4
7
120-129
286
257
172
124
119
101
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
25
37
67
69
102
117
124
116
150
120
170-179
5
15
25
30
29
45
54
44
77
56
180 and over
2
6 6
1000 1000
11
14
24
21
27
1000
78
47
Total
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
176.4
158.7
120.0
10O8
82.8
91.9
75.8
130-134
177.0
176.5
170.0
156.0
142.3
130.2
1303
115.7
135-139
147.9
147.9
149.0
159.6
156.4
157.5
141.3
131.3
140-144
108.4
115.2
1204
141.1
141.1
158.6
130.2
121.7
145-149
78.4
85.4
94.1
113.9
122.8
136.7
111.8
102.6
150-154
51.8
58.8
69.7
85.9
95.5
106.9
94.3
87.5
155-159
30.4
36.3
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
7.3
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
03
0.6
1.2
2.6
3.0
3.8
9.3
19.6
185-189
OO
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
07
2.1
5.7
195-199
01
0.2
03
01
1.2
2.7
200-204
1.2
205-209
OS
210-214
0.2
The frequency curves are shown in graphic form on page 42.
RACK 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 Joseph H. Gora, Colonel,
Medical Corps, United States Army, Philadelphia, 1918, page 493. The chest expansion must
not, of course, be confused with pulmonary capacity. B. 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. He 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
M
ON
M
o
u
o
a
P
o
ll
I§
§^
^^
J
"^
,/
?^
/
5V|
j'^
/
'^
/
'
^
/
/
\
\
k.-
^
I ^ § $ <^
tff/-oe/
■i'9/-09/
6e/-S£/
te/-oe/
0//-S//
M -0/
42
DISTRIBUTION OF CHEST MEASUREMENTS ACCORDING TO AGE
OF ACCEPTED UNITED STATES ARMY RECRUITS (WHITE)
1906-1915, PER 1000
Chest
Measurement
18 Years
and Under
19
20
21
22
23
24
25
26
Ail
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
296
287
257
246
222
203
.181
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
IS
21
32
45
54
66
n
81
107
n
37
3
5
9
15
19
25
31
34
60
34
38
1
1
2
4
8
10
13
14
36
18
39 and over 0.4
1
2
1000
2
3
4
7
8
39
17
Total
1000
1000
1000
1000
1000
1000
1000
1000
1000
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-
CHARUER FREQUENCY CURVES
Inches
18 Years
and Under
19
20
21
22
23
24
25
26 and
Over
Under 31
225.8
93.5
75.9
41.5
32.7
26.0
21.4
20.9
16-2
32
281.4
225.4
197.1
143.5
122.4
105.3
91.4
88.8
66.3
33
202.9
267.7
254.5
232.6
213.9
197.7
181.3
176.9
135.9
34
131.1
208.9
217.9
239.2
237.4
234.5
227.5
224.2
186.5
35
82.2
120.6
139.1
176.7
189.5
199.2
205.0
204.9
192.9
36
45.2
54.8
70.6
100.0
116.0
129.8
142.0
144.5
160.4
Z1
20.6
20.5
29.8
44.8
56.6
tl.Z
78.6
81.7
111.6
38
7.8
6.4
10.7
16.1
22.3
28.2
35.4
37.9
67.0
39
2.4
1.7
3.4
4.6
7.0
9.4
13.0
14.5
35.2
40
0.7
0.4
0.9
0.9
1.8
2.5
3.8
4.5
16.6
41
0.1
0.1
0.3
0.1
0.2
0.3
0.7
1.1
7.1
42
0.1
0.1
0.1
0.1
0.1
0.2
2.7
43
1.0
44
0.4
45
0.2
The frequency curves are shown in graphic form on page 44,
43
M
ON
M
I
o
ON
M
I
CO
(/5
(U
a
CO
(0
(0
U
I
I
i
I
I
I
t
I
d
.1
/
/
/
/
-
/
/
/
>
/
/
\
\
\
\
\
\
I
1=5^
i
1
1
0
/
/
/
/
/
/
/
/
/
/
(
s
N
^1
i I
^1
"^1
^
^
^
^
^
^
&
^
^1
i^i
•^^
^1
/
/
/
1
/
/
\
\
\
■I
I
Is
/
/
/
/
/
/
/
/
(
\
\
\
\
-^
»5l
i ^ 1 -
z
/
1
t
^ ^
^ /
^ 7-
S L
f^
^. ^
^ V
s. ^^
^ s
^ \
I
^
1
J
7
t
7
if\ J-
53 ^^
? ^
» /
^ 7_
J T
\
^
^
\,
V
^
III-
7
I
/
^ J-
s /
^ z
^ /
^ ,
i z
V
\
\
-N
\
'I
'is
I
'I
44
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
Measurement
18 Years
and Under
19
20
21
22
23
24
25
26
and Over
All
Ages
Under 31
178
137
98
72
51
32
31
27
17
40
31
203
210
162
127
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
83
113
135
132
134
162
132
36
10
21
31
50
44
71
83
76
111
82
37
3
4
9
15
14
35
22
26
60
39
38
2
9
5
4
10
8
14
33 '
20
39 and over
2
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,i 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
HEIGHT-
Feet
Inches
weigh:
Pounds
5 1/12
61
118
5 2/12
62
120
5 3/12
63
124
5 4/12
64
128
5 5/12
65
130
5 6/12
66
132
5 7/12
67
134
5 8/12
68
141
5 9/12
69
148
5 10/12
70
155
5 11/12
71
162
6
n
169
6 1/12
IZ
176
6 2/12
74
183
6 3/12
75
190
6 4/12
76
197
6 5/12
77
204
6 6/12
78
211
STANDARD OF PHYSICAL PROPORTIONS ADOPTED
MAY 18, 1917
STANDARD TABLE OF HEIGHT, WEIGHT AND CHEST
MEASUREMENTS, UNITED STATES ARMY, 1917
-CHEST MEASUREMENT •
At Expiration Mobility
Inches Inches
31 2
31 2
31 2
2>2 2
32 2
2>2y2 2
33 2
Z2>% 2H
^Z'A 2K
34 2y2
34^ 2^
3434 3
35^ 3
36^ 3
363/4 354
37^ 3^
37^ 33^
38^ 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
(>8 and under 69 2 12
69 and under 70 2 15
70 and under 7Z 2 ^ 20
72) 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. The 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 lbs.,
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
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.
49
The ratio of rejections on the ground of unfitness for mihtary 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
miHtary 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 Ryssia 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
determined 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-
cHned, or, respectively, 19.3 per cent, on account of general debility,
72 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 Wiirttem-
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 Wiirttemberg.
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
general 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 decHning 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
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
1st 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
mcreased 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 sufificient 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,
1.9 per cent.; tuberculosis, 1.2 per cent.; varicose veins, 0.9 per cent.;
errors of refraction, 0.8 per 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
fiatfoot 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, or, 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 soldiers in 1906 29.8 per cent., for German recruits during
1899-1903 40.2 per cent., and for French 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 anthropometric 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 6Z.Z 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 in a
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, in
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
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 ^f 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 the returns 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^SiVe. 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 MiHtary District to a minimum of 37.5 in
the Fourth MiHtary 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 Sodily 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 per 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 Tromsoe District, or 16.6 per cent. Theprincipal 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. The 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 26.12 per cent., and for diseases of the heart and circulatory
organs, 5.65 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 orf
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 for a rejection
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 decHne 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 fate 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 are 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 appHcants 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 rejection among
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 seriously 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 poHcy 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-
pometric 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 training 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) 3.1
4. Goitre 2.8
5. Flatfoot 2.4
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 also a 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 of a 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 be acceptable 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 2.4
2. General Bodily Debility 1.9
3. Tuberculosis 1-2
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-comparabiHty of the
data with those of Germany and Austria. For tuberculosis, which is re-
turned separately for France, is probably included in general debiHty
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
results 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 Z.7
5. General Bodily Weakness 3.3
6. Hernia 2.7
Next to goitre errors of refraction are apparently the principal cause
of military unfitness in the Sv^^iss 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 5.1
2. Deficient Development of Chest 4.1
3. Diseases of the Eye, including Errors of Refraction 2.1
4. Scrofula, Anemia, Weakness, etc 2.0
5. Diseases of Bones, Extremities, etc 1.9
6. Hernia 1 .5
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 : 8.0
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 respiratory 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 rejected
on this account was 0.46 per cent.
CAUSES OF REJECTION IN THE SWEDISH ARMY
The statistics for Sweden are for the period 1903-07, diflferentiating
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
course 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.). It is 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
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 RE-JECTION IN THE BRITISH ARMY
1906-1910
Per Cent.
Examined
1. Deficient Chest Measure 5.3
2. Dental Defects and Deficiencies 5.2
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 ^ 1.2
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 miHtary 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 0.7 0.3
8. Flatfoot 0.6 07
9. Hernia 0.5 05
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
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 develbpment. 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 Percent.
Examined
1. Causes not Physical 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 0.80
6. Flatfoot 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.
11
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
L Venereal Diseases 2.86
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. The 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 Footas 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 miHtary ex-
perience has a bearing upon the somewhat higher rejection ratio for
flatfoot.
CAUSES OF REJECTION— FILIPINO AND PORTO
RICAN RECRUITS
Of exceptional 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 FiHpino 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 FiHpino 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 and 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 IV'avy, 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 w^hen 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
quaHfied 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." As a 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 office 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 thei 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 5.37
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 1.59
Respiratory 161 1.56
Genito-urinary (Non-venereal) 142 1.39
Skin 118 1.15
Ill-defined or Not-specified 93 .91
Digestive System 82 .80
Alcoholism and Drug Habit 79 .77
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 Z.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 flatfo'ot, 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
84
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
Fiscal
Number of
Applicants
Applicants
Later Rejected
Year
Applicants
Rejected
Per Cent.
Accepted
Per Cent.
at Army Posts
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
23.3
4,194
1917
367,579
187,388
51.0
180,191
49.0
17,256
Total 961,702 639,460 66.5 322,242 33.5 36,093
According to this table, out of 961,702 appHcants 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 of^ce were made public. In answer to the
important question whether the rejection statistics are really conclusive
as regards the physical condition of the registrants or merely a statis-
tical enumeration of the principal causes of rejection on the ground
of unfitness for mihtary 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 no 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 110>4 pounds at the time of the examination,
whereas the prescribed minimum for applicant's weight was 112 pounds.
His chest measure was V/^ 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 deHberately 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 general 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 fiatfoot, 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
examination blank was passed from physician to physician, each making a record
of his 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 Hkely 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 percentages 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 alcohoHsm
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 appHcants, 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
Of 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 ot
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. The 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 Medical 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 of 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 gen-
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 examination 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
the 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, i. 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' a'n 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 mihtary purposes only.
101
The hew 'staiiiidrcfs' mark '^arf 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 EngHsh, 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 efftciency 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
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 precludes 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
Kxamination 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
Body:
Weight
Stature
Height to shoulder (mean).
Height sitting
Head:
Deformation of
Length
Breadth
Height
Color of eyes
Color of hair...
Nature of hair.
Nose
Face :
Length to nasion
Length to crinion
Breadth, bizygom
Miscellaneous :
Shoulders:
Breadth
Chest:
Mean breadth at nipple height.
Mean depth at nipple height...
OBSERVATIONS
Lips
Chin
Body and limbs.
Nasal septum Dynamometric Pressure j
f r. hand.
[1. hand.
104
APPENDIX B
THE ROYAL ANTHROPOLOGICAL INSTITUTE
50, Great Russell Street,
London, W. C.
To the: Honorary Se:cri:tary of the
Board oiP Scie:ntific 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.
Premous 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
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 considerations. 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.
Organisation and Scope of the Survey,
So far, only the reasons for urging the institution of an anthropomeit-
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.)
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 Organisation. — 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 more 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 survey 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 Normaft 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
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. A discussion followed in the House of
Lords (July 20th, 1905). Lord Londonderry, replying on behalf of
the Government, whilst approving of an Anthropometrical Survey, ap-
peared to think that there would be a difficulty in carrying it out
because parents might object to their children being measured. In
short, the labours of the Inter-Departmental Committee, and the en-
deavours of a generation of anthropologists, were cast aside because
the Government of the day feared to face the prejudice and ignorance
of a small part of the population.
We are, dear Sir,
Your obedient Servants,
(Signed) H. S. HARRISON,
T. A. JOYCE,
Hon. Secretaries of the Royal Anthropological Institute.
January, 1917.
Ill
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
Ages
Total
Single
Married
Wido
Divorced
18
1,065,265
1,072,646
18,208
300
19
1,056,291
1,005,700
61,198
808
20
1,050,095
931,707
109,245
2,325
21
1,046,598
849,661
166,397
3,842
22
1,040,202
766,104
237,709
5,658
23
1,031,708
685,568
322,678
7,477
24
1,021,315
610,568
396,014
9,296
25
1,007,924
543,622
453,671
11,216
26
990,236
477,179
502,730
12,732
27
970,849
416,273
541,674
14,247
28
949,763
363,925
571,514
15,662
29
927,278
318,623
593,768
16,874
30
902,994
280,871
608,435
18,087
31
876,712
248,153
616,021
18,895
32
851,229
219,966
616,527
19,704
33
816,452
196,811
611,469
20,512
34
802,662
176,677
603,883
21,421
35
779,577
160,570
597,814
22,230
36
768,285
148,993
596,296
23,341
37
756,093
141,442
595,265
24,655
38
743,102
135,905
592,756
26,171
39
729,011
129,865
586,181
27,787
40
714,121
121,812
571,514
30,718
41
679,544
112,248
551,789
32,940
42
645,667
101,677
521,949
35,467
43
612,789
89,597
487,051
38,195
44
580,810
79,027
457,717
41,226
45
549,631
70,973
435,969
44,561
46
543,833
63,926
420,796
48,198
47
538,938
57,382
413,715'
52,038
48
534,941
52,349
408,658
56,282
49
531,643
48,825
404,612
60,829
Note. — The actual age returns, by single years of life, according to the Census,
include numerous inaccuracies in matters of minor detail. It has therefore seemed
advisable to graduate the data in conformity to standardized methods of sta-
tistical practice. The combined totals for the three groups, by conjugal condi-
tion, varies slightly from the estimated graduated total, but the differences
are relatively unimportant. The estimates are, of course, without refer-
ence to the effect of the first and second selective drafts, and the mortality of
the American forces at home and abroad since the outbreak of the war.
112
APPENDIX D
Two Letters on Unnecessary Rejections on Account of Deficiency
in Stature (New York Sun).
To THE Editor of The Sun — Sir: Evidence is not lacking that the
miHtary-service rule requiring a height of 63 inches on the part of
applicants for admission is depriving Uncle Sam of the fighting
ability of thousands of young men who are eager to go to the front
and help the good cause.
Why is it that the military authorities at Washington continue to
bewail a shortage of men of draft age for active service and threaten
to change the limit of the draft age from 31 to 40 years, when there
are thousands of young men of draft age, fine specimens of manhood
physically, mentally and morally, courageous and fearless, all anxious
to do their bit, and do it with a vim?
With every branch of the service urging early enlistment, with
boys in the colleges enrolled for service just as soon as the emergency
arises, why, with all this, is a man of sound mind and healthy body
refused for the National Army because he happens to be less than
half an inch below the required height of 5 feet 3 inches?
Take my case as an example :
I am a young man, 31 years of age, a graduate of the College of
the City of New York, post-graduate student at New York University,
former athletic director of playgrounds, former principal of vacation
playgrounds, a man who has devoted fourteen years to athletic
pastimes, and has made a close study of athletic conditions and
methods.
In addition, I also have had considerable military training both as a
member of a cadet corps and a member of the Newspaper Men's
Officers' Training Corps. I was one of the organizers of the latter.
I passed my physical and mental tests for the First Officers' Training
camp at Plattsbufg, except as to height, and although recommended
for admission, was rejected because I lacked the required height. I
tried to gain admission to the Second Officers' Training camp, but
again was turned down because I was too short.
With two of my brothers in the service, one a first lieutenant in
the infantry, A. E. F., and the other in the balloon photographic
observation section of the Signal Corps, I was determined to try again
to enter the active service. I applied for admission to the Marine
Corps, but was informed by Lieutenant Gardner that the corps would
be glad to have me because of my special training and experience, but
that I was far too short for that branch of the service.
I then applied at one of the recruiting stations of the Regular
Army and heard the same words repeated. That application was
filed before the* height regulations were reduced last July, and I
finally decided to wait until called into the service through the draft.
113
Now for the real blow. After being placed in Class lA and waiting
patiently for my call, I was informed by my local board last week
that the new army regulations forbade my induction into active
service because I was only 62^ inches, or 5 feet 2J/4 inches in height.
That I was informed is half an inch below the required height. My
case was appealed to the Medical Advisory Board, where I was
informed that I am 62^ inches in height, still short of the required
minimum.
At that, I was given to understand I would be accepted for active
work, yet today the local board chairman told me I probably would
never see active service, as the requirements will not permit induction
into any other but special service. I was told a definite decision has
not yet been reached in my case, but that it was useless for me to build
any hopes of being accepted.
This, mind you, despite the fact that I am as healthy, strong and
vigorous as when I taught physical training to the boys of the south
section of Brooklyn, where I was stationed by the Board of Education
for four years. As there are plenty of sickly fellows ready to do
clerical duty, why is it necessary to pick upon a healthy chap, fit for
the real kind of war work? F.
New York, July 20.
To THE Editor of The Sun — Sir: Regarding the letter on the
editorial page of The Sun of July 21 signed "F," and dated July 20, I
beg to inform you that on Friday, July 19, all local boards in New
York City were notified by telegram that the minimum height require-
ment had again been reduced to sixty inches and the minimum weight
requirement to 110 pounds, the amendment being available for all
classes.
The minimum height requirement was sixty inches up to June 5,
1918, when it was raised to sixty-three inches, and the minimum
weight from 100 to 116 pounds. The latest change in physical require-
ments restores the minimum height to what it was June 5.
I venture to predict that if the only ground of rejection of your
correspondent was his height, he will be inducted into mihtary service
of the United States very soon. Martin Conboy,
Director of the Draft for the City of New York.
New York, July 23.
114
UNIVERSITY OF CALIFORNIA LIBRARY
BERKELEY
Return to desk from which borrowed.
This book is DUE on the last date stamped below.
;^ff
RECEIVED B
CIRCULATION DEIjT,
LD 21-100m-9,'47(A5702sl6)476
YC OZ7^3
GENERAL LIBRARY - U.C. BERKELEY
B0D020bD77
415587
UNIVERSITY OF CALIFORNIA LIBRAJ^Y
/3oUy
Live Music Archive
Librivox Free Audio
Metropolitan Museum
Cleveland Museum of Art
Internet Arcade
Console Living Room
Books to Borrow
Open Library
TV News
Understanding 9/11