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Chapter 18

PRENATAL NUTRITIONAL DEFORMITIES AND
DISEASE TYPES

A RELATIONSHIP between physical types and certain disease susceptibilities has been recognized by diagnosticians for centuries. The skill of many physicians in reading intuitively and from external signs the nature of their patients' troubles when these could not be classified with precision played an important part in the successful warfare against disease in the period preceding the advance in modern laboratory technique. For many of the old-time physicians, these constitutional qualities were expressed as diathesis. An individual would be recognized as having a phthisical diathesis (a susceptibility to tuberculosis). Similarly, the arthritis group had a rheumatic diathesis. While modern science has undertaken to express its findings numerically, the problem of reducing the diatheses to mathematical formulas has required so many overlappings, that it has been impossible to establish definite limiting boundaries.

In my investigations regarding the types of individuals who develop rheumatic group lesions as a result of dental focal infections, (1) I found that individuals could be divided into very definite groups in which 15.05 per cent with severe lesions belonged to families in which similar disease symptoms had occurred. Evidence was disclosed of a systemic factor that played a controlling role in determining whether or not the individual would be seriously injured from dental focal infections. It became very clear that the soil was quite as important a determining factor as was the type of infection. This finding led me to broaden the scope of my investigations to include a search for control cases that were free from the degenerative processes. I was not able to find these controls in the clinical material afforded by our modern civilization, and therefore extended the search to isolated primitive racial stocks.

Associated with a fine physical condition the isolated primitive groups have a high level of immunity to many of our modern degenerative processes, including tuberculosis, arthritis, heart disease, and affections of the internal organs. When, however, these individuals have lost this high level of physical excellence a definite lowering in their resistance to the modern degenerative processes has taken place. To illustrate, the narrowing of the facial and dental arch forms of the children of the modernized parents, after they had adopted the white man's food, was accompanied by an increase in susceptibility to pulmonary tuberculosis.

In Fig. 113 will be seen four young people, examined in the tuberculosis wards of the Juneau (Alaska) Hospital for Indians and Eskimos. All exhibited marked evidence of prenatal injury. Note the cuspids erupting outside the line of the arch. The teeth of the upper arch of the boy at the upper left, pass inside the teeth of the lower arch. His upper arch is so narrow that even a finger could not be passed between the lateral walls. These pictures had to be taken with short exposures in the poor light of the wards. They reveal, however, the conditions.

FIG. 113. Eskimo children seriously ill in the tuberculosis wards of the government hospital at Juneau, Alaska. They were too ill to be moved to good light for photographing. Every tubercular child in these wards had disturbed facial development and deformed dental arches. The parents were living on modern foods.

In Figs. 114 and 115 are shown several individuals photographed in the tuberculosis hospital in New Zealand. Note the lack of development of the middle third of the face and the narrowing and lengthening of the face. In several individuals the teeth of the upper arch closed inside the teeth of the lower arch, instead of outside, as in normal persons. Here again, 100 per cent of the young people with tuberculosis gave evidence of injury in the formative period, and 91.2 per cent of the total number of patients were found to have disturbed dental arches.

FIG. 114. These are patients in the Maori Hospital for tuberculosis in New Zealand. Note the very marked underdevelopment of the middle third of the face above and of both middle and lower thirds of the face below. Every patient under thirty years of age in these wards had deformed dental arches and disturbed facial development.

FIG. 115. These girls are also in the tuberculosis ward of the New Zealand Hospital for Maori. Note the marked disturbance in development of the face and dental arches. All have pinched nostrils.

In Fig. 116 are shown four typical individuals in the tuberculosis hospitals in Hawaii; one in Hilo and the other in Honolulu. In each of these hospitals 100 per cent of the individuals had abnormal development of the face and dental arches.

FIG. 116. These are native Hawajians in tuberculosis hospitals. Every child in the wards showed marked disturbance of facial development and dental arch form.

While we know many of the factors contributing to the nature of diatheses, I have found no data dealing with the forces which determine diatheses, except the influence of heredity. The data I am presenting in this volume, deal with forces other than heredity.

An outstanding advance in organizing the data which relate the physical characteristics of individuals to their disease susceptibilities has been made by the Constitutional Clinic of Columbia University and the Presbyterian Hospital of New York, under the able direction of Dr. George Draper. He has found it necessary in order to study man as a whole, to view him from four different angles: "his form, his function, his immunity mechanism and his psychology." These four attributes he has designated as the "four panels of personality." Dr. Draper has published several communications including two textbooks, one entitled, "Human Constitution," (2) and the other, "Disease and the Man." (3) Dr. Draper has approached this problem from the data provided in the medical clinics, and therefore, from the characteristics of affected individuals, whereas my approach has been through a study of the primitive groups and the physical changes and disease susceptibilities which occur as a result of their modernization. The similarity of our conclusions greatly emphasizes the importance of the findings of each. Dr. Draper has emphasized the importance of the face and of the dental arches in the general matter of susceptibility to disease. He closes one of his chapters, entitled The Relation of Face, Jaws and Teeth to Human Constitution and Its Bearing on Disease, as follows:

The lessons which we have learned from these observations, however, is that the face and jaws hold much information of value to the student of the human being. As clinicians in the field of internal medicine we have been taught to observe the gums and teeth in order to detect possible foci of infection. But for the student of clinical organismalism, the teeth and jaws hold much valuable information about the total personality. For the worker in the dental branch of medicine it would seem that an unusual opportunity is offered for extending such observations and correlations. It may very well be that the dental student who becomes interested in the relation of the mouth to the organism may form a most important link with the responsibilities of internal medicine.

The more we come to view man as a totality, as an organism which functions as a whole and not as a collection of separate elements, the more do all the special branches of medicine become fused with the general concept which forms the basis of this discussion, namely, the relation of the human organism as a whole to those various reactions of maladjustment with environment which we call disease.

It is clear that a definite association of abnormal facial patterns with specific disease susceptibilities exists. From my studies it is also clear that these abnormal facial patterns are associated with influences resulting from a change in the nutrition of the parents of the individual. We are at this point concerned with the forces that underlie these phenomena.

In approaching this problem as it applies to human beings, much can be learned from a study of domestic and wild animals. Until recent years it has been common knowledge among the superintendents of large zoos of America and Europe that members of the cat family did not reproduce efficiently in captivity, unless the mothers had been born in the jungle. Formerly, this made it necessary to replenish lions, tigers, leopards and other felines from wild stock as fast as the cages were emptied by death or as rapidly as new stock should be added by enlargement.

The story is told of a trip to Africa made by a wild animal specialist from the London zoo for the purpose of obtaining additional lions and studying this problem. While in the lion country, he observed the lion kill a zebra. The lion proceeded then to tear open the abdomen of the zebra and eat the entrails at the right flank. This took him directly to the liver. After spending some time selecting different internal organs, the lion backed away and turned and pawed dirt over the carcass which he abandoned to the jackals. The scientist hurried to the carcass and drove away the jackals to study the dead zebra to note what tissues had been taken. This gave him the clue which when put into practice has entirely changed the history of the reproduction of the cat family in captivity. The addition of the organs to the foods of the captive animals born in the jungle supplied them with foods needed to make reproduction possible. Their young, too, could reproduce efficiently. As I studied this matter with the director of a large lion colony, he listed in detail the organs and tissues that were particularly selected by animals in the wilds and also those that were provided for animals reproducing in captivity. He explained that, whereas the price of lions used to be fifteen hundred dollars for a good specimen, they were now so plentiful that they would scarcely bring fifteen cents. If we observe the parts of an animal that a cat eats when it kills a small rodent or bird, we see that it does not select exclusively the muscle meat.

During my biological investigations using animals, I have had barn rats gnaw their way into the room where the rabbits were kept and kill several animals during a night. On two different occasions, only the eyes of the rabbits had been eaten, and the blood may have been sucked. On another occasion the brains had been eaten. It was evident that these rats had a conscious need for special food elements that were provided by these tissues.

No phases of the problem of physical degeneration can be as important as knowledge of the forces that are at work and the methods by which they operate. It is clear from the data presented in previous chapters that these forces can become operative with sufficient speed to make a difference in two generations, one succeeding the other. It is also clear from preceding data that these forces originate in the change of the nutrition of the parents.

A chemical analysis of the food (Chapter 15), discloses a marked reduction in the intake of some of the vitamins and minerals in individuals who are undergoing a degenerative process.

Many investigators have presented important data dealing with the role of vitamin A in prenatal as well as postnatal growth processes. It is known that the eye is one of the early tissues to develop injury from the absence of vitamin A, hence the original name for this vitamin was the xerophthalmic vitamin. The importance of vitamin A to the eye, and the fact that this vitamin is stored in eye tissue have been emphasized by several investigations.

Wald (4) in discussing vitamin A in eye tissues states:

Extracts of eye tissue (retina, pigment epithelium and choroid) showed the characteristic vitamin A absorption band at 620 mu. with the SbC13 test and were also potent in curing vitamin A deficient rats. The concentration of vitamin A was very constant for different mammals, at about 20 Y per g. dry tissue. Values for frog tissues were much higher.

This comment is of interest in connection with the observation that I have previously quoted regarding the raid of barn rats on the rabbit cages in the stress of deep winter. While it has been shown that vitamin A is essential for the normal function of eyes, its role in the formation of eye tissues has not been clearly understood. Probably the most sensitive procedure for testing the depletion of vitamin A in domestic animals today is by observing their behavior in semi-darkness.

Edward Mellanby (5) has presented important new data dealing with vitamin A deficiency and deafness. He states in an abstract of a paper read before the Biochemical Society, in London in November 1937, the following:

In previous publications I have shown that a prominent lesion caused by vitamin A deficiency in young animals, especially when accompanied by a high cereal intake, is degeneration of the central and peripheral nervous systems. In the peripheral system it is the afferent nerves which are principally affected, including the eighth nerve, both cochlear and vestibular divisions. It has now been possible to show that vitamin A deficiency produces in young dogs degenerative changes in the ganglia, nerves and organs of both hearing and balance inside the temporal bone. All degrees of degeneration have been produced, from slight degeneration to complete disappearance of the hearing nerve. The nerves and ganglion cells supplying the organ of Corti are more easily damaged than those of the vestibular division. As might be expected when once the spiral ganglion cells have disappeared, additions of vitamin A to the diet have no effect, and the organ of Corti remains completely denervated. The "inattention" of dogs on these diets which I previously ascribed to cerebral defect is undoubtedly due to deafness. It now remains to determine whether these results may be extended to explain certain forms of deafness in man.

The serious effects of deficiency in vitamin A on pregnant rats has been investigated and reported by Mason (6) as follows:

Abnormalities are described in the pregnancies of rats maintained on diets deficient in vitamin A in varying degree. Prolongation of the gestation period up to 26 days in severe cases and a long and difficult labour which might last 2 days and often resulted in death of both mother and young were characteristic.

Defects due to deficiencies in vitamin A in the diet of dairy animals, (pregnant cows, their offspring and normal calves fed on the milk from those cows) have been reported upon by Meigs and Converse (7) as follows:

In 1932 we reported from Beltsville evidence that farm rations frequently fed to calves may be dangerously low in vitamin A, and that milk produced by cows fed hay which has lost its green color may be an unsafe source of vitamin A in the calf ration. This preliminary paper reported results dealing with four cows which had been fed over two years on a good grain mixture and late-cut low-color timothy hay. Of six calves born of these cows, two were dead, one was unable to stand and died shortly after birth, and three were both weak and blind. The fact that cows so fed were unable to properly nourish their calves before birth led to the question whether the milk from these cows might not be deficient for normal growth of calves from other cows fed on rations adequate in vitamin A. This preliminary report included results on three normal calves fed milk from those cows fed low-color timothy hay. The three calves died at fifty-seven, sixty-two, and seventy-one days of age, respectively.

Since growth, prenatal and postnatal, is related directly to the pituitary body, we are specially interested in the knowledge available on the functioning of this gland.

The work of Barrie (8) throws important light on this subject. He has reported as follows:

Partial deficiency of vitamin E as shown in the female rat fed on a diet containing only a trace of vitamin E but which is otherwise complete, results in the prolongation of gestation, which may be continued as long as 10 days beyond the normal period. The offspring under these conditions are abnormal. These young may develop slowly and be thin and undersized in spite of sufficiently profuse lactation, or they may become extremely fat and develop a leg weakness and carpopedal spasm about 18 days after birth. Animals of both types have thin skulls and short silky fur. Complete E deficiency in the adult also produces the soft fur and imperfectly calcified skull. Partially E deficient animals occasionally give birth to a litter but fail to lactate.

The changes observed are similar in several ways to those produced by hypophysectomy (surgical removal of pituitary gland). Marked degranulation of the anterior pituitary is found in both the abnormal young and the adult sterile animals. Lack of vitamin E therefore produces a virtual nutritional hypophysectomy in the young rat.

The inability of various species to complete gestation when vitamin E is not provided in adequate quantity has been reported by many investigators. A. L. Bacharach, E. Allehorne and H. E. Glynn have used their study of this factor as a means of estimating the quantity of vitamin E in the diet. (9) They state:

A diet suitable for work on vitamin E causes female rats, fed on this diet from weaning, to show a gestation-resorption rate not significantly differing from 100 per cent; when the diet is supplemented with adequate amounts of vitamin E, also administered from weaning, the live litter rate does not differ significantly from 100 per cent. It is found that, on such a diet, the percentage of implantations (conceptions) is markedly different between animals that have been submitted to a single gestation-resorption, owing to lack of vitamin E, and animals that are mated for the first time. The authors suggest that the process of undergoing gestation-resorption brings about some deep-seated changes in the reproductive mechanism of the rat, of a kind not hitherto recognized as characterising the vitamin E deficiency syndrome.

One of the outstanding changes which I have found takes place in the primitive races at their point of contact with our modern civilization is a decrease in the ease and efficiency of the birth process. When I visited the Six Nation Reservation at Brantford, Ontario, I was told by the physician in charge that a change of this kind had occurred during the period of his administration, which had covered twenty-eight years and that the hospital was now used largely to care for young Indian women during abnormal childbirth (Chapter 6).

A similar impressive comment was made to me by Dr. Romig, the superintendent of the government hospital for Eskimos and Indians at Anchorage, Alaska. He stated that in his thirty-six years among the Eskimos, he had never been able to arrive in time to see a normal birth by a primitive Eskimo woman. But conditions have changed materially with the new generation of Eskimo girls, born after their parents began to use foods of modern civilization. Many of them are carried to his hospital after they had been in labour for several days. One Eskimo woman who had married twice, her last husband being a white man, reported to Dr. Romig and myself that she had given birth to twentysix children and that several of them had been born during the night and that she had not bothered to waken her husband, but had introduced him to the new baby in the morning.

Sherman, (10) who has made many important contributions to our knowledge of vitamin A, has shown in a recent communication that an amount of vitamin A sufficient to support normal growth and maintain every appearance of good health in animals, may still be insufficient to meet the added nutritive demands of successful reproduction and lactation. With the failure to reproduce successfully, there usually appears in early adult life an increased susceptibility to infection, and particularly a tendency to lung disease at an age corresponding to that at which pulmonary tuberculosis so often develops in young men and women. He states, further, that vitamin A must be supplied in liberal proportions not only during the growth period but during the adult period as well, if a good condition of nutrition and a high degree of health and vigor are to be maintained.

Hughes, Aubel and Lienhardt (11) have shown that a lack of vitamin A in the diets of pigs has resulted in extreme incoordination and spasms. They also emphasize that gilts bred prior to the onset of the nervous symptoms either aborted or farrowed dead pigs.

Hart and Gilbert (12) have shown that the symptoms most commonly seen in cattle having a vitamin A deficiency are the birth of dead or weak calves, with or without eye lesions. They report also a condition of newborn calves which simulates white scours, and the development of eye lesions in immature animals.

Hughes (13 has shown that swine did not reproduce when fed barley and salt, but did so when cod liver oil was added to this food.

Sure (14) has shown that a lack of vitamin A produces in females a disturbance in oestrus and ovulation, resulting in sterility. Further, he states, that resorption of the fetus may be produced by lack of vitamin A, even on a diet containing an abundance of vitamin E, which is known as the anti-sterility vitamin.

One of the most important contributions in this field has been made by Professor Fred Hale, of the Texas Agricultural Experiment Station, at College Station, Texas. He has shown that many physical deformities are readily produced by curtailing the amount of vitamin A in the ration of pigs. He produced fifty-nine pigs (15) that were born blind, every pig in each of six litters-where the mothers were deprived of vitamin A for several months before mating and for thirty days thereafter. In pigs, the eyeballs are formed in the first thirty days. He found, as have several others, that depriving pigs of vitamin A for a sufficient period produced severe nerve involvements including paralysis and spasms, so that the animals could not rise to their feet. He reported that one of these vitamin A deficient pigs that had previously farrowed a litter of ten pigs, all born without eyeballs, was given a single dose of cod liver oil two weeks before mating. She farrowed fourteen pigs which showed various combinations of eye defects, some had no eyes, some had one eye, and some had one large eye and one small eye, but all were blind.

FIG. 117. Above, this pig was one of fifty-nine born without eyeballs and with other serious deformities due to lack of vitamin A in the mother's diet. Offspring of these blind pigs when normally fed had perfect eyes and no deformities. Below, A, at left shows normal eye of a pig at nine months. B, at right shows partial eyeballs and optic nerves produced in offspring when one dose of vitamin A was given two weeks before mating. (Courtesy of Professor Fred Hale.)

In Fig. 117 I am able through Professor Hale's kindness, to show an eyeless pig and a normal eye of a pig (at the left) and (at the right) a pair of incomplete eyes from a pig born in the litter just mentioned. This one dose of vitamin A made possible the partial formation of optic nerves and eyeballs. A typical eyeless pig is shown in Fig. 118 (lower). Note its deformed ears. Among the many physical injuries which develop in the pigs born to sows fed on a diet deficient in vitamin A are serious defects of the snout, dental arches, eyes and feet. This pig was born without eyeballs. It also had club feet and two tumors. In Fig. 118 (upper right) is shown a pig with cleft palate, and in Fig. 119 (upper right) one with double hairlip. In Fig. 118 (upper left) is shown a boy with cleft palate and defective eyes. One of the very important results of Professor Hale's investigations has been the production of pigs with normal eyes, born to parents both of whom had no eyeballs due to lack of vitamin A in their mother's diet. The problem clearly was not heredity. Two litters, one containing nine pigs and the other eight, which were born to mothers that had been deprived of vitamin A before mating and for thirty days thereafter, produced the following lesions: All had complete absence of eyeballs; some lacked development of the opening of the external ear; others had cleft palate, harelip, displaced kidneys, displaced ovaries, or displaced testes.

FIG. 118. Upper left: Boy has cleft palate, and harelip. Upper right: Pig has cleft palate, no eyes. Below, Pig has club feet, deformities of the ears, two tumors and no eyeballs due to lack of adequate vitamin A in the mother's diet. (Kindness of Professor Hale.)

FIG. 119. Many young of modern domestic animals are born with deformities. At the upper left is seen a pup with cleft palate. In two previous litters all the pups were deformed and unable to live. At the upper right is one of Professor Hale's pigs with double harelip. Below two blind lambs and one with club foot.

It is of interest that in October, 1935, Professor Hale reports that the Texas Agricultural Experiment Station was informed that a litter of fourteen pigs had been born blind in June, 1935, on a farm at Ralls, Texas. Of these, six pigs were raised and brought to the Station for further study. The farmer owning the pigs stated that no green feed was available on his farm from March, 1934, until May, 1935. It will be noted that this condition paralleled the experimental conditions at the station under which by restricting vitamin A before and immediately after gestation fifty-nine pigs were produced without eyeballs.

Professor Hale reports that in April, 1935, a litter of seven pigs were born blind at McGlean, Texas, which was suffering from drought conditions, similar to those at Ralls. The litter and dam were purchased by the Experimental Station. Matings were made between blind pigs. These were fed rations containing ample vitamin A, and normal pigs with normal eyeballs were produced. Even the mating of a blind son with his mother who had produced him when on deficient diet, produced only normal pigs when both had ample vitamin A. He states, "If an hereditary factor had been the cause of this congenital blindness, these matings would have produced some blind pigs, even if vitamin A were present in the ration." The problem of congenital cleft palate has been very embarrassing to those parents whose children have been so afflicted. It is of interest that breeders of fancy dogs are frequently embarrassed by having this problem develop in their kennels or among litters born to parent stock obtained from their kennels.

In Fig. 119 (upper left) I have shown a water spaniel pup with cleft palate. This pup was not able to nurse because of the impossibility of producing suction without a palate. When fed artificially the milk was expelled through the nostrils. The mother had given birth to two previous litters all of which were dead at birth or died soon after. Her diet had been reinforced with mineral calcium phosphate in tablet form hoping to insure normal offspring. This is not nature's method.

I am informed by a veterinary that he has experienced trouble with harelip, cleft palate or serious facial deformities among dogs that are pets in homes where they are lavishly coddled and fed the things they like best. He stated that he has more trouble with head defects in bulldog pups than any other breed.

There are few if any problems connected with modern degeneration on which so much light is thrown as that supplied by recent investigations on the problems of paternal responsibility for defects in the offspring. There are several reasons for this. Because the mother has the sole responsibility for the nourishment of the fetus during the formative period and she alone provides the handicaps incident to the process of birth, it is very natural that defects are practically all interpreted as being associated with these processes. This unfortunately, has been embarrassed further by the fact that since distortions in behavior do not appear until sometime after birth, normality was largely assumed to be present up to the time of their appearance, and therefore of necessity would be contributions from the child's environment. As such they would be subject naturally to treatment by applying influences to change the mental environment. Hence the entire problem of the role of the sex cells through controlling the architecture of the body including the brain has been largely overlooked. Very important light is thrown on this problem in the data provided on the pup shown in Fig. 120. This shows a dachshund pup with cleft palate and a very severe spinal deformity. This is not unlike deformities frequently seen, or unlike that of the pup shown in Fig. 119. The highly significant circumstance is the fact that these same deformities not only appeared also in another pup of this same litter but in one pup in each of three other litters about the same time. While four mothers were involved these four litters were all sired by one father. The paternal responsibility is clearly established.

FIG. 120. This pup had cleft palate, as seen above, and grossly deformed spine, as shown below. It was one of two pups born in the same litter with the same defects and one of five pups born in four litters with these same defects. Five different mother dogs were involved but all pups were from the same father dog.

At the right in Fig. 119 a lamb is shown with club feet and two lambs without eyeballs. I am told that in some of the sheep raising states quite a number of deformities occur in lambs at birth. One writer states:

These deformities may maintain themselves in any number of ways. We have them two-headed, 5 and 6 legs, 2 tails, born without eyes, hermaphrodites, born with ribs on one side and any number of such deformities. A common deformity in sheep is under-shot and over-shot jaws. This simply means that the upper jaw extends farther to the front that the under jaw and the front teeth do not meet. This is called over-shot and the reverse is called under-shot.

It will be noted that a common deformity in sheep relates to an under-development of either the upper or lower jaw which is one of the most common expressions of disturbed development in humans.

Some illustrations of the deformities that may occur in domestic animals are shown in Fig. 121. Above are seen two cows each with an extra foreleg attached to the shoulder; below, to the left is shown a double-faced calf which also had a cleft palate; to the right a cat with deformed legs.

FIG. 121. Typical deformities in domestic animals. Above, two cows with an extra foreleg hanging from the shoulder. Below, left, double faced calf. Right, cat with deformed legs.

In corresponding with Professor Hale, I inquired whether they had information as to the effect of vitamin A deficiency on the sire. He replied, "If we reduceed the vitamin A content of the body of the sire, he would become sterile and, therefore, we could not try this procedure." The question arises as to what the effect would be of a less severe depletion of vitamin A of both parents.

It is a very easy matter to place the full responsibility on the mother, when defects develop in the children. These data indicate that either parent may contribute directly to certain of the defects of the children, due to defects in the germ plasm.

A practical case from my field studies includes a full-blooded Eskimo woman who was married twice, the second time to a white man, by whom she had several children. She had insisted on selecting and preparing the native foods for herself, though she prepared the white man's imported foods for him. With a total of twenty-six pregnancies she did not have any tooth decay. He had rampant tooth decay, and a marked abnormality in the development of face and of the dental arches. Several of the children had incomplete development of the face and of the dental arches. One of the girls who was married had very narrow dental arches and nostrils and a typical boyish type of body build. Unlike her mother, this girl had a very severe experience in the birth of her only child and insisted that she would not take the risk of having another. Several daughters have narrow arches. The question arises whether the deficient nutrition of the father may have been the contributing factor in the injury of their children.

New light is being thrown on human problems by animal investigations. One study that is particularly instructive has been conducted by McKenzie and Berliner of the University of Missouri. (Bulletin No. 265.) The experimental animals used were sheep. Their studies indicated to them that they could predict the level of fertility of the sire by studies made on the seminal fluid. They found that the percentage of abnormal spermatozoa increased to 84 per cent under unfavorable conditions and reduced to less than 15 per cent under favorable conditions. When the unfavorable conditions characterized by these abnormal spermatozoa prevailed the females did not conceive. High temperature proved to be an important controlling factor as indicated by variation in percentage of abnormal sperm. In one breed the average variation was from 2.5 per cent in January to 22 per cent defective in August; in another breed from 18 per cent in January to 73 per cent defective in August. They also found that the same result could be produced in the winter by keeping the sires in heated rooms or by applying heat externally. They further found that when the percentage of abnormal sperm was high a condition of sterility was apparently established. In a personal communication from Professor McKenzie he states that their inference is that with a high percentage of abnormal sperm the ova either are not fertilized or that fertilization takes place and that prenatal death occurs in a certain number of the cases, and that there is an appreciable prenatal death loss in sheep, horses, cattle, and swine. I have referred to the data presented by Mall indicating that 15 per cent of human conceptions in England are expelled as deformities in the second and third month of gestation. McKenzie also presents data relating to swine in which a sire that showed a high percentage of abnormal sperm was bred to two groups of sows of similar breed. One was maintained in a barn without access to pasture, the other received similar rations plus access to pasture. The group without pasture produced a high percentage of mummies, small litters, and abnormal pigs (open abdominal walls with viscera protruding and exposed spine in the region of the lumbar vertebrae). The second group on the same food with the addition of pasturage produced normally large-size litters without mummies. The following year this experiment was repeated reversing the groups of sows and using a similar high percentage of defective sperm in the same sire. The same results occurred, with the group maintained without access to pasture. This emphasizes the need for the vitamins and minerals that are provided in natural foods, particularly vitamin A and seems to relate to the studies of Hale in which the absence of vitamin A produced gross defects. These studies on domestic animals strongly emphasize the necessity that both parents shall have adequate nutrition before conception occurs and subsequently for the mother.

Until very recently there has been exceedingly little literature dealing with the factors contributing to the abnormal development of fetuses in either domestic animals or humans. Williams, who is one of the few students of this problem as it relates to domestic animals, in referring to this phase has commented that there is no treatise in the English language on teratology (development of monsters) in domestic animals. (16) He emphasizes that these defects are growing in numbers and economic importance. He refers to Burki's studies in Switzerland indicating that this difficulty has constantly and enormously increased in his territory. This veterinary has asked "Are our cows degenerating?" It is of interest that a type of deformity commonly recognized among veterinaries as a distortion of the head presenting a lack of development of the bones of the middle part of the face including the upper jaw is commonly called "bull-dog calf." This is particularly important in connection with the frequent human deficiency of lack of development in the middle third of the face. Williams emphasizes the common knowledge that Boston bull-dogs are not prolific and because of the difficulty of giving birth to their young, some veterinarians resort routinely to caesarian section. Fortunately, seriously deformed specimens are seldom born alive and usually do not continue to term. Williams states that Loje has observed ten grossly deformed calves of a particular type that were traced to the same sire; also a series of five with this deformity reported by Hutt were traced to one sire. Among the deformities in domestic animals cleft palate or absence of palate is very common. These studies on domestic animals strongly emphasize two facts; first, that deformities among these animals are very similar to those that develop in humans, and second, that the defects are largely related to the original germ cells and that the male may provide the defect quite as well as the female. Several of the primitive races have understood and provided against these mishaps.

Moench and Holt of the Cornell Medical School and New York Hospital (17) have made important studies on humans and have found a very high incidence of sterility when abnormal forms of spermatozoa reached 25 per cent. Among the abnormal forms they found one particular family with a particular type of abnormal sperm reaching 12 per cent. Their breeding record was decidedly bad and fetal malformations repeatedly occurred. In their group, in 63 sterile matings the men were normal 21 times and abnormal 37 times. They listed over 40 different abnormal or deformed types of sperm. They conclude:

In a normal semen the abnormal sperm heads do not exceed 19 to 20 per cent.
When the sperm head abnormalities reach 20 to 23 per cent, impaired fertility can be assumed.
When the sperm head abnormalities are above 25 per cent, clinical sterility is usually present.
An important contribution to the question of the relation of the germ cells of the father to the type of defects that are prevalent in his family history has been made in recent studies conducted in Germany. (18)

Two German surgeons concerned with enforcing the sterilization law in Berlin have taken advantage of their opportunities to make an important contribution to the study of fecundity.

Several studies have been published previously, of the spermatozoa of normal men. This book offers a study of the spermatozoa of men who had been diagnosed as hereditarily defective. At the time of the operation, the upper part of the vas deferens was washed out, and the sperm thus obtained were studied in great detail, 20 different types of abnormality being distinguished.

In their control studied, the normal man is found to produce 19 per cent of morphologically defective sperm. By contrast, the chronic alcoholic patient produces 75 per cent of defective sperm.

Previously it has been assumed that as much as 25 per cent or 30 per cent of abnormal sperm were a good evidence of lowered fertility if not of sterility. But the fertility of these chronic alcoholics was not diminished, the authors claim.

In cases of inherited mental defect, 62 per cent of abnormal sperm were produced, accompanied by low fecundity,--as is the case generally with the mentally defective male. On the other hand, in hereditary deafness, 62 per cent and in hereditary blindness 75 per cent of defective sperm appeared.

Epilepsy and schizophrenia (dementia praecox) both supposed to be constitutional in origin, show less abnormality of spermatozoa (58 per cent and 54 per cent respectively) than blindness and deafness.

The fact that in the past almost the entire emphasis of change in physical, mental and moral qualities has been assigned to the forces of heredity, strongly emphasizes the lack of information regarding the nature of the forces at work and the points at which their influence constitute the determining factors. The data previously presented in this chapter dealing with the role of vitamins A and E throw valuable new light on this phase. It is important, however, that new data are available dealing with the factors which injure the germ cells and which Tredgold has spoken of as "poisoned germ cells."

In a personal communication received from Professor T. S. Sutton of the College of Agriculture, Ohio State University, he makes the following observation:

For several years we have been interested in the study of the effects of vitamin A deficiency. Right now our main consideration is the effect of this deficiency on reproduction. We find that a diet low in vitamin A will cause reproductive failure, which seems to be caused chiefly by a degeneration of the germinal epithelium of the gonad. This is particularly true in the case of the male. I think we have rather convincing evidence that this is a direct dietary damage to the gonad (ovary or testis), rather than a disruption of the endocrine balance which might result in sterility as appears to be the case in vitamin B deficiency.

The degenerative processes which occur in nerve tissues due to vitamin A deficiency have been studied by Professor Sutton and his associates. (19) They have been able to show detailed progressive degeneration within nerve fibers as a result of vitamin A deficiency.

In the light of the newer information it is quite clear why we may have anyone of the following distinct expressions in the reproductive process, namely, physical excellence of succeeding generations (such as obtains among many of the primitive races as I have shown); complete reproductive failure or sterility or partial failure resulting in defectives of various types at the borderline between these two phases. It is the rapid and progressive increase in this last group which constitutes the progressive degeneration of our modern civilization.

One of the main problems in this study has to do with the relation of nutrition to the modification of the growth of the child, both in its formative period and in the stage of adolescence. I have shown that in many of these primitive racial stocks there occurs in the first generation after the displacement of native foods by imported foods a marked change in facial and dental arch forms. These changes happen most frequently in the later children in the families and come about notwithstanding the impact of heredity through all the previous generations of excellent physical development. Clinically, the evidence is abundant, that this change occurs in these primitive racial stocks regardless of color, geographic location, temperature, and climate. We are apparently dealing here with a factor which, while it may be related to the germ plasm and to the prenatal growth period, clearly involves other forces than those that are at work in the case of hereditary defectives. Since these changes have to do directly with disturbances in growth of the head, particularly of the face and of the dental arches, we are concerned with such evidence as may be available as to the nature of the forces that readily affect the anatomy of the skull.

The general architecture of the body is apparently determined primarily by the health of the two germ cells at the time of their union. This architectural design may not be completely fulfilled due to interference with nutritive processes both before and after birth. In this large problem of the relationship between physical design of the body and resistance or susceptibility to disease, we may have determining factors operating at different periods in prenatal and postnatal growth. The accumulating evidence strongly emphasizes that disease susceptibility is a widely variable factor and associated with certain types of developmental disturbances.

In a discussion of tuberculosis susceptibility before a meeting of specialists in that field, emphasis was placed upon the fact that other factors than the bacteria played controlling roles in the matter of susceptibility to tuberculosis.

Weisman has recently made an important contribution to the problem of physical development and susceptibility to tuberculosis. He has presented (20) statistical data indicating the type of chest deformity which predisposes an individual to tuberculosis. He states:

In a study previously made on the shape of the normal and of the tuberculosis chest, it was found that the average normal chest was flat and wide and that the average tuberculous chest was deep and narrow. It was also shown that the deep chest was an underdeveloped, primitive type of chest, resembling an infant's chest in shape. Later studies on the shape of the chest and on environment showed that children from the poorer socio-economic environments had on the average a deeper chest, weighed less and were shorter than the children from the higher socio-economic levels. An investigation recently made on the incidence of tuberculosis in the various school districts in Minneapolis revealed that there is a very high incidence of tuberculosis among the children from the slums where the deep chest prevails. Ten times as many cases of tuberculosis were reported from a school district which is perhaps the poorest in the city as were reported from the best school districts.

This study, which shows that there is a definite correlation between the deep chest and the positive reaction to tuberculin adds one more link to the chain of evidence supporting the contention that the deep chest is more or less associated with tuberculosis. It also helps to explain why there is such a high incidence of tuberculosis among the poor in the slum districts. The children in the slums are physically underdeveloped. They are not only shorter and lighter but they have on the average a deep, primitive, infantile type of chest, one that has not gone through the normal process of development. Even the new-born and infants are shorter and lighter and have a deeper chest than the average infant from a better environment.

It is important to note that Dr. Weisman associated the type of chest which predisposes the individual to tuberculosis, with a prenatal condition since he states "even the new-born and infants are shorter and lighter and have a deeper chest than an average infant from a better environment." This work throws important light on why in the primitive groups the children born to parents who are living on the imported nutrition lower in vitamins and minerals than the native foods, not only showed a greatly increased incidence of tuberculosis over the children born to parents on the native diet but also proved to be those individuals who, in facial and dental arch form, presented positive evidence of prenatal injury. We also have a direct explanation for the observations that have been emphasized by Dr. George Draper, that physical form has a direct relationship to disease susceptibility of certain types, frequently spoken of as diatheses.

It is important in this connection to call to mind the statement made by some clinicians that tuberculosis patients with narrow nostrils tend to make a poor fight. These narrow nostrils are clearly related to prenatal injury resulting primarily from defective germ cells which determine the architecture, not heredity but intercepted heredity.

It is very easy to understand the effects of gross physical lesions such as the absence of eyeballs, harelip and cleft palate. These defects can readily be seen. The problem is very different, however, when we are dealing with disturbances of function due to minute anatomical lesions in either external or internal organs such as the brain. These latter will be discussed in the next chapter.

REFERENCES

PRICE, W. A. Dental Infections. Cleveland, Penton, 1923.
DRAPER, G. Human Constitution. Phila., Saunders, 1924.
DRAPER, G. Disease and the Man. N. Y., Macmillan, 1930.
WALD, G. Vitamin A in Eye Tissues. J. Gen. Physiol., 18:905, 1935.
MELLANBY, E. Vitamin A deficiency and deafness. Biochem. J. In press.
MASON, K. E. Foetal death, prolonged gestation and difficult parturition in the rat as a result of vitamin A deficiency. Am. J. Anat., 57:303, 1935.
MEIGS, E. B. and CONVERSE, H. T. Some effects of different kinds of hay in the ration on the performance of dairy cows. J. Dairy Sci., 16:317, 1933.
BARRIE, M. M. Nutrition anterior pituitary deficiency. Biochem. J. In press.
BACHARACH, A. L., ALLEHORNE, E., GLYNN, H. E. Investigations into the method of estimating vitamin E. 1. Influence of vitamin E deficiency on implantation. Biochem. J., 21:2287, 1937.
SHERMAN and MACLEOD. The relation of vitamin A to growth, reproduction and longevity. J. Am. Chem. Soc., 47:1658, 1925.
HUGHES, AUBEL and LIENHARDT. Importance of vitamins A and C in the ration for swine, concerning especially their effect on growth and reproduction. Kansas Agric. Sta. Tech. Bull., No. 23, 1928.
HART and GILBERT. Vitamin A deficiency as related to reproduction in range cattle. Univ. of Calif. Agric. Exper. Sta. Bull., No. 560, 1933.
HUGHES, E. H. Effects of vitamin A deficient diet of sows. J. Agric. Res., 49:943, 1934.
SURE, B. Dietary requirements for fertility and lactation; dietary sterility associated with vitamin A deficiency. J. Agric. Res., 37:87, 1928.
HALE, F. The relation of maternal vitamin A deficiency to microphthalmia in pigs. Texas S. J. Med., 33:228, 1937.
WILLIAMS, W. L. The problem of teratology in clinical veterinary medicine. Cornell Veterinarian, 26:1, 1936.
MOENCH, G. L. and HOLT, H. Sperm morphology in relation to fertility. Am. J. Obst. and Gynec., 22:199, 1931.
STIASNY, H. and GENERALES, K. Erbkranheit and Fertilitaet. Ferdinand Enke Verlag, Stuttgart, 1937. Review, J. Heredity, 29:9, 1938.
SUTTON, T. S., SETTERFIELD, H. E. and KRAUSS, W. E. Nerve degeneration associated with avitaminosis A in the white rat. Ohio Agric. Exper. Sta. Bull., No. 545, 1934.
WEISMAN, S. A. Correlation of the positive reaction to tuberculin and the shape of the chest. J.A.M.A., 109:1445, 1937.

Chapter 19

PHYSICAL, MENTAL AND MORAL DETERIORATION

AFTER one has lived among the primitive racial stocks in different parts of the world and studied them in their isolation, few impressions can be more vivid than that of the absence of prisons and asylums. Few, if any, of the problems which confront modern civilization are more serious and disturbing than the progressive increase in the percentage of individuals with unsocial traits and a lack of irresponsibility.

Laird (1) has emphasized some phases of this in an article entitled, The Tail That Wags the Nation, in which he states: "The country's average level of general ability sinks lower with each generation. Should the ballot be restricted to citizens able to take care of themselves? One out of four cannot." He has illustrated the seriousness of this degeneration by presenting details as follows:

Although we might cite any one of nearly two dozen states, we will first mention Vermont by name because that is the place studied by the late Dr. Pearce Bailey. "It would be," he wrote, "safe to assume that there are at least 30 defectives per 1000 in Vermont of the eight-year-old mentality type, and 300 per 1000 of backward or retarded persons, persons of distinctly inferior intelligence. In other words, nearly one-third of the whole population of that state is of a type to require some supervision.

From a broad view of the problem of modern degeneration it will be helpful to note the observations by Tredgold (2) in mental deficiency. He states:

It is thus evident that the condition of mental deficiency, whilst presenting many interesting problems to the physician, the pathologist, and the psychologist, has also a much wider interest and importance. Since in Man the predominate feature is Mind, and since it is by its development and evolution that human progress has taken, and must take place, it is clear that the question of its disease, and particularly of its defect, is one of supreme importance to the statesman, the sociologist, the philosopher, and the whole community.

In connection with these investigations among primitive races it is interesting to note that the data are in complete harmony with the data which clinical pathologists, clinicians and anatomists have obtained in their study of the physical and structural characteristics of individuals who make up the deficiency groups. In discussing the problem of the significance of the shape of the palate, Tredgold (2) states:

Palate--The association of abnormalities of the palate with mental deficiency has long been recognized, and there is no doubt that it is one of the commonest malformations occurring in this condition. Many years ago Langdon Down drew attention to the subject, and more recently Clouston has recorded a large number of observations which show conclusively that, although deformed palates occur in the normal, they are far and away more frequent in neuropaths and the mentally defective. He states that deformed palates are present in 19 per cent of the ordinary population, 33 per cent of the insane, 55 per cent of criminals, but in no less than 61 per cent of idiots. Petersen, who has made a most exhaustive study of this question, and has compiled an elaborate classification of the various anomalies found palatal deformities present in no less than 82 per cent of aments, (mental defectives), in 76 per cent of epileptics, and in 80 per cent of the insane.

Probably every city in the United States has made special provision for both mentally deficient groups and unsocial individuals, either in special schools or in special classes. In Cleveland, we have had a large school devoted to the problems of the so-called pre-delinquent boys, of whom nearly all have been before the courts and are assigned to this institution because they are not well enough adjusted to be kept in their normal school environment. In discussing the characteristics of these boys with the principal of that school, I asked him what the probabilities were that many of these boys would finally become involved in crime. His comment was, in effect, that they were virtually in the vestibule of a penal institute, when judged by the experience of previous boys from that school.

In approaching a study of this group, it is helpful to observe the experience of the well-equipped institutions organized for the correction of the abnormal trend which characterizes these boys. In this connection, there is a helpful report by the United States Dept. of Labor, Publication No. 203, which gives the result of tracing the after careers of 621 boys who were in five of the best-known correctional institutions. It was found that 66 per cent had been arrested and 58 per cent convicted one or more times after having been paroled from the institution. It is apparent from data of this type that probably the forces that produce these abnormal expressions cause irreparable damage in the brain tissue. Practically all recent crime reports are recording an increase in juvenile crime. The Children's Bureau of the Dept. of Labor stated (Nov. 4, 1938): "that juvenile delinquency spurted during 1937 for the first time since 1930," but it cannot explain why until further study.

Reports to the bureau from 28 courts in 17 states and the District of Columbia showed that they handled 31,038 cases during 1937, an increase of 3,000 over 1936. The report showed that 44 per cent of the cases involved children between 14 and 15 years old; 22 per cent those between 12 and 13 years, and 10 per cent those between 10 and 11. Boys' cases comprised 8 5 per cent of the total.

As an approach to this problem I have made an examination of 189 boys in the Cleveland school for pre-delinquents. I gave particular attention to those physical signs of nutritional injury, which seemed to be definitely assigned to the formative period of the child. We endeavored to obtain detailed information relative to the family history and to the birth of the child. We were fortunate in having the assistance of the officers, and of a nurse in the dental service of the Health Department of the Board of Education, a nurse who made visits to the homes of many of these boys to obtain the information directly from the mothers.

In this group of boys, there were twenty-nine for whom I had not sufficient details to include their cases in the studies. Of the 189 in the group, there were only three with sufficiently normal dental arches to be classified as normal. Accordingly, 98.4 per cent proved to be individuals with more or less marked abnormality. Many of the faces were very badly deformed.

While often it will be difficult to place the responsibility entirely on either parent for the child's abnormal physical development, it is of interest to study the birth rank of these children. The average number of children in the families represented by these 160 children is 4.75. Of these, thirty-five, or 21.9 per cent, are first children in the families represented; thirteen, or 9.1 per cent, are only children; thirty-nine, or 24.4 per cent, are last children; and thirty-six or 22.5 per cent, are fifth children or later. Sixty-two, or 38.7 per cent, are either the first or last child. It will be seen from these data that the first or last child, or even a late child in a large family, tended to have a distinctly poorer chance than the intermediate children in the families in which these studies were made. Statistical data relating the age of the mother and father to prenatal deficiency of their offspring reveal that abnormally young parents have a much higher percentage of defective children than do those in the most favorable child-bearing period of life. The group at the Cleveland school included only those boys who have been before the courts because of more or less serious phases of delinquency. If they are in a considerable part the products of a defective society, it seems quite unfair that they should be held entirely responsible for that delinquency, which has put them in this institution. If they are destined for a penal institute in which they will be held entirely responsible for that abnormality which resulted in their misdemeanor, as has been the procedure in the past, are they receiving just consideration? Society may be justified in protecting itself from their misdeeds by placing restrictions about them, but it does not seem that society is justified in shifting the entire responsibility to the affected individuals.

Recent studies of the mental capacity of felons brought before the Common Pleas Court in Cleveland have shown that of 3,197 convicted felons examined in the medical clinic only 42.3 per cent were classified as normal. Fifty-five and nine-tenths per cent were classed as defective delinquents and only 1.8 per cent as insane. The outgrowth of this study has resulted in the drafting by the Cleveland Bar Association of a new criminal law for Ohio to be presented to the coming State Legislature. This bill provides for the creation of a new criminal class composed of what are called defective delinquents. This includes morons and others of abnormal mentality but not insane who commit felonies or misdemeanors. The purpose of this legislation is to afford special treatment for law violators falling within the new classification, making it possible to segregate delinquents in separate institutions. The Ohio law like that of most other states now recognizes only two types of criminals, sane and insane, and if not insane they must be punished.

It is proper that we should ask who is to blame for the abnormalities which render these young men incapable of making the necessary adaptation to our environment.

An important characteristic of the boys in the Cleveland school was their low intelligence. Practically all were recorded as retarded or mentally backward prior to their transfer to this institution.

It is important that we note the characteristics of groups that are similarly retarded, but who have not demonstrated sufficiently unsocial characters to have to be placed in the pre-delinquent groups. We shall recognize them as individuals who may never commit unsocial acts sufficient to get them into trouble, though they will doubtless continue in the group of mentally backward persons. Such a group is to be found in the Outwaithe School in Cleveland. The children in this school, which enrolls about one thousand students, were examined in order to ascertain whether there might be groups that are similarly afflicted physically. The school is distinctive because it has a very high percentage of children who are backward mentally. Many of these children have been concentrated there in order to bring them under the influence of special teachers. In an examination of a cross section of the children, almost all were found to have had distinct injury in the formative period, as evidenced by the changes in facial form. A preliminary survey of the backward children of this institution was made by having typical classes selected by an official of the school from ages ranging from eleven to seventeen. I examined the arches and made measurements of the head and face. With the assistance of the school nurse I obtained records of the other children in the families selected. This latter survey was supplemented by field work by the nurse. The intelligence quotients, as reported in the records, were also provided. In the twenty-nine individuals so studied, seven, or twenty-five per cent were first children; fourteen, or fifty per cent last children in the families. Only one individual was found with approximately normal dental arches, that is, approximately three per cent of the individuals. Twenty-eight children, or 97 per cent, had abnormality of one or both dental arches. These children were placed in this institution because they were backward mentally, although as a group they are comparable to the group studied in the Thomas A. Edison School, where the grouping was based on delinquent traits. A cursory examination was made by observing other pupils in this school in their classes and on the grounds. A large percentage of severe facial and dental arch deformities and a very high percentage with definite disturbances in facial growth were evident. These data are presented as applying to a group of individuals characterized by a disturbed mentality, to the extent that they were assigned to special classes for the mentally retarded. While the group constituting the school population at Outwaithe represented the relatively large group of pupils assigned to special classes for backward children and did not carry the stigmata of delinquency carried by those of the Thomas A. Edison School, both groups had many physical defects in common.

We are, accordingly, concerned with the relationship existing among various stages of mental backwardness, pre-delinquency and criminality. To throw light on this subject, I visited our State Penitentiary to observe the characteristics of facial and dental arch development of the individuals whose unsocial traits had brought them to this institution. I visited the dental clinic with the director, Dr. May, and saw the mouths of typical members of that colony as they were presented for oral examination. I asked the director what, if any, special features of the oral cavity he had observed to be characteristic of this group and different from those he had observed outside the institution in his private practice. He stated that he had noted continually that there was a tendency for the tongue to be too large for the mouth. This is a constant characteristic of another group of mentally injured, namely, the Mongoloid. This institution has a population of approximately four thousand individuals. A high percentage of them gave marked evidence of injury in the prenatal period as expressed in disturbances of facial form and the shape of the dental arches. In observing over half the population at work or exercise, I did not see one with a typically normal facial development. In Fig. 122 will be seen typical examples of this group. These show front and side views (see Hooton's recent book. 15a).

FIG. 122. Criminals. Were their unsocial traits related directly to incomplete brain organization associated with prenatal injury?

Newspaper daily illustrated reports of crimes committed by young criminals show almost continually these evidences of prenatal injury. Note the two characters Bird and Nixon, Fig. 123.

FIG. 123. Note the marked lack of normal facial development of these notorious young criminals. Nixon is only 18. These are typical samples seen frequently in the daily press.

It is important to emphasize the fact that the disturbances in the development of the head, face and brain may have a variety of expressions. In the more severe form characteristic of the Mongoloid group, as seen in Fig. 124 the facial injury is typical and is associated with a mental disturbance which, in turn, has been shown to be associated with typical brain lesions. The individuals of that group, however, do not tend to be criminals. Indeed, their injury is too severe. As a group they are apt to be docile, tractable and happy. Indeed, in the mentally backward and criminal groups in their various stages, we find facial patterns typical of large numbers of individuals we see on the streets, who are in school or in business, and entirely capable of maintaining a respected and honorable position in society. Accordingly, it is not justified, and indeed would be entirely unfair, to associate their disturbed facial and dental arch development with traits that would be normally found in the grossly unsocial groups. We cannot by viewing the face evaluate the kind or extent of brain injury that is associated with prenatal malnutrition of that individual. Indeed, these various divergent facial patterns are accepted by our modern civilization as representative of the many varieties or patterns constituting a normal population. It is not until we see primitive groups living under a controlled natural environment that we see Nature's model and design of the human physiognomy.

FIG. 124. This is a typical mongoloid defective. Note the marked lack of development of the middle third of the face and nose with the upper arch too small for the lower. Individuals of this type look alike and act alike and all have typical speech and behavior defects. These are now associated with definite defects in the brain. Nearly all are either a first or last child. A large percentage are born to mothers over forty years of age.

We are concerned to know the percentage in any typical colony of our modern civilization that may be placed in the various classifications of normal, mildly backward mentally, severely backward mentally, unsocial, delinquent, criminal, idiots, epileptic and insane. Tredgold (2) reports two surveys in England and Wales which give figures on the proportion of the population that could be identified with definite lesions. It would be fortunate if a survey could be made in the United States that would indicate the extent of the increase in delinquents of various types, including racketeers and criminals. It would be very helpful if these data could be related to the degrees of prenatal injury. There are many phases of modern degeneration which lend themselves to study from the standpoint of the probable role of progressive decline in the efficiency of nutrition to the progressive increase in morbidity, mortality, mental deficiency and delinquency. This is discussed in the next chapter on Soil Depletion, Plant and Animal Deterioration.

From the point of view of this problem the differences between the modern white civilizations and many of the primitive groups is interesting. Criminal tendencies in isolated primitives are so slight that no prisons are required. I have referred to the Loetschental Valley in Switzerland, which, until recently, has been physically isolated from the process of modernization. For the two thousand inhabitants in that valley, there is no prison. In Uganda, Africa, the Ruanda tribes estimated to number two and a half millions, had no prisons.

Observation of Nature's normal facial patterns in the primitive racial stocks, establishes types within the limits of normality. The readers of this text by observing the individuals in any given families may see in how large a percentage of white families the progressive narrowing and lengthening of the face in the younger members of the family as compared with the older occurs. Further observations will enable one to recognize rapidly, even without experience and special training in anatomy, these evidences of prenatal injury.

I made a survey in the New England States, Quebec and Eastern Ontario, because the United States death rate from heart disease as reported by the American Heart Association was shown to be highest in Vermont and New Hampshire, followed closely by Massachusetts and New York. I first visited the New York State Hospital for tuberculosis patients at Raybrook, near Saranac. With the assistance of a member of the staff, I examined fifty young men and women in the wards. In that group, only three were found with normal facial and dental arch development. These three individuals were marble cutters who were suffering from silicosis. The forty-seven other individuals examined (94 per cent) were found to have marked evidence of injury in the developmental period. At the state fair at Rutland, Vermont, to which residents came from various communities throughout the state, I was able to count, by observing and recording the individuals who passed, that in each 100 people, three out of four gave evidence of injury in the developmental period. Similar studies were made at the State Farm for delinquent boys and girls, almost all of whom had been before the courts. 1 found that a very high percentage, approximating 100 per cent of those observed, had received injuries in the prenatal period. I then went to Quebec and studied groups of school children in the early teens. I observed groups in which a very high percentage gave marked evidence of prenatal injury. This seemed aggravated in districts where the farms had been abandoned, because the land was not producing as well as in the past. I studied Indians in two Indian Reservations, also, and there again found marked evidence of injury typical of our modernized communities. Similarly, a limestone district in Ontario was visited and critical observations were made of the facial form of the new generation, in regions in which the fertility of the soil had been definitely depleted through exhaustion. These again showed evidence of prenatal injury through faulty nutrition. The prisoners in a jail were examined, and all of them except two habitual drunkards showed marked evidence of prenatal injury.

If space permitted, it would be interesting to include here a discussion and illustrations of the physical characteristics of the racketeers and criminals whose pictures are shown in our newspapers almost daily. It is rare that a normal face is depicted in this group.

As an approach to more detailed study of the available information regarding the processes that are involved in the production of facial deformities, it will be helpful to think of the face as constituting the floor of the anterior part of the brain. The pituitary body is situated on the underside of the brain just back of the eyes. It is the governing body for the activity of growth, and largely controls the functioning of several of the other glands of internal secretion. It is, as it were, the master of the ship. We are, accordingly, primarily concerned with the role that it plays, and the forces which control its own development and function. Its dependence upon vitamin E has been demonstrated by many workers. For example, Dr. M. M. O. Barrie (3) has reported that an inadequate amount of vitamin E produces marked disturbance in the growth of the offspring of rats. He states:

The changes observed are similar in several ways to those produced by hypophysectomy (removal of pituitary gland). Marked degranulation of the anterior pituitary is found in both the abnormal young and the adult sterile animals. Lack of vitamin E therefore produces a virtual nutritional hypophysectomy in the young rat.

The work recently done in this field by Dr. Hector Mortimer and his associates in McGill University, Montreal, has included studies of skull development of rats. He has shown that the surgical removal of the pituitary body at the base of the brain in very young rats produces regularly a certain type of defect in skull development. This has been characterized by a lack of development forward of the muzzle or face, with a narrowing of the nose and dental arches. He found that by the addition of extracts made from the pituitary glands, which he had removed surgically, he entirely prevented the development of these defects, thereby establishing the relation of the injury to deficiencies of the hormones developed by that organ. Another approach to the problem on which he has expended much fruitful effort, has been in connection with the study of the skulls of individuals who are known to have disturbances in the functioning of the pituitary gland through the interference caused by tumors. Common illustrations are the cases of acromegaly or giantism. By associating these physical changes in bodily form with each x-ray, data obtained from skiagraphs, together with the history and the nature of the tumor, considerable information has been developed. Another important series of studies has included the correlation, by means of the x-rays, of the skulls of individuals suffering from certain types of physical and mental disturbances, with certain abnormalities in the skull as shown by the x-rays. By these various means Dr. Mortimer has been able to divide the various types of skull defects and developmental and growth defects into distinct classifications. With this yardstick he is able to classify individuals from their Roentgenograms. It is of interest that in his work, in association with Dr. G. Levine, Dr. A. W. Rowe and others at the Evans Memorial for Clinical Research and Neuro-Endocrine Research in Boston, important relationships have been established through the examination of over three thousand case histories. X-ray records of the skull are included in the studies. They report that independent and previous physiological investigations gave evidence at the time of the examination of disturbed pituitary function. Dr. Mortimer's excellent investigations seem to indicate clearly that facial and dental arch form are directly related to and controlled by the functioning of the pituitary body in the base of the brain. Dr. Barrie (3) reports that partial deficiency of vitamin E, as shown in the case of the female rat, results in the prolongation of gestation which may be continued as long as ten days beyond the normal period. The offspring under these conditions are abnormal. Further, animals deficient in vitamin E, occasionally give birth to a litter, but fail to lactate.

When we realize that one of the best sources of vitamin E is wheat germ, most of which is removed from white flour, usually along with four-fifths of the mineral, we see one cause of the tragedy that is overwhelming so many individuals in our modern civilization. In many individuals it may be wise to reinforce our modern white bread and starchy dietary with wheat germ, which can be obtained in package form from the manufacturers of flour. As this is put up in cans, all air is displaced with an inert gas when the cans are sealed. While in this way oxidation of the embryo which is very fragile, is prevented, as soon as the seal is broken, oxidation sets in and progresses rapidly, producing a product that is not comparable to the wheat embryo of freshly cracked whole wheat. My investigations indicate that Nature has put just the right amount of embryo in each grain of wheat to accompany that quantity of food. If the whole wheat is prepared and eaten promptly after grinding and exposing the embryo to oxidation, the effect desired by Nature is adequately provided.

It is important to emphasize in connection with the development of the deformities of the face that other skeletal deficiencies or abnormalities result from the same disturbing factors. One of these is the narrowing of the entire body, with a tendency to increase in height. This is shown in many of the family groups of modernized primitives. The effect of this narrowing of the body, which in girls results in the boyish type of figure due to the narrowing of the hips, introduces an entirely new and serious problem in the experience of our modern civilization when confronted with the problems of childbirth.

Among primitive races living in a primitive state childbirth was a very simple and rapid process, accompanied by little fear or apprehension; whereas, in the modernized descendants, even in the first and second generations of those individuals born to parents after they had adopted the foods of modern white civilizations, serious trouble was often experienced.

We have been considering the changes which take place in the skeletal growth as a result of the disturbances in the functioning of the pituitary body of the individual after birth, or of the mother during the prenatal period. We are also concerned with changes in the soft tissues, particularly the brain. I have presented data indicating that a very large percentage of mentally backward children have disturbances in facial development. The available data also indicate that a large percentage of those who are seriously injured in facial form have some disturbance in their mental or moral character. Whether there is relationship between the processes which develop these physical abnormalities in brain growth and mental efficiency, including emotional states and character traits is now to be considered.

An important contribution has been made to this phase of the problem by Dr. James Papez, Professor of Anatomy at Cornell University, (4) who concludes his report:

Is emotion a magic product, or is it a physiologic process which depends on an anatomic mechanism? . . . The evidence presented is . . . suggestive of such a mechanism as a unit within the larger architectural mosaic of the brain.

Research data have been presented which deal with the anatomical defects of the brain of individuals suffering from the typical mental and physical patterns of the so-called Mongolian idiot. In these cases the gyrus cinguli of the brain were found to be absent, which indicates the impossibility that these individuals function normally either physically or mentally.

Modern civilization has provided a large group of the defectives known as Mongolian idiots. They have very definite characteristics both physical and mental. Among the former, one of the most universal expressions is a vacant stare associated with a face that is markedly underdeveloped in the middle third, usually accompanied by narrow nostrils and a narrow upper dental arch.

One of the outstanding characteristics of the group is their inability to develop mentally beyond three to eight years of age. Because of the difficulty of building a character and intelligence level beyond infancy, these unfortunates are housed largely in state institutions for feebleminded. Since the physical picture is similar to that which occurs in a much less severe form in a large number of individuals in our modern civilization, it is important that we study this group in the light of the information that is available with regard to their physical, mental and moral characteristics, and in the light of such information as is available regarding their origin.

The surveys that have been made reveal the fact that nearly all of them are born to mothers more than forty years of age, and apparently at a period of very low efficiency in reproductive capacity. While most of the discussion and literature stress the importance of the age of the mother, some data are now available which throw responsibility also on the paternal side.

Korosi, as reported by Tredgold in Mental Deficiency, came to the conclusion as a result of the investigation of 24,000 unselected individuals that the children of fathers below twenty or above forty years of age are weaker than the children of fathers between these ages. Also, the children of mothers over forty years of age are weaker than those born to mothers below this age. Tredgold presents data connecting defective structures in the brain with certain phases of physical behavior and mental deficiencies. He quotes many authors whose data correspond with his own. Much of this material relates to accounts of incomplete prenatal development of nerve structures in the brain.

We are particularly interested in the origin and the nature of the brain lesions. Penrose, (5) in analyzing the relative etiologic importance of birth order and maternal age in Mongolism presents data obtained from an examination of 224 defectives in which the total number of children in all the families involved was 1,013. Accordingly, in these families approximately 20 per cent were so affected. The average number of children per family was five and one-half. He states:

Mongolian imbeciles are very often born last in a long family. This fact, which was pointed out many years ago by Shuttleworth, has led clinicians to believe that Mongolism is to some extent a product of the exhaustion of maternal reproductive powers due to frequent child bearing. . . . The conclusion is widely accepted with the reservation that the affected child is not necessarily born at the end of the family. Several cases are first-born, in fact, and it is sometimes stated that the conditions occur more frequently in first and last children than in other ordinal positions. There is, however, ample evidence that Mongolian imbeciles have a significantly later birth rank than normal children.

G. Ordahl (6) has reported on a study of ninety-one cases in which he found that fifty-six or 60 per cent were the last born. The families averaged five children. He states that "uterine exhaustion is the most commonly advanced reason for Mongolism." Madge T. Macklin (7) says, "It is usually stated that it (Mongolism) occurs more frequently in the later pregnancies owing either to reproductive exhaustion or to too advanced age of the mother." We are concerned at this point for evidence that will throw light on the relationship between the functioning of the pituitary body in the base of the brain and the development of this type of facial and mental deformity.

A striking case is that of a boy sixteen years of age who was a typical Mongolian idiot. He had two sisters who were much older than he. His mother was a partial invalid when he was born late in her life. We have no data relative to the details of the children who may have been lost. His father was living and well except for a railroad injury. This boy at the age of sixteen was infantile in many of his characteristics and developments. The genitals were those of a boy eight years old. The facial expression was that of the typical Mongolian idiot. By the Binet test he had a mentality of about four years. Roentgenograms of his hands showed that the epiphyseal bones had not united. He played on the floor with blocks and with rattles like a child. His interest was in children's activities. (Fig. 125.) The outstanding physical characteristic was his maxillary arch which was so much smaller than the mandibular arch that it went entirely inside it. In order to give him a masticating surface, and with the hope of helping him both physically and mentally, since several cases had greatly benefited by such an operation, I determined to widen his arch by moving the maxillary bones apart about one-half inch. The position of his teeth before the moving of the bones is shown in Fig. 126. Roentgenograms showing the opening of the median suture with increase of pressure are also shown in Fig. 126. An important phase of this case was that the left nostril was entirely occluded, and probably had been all his life. A rhinologist spent half an hour trying to shrink the tissue with adrenalin and cocain sufficiently to get air or water through, and was not able to do so. The quantity of air that he was able to inhale through his right nostril was so scant that he continually breathed with his mouth open. At night he was forced to lie with something like his coat rolled into a hard ridge and placed under the back of his neck and his head pushed far back to a position that would open his mouth and retain it so, or he would awaken, strangling because of the closing of his mouth.

FIG. 125. These views show physical changes in the mongoloid type due to movement of maxillary bones to stimulate the pituitary gland in base of brain. Left, front and side view before, center, front and side view in thirty days. Right, front and side view six months after. Aged sixteen, infantile before, adolescent after operation. While he improved mentally he was harmless before and a sex pervert after operation and had to be placed in an institution.

FIG. 126. These x-ray pictures show the position of the teeth before operation to move maxillary bones; and progessively, by the dates shown, the widening of the upper arch. In twelve weeks' time the boy passed through adolescence. New bone rapidly filled in the space between the separated bones. The space was retained with a fixed bridge carrying two additional teeth. His mother was nearly fifty when he was born.

With the movement of the maxillary bones laterally, as shown progressively in Fig. 126, there was a very great change in his physical development and mentality. He grew three inches in about four months. His moustache started to grow immediately; and in twelve weeks' time the genitals developed from those of a child to those of a man, and with it a sense of modesty. His mental change was even more marked. The space between the maxillary bones was widened about one-half inch in about thirty days. This lateral pressure on the maxillary bones was accomplished by rigid attachments to the teeth of the two sides of the upper arch. The outward movement of the maxillary bones (which form the roof of the mouth and sides of the nose) by pressure on the temporal bones produced a tension downward on the floor of the anterior part of the brain, thus stimulating the pituitary gland in the base of the brain. In a few weeks' time he passed through stages that usually take several years. At first, he got behind the door to frighten us; later, he put bent pins on chairs to see us jump when we sat down, and finally he became the cause of a policeman's coming to the office from where he was conducting traffic on the corner below to find who it was squirting water on him when his back was turned. He developed a great fondness for calling people over the telephone, wanted to borrow my automobile to take his mother for a drive, and with his arm caressingly about the shoulders of one of the secretaries, invited her to go with him to a dance. All this change developed in about twelve weeks.

A most remarkable event happened in connection with this procedure. He lived in another city, and so, while with me, stayed in a boarding house at a little distance from my office in order that he might have frequent, and almost constant attention. On his return to his home town, his efficiency had increased to such an extent that his mother could send him with the money to the grocery store with the order for the day's groceries, and he could bring back the right change and could tell when it was correct. He could also come alone to me ninety miles by railroad and make two changes of trains and the various transfers on the street cars of the city with accuracy and safety.

He wore an appliance in his mouth to keep the bones in position. This appliance became dislodged; the maxillary bones settled together; immediately, or in a day or two, he lapsed into his old condition of lethargy accompanied by an old trouble, which had frequently been distressing, namely, nausea, this sometimes lasting for twenty-four hours. With the readaptation of the separating appliance and the reconstruction of the retaining appliance, he returned rapidly to his improved condition.

But a new problem had developed. We had changed an infant to a potential man with the impulses of a man, but with the mind of a child. With the change in his physical condition he became a menace in his community as a sex pervert. His mother died and his sister married. It became necessary to have him placed in a state institution for defectives. During the period he was in my care, he had learned to read child stories and newspaper headings, and had spent much time doing so. The changes in his physical appearance are shown in Fig. 125, above, front view, and below, side view. The first picture at the left shows his appearance before the operation; the second, thirty days after; and the last, six months later. The opening produced in the upper arch in front of half an inch was filled by supplying two teeth on a restoration, which at the same time held the maxillary bones in their new position. In six months he had developed whiskers and moustache. The progressive changes in the position of the maxillary bones with the opening of the median suture are shown in Fig. 126, together with the mechanical appliance. In the last view, the restoration carrying the porcelain teeth to fill the space is shown.

A very important contribution to our knowledge of the cause of Mongolism has recently been published by Dr. Clemens E. Benda, (8) Clinical Director of the Wrentham State School, Wrentham, Massachusetts, in association with the Harvard Medical School of Boston. He and his group have approached the problem of Mongolism from two different angles; first, as to determine whether it is accidental, and second, whether it is a unit of symptoms which can be related to more essential alteration. Their studies including careful anatomical studies have been made on the basis of an examination of 125 Mongoloids. He states:

Summarizing our investigations, the pituitary in mongoloids reveals a peculiar and definite pathology. On the basis of fourteen cases we feel justified in emphasizing that in mongolism definite failure of the pituitary development is to be found. Mongolism appears as a hypopituitarism of a specific type, in which the absence or deficiency of basophiles seems to be essential.

The evidence indicates that this severe type of facial and brain injury is related directly to a lowered reproductive capacity of the mother associated with age, since the majority are born to mothers beyond forty years of age, and to an inadequate nutrition of the mother, particularly in vitamin E since this vitamin plays so important a role in the nutrition of the pituitary body.

Important new data have been provided in an analysis of births in the United States in connection with the development of the Mongolian group. Bleyer (9) has reported a study of 2,822 cases. He reports that of the total births in the United States in 1934, of 1,095,939, there were 1,822 reported as Mongoloids. The average age of the mothers of these individuals was forty-one years. He reports data indicating that in the age group of mothers forty to forty-four the chances of the development of a Mongoloid would be seventy-five times as high as normal expectancy, and in the age forty-five to forty-nine the chances are 125 times normal expectancy. In a group of 1,942 Mongoloids, 1,100 or 57 per cent were last children. These data are in keeping with those of several other investigators, and emphasize the problem of depleted reproductive capacity.

The interesting problems involved in the birth of identical twins throw light on the origin of both physical and mental characters. It is a matter of great significance in connection with these studies that anomalies which we can associate with parental deficient nutrition are reproduced in both twins. Important additional light has been thrown on this phase by a family of six pairs of fraternal twins born to the same parents. These are reported by Dr. William W. Greulich, of New Haven. (10) It is significant that nine of these individuals (one of the oldest pair is deceased, and the youngest twins are yet babes in arms) show marked narrowing of the nostrils and lack of development of the middle third of the face, narrowing of the face and tendency to be mouth breathers. Further, the severity of this condition appears to be progressively more severe in the younger pairs of twins, sufficiently grown to show facial development. There is accordingly, evidence here of progressive lowering of reproductive efficiency, and the fact that both individuals are involved similarly has great significance, since they are fraternal twins arising from a single ovum. This seems clearly to relate this disturbance with a deficient germ plasm. Factors that are reproduced in identical twins would include both hereditary characters and those that are produced by a disturbance in environment resulting in an interference with normal hereditary processes. In a case of twins that are not identical, there is significance in the development of similar deformities which are likely to be of acquired origin rather than of hereditary origin. In Fig. 127 is seen a pair of twins. Note that they have similar disturbance in the development of the dental arches with the upper laterals depressed and the cuspids crowded outward in the arch.

FIG. 127. These boys are twins, not identical. Note, however, both have same type of deformity of the dental arch, apparently due to the same cause.

A very important source of information which deals with the relation of disturbances of the physical development of the head and mentality is provided by a study of the members of the teen-age group who are classed as mentally backward. In an examination of a Cleveland school in a colored district that has been set aside largely for boys and girls who are distinctly deficient in their ability to learn, it was disclosed that a very large percentage suffered from gross facial deformities when judged by these standards. Typical individuals in this group are shown in Fig. 128, one is white, lower left. It is clear that these boys were all physically injured in the formative period. Their clinical history indicates that the brain was involved in this disturbed development.

FIG. 128. These four boys are typical of a group of several hundred in a special school for backward children. Practically all showed some evidence of incomplete facial and dental arch development. The range of defects is wide. Blacks are similarly injured as whites. This is inhibited heredity.

One of the problems involved in the development of the group of disturbances having physical and mental expressions, is associated with the sensitiveness of the body during the period of adolescence. Many students of degenerative problems have emphasized various phases of this large problem. Burt" commented: "It is almost as though crime were some contagious disease, to which the constitutionally susceptible were suddenly exposed at puberty, or to which puberty left them peculiarly prone." The age of adolescence is also the period of greatest susceptibility to dental caries. Data derived from chemical studies of the blood and saliva show that in this period of susceptibility to dental caries the supplies of minerals and vitamins are inadequate to meet Nature's demands, and the system borrows minerals from the skeleton to maintain vital processes. Lichtenstein and Brown (12) report data which reveal that educational quotients, like intelligence quotients, fall with increase in age during the years of developing puberty. They show that the educational quotient at nine years of age for the group studied was 100; at eleven years of age, 89; at twelve years, 83; and at thirteen years, 74. The changes in facial and dental arch form, which I have described at length in this volume, develop in this age period also, not as a result of faulty nutrition of the individual but as the result of distortions in the architectural design in the very early part of the formative period. Apparently, they are directly related to qualities in the germ plasm of one or both parents, which result from nutritional defects in the parent before the conception took place, or deficient nutrition of the mother in the early part of the formative period. Case records show that the first signs of delinquency generally make their appearance during these years. The age reported most frequently was that of thirteen.

One expression of the rate of the progressive degeneration that is taking place in the United States is the increase in delinquency and crime in young people between twelve and twenty years of age, as well as in crime in general. Edgar Hoover, Director of the Bureau of Investigation, has recently published data showing comparative figures for 1936 and 1937, during which time crimes in the United States increased from 1,333,526 to 1,415,816, an increase of six per cent. This increase is occurring in spite of the rapid development of social organizations for improving the environment.

Preventive measures among the unsocial group, who pass through the stages of predelinquency and crime, have been almost entirely confined to improvement in the social surroundings of the growing youth. While, no doubt, individuals with a low factor of safety are less likely to develop serious criminal tendencies under favorable environments, such factors as constitute a first-conditioning force, i.e., injury of the germ plasm, and deficient nutrition in the developmental period are not corrected by these efforts. These new data relating to the nature of the underlying causes strongly emphasize the need for beginning much earlier. Indeed, the preparation for the next generation should begin early in the life of the preceding generation.

Many investigators have emphasized the sensitiveness of the nervous system to disturbances in the formative period. Considerable data have been presented indicating that the tissues of the nervous system are the most easily affected of all the structures of the body. The extent of the injuries to the nervous system vary through a wide range.

Harris in his chapter on "Congenital Abnormalities of the Skeleton" in Blacker's (13) "Chances of Morbid Inheritance" has presented data indicating the sensitive period at which the ovum is most likely to be injured:

Few normal human embryos have been subjected to careful study. The vast majority of human embryos examined have been abnormal, and it is their abnormality which has led to their abortion between the sixth and thirteenth weeks of embryonic life, a critical period associated with the development of the placenta, during which the death rate is probably in the neighborhood of at least 15 per cent.

In tracing the development of the human embryo, he tells why the growth process is very different from that of the development of embryos of lower forms. He states regarding deformed ova: "Ova that survive the eighth week tend to live on to term, and are born as monsters." I have referred previously to a personal communication from Professor Shute, of the University of Western Ontario, which states that he had been impressed with the high percentage of deformities in aborted fetuses. This seems to be Nature's method of eliminating defective individuals. Harris says further:

It is sometimes suggested that threatened abortions in early pregnancy should not be treated by rest and quiet, as it is quite possible that the uterus is attempting to rid itself of a pathological ovum which might become a monster in the future.

The available data emphasize strongly that a very small percentage of the total gross deformities ever develop to menace society. Harris quotes Mall: (14)

He estimated from the records of 100,000 pregnancies that there were 80,572 normal births, 11,765 abortions of normal embryos and early monsters, and 615 monsters born at term. Thus at term 1 child in 132 is born with some anatomical defect. For each such case appearing at term, 12 others died and were aborted during pregnancy.

These data deal with gross defects involving physical deficiencies in the infant and indicate that the defects that are produced in the formative period, which are less severe than the above, are not recognizable at birth and may not be until long afterwards. According to Harris, "During the fourth week of embryonic life the head, brain and spinal cord are most susceptible to adverse conditions." He traces the sensitive areas of the various structures through the various weeks in the embryonic history. The deformities of the face among the primitive races which I have illustrated extensively frequently are not revealed until the eruption of the permanent dentition and the development of the adult features. While it is true that many children show deformity in facial development even in babyhood and childhood, those individuals are usually much more seriously injured when the adult face is developed.

Bloom (15) has presented the anatomical and histological characteristics of a defective born to a mother fifty-one years of age, whose general health was reported as good. The infant's facial pattern was markedly divergent from normal and practically no brain tissues had been formed. This expression of an extreme injury was entirely beyond that with which we are concerned in the study of the mental and the moral cripples who constitute an increasing part of our society. This is presented to emphasize Nature's inexorable requirement that each parent shall be individually physically fit for the responsibility of producing the next generation. Several primitive races studied have realized this responsibility.

There are some phases of modern physical degeneration in which most of us take part with remarkable complacency. We would consider it a great misfortune and disgrace to burn up the furniture in our homes to provide warmth, if fuel were available for the collection. This is precisely what we are doing with our skeletons by a process of borrowing, simply because we fail to provide new body repairing material each day in the food. You are all familiar with the tragic misfortune that overtakes so many elderly people through the accident of a broken hip or other fractured bone. Statistics show that approximately 50 per cent of fractured hips occurring in people beyond 65 years of age never unite. We look upon this as one of the inevitable consequences of advancing age. In Chapter 15 I have referred to the small boy whose leg was broken when he fell in a convulsion while walking across the kitchen floor. That bone did not break because the blow was hard but because the minerals had been borrowed from the inside by the blood stream in order to maintain an adequate amount of the minerals, chiefly calcium and phosphorus in the blood and body fluids. He had been borrowing from his skeleton for months because due to a lack of vitamins he could not absorb even the minerals that were present in the inadequate food that he was eating. The calcium and the phosphorus of the milk were in the skimmed milk that he was using but he needed the activators of the butter-fat in order to use the minerals. Simply replacing white bread with these activators and the normal minerals and vitamins of wheat immediately checked the convulsions.

We have many other expressions of this borrowing process. Much of what we have thought of as so-called pyorrhea in which the bone is progressively lost from around the teeth thus allowing them to loosen, constitutes one of the most common phases of the borrowing process. This tissue with its lowered defense rapidly becomes infected and we think of the process largely in terms of that infection. A part of the local process includes the deposit of so-called calculus and tartar about the teeth. These contain toxic substances which greatly irritate the flesh starting an inflammatory reaction. Many primitive peoples not only retain all of their teeth, many of them to an old age, but also have a healthy flesh supporting these teeth. This has occurred in spite of the fact that the primitives have not had dentists to remove the deposits and no means for doing so for themselves. Note particularly the teeth of the Eskimos. The teeth are often worn nearly to the gum line and yet the gum tissue has not receded. Many of these primitive groups were practically free from the affection which we have included in the general term of pyorrhea or gingivitis. Pyorrhea in the light of our newer knowledge is largely a nutritional problem. While nutrition alone often will not be adequate for correcting it, when established practically no treatment will be completely adequate without reinforcing the nutrition in so far as deficient nutrition has been a contributing factor. Nutrition plus the frequent removal of deposits, plus suitable medication will check and prevent pyorrhea but not correct the damage that has already been done. The elements that are chiefly needed in our nutrition are those that I have outlined as being particularly abundant in the menus as used by several of the primitive races. These are discussed in detail in Chapter 15.

Another important aspect of this problem of borrowing has to do with the progressive shrinking of the skeleton as evidenced by the shortening of the stature. I have measured many individuals who have lost from two to six inches in height in a decade or two. I have seen a few individuals who have lost as much as ten inches of their height by this process of borrowing from the skeleton. Our bodies need a certain amount of fresh minerals every day with which to manufacture blood. The days that these minerals are not provided in the foods they will be taken from our storage depots, the skeleton.

A particularly tragic phase of this problem of borrowing from the bone is seen in growing girls and is chiefly due to their ambition to avoid enlargement of their bodies to keep down their weight. The girls deprive themselves of body building material at a time when their bodies are growing and are requiring considerable new mineral. Forming bone has a prior claim on minerals, which is sufficiently commanding to induce the individual to borrow from bones that are already formed to provide for the necessary lengthening and growth. By this process many of the bones of the body are softened, particularly the bones of the spine. Curvatures develop, one of the expressions of which may be round or stooped shoulders.

Among primitive races this type of girl, so commonly seen in our modern civilization, is absent. Probably not one of these girls has ever suspected the suffering and sorrow that is being stored up for future life as a result of this bad management at a critical time in her development. Fig. 134 illustrates one of the tragedies of this borrowing process. Practically all of these physical evidences of degeneration can be prevented and fortunately many of them can be relieved in large part with an adequate nutrition. Even ununited fractures often can be induced to unite by an adequate reinforcement of the nutrition. This is true not only for young people but for elderly people as well.

In addition to the problems growing out of physical injuries through lack of development before birth, which express themselves as facial and other deformities, there is increasing need for concern for physical handicaps entailed in underdevelopment of the hips. The difficulty encountered at childbirth in our modern civilization has been emphasized by Dr. Kathleen Vaughan (16) of London. In her book, "Safe Childbirth," she states that faults of development more than race modify pelvic shape. In the Foreword to her book, Dr. Howard A. Kelly, Professor Emeritus of Gynaecological Surgery, Johns Hopkins University, says:

Dr. Vaughan presents such an array of facts and data that the book must impress every reader. It is of vital importance that her conclusions be considered, for in my opinion our methods of bringing up our girls and the habits of our women with many of the customs of 'civilized' life must be radically readjusted.

This important work should be made available for reference in the school libraries of the United States. Further data from it are presented in Chapter 21.

The great contrast in discomfort and length of time of the labor of modern mothers is to be contrasted with ease of childbirth among primitive mothers. Many workers among the primitive races have emphasized the vigorous health and excellence of the infant at birth. We have here, therefore, emphasis on the need in the interest of the infant that the mother shall have an easy and short labor. Both of these factors are directly influenced by the vitamin content of the mother's body as supplied by her nutrition and also by the physical development of her body if her mother at the time of gestation and prior to conception had adequate vitamins in her food to insure perfect germ cells.

The sensitivity of the brain to injury resulting from medication given the mother has been emphasized by Dr. Frederic Schreiber of Detroit. In his paper before the American Medical Association meeting in San Francisco, June, 1938, he was quoted as saying (17) that the analysis showed that 72 per cent of the children had shown difficulty in breathing at the time of birth or in the first few days following birth. He concluded, therefore, that this difficulty in breathing was the cause of the brain damage.

Difficulty in breathing would lead to a shortage of oxygen. An insufficient supply of oxygen in the blood stream would have serious effects upon the tissues of the brain. In this connection, he cited evidence found in post-mortem examinations that deficiency of oxygen caused microscopic changes in the brain.

X-ray photographs of some of the children examined by Dr. Schreiber showed various degrees of brain atrophy.

The contribution of Dr. Schreiber also emphasizes strongly the susceptibility of the brain tissue to injuries which may handicap the individual throughout life.

REFERENCES

LAIRD, D. The tail that wags the nation. Rev, of Revs., 92:44, 1935.
TREDGOLD, A. F. Mental Deficiency (Amentia). Ed. 5. New York, William Wood, 1929.
BARRIE, M. M. O. Nutritional anterior pituitary deficiency. Biochem. J. In press.
PAPEZ, J. A proposed mechanism of emotion. Arch. Neur. and Psychiat., 38:713, 1937.
PENROSE, L. S. Maternal age in Mongolism. Proc. Roy. Soc. Lond., 115: 431, 1934.
ORDAHL, G. Birth rank of Mongolians: Mongolism, definite form of mental deficiency, found more frequently in the later birth ranks. J. Hered., 18:429, 1927.
MACKLIN, M. T. Primogeniture and developmental anomalies. Human Biol., 1:382, 1929.
BENDA, A. E. Studies in the endocrine pathology of mongoloid deficiency. Proc. Am. A. Ment. Deficiency, 43:15 1, 1938.
BLEYER, A. Idiocy--the role of advancing maternal age. Proc. Am. Assn. Ment. Defic., 61:10
GREULICH, W. W. The birth of six pairs of fraternal twins to the same parents. J.A.M.A., 110:559, 1938.
BURT, C. L. The Young Delinquent. London, University of London Press, 1925.
LICHTENSTEIN, M. and BROWN, A. W. Intelligence and achievement of children in a delinquency area. J. Juvenile Research, 22:1, 1938.
BLACKER, C. P. Chances of Morbid Inheritance. Baltimore, Wood, 1934, chapter 18.
MALL, F. P. On the frequency of localized anomalies in the human embryos and infants at birth. Am. J. Anat., 22:49, 1917.
BLOOM, D. D. Abnormalities encountered in dissection of the head and neck of an anencephalic monster. 16:226, 1937.

15a HOOTON, E. A. Crime and the Man. Cambridge, Harvard University Press, 1939.
VAUGHAN, K. Safe Childbirth. Baltimore, Win. Wood, 1937.
SCHREIBER, F. Brain Damage at Childbirth. Cleveland Press, June 23, 1938.

Chapter 20

SOIL DEPLETION AND PLANT AND ANIMAL
DETERIORATION

THE data available on the subject of soil depletion and animal deterioration are so voluminous that it would require a volume to present them adequately. When we realize the quantities of many of the minerals which must enter into the composition of the bodies of human beings and other animals, we appreciate the difficulty of providing in pasture and agricultural soils a concentration of these minerals sufficient to supply the needs for plant growth and food production. If we think of growing plants and grasses in terms of average soil tilled to a depth of seven inches, we are dealing with a total of approximately two million pounds of soil per acre, of which two thousand pounds will be phosphorus in its various chemical forms, some of which will not be readily available for plants. If one-half of this phosphorus were present in an available form, there would be enough for only one hundred poor crops, utilizing ten pounds to the acre for the seed alone; or for forty good crops, taking twenty-five pounds per acre, assuming that the seed were to be removed from that land and not replaced. A sixty-bushel crop of wheat or corn per acre takes twenty-five to twenty-eight pounds of phosphorus in the seed. The soil is depleted of calcium similarly, though that mineral is not usually present in such limited amounts nor so rapidly taken away as is phosphorus. The leaves and stems of rapidly growing young plants and grasses are rich in calcium and phosphorus. As the plants ripen the phosphorus is transported in large amounts to the seed while most of the calcium remains in the leaves. A large part of the commerce of the world is concerned with the transportation of chemical elements as foods, chief of which are calcium and phosphorus. Whether the product of the soil is ultimately used as wheat for bread, milk and meat for foods, or wool and hides for clothing, every pound of these products that is shipped represents a depletion of soil for pasturage or for grain production.

If we think of one hundred good crops constituting the limit of capacity of the best soils, and one-fourth of that for a great deal of the acreage of the tillable soil, we are probably over-generous. This problem of depletion may seem to many people unimportant, either because there has been no consciousness that depletion has been taking place, or because they believe that replenishment is a simple matter.

In correspondence with government officials in practically every state of the United States I find that during the last fifty years there has been a reduction in capacity of the soil for productivity in many districts, amounting to from 25 to 50 per cent. I am informed also that it would cost approximately fifty dollars per acre to replenish the supply of phosphorus.

Many people realize that farms they knew in their childhood have ceased to be productive because they have "run out." The movement of population to cities and towns is, in part, the result of the call of the social center and in part a consequence of the need of forsaking depleted soil. While there are many things that influence the movement from the farms, there is much to be learned from the government census reports which deal directly with farm acreage and values.

If we relate the levels of life of human and domestic animals to the problem of soil depletion, we find two important groups of data. First, there are those which relate to specific land areas, some small and some very large; and second, those which relate to civilizations and groups, both large and small that have passed out of existence or are rapidly deteriorating. A study of the skeletons of the past and present often discloses a progressive breakdown. For example, we may mention the important anthropological findings of Professor Hooton of Harvard, who, in his examinations of various pueblos of the Western Plains, especially at the Pecos Pueblo where the progressive burials have been uncovered, has brought to light the calendar of a civilization extending over a thousand years. These findings show that there has been over the period of years a progressive increase in skeletal deformities, including arthritis and dental caries, together with a reduction in stature, suggesting a direct relationship to progressive depletion of the soil.

In a recent magazine article, I have presented data (1) comparing the mineral content of different pasture grasses, and relating these to deficiencies in cattle. Unfortunately, space does not permit reviewing these data here in detail. They show that calcium varied from 0.17 per cent for a dry pasture grass in Arizona to 1.9 per cent in a Pennsylvania pasturage plant, to 2 per cent in a British Columbia pasturage plant, a range of over ten fold. Similarly, phosphorus was shown to vary from 0.03 per cent to 1.8 per cent, a range of sixty fold. Neither pasture animals nor human beings can eat a sufficient amount of low mineral plant food to provide the total mineral requirements of ordinary metabolism. In cases of overload, such as pregnancy and lactation in adults, and rapid growth in children, the demand is increased greatly. For example, a high-milk-production cow from southern Texas on a certain low mineral pasture will run behind her normal requirements about 60 grams of phosphorus and 160 grams of potassium per day. In that district large numbers of cattle were unable at the time to maintain their own bodies, let alone reproduce or provide milk. Many cattle in the district developed loin disease. It was found that moving them to another plot of ground where the soil was not depleted provided recovery.

About thirty-seven billion dollars, or approximately 40 per cent of the cash income of salaries and wages of the people in the United States, is used for the purchase of foods. When we add to this the expenditure of energy by the people living on the land, it represents a total, probably exceeding fifty billion dollars a year that is spent for the chemicals that are provided in the foods, a large amount of which, perhaps 50 per cent, will have been expended for calcium and phosphorus, perhaps 25 per cent for other chemicals, and 25 per cent for special vitamin or activator carrying foods. Of this enormous transportation of minerals from the soil an exceedingly small proportion gets back to the tillable land in this country. Orr (2) states that "Consumption in the United Kingdom of live stock products mostly derived from grass lands has been estimated at about four hundred million pounds sterling per annum (nearly two billion dollars) ." This includes dairy products, meats and hides. Never in the history of the world has there been such a large scale depletion of the soil by transportation away from the tilled and pasturage areas. Sickness in the United States has been calculated to cost nearly half as much as food, and is increasing.

An important discovery has been made with regard to the feeding of dairy cattle and other live stock: the nutritive value of young grass, when in a state of rapid growth, carries not only a very large quantity of minerals, but also digestible proteins in amounts that are approximately equivalent to those provided by the concentrated cereal cattle foods, such as linseed cake. It is observed also that not only do the milk products of such cows remain at a high level while the cows are on the rapidly growing young grass, particularly a rapidly growing young wheat grass or young rye grass, but the animals themselves are in better physical condition than when on grain concentrates. Further, that calves fed on the milk of those cows grow much more rapidly than they do when the cows are on other fodder and have a much higher resistance to disease. Grass, to provide these nutritional factors, must be grown on a very rich, well-balanced soil. A young plant, of necessity, produces a rapid depletion of soil. Minerals and other chemicals are removed and therefore there is need for adequate replacement.

In Chapter 18 I have reported investigations made by Professors Meigs and Converse at the Beltsville Experimental Station, in which they have shown that feeding cattle on a grade of dried hay that was low in chlorophyll resulted in the development of dead or blind calves, and further that when the milk of these cows was fed to three normal calves they died in fifty-seven, sixty-two and seventy-one days respectively. These calves had been fed on whole milk until twenty days of age. They show that the main deficiency in this ration was vitamin A.

Since mammals require milk in infancy and since it is the most efficient single food known, I have made a special study of milk and its products. The role of the vitamins and other activating substances in foods is quite as important and essential as that of minerals. These activating substances, in general, can be divided into two groups, those that are water-soluble and those that are fat-soluble, the former being much more readily obtained in most communities, than the latter. Since the fat-soluble and also the water-soluble vitamins are essential for mineral utilization and particularly since the fat-soluble activators are so frequently found to be inadequately supplied in diet and are usually more difficult to obtain, a special effort has been made to determine the level of these in dairy products in many different places for different seasons of the year. To accomplish this, I have obtained each year since 1927 samples of cream and butter, mostly butter, for analysis for their activator content. The work has rapidly extended so that for the eleventh year we are receiving now (1939) samples from several hundred places distributed throughout the world, usually once or twice a month throughout the year. Methods used for these studies are both biologic and chemical. These data are used in connection with morbidity and mortality statistics for the same districts.

The progressive changing of the levels of life is shown by the morbidity and mortality statistics of the various areas of the United States and Canada. The American Heart Association publishes, from time to time, very important data relative to the number of deaths from heart disease in the various states of the Union. It is of interest to note that the highest mortality levels that are obtained are found in those states, in general, that have been longest occupied by modern civilizations, namely, the Atlantic States, the New England States, the Great Lakes States and the Pacific States. Their data published in their booklet ~tHeart Disease Mortality Statistics" and based on the United States Registration area reveal that the death rate per 100,000 population was 123 in 1900. The data sent me in November 1937 from the United States Census Bureau, Department of Commerce, in Washington, report the death rate from heart per 100,000 for 1934 as 239.9, in other words an increase of 86.9 per cent in thirty-four years. Figures provided by the Bureau of Census for England and Wales show the death rate per 100,000 to be 269.3; and for Scotland, 232. While the average figure for the United States Registration area of 224 deaths per 100,000 seems very high, it is exceedingly important to note that the New England States were much higher, leading the entire country. Massachusetts reported 307.3; New Hampshire, 323.1; Vermont, 310.8; New York, 302.1; Maine, 297.5. The rate of increase in the decade of 1921 to 1930 was 51.3 per cent for Delaware; 52 per cent for Connecticut, 51 per cent for Pennsylvania, 59.4 per cent for Missouri, 60.0 per cent for Washington; 55 per cent for Wisconsin; 64 per cent for Louisiana; 71 per cent for Florida; 63 per cent for South Carolina; 81 per cent for Montana; 61 per cent for Kentucky; and 51.9 per cent for North Carolina. Such rates of increase as these are cause for alarm.

Sir Arnold Theiler, who spent a quarter of a decade studying the problems of nutritional deficiency diseases among pasture animals in South Africa, has discussed at length the reduction of phosphorus in available quantities for plant development as constituting, by far, the most important mineral deficiency. He reported data obtained from many countries through the world, indicating that the deterioration of cattle and sheep can be directly traced to an inadequate amount of phosphorus in the soil. He states, in discussing the relation of this problem to the conditions as they obtain in Australia, that: (3)

Amongst the Australian data the figures showing depletion of phosphorus as a result of sale of products off the farm without adequate replacement by manuring, are interesting. Thus Richardson estimates that it would take two million tons of superphosphate to replace the phosphorus removed in the form of milk, mutton and wool. In the "ranching stage" of the development of a country the fact is often forgotten that the balance of Nature is frequently disturbed to the detriment of generations to come.

It is important to keep in mind that morbidity and mortality data for many diseases follow a relatively regular course from year to year, with large increases in the late winter and spring and a marked decrease in summer and early autumn. The rise and fall of the level of morbidity with the changing season produces curves that are exceedingly regular for the same place from year to year. The distribution, however, is distinctly different for different latitudes and altitudes. It is further of special importance to note that the curves for the Southern Hemisphere, with its opposite seasons, are in reverse of those of the Northern Hemisphere, and have very similar levels for the same seasonal periods. I have obtained the figures for the levels of morbidity for several diseases in several countries, including the United States and Canada. I find that the distribution of the rise and fall in morbidity and mortality does not follow the sunshine curve but does follow the curve of vegetable growth. Accordingly, I have made studies by dividing the United States and Canada into sixteen districts, four from East to West and four from North to South. I have plotted by months the levels of mortality for heart disease and pneumonia in these various districts, from figures obtained from the governments of these two countries. Similarly, I have plotted curves for the vitamin content found in butter and cream samples obtained from these sixteen districts. When these are arranged in accordance with the levels by months they are found, in each case, to be opposite to the mortality from heart disease and pneumonia. It is also important to note that while these curves show a higher midsummer level of vitamins in dairy products in the northern tier of districts, the period of high level is shorter than in the more southern division. Two peaks tend to appear in the summer cycle of curves for the vitamins, one representing the spring period of active growth and the other, the fall period. These peaks are closer together in the north than in the south.

A particularly important phase of this study is the finding of a lower level of vitamins throughout the year in those districts which correspond with the areas of the United States and Canada that have been longest settled, and consequently most depleted by agriculture. A similar study has been made based on the data published in a report by Tisdall, Brown and Kelley, (4) of Toronto. Their figures for children's diseases which included chicken pox, measles, nephritis, scarlet fever, hemorrhage of newborn, tetany and retropharyngeal abscess were arranged according to the incidence for each month. All of these diseases show a relatively high incidence during February and March, rising in December and January, falling during April and May, reaching a very low level in midsummer and then making a rapid increase during the autumn. These are opposite to the vitamin levels found in the dairy products of Ontario for the same months.

In Chapter 3, I discussed data obtained during two summers in the Loetschental and other Swiss valleys. The Loetschental Valley has been isolated from contact with surrounding civilizations by its unique physical environment. For twelve hundred years during which time a written history of the valley has been kept, the people have maintained a high level of physical excellence providing practically all their food, shelter and clothing from the products raised in the valley. Cattle and goats provided milk, milk products and meat. The stock was carefully sheltered during the inclement weather and great care was used to carry back to the soil all of the enrichment. This, of course, is a process that is efficiently carried out in many parts of the world today. In this manner extensive depletion of the minerals required for food for animals and human beings may be prevented. Their practice is in striking contrast to that in many of the agricultural districts of the United States in which the minerals are systematically shipped from the land to the cities, there to be dissipated to the ocean through the sewerage system. Among many primitive races there is some attempt to preserve the fertility of the soil. For example, in Africa, many of the tribes that depend in part on agriculture, cleared off only a few acres in the heart of a forest and cropped this land for a limited number of years, usually less than ten. Great care was taken to prevent the loss of the humus both through drenching rains and wind erosion. The decaying vegetation and lighter soil that might be dislodged by the water were caught in the entanglement of roots and shrubbery surrounding the agricultural patch. The surrounding trees protect the soil from wind erosion. Care was taken not to form gullies, furrows and grooves that could carry currents of water and thus float away the valuable humus from the soil. This again is in contrast to conditions in other parts of the world, particularly in the United States. Sears (5) has stated that "Bare ground left by the plow will have as much soil washed off in ten years as the unbroken prairie will lose in four thousand. Even so, soil in the prairie will be forming as fast as, or faster than it is lost." In Nature's program, minerals are loaned temporarily to the plants and animals and their return to the soil is essential. To quote again from Sears.

What is lent by earth has been used by countless generations of plants and animals now dead and will be required by countless others in the future. In the case of an element such as phosphorus, so limited is the supply that if it were not constantly being returned to the soil, a single century would be sufficient to produce a disastrous reduction in the amount of life.

The history of preceding civilizations and cultures of mankind indicate the imbalances that have developed when minerals have been permanently transferred from the soil. There are only a few localities in the world where great civilizations have continued to exist through long periods and these have very distinct characteristics. It required only a few centuries, and in some profligated systems a few decades to produce so serious a mineral depletion of the soil that progressive plant and animal deterioration resulted. In such instances, regular and adequate replenishment was not taking place.

The replenishment may be made, as in the case of the prairie with its plant and animal life, through a replacement in the soil of borrowed minerals, a program carried out efficiently by a few intelligent civilizations. The balance of the cultures have largely failed at this point. Another procedure for the replenishing of the depleted soils is by the annual spring overflow of great water systems which float enrichment from the highlands of the watersheds to the lower plains of the great waterways. This is illustrated by the history of the Nile which has carried its generous blanket of fertilizing humus and rich soil from the high interior of Africa northward over its long course through Sudan and Egypt to the Mediterranean, and thus made it possible for the borders of the Nile to sustain a population of greater density than that of either China or India. The salvation of Egypt has been the fact that the source of the Nile has been beyond the reach of modernizing influences that could destroy Nature's vast stores of these replenishing soil products. Where human beings have deforested vast mountainsides at the sources of the great waterways, this whole problem has been changed.

A similar situation has occurred in China. Her two great rivers, the Yangtze and the Yellow River, having their sources in the isolated vastness of the Himalayas in Tibet, have through the centuries provided the replenishment needed for supporting the vast population of the plains of these great waterways. Together with this natural replenishment the Chinese have been exceedingly efficient in returning to the soil the minerals borrowed by the plant and animal life. Their efficiency as agriculturists has exceeded that of the residents of most parts of the populated world.

The story in Europe and America has been vastly different in many districts. The beds of roots of trees and grasses that hold the moisture and induce precipitation have been rudely broken up. An important function of the plant and tree roots is the entanglement of dead plant life. Vegetation holds back moisture at the time of melting snows and rainy seasons so efficiently that disastrous floods are prevented and a continuing flow of water maintained over an extended period. Under the pressure of population more and more of the highlands have been denuded for agriculture; the forests have often been ruthlessly burned down, frequently with the destruction of very valuable timber. The ashes from these great conflagrations provided fertilizer for a few good crops, but these chemicals were dissipated rapidly in the swift flow of the water in which they were soluble, with the result that vast areas that Nature had taken millenniums to forest have been denuded and the soil washed away in a few decades. These mountainsides have become a great menace instead of a great storehouse of plant food material for the plains country of the streams. Loss of timber which was needed greatly for commerce and manufacture has been another disastrous result. The heavy rains of the spring now find little impediment and rush madly toward the lower levels to carry with them not the rich vegetable matter of the previous era, but clay and rocks which in a mighty rush spread over the vast plains of the lowlands. This material is not good soil with which to replenish and fertilize the river bottoms. On the contrary, it often covers the plains country with a layer of silt many feet deep making it impossible to utilize the fertile soil underneath.

We have only to look over the departed civilizations of historic times to see the wreckage and devastation caused by these processes. The rise and fall in succession of such cultures as those of Greece, Rome, North Africa, Spain, and many districts of Europe, have followed the pattern which we are carving so rapidly with the rise and fall of the modernized culture in the United States.

The complacency with which the masses of the people as well as the politicians view our trend is not unlike the drifting of a merry party in the rapids above a great cataract. There seems to be no appropriate sense of impending doom.

An outstanding example of our profligate handling of soil and watersheds may be seen in our recent experiences in the Mississippi Basin. The Ohio River draining the western slopes of the Allegheny Mountains has gone on rampages almost annually for a decade carrying with it great damage to property and loss of life. Other branches of the Mississippi, particularly the Missouri, draining the eastern slopes of the Rocky Mountains have gone out of control so that vast areas are flooded with silt. There is now a concerted effort to stem this series of cataclysms by building dykes along the great waterways to raise the banks and dams in the higher regions of the watershed to hold back the floods. These artificial lakes become settling pools for the silt and soon lose their efficiency by being filled with the debris that they are holding back from the lower levels. An effort is also being made to reforest which is purposeful, but when we consider the millenniums of time that Nature has required to build the tanglewood of plant life, shrubbery and trees over the rocks and through the gullies to act as great defenses for holding back the water, these modern programs offer very little assurance for early relief.

Another very destructive force is the wind. When surfaces are denuded either at high or low altitudes the wind starts carving up the soil and starts it on the march across the country. We call the demonstrations dust storms. When we travel through our Western States, it is not uncommon to see buildings and trees partially buried in these rolling dunes of drifting sand. When we were traveling across the desert of Peru in 1937, we saw in many places mountain-like dunes rolling slowly across the country, frequently so completely blocking former traffic routes that long detours were necessary. When we were flying over eastern Australia in search of groups of primitive aborigines, we saw great forests gradually being engulfed with these marching billows of sand so that most of the trees were covered to their tips.

Few people will realize that it is estimated that only about 45 per cent of the land surface of the United States is now available for agricultural purposes and grazing. This includes vast areas that are rapidly approaching the limit of utility.

In one of my trips to the Western States I visited a large ranch of some fifty thousand acres. I asked the rancher whether he was conscious of a depletion in the soil of the ranch in its ability to carry pasture cattle. He said that it was very greatly depleted, that whereas formerly the cows on the ranch were able to produce from ninety-three to ninety-five healthy calves per hundred cows annually, nearly all of sufficiently high physical quality to be available for reproductive purposes, now he was getting only forty to forty-four calves per hundred cows annually and usually only ten or eleven of these were physically fit for reproductive purposes. He stated also that he was able to raise as many calves for restocking the ranch on the plant food produced on the fifty acres to which he was applying a high fertilization program as on the rest of the fifty-thousand-acre ranch. Of late most of the calves for the ranch had to be imported from other states.

In a city in the vicinity I inquired of the director of public health what the death rate was among their children up to one year of age. He stated that the figures were progressively increasing in spite of the fact that they were giving free hospitalization and free prenatal and postnatal care for all mothers who could not afford to pay for the service. This death rate had more than doubled in fifty years. I asked how he interpreted the increasing mortality rate among the infants and mothers. His comment was in effect that they could not explain the cause, but that they knew that the mothers of this last generation were far less fit physically for reproduction than their mothers or grandmothers had been.

To many uninformed people the answer will seem simple. Those who are responsible for these programs, recognize the difficulty in replenishing the exhausted minerals and food elements in adequate quantity. I have been informed by the director of the department of agriculture of the state of Ohio that it would cost fifty dollars per acre to restore the phosphorus alone that has been exhausted during the last fifty to one hundred years. He stated that the problem is still further complicated by the fact that the farmer cannot go to a bank and borrow money to buy this fertilizer. If, however, he buys adjoining acreage to double his own, he can then borrow twice as much money as he can on his own farm. But this is not all of the difficulty. Recent data indicate that if sufficient phosphorus in a form easily available for plant use were supplied to the land at once, it would kill the plant life; it must be provided in a form in which by a process of weathering it is made slowly available for plant utilization. Phosphorus is only one of the minerals that is readily taken from the soil. Other minerals also are difficult to provide. I have been able practically to double the weight and size of beets in five weeks by the addition of a tablespoonful of ferric ammonium citrate to each square foot of garden soil.

An important commentary on soil depletion is provided by the large number of farms that have been abandoned in many districts throughout the United States. The severe industrial depression which has thrown large numbers of shop and mill workers out of employment, has induced a considerable number of these to return to the land for subsistence. As one drives through farming districts that once were very fertile many farms are seen apparently abandoned insofar as tillage is concerned.

In my studies on the relation of the physiognomy of the people of various districts to the soil, I have found a difference in the facial type of the last generation of young adults when compared with that of their parents. The new generation has inherited depleted soil. In many communities three generations of adults are available for study. The yardstick for these comparisons has been developed in the preceding chapters. It will be of interest for the readers to apply this yardstick to their own brothers and sisters in comparison with the parents and particularly their grandparents. The most serious problem confronting the coming generations is this nearly unsurmountable handicap of depletion of the quality of the foods because of the depletion of the minerals of the soil.

REFERENCES

PRICE, W. A. New light on the control of dental caries and the degenerative diseases. J. Am. Dent. Assn., 18:1889, 1931.
ORR, J. B. The composition of the pasture. London, H. M. Stationery Office. E.M.B., 18, 1929.
THEILER, A. and GREEN, H. Aphosphoris in ruminants. Nutrition Absts. and Rev., 1:359, 1932.
TISDALL, BROWN and KELLEY. The age, sex, and seasonal incidence in children. Am. J. Dis. Child., 39:163, 1930.
SEARS, P. B. Deserts on the March. Norman, University of Oklahoma Press, 1935.

Chapter 21

PRACTICAL APPLICATION OF PRIMITIVE WISDOM

IF THE observations and deductions presented in the foregoing chapters are exerting as controlling an influence on individual and national character as seems to be indicated, the problem of the outlook for our modern civilization is changed in many important aspects. One of the most urgent changes in our viewpoint should be to look upon the assortment of physical, mental and moral distortions as due, in considerable part, to nutritional disturbances in one or both parents which modify the development of the child, rather than to accepted factors in the inheritance. The evidence indicates that these parental disturbances of nutritional origin may affect the germ plasm, thus modifying the architecture, or may prevent the mother from building a complete fetal structure, including the brain. In other words, these data indicate that instead of dealing entirely with hereditary factors, we are dealing in part with distortions due to inhibitions of normal hereditary processes. This changes the prospects for the offspring of succeeding generations. Atavism will still have plenty to her credit even if she must give up her claim to distortions of individual characteristics.

Jacobson (1) has summarized the determining factors in individuality and personality when he says "The Jekyll-Hydes of our common life are ethnic hybrids." Most current interpretations are fatalistic and leave practically no escape from our succession of modern physical, mental and moral cripples. Jacobson says of our modern young people:

Very much of the strange behavior of our young people to-day is simply due to their lack of ethnical anchorage; they are bewildered hybrids, unable to believe sincerely in anything, and disowned by their own ancestral manes. To turn these neurotic hybrids loose in the world by the million, with no background, no heritage, no code, is as bad as imposing illegitimacy; their behavior, instead of expressing easily, naturally and spontaneously a long-used credo, will be determined by fears and senseless taboos. How can character be built upon such foundations? There is a ludicrous as well as a pathetic side to the situation presented by a Greek puzzled by his predominantly German children, or by the German woman unable to understand her predominantly Spanish progeny. It is a foolish case over again of hen hatching ducklings, of wolf fostering foundlings.

If our modern degeneration were largely the result of incompatible racial stocks as indicated by these premises, the outlook would be gloomy in the extreme. Those who find themselves depressed by this current interpretation of controlling forces would do well to recall the experiments on pigs referred to in Chapters 17 and 18, in which a large colony all born blind and maimed because of maternal nutritional deficiency--from deficient vitamin A--were able to beget offspring with normal eyes and normal bodies when they themselves had normal nutrition.

Much emphasis has been placed on the incompatibility of certain racial bloods. According to Jacobson, (1)

Aside from the effects of environment, it may safely be assumed that when two strains of blood will not mix well a kind of "molecular insult" occurs which the biologists may some day be able to detect beforehand, just as blood is now tested and matched for transfusion.

It is fortunate that there is a new explanation for the distressing old doctrine which holds that geniuses cannot be born unless there is an abundant crop of defectives. In this connection Jacobson says,

The genius tends to be a product of mixed ethnic and nervously peculiar stock--stock so peculiar that it exhibits an unusual amount of badness. The human family pays dearly for its geniuses. Just as nature in general is prodigal in wasting individuals for the development of a type, or species, so do we here find much human wastage apparently for a similar purpose. One may think of the insane and the defectives as so many individuals wasted in order that a few geniuses may be developed. It would seem' that in order to produce one genius there must be battalions of criminals, weaklings and lunatics. Nietzsche must have had biologic implications of this sort in mind when he spoke of the masses as merely "fertilizers" for the genius. This is why the genius has been compared to the lily on the dunghill. He absorbs all the energy of his family group, leaving the fertilizing mass depleted.

Our recent data on the primitive races indicate that this theory is not true, since in a single generation various types and degrees of physical, mental or moral crippling may occur in spite of their purity of blood and all that inheritance could accomplish as a reinforcement through the ages.

The extent to which the general public has taken for granted that there is a direct relationship between mental excellence and mental deficiency is illustrated by the commonly heard expression "great wits and fools are near akin" which expresses tersely the attitude of a modern school of psychiatry. This doctrine is not supported by controlled data from scientifically organized investigations. One of the principal exponents quoted is Maudsley who stated "it is not exaggeration to say that there is hardly ever a man of genius who has not insanity or nervous disorder of some form in his family." Many reviews of the lives of great men have been published in support of this doctrine. Havelock Ellis, however, one of the leading psychologists and psychiatrists of our day, has shown that the percentage of cases substantiating this doctrine is less than 2 per cent and less than half that proportion found in the population at large, which in a tested group he found to be 4.2 per cent. East of Harvard in discussing this problem states, after reviewing the evidence pro and con: "Thus it is seen that where one collates the work of the most competent investigators on the possibility of relation between insanity and genius the conclusion is unavoidable that none exists."

Those who still believe in the old fatalistic doctrines may answer the questions why the last child is affected seriously much more often than would be expected through chance; or why the most severe defectives are born after mothers have exceeded forty years of age; and still further why our defectives are found chiefly among the later members of large families. These facts are not explainable by Mendel's laws of heredity.

Professor J. C. Brash, of the University of Birmingham, in his monograph (2) discusses the current theories in detail. He emphasizes the role of heredity as the controlling factor in the origin of divergencies. However, all of the distortions of the face and jaws which he presents as being related to heredity can be duplicated, as I have shown, in the disturbances appearing in the first and second generation after primitive racial stocks have adopted the foods of our modern civilizations in displacement of their native foods. He emphasizes the importance of an adequate diet during the growth period of the child, and also the fact that malocclusion is not a direct manifestation of rickets. Hellman has emphasized the importance of childhood diseases. The disturbances which we are studying here, however, are not related to these influences.

Two of the outstanding advances in laboratory and clinical approach to this problem of the relation of the structure of the brain to its function as expressed in mentality and behavior have been the work of Tredgold in England, referred to in Chapter 19, and the "Waverly Researches in the Pathology of the Feeble-Minded," in Massachusetts. Tredgold recognizes two sources of brain injury, "germinal blight" and ''arrest'' and puts particular stress on the former as being pathological and not spontaneous, and related to the germ of either or both parents due to poisoning of the germ cell. The "arrest" problems have to do with intra-uterine environmental disturbances.

The Waverly group have made very detailed anatomical studies, both gross and microscopic, of brains of mental defectives and related these data to the clinical characteristics of the individuals both mental and physical when living. They have reported in detail two groups of studies of ten individuals each. In their summary of the second group they state: (3)

The provisional conclusions drawn from the second series and the combined first and second series are much in agreement with the original conclusions drawn from the first series which were as follows: First that measurable brain can be correlated with testable mind in the low and high orders with fairly positive results. That is the small simple brains represented the low intellects or idiots and the most complex brain patterns corresponded to the high grade, moronic and subnormal types of feeble-mindedness.

The lessons from the primitive races demonstrate certain procedures that should be adopted for checking the progressive degeneration of our modernized cultures. If, as now seems indicated, mal-development with its production of physical, mental and moral cripples is the result of forces that could have been reduced or prevented, by what program shall we proceed to accomplish this reduction or prevention?

I have presumed in this discussion that the primitive races are able to provide us with valuable information. In the first place, the primitive peoples have carried out programs that will produce physically excellent babies. This they have achieved by a system of carefully planned nutritional programs for mothers-to-be. It is important to note that they begin this process of special feeding long before conception takes place, not leaving it, as is so generally done until after the mother-to-be knows she is pregnant. In some instances special foods are given the fathers-to-be, as well as the mothers-to-be. Those groups of primitive racial stocks who live by the sea and have access to animal life from the sea, have depended largely upon certain types of animal life and animal products. Specifically, the Eskimos, the people of the South Sea Islands, the residents of the islands north of Australia, the Gaelics in the Outer Hebrides, and the coastal Peruvian Indians have depended upon these products for their reinforcement. Fish eggs have been used as part of this program in all of these groups. The cattle tribes of Africa, the Swiss in isolated high Alpine valleys, and the tribes living in the higher altitudes of Asia, including northern India, have depended upon a very high quality of dairy products. Among the primitive Masai in certain districts of Africa, the girls were required to wait for marriage until the time of the year when the cows were on the rapidly growing young grass and to use the milk from these cows for a certain number of months before they could be married. In several agricultural tribes in Africa the girls were fed on special foods for six months before marriage. The need for this type of program is abundantly borne out by recent experimental work on animals, such as I have reported in Chapters 17, 18 and 19.

Another important feature of the control of excellence of child life among the primitive races has been the systematic spacing of children by control of pregnancies. The interval between children ranged from two and a half to four years. For most of the tribes in Africa this was accomplished by the plural-wife system. The wife with the youngest child was protected.

The original Maori culture of New Zealand accomplished the same end by birth control and definite planning. In one of the Fiji Island tribes the minimum spacing was four years.

These practices are in strong contrast with either the haphazard, entirely unorganized programs of individuals in much of our modern civilization, or the organized over-crowding of pregnancies also current. The question arises immediately: what can be done in the light of the data that I have presented in this volume to improve the condition of our modern civilization? A first requisite and perhaps by far the most important is that of providing information indicating why our present haphazard or over-crowded programs of pregnancies are entirely inadequate. This should include, particularly, the education of the highschool-age groups, both girls and boys.

In the matter of instruction of boys and girls it is of interest that several of the primitive races have very definite programs. In some, childbirth clinics supervised by the midwife are held for the growing girls. With several of these tribes, however, the ease with which childbirth is accomplished is so great that it is looked upon as quite an insignificant experience. Among the ancient Peruvians, particularly the Chimu culture, definite programs were carried out for teaching the various procedures in industry, home-building and home management. This was accomplished by reproducing in pottery form, as on practical water jugs, the various incidents to be demonstrated. The matter of childbirth was reproduced in detail in pottery form so that it was common knowledge for all young people from earliest observation to the time the practical problems arose. Many of the problems related directly were similarly illustrated in pottery forms.

It is not sufficient that information shall be available through maternal health clinics to young married couples. If pigs need several months of special feeding in order that the mothers-to-be may be prepared for adequate carrying forward of all of the inheritance factors in a high state of perfection, surely human mothers-to-be deserve as much consideration. It is shown that it is not adequate that sufficient vitamin A be present to give the appearance of good health. If highly efficient reproduction is to be accomplished there must be a greater quantity than this. There is no good reason why we, with our modern system of transportation, cannot provide an adequate quantity of the special foods for preparing women for pregnancy quite as efficiently as the primitive races who often had to go long distances without other transportation than human carriers.

The primitive care of a newborn infant has been a matter of severe criticism by modernists especially those who have gone among them to enlighten them in modern ways of child rearing. It is common practice among many primitive tribes to wrap the newborn infant in an absorbent moss, which is changed daily. A newborn infant, however, does not begin having regular all over baths for a few weeks after birth. While this method is orthodox among the primitives it is greatly deplored as a grossly cruel and ignoble treatment by most moderns. Dr. William Forest Patrick of Portland, Oregon was deeply concerned over the regularly occurring rash that develops on newborn infants shortly after they are first washed and groomed. He had a suspicion that Nature had a way of taking care of this. In 1931 he left the original oily varnish on several babies for two weeks without the ordinary washing and greasing. He found them completely free from the skin irritation and infection which accompanies modern treatment. This method was adopted by the Multanomah County Hospital of Oregon which now reports that in 1,916 cases of unwashed, unanointed babies only two cases of pyodermia occurred. They record that each day the clothing was changed and buttocks washed with warm water. Beyond this the infants were not handled. Dr. Patrick states that within twelve hours after birth by Nature's method the infant's skin is clear, and Nature's protective film has entirely disappeared. In my observations of the infant's care among primitive races I have been continually impressed with the great infrequency with which we ever hear a primitive child cry or express any discomfort from the treatment it receives. Of course, when hungry they make their wants known. The primitive mother is usually very prompt, if possible, to feed her child.

Among the important applications that can be made of the wisdom of the primitive races is one related to methods for the prevention of those physical defects which occur in the formative period and which result in physical, mental and moral crippling. When I visited the native Fijian Museum at Suva, I found the director well-informed with regard to the practices of the natives in the matter of producing healthy normal children. He provided me with a shell of a species of spider crab which the natives use for feeding the mothers so that the children will be physically excellent and bright mentally, clearly indicating that they were conscious that the mother's food influenced both the physical and mental capacity of the child. The care with which expectant mothers were treated was unique in many of the Pacific Islands. For example, in one group we were informed that the mother told the chief immediately when she became pregnant. The chief called a feast in celebration and in honor of the new member that would come to join their colony. At this feast the members of the colony pledged themselves to adopt the child if its own parents should die. At this feast the chief appointed one or two young men to be responsible for going to the sea from day to day to secure the special sea foods that expectant mothers need to nourish the child. Recent studies on the vitamin content of crabs have shown that they are among the richest sources available. We have then for modern mothers the message from these primitives to use the sea foods liberally, both during the preparatory period in anticipation of pregnancy and during that entire period. In Fig. 129 will be seen a woman of one of the Fiji Islands who had gone several miles to the sea to get this particular type of lobster-crab which she believed, and which her tribal custom had demonstrated, was particularly efficient for producing a highly perfect infant.

FIG. 129. This Fiji woman has come a long distance to gather special foods needed for the production of a healthy child. These and many primitive people have understood the necessity for special foods before marriage, during gestation, during the nursing period and for rebuilding before the next pregnancy.

For the Indians of the far North this reinforcement was accomplished by supplying special feedings of organs of animals. Among the Indians in the moose country near the Arctic circle a larger percentage of the children were born in June than in any other month. This was accomplished, I was told, by both parents eating liberally of the thyroid glands of the male moose as they came down from the high mountain areas for the mating season, at which time the large protuberances carrying the thyroids under the throat were greatly enlarged.

Among the Eskimos I found fish eggs were eaten by the childbearing women, and the milt of the male salmon by the fathers for the purpose of reinforcing reproductive efficiency.

The coastal Indians in Peru ate the so-called angelote egg, an organ of the male fish of an ovoviviparous species. These organs were used by the fathers-to-be and the fish eggs by the mothers-to-be.

In Africa I found many tribes gathering certain plants from swamps and marshes and streams, particularly the water hyacinth. These plants were dried and burned for their ashes which were put into the foods of mothers and growing children. A species of water hyacinth is shown in Fig. 130. The woman shown in Fig. 130, with an enormous goiter, had come down from a nine-thousand-foot level in the mountains above Lake Edward. Here all the drinking water was snow water which did not carry iodine. She had come down from the high area to the sixthousand-foot level to gather the water hyacinth and other plants to obtain the ashes from these and other iodine carrying plants to carry back to her children to prevent, as she explained, the formation of "big neck," such as she had. The people living at the six-thousand-foot level also use the ashes of these plants.

FIG. 130. This African woman with goiter has come down from the 9000 foot level in the mountains in Belgian Congo near the source of the Nile to a 6000 foot level to gather special plants for burning to carry the ashes up to her family to prevent goiter in her children. Right, a Nile plant, a water hyacinth burned for its ashes.

Among many of the tribes in Africa there were not only special nutritional programs for the women before pregnancy, but also during the gestation period, and again during the nursing period.

As an illustration of the remarkable wisdom of these primitive tribes, I found them using for the nursing period two cereals with unusual properties. One, was a red millet which was not only high in carotin but had a calcium content of five to ten times that of most other cereals. They used also for nursing mothers in several tribes in Africa, a cereal called by them linga-linga. This proved to be the same cereal under the name of quinua that the Indians of Peru use liberally, particularly the nursing mothers. The botanical name is quinoa. This cereal has the remarkable property of being not only rich in minerals, but a powerful stimulant to the flow of milk. I have found no record of the use of similar cereals among either the English or American peoples. In Chapter 14, I presented data indicating that the Peruvians, who were descendants of the old Chimu culture on the coast of Peru, used fish eggs liberally during the developmental period of girls in order that they might perfect their physical preparation for the later responsibility of motherhood. These fish eggs were an important part of the nutrition of the women during their reproductive period. They were available both at the coast market of Peru and as dried fish eggs in the highland markets, whence they were obtained by the women in the high Sierras to reinforce their fertility and efficiency for childbearing. A chemical analysis of the dried fish eggs that I brought to my laboratory from Alaska as well as of samples brought from other places has revealed them to be a very rich source of body-building minerals and vitamins. Here again, I have found no record of their use in our modern civilization for reinforcing physical development and maternal efficiency for reproduction. As I have noted in Chapter 15 special nutrition was provided for the fathers by tribes in the Amazon jungle, as well as by the coastal tribes.

Professor Drummond, a British bio-chemist, in discussing the question of the modern decline in fertility, before the Royal Society of Medicine (4) suggested that the decline in the birth rate in European countries, during the last fifty years, was due, largely, to the change in national diets which resulted from the removal of vitamins B and E from grains when the embryo or germ was removed in the milling process. He called attention to the fact that the decline in the birth rate corresponded directly with the time when the change was made in the milling process so that refined flour was made available instead of the entire grain product.

Of the many problems on which the experience of the primitive races can throw light, probably none is more pressing than practical procedures for improving child life. Since this has been shown to be largely dependent upon the architectural design, as determined by the health of the parental germ cells and by the prenatal environment of the child, the program that is to be successful must begin early enough to obviate these various disturbing forces. The normal determining factors that are of hereditary origin may be interrupted in a given generation but need not become fixed characteristics in the future generations. This question of parental nutrition, accordingly, constitutes a fundamental determining factor in the health and physical perfection of the offspring.

One of the frequent problems brought to my attention has to do with the responsibility of young men and women in the matter of the danger of transmitting their personal deformities to their offspring. Many, indeed, with great reluctance and sense of personal loss decline marriage because of this fear, a fear growing out of the current teaching that their children will be marked as they have been.

On the presumption that all mentally crippled individuals will be in danger of transmitting these qualities to their offspring there is a strong movement continually in operation toward segregating such individuals or incapacitating them by sterilization. Several primitive racial stocks have produced large populations without criminals and defectives by means of an adequate nutritional program which provided normal development and function. May it not be that even our defectives, when they have resulted from poisoning of germ cells or interference with an adequate normal intrauterine environment, may be able to build a society with a high incidence of perfection, that will progressively return toward Nature's ideal of human beings with normal physical, mental and moral qualities? Because of its interpretation of the individual's responsibility for his mental and moral qualities, society has not only undertaken to protect itself from the acts of so-called unsocial individuals but has proceeded to treat them as though they were responsible for the injury that society has done to them. Does it not seem inevitable that this apparently false attitude will change if it be demonstrated that they are the result of a program of inadequate nutrition for the parents.

As we have seen, the children born in many of the families of primitive racial stocks after the parents have adopted our modernized dietary, may have marked changes in the facial and dental arch forms. In our modernized white civilization this change occurs so frequently that in a considerable percentage of the families there is seen a progressive narrowing of the dental arches in the succeeding children of the same family. Since the position of the permanent teeth which erupt at from seven to twelve years of age, can be determined by x-rays early in child life, this procedure provides an opportunity to anticipate deformities that will make their appearance with the eruption of the permanent teeth.

In Fig. 131, may be seen the x-rays of the upper arches of three children. Even under conditions causing the permanent teeth to develop irregularly the deciduous dental arch will not show the deformity that will be expressed later in the permanent dental arch. The abnormal placement of the developing permanent teeth, however, will show the deformity that is later to be produced in the face even though the deciduous arch is normal in design. Both deciduous and permanent teeth can be seen at the same time. In Fig. 131 it will be seen that there is a progressive deformity revealed in the position of the permanent teeth in these three children. (Most severe in the youngest.) This narrowing of the curve made by the permanent teeth is a condition characteristic of a large number of individuals, occurring in at least 25 per cent of the families throughout the United States; in some districts the percentage will reach 50 to 75 per cent.

FIG. 131. X-rays of teeth of three children in one family show in the teeth and upper arch a progressive injury in the younger children as indicated by the progressive narrowing of the placement of the tooth buds of the upper permanent teeth. Note the narrowing curve of the arch.

Another striking illustration of this progressive injury in the younger members of the family, detected early by the x-rays, is shown in Fig. 132. Note the breadth of the arch of the permanent teeth of the oldest child (to the left), and the marked narrowing of the arch of the two younger children (to the right).

FIG. 132. These x-rays illustrate the progressive injury in the two younger children in this family. Note the progressive narrowing of the permanent arch illustrated by the lapping of the laterals over the centrals in the youngest, and decreasing distance between the cuspids.

While the application of orthodontic procedures for the improve- ment of the facial form and arrangement of the teeth will make a vast improvement in facial expression, that procedure will not modify disturbances in other parts of the body, such as the abnormal underdevelopment of the hips and pelvic bones. If an improvement in nutrition for the mothers-to-be is adequately provided in accordance with the procedures of the primitives, it should be possible to prevent this progressive lowering of the capacity of our modern women to produce physically fit children.

Fig. 133 is another illustration. The oldest child, ten years of age, is shown at the upper left. She has a marked underdevelopment of the width of the face and dental arches. The nostrils are abnormally narrow and she tends to be a mouth breather. She is very nervous and is becoming stooped. In the lower left photograph, is shown an x-ray of the narrowed upper arch. At the right is shown her younger sister, six years of age. It will be seen that the proportions of her face are much more normal and that she breathes with complete ease through her nose. She has none of the nervous trouble of her older sister. In the x-rays, below, at the right, it will be seen that her permanent arch, as indicated by the positions of the permanent teeth, although not so far advanced as that of her sister, has good design. The history of these pregnancies is of interest. The duration of labor for the first child was fifty-three hours and for the second three hours. Following the birth of the first child the mother was a partial invalid for several months. Following that of the second child the experience of childbirth made but slight impression on the strength and health of the mother. During the first pregnancy no special effort was made to reinforce the nutrition of the mother. During the second pregnancy the selection of foods was made on the basis of nutrition of the successful primitives. This included the use of milk, green vegetables, sea foods, organs of animals and the reinforcement of the fat-soluble vitamins by very high vitamin butter and high vitamin natural cod liver oil. It is a usual experience that the difficulties of labor are greatly decreased and the strength and vitality of the child enhanced where the mother has adequately reinforced nutrition along these lines during the formative period of the child.

FIG. 133. In this family the first child to the left was most injured in the formative period as shown in the form of the face and dental arches above and x-rays below. The first child required fifty-three hours of labor and the second three hours, preceded by special nutrition of the mother.

The problem of maternal responsibility with regard to the physical capacity of their offspring to reproduce a healthy new generation comprises one of the most serious problems confronting modern degenerating society. In a previous chapter I have discussed the difficulty that zoological garden directors have had in rearing members of the cat family in captivity. It has been a very general experience until the modern system of feeding animal organs was instituted, that unless the mothers-to-be had themselves been born in the jungle the lack of development of the pelvic arch would frequently prevent normal birth of their young. In the Cleveland Zoo a very valuable tigress, that had been born in captivity, found it impossible to give birth to her young. Although a Caesarian operation was performed, she lost her life. The young also died. One of the veterinaries told me that the pelvic arch was entirely too small to allow the young to pass through the birth canal. Studies of the facial bones of this animal showed marked abnormality in development.

The result of disturbance in the growth of the bones of the head and of the development of general body design is quite regularly a narrowing of the entire body, and often there is a definite lengthening. Statistics have been published relative to the increase in the height of girls in colleges during the last few decades. This is probably a bad rather than a good sign as actually it is an expression of this change in the shape of the body. I am informed by gynecologists that narrowing of the pelvic arch is one of the factors that is contributing to the increased difficulties that are encountered in childbirth by our modern generation.

A typical case illustrating the relationship between the lack of pelvic development and deformity of the face, is presented in Fig. 134. This girl presented a very marked underdevelopment of the lower third of the face which produced the appcarance of protrusion of her upper teeth so that it was quite difficult or impossible for her to cover them with her lips. An operation to improve her appearance consisted in removing the first bicuspid on each side above and then moving the bone carrying the anterior teeth backward with appliances, the width of the two removed teeth. This changed the relationship of the teeth as shown in the two upper views in Fig. 134. The operation greatly improved her facial appearance and she lost the inferiority complex which had prevented her from mingling with young people. When she went to the hospital for her first child, there was special concern because of her weak heart, and every effort was made to obtain a normal birth rather than one by Caesarian section. This proved impossible and the Caesarian operation was done. Great difficulty was experienced in saving the life of the mother and child. Her boyish figure, of which she had been so proud, and which had been a part of her serious deformity, during her formative period had nearly resulted in her undoing. She nursed her baby for some time but the overdraft of reproduction on her frail body was so great that she aged rapidly, her back weakened and she stooped forward as shown in Fig. 134, lower right. In the view at the lower left, it will be seen that the teeth remained in their new position. A point to keep in mind is that her physical deficiency was probably directly caused by an inadequate nutrition of her mother during the intrauterine development and prior to conception. It is, of course, possible that the father also contributed a poisoned germ cell that constituted a disturbance in the architectural design of the offspring. In this connection, it is important to have in mind the tragic influence of a program of deliberate starvation of mothers-to-be in order that the bones of the baby may be soft and thus provide an easy birth. Some literature has been published indicating the foods that would be efficient in accomplishing this. This means almost certain wreckage or handicapping of the child's life.

FIG. 134. This girl suffered with a serious deformity of her face. She also had very contracted pelvic arch. The facial deformity was improved as shown. She nearly lost her life with the birth of her first baby which was removed by Caesarian operation. Note her badly deformed back from the overload of reproduction.

Information from many sources may suggest that the expectant mother needs more calcium and more vitamin D. She may go to the pharmacy with a prescription or on her own initiative obtain calcium tablets and so-called vitamin D as a synthetic preparation. We are concerned here with data which will throw light on the comparative value of the treatment the modern mother will thus give herself with that that the primitive mother would provide.

Dr. Wayne Brehm who is associated with two Columbus, Ohio, hospitals has recently published the results (5) of a study of the effect of the treatment received in 540 obstetrical cases divided into six groups of ninety individuals each, on the basis on which their nutrition was reinforced in order to study the comparative effects of the different treatments. The reinforcement of the diet consisted in Group 1 of taking calcium and synthetic vitamin D as viosterol; Group 2, calcium alone; Group 3, viosterol alone; Group 4, calcium and cod liver oil; Group 5, cod liver oil alone and Group 6, no reinforcement. For those receiving the calcium and viosterol there was extensive calcification in the placentae, marked closure of the fontanelle (the normal opening in the top of the infant skull) and marked calcification in the kidneys. For those receiving calcium alone there was no placental calcification, slight closure of the fontanelle and no calcification of the kidneys. Group 3 receiving viosterol had moderate to marked placental calcification, moderate closure of the fontanelle and no calcification of the kidneys. Those receiving cod liver oil alone had very slight placental calcification, slight fontanelle closure and no calcification in the kidneys. Those receiving no reinforcement had very slight placental calcification, normal fontanelle closures and no calcification of the kidneys. The effect on the mother was a prolonging of labor in Group 1 and at birth the fetal heads were less moulded not being able to adjust their shape to the shape of the birth tube. These infants had a general appearance of ossification or postmaturity. This strongly emphasizes the great desirability of using Nature's natural foods instead of modern synthetic substitutes.

It is a matter of great importance that the most serious disturbances in reproduction and childbirth are occurring in the most civilized parts of the world. In Chapter 19 I have referred to the important work of Dr. Kathleen Vaughan entitled "Safe Childbirth." She has not only had wide experience among several tribes in India and in the British Hospitals but has collected a large quantity of information regarding the experience of many races throughout the world. Her data strongly emphasize the necessity that the growing girl shall be allowed to have an active outdoor life not only until the completion of the building of her body at about fourteen years of age, but through the child-bearing period. In practically all countries a restricted sedentary indoor life greatly increases the complications associated with childbirth. She quotes Whitridge Williams to the effect that: "At the onset of pregnancy the (males) are 125 to 100 (females), and he adds that sex is determined in the germ cells, primarily or immediately after their union, and is immutable by the time segmentation of the ovum begins." Notwithstanding this advantage, prenatal and infant mortality reduces the proportion of boys to a level below that of girls. Dr. Vaughan in her reference to the data on the annual report of the chief medical officer, the Minister of Health, states as follows:

Our infant mortality returns show that over half the number of infants dying before they are a year old die before they have lived a month (and 6,744 of them before they are twenty-four hours old), strongly suggesting that their vitality was impaired by the process of birth. The figures of those who did not survive one month are 20,060, and of these more than half are males. So we lose over ten thousand boys every year under a month old! (Public Health Report, No. 55, British). Hear what Dr. Peter McKinley has to say on the subject. "The death rate of infants in the period immediately subsequent to birth is nine times as high as that which occurs later in the first years of life." He shows how the difficulty experienced by the mothers during parturition leads to the death of infants at and just after birth, and says in this connection, "Infant deaths under a month are significantly associated with the death rates of mothers in childbearing." He quotes Netherland statistics showing that of stillbirths due to difficulty during birth, male stillbirths predominate, and says, "These figures might be taken in support of the view that the greater size of the male head is a cause of some greater difficulty in labour than there is with a female birth." Here, indeed, in civilized childbirth is the laboratory where the sex of the population is finally determined-the actual births of boys and girls are nearly equal in number, but the small ones slip through; the larger children are the ones who are killed during birth, or so damaged that life is heavily handicapped, and we are left with an enormous surplus female population. This destruction of male infants, which goes on day by day and year by year, puts the consequences of the Great War into the shade. Our surplus female population (now reaching over one and a half million in excess of the male) is directly due to it. We have no need of Pharaoh's midwives to kill our boys off at birth (Exodus i. 16). Civilization does it unaided, for all civilized races as they pass their zenith and are on the downgrade have eventually had to face the same problem, the outnumbering of men by women, and most of them have met it as the East does to-day by female infanticide. A more intelligent policy would be to prevent the males dying at birth. We see that difficult childbirth leads to a high maternal mortality, but it is also the cause of a high infant mortality falling most heavily upon the male infants, and it is also responsible for the production of mental defectives in ever-increasing numbers.

Dr. Vaughan's work places emphasis on the necessity that the human body be properly built, especially that of the mother-to-be. She shows clearly that the shape of the pelvis is determined by the method of life and the nutrition. In all primitive tribes living an outdoor life childbirth is easy and labor is of short duration. She shows that this is associated with a round pelvis and that the distortion of the pelvis to a flattened or kidney shape, even to a small degree, greatly reduces the capacity and therefore the ease with which the infant head may pass through the birth canal. In Dr. Vaughan's wide experience she has observed two ways by which a rough estimate of the pelvic shape and capacity may be anticipated: first, by the gait of the individual, because the angle of the hips is determined by the shape of the pelvis; and second, by the teeth and jaws. She has recognized an association between facial and dental arch deformities and deformed pelvis.

During my investigations in eastern Australia I was informed that the birth rate among the whites had declined over a large area and to such an extent that many families had no children and many women could produce only one child. The diets used in that district were very largely refined white-flour products, sugar, polished rice, vegetable fats, canned goods and a limited amount of meat. The alarm regarding the declining birth rate in Australia has recently been a matter of discussion by the New South Wales legislature as indicated by an Associated Press dispatch from Sydney, Australia, dated August 1, 1938: "A 'stork derby' with sweepstakes prizes was proposed in the New South Wales Legislature today to boost Australia's falling birth rate."

A report just received from the Bureau of Home Economics, Department of Agriculture, Washington, presents figures for the average amount of the various foods used in different income groups in different parts of the United States. These showed that in general about one-third of the income up to $2500 was spent for food per family; further, that the total flour equivalent ranged from 0.39 to 0.50 pound per capita per day. These quantities will furnish about 829 to 1063 calories per day, per capita. It will be seen at once that this provides a large number of the calories required for growing children and sedentary adults per day. With this number of calories derived from refined flour products there is no adequate provision for a normal amount of such body-building materials as minerals and vitamins. These have been removed, largely, in the milling process, and are largely denied to our modern civilization insofar as the cereal foods are concerned. This includes vitamin E, so essential for the functioning of the pituitary gland, the master governor of the body.

One of the most important lessons we may learn from the primitive cultures is the detail of their procedures for preventing dental caries. Since I have devoted an entire chapter (Chapter 16) to this I will make only a brief comment here. Simply stated, the practical application of the primitive wisdom for accomplishing this would involve returning to the use of natural foods which provide the entire assortment of bodybuilding and repairing food factors. This means the recognition of the fact that all forms of animal life are the product of the food environments that have produced them. Therefore, we cannot distort and rob the foods without serious injury. Nature has put these foods up in packages containing the combinations of minerals and other factors that are essential for nourishing the various organs. Some of the simpler animal forms are able to synthesize in their bodies some of the food elements which we humans also require, but cannot create ourselves. Our modern process of robbing the natural foods for convenience or gain completely thwarts Nature's inviolable program. I have shown how the robbing of the wheat in the making of white flour reduced the minerals and other chemicals in the grains, so as to make them sources of energy without normal body-building and repairing qualities. Our appetites have been distorted so that hunger appeals only for energy with no conscious need for body-building and repairing chemicals.

A first requisite for the control of tooth decay is to have provided an adequate intake of the body-building and repairing factors by the time the hunger appeal for energy has been satisfied. A sufficient variety of foods must be used to supply the body's demand for those elements which it needs in large quantities, that is, calcium and phosphorus, and the other elements which it needs in smaller quantities, though just as imperatively. One of the serious human deficiencies is the inability to synthesize certain of the activators which include the known vitamins. This makes necessary the reinforcement of the nutrition with definite amounts of special foods to supply these organic catalysts, especially the fat-soluble activators, including the known vitamins, which are particularly difficult to provide in adequate quantities. I have shown that the primitive races studied were dependent upon one of three sources for some of these fat-soluble factors, namely, sea foods, organs of animals or dairy products. These are all of animal origin. I have indicated in Chapter 16 the nutritional programs that have proved in clinical testing adequate for providing the body with nutrition that will not only prevent tooth decay, but check it when it is active. The stress periods of life, namely, active growth in children and motherhood, do not constitute overloads among most of the primitive races because the factor of safety provided by them in the selection of foods is sufficiently high to protect them against all stresses. I have indicated the type of nutrition that is especially needed for these stress periods in our modern civilization. Also, that it is not necessary to adopt the foods of any particular racial stock, but only to make our nutrition adequate in all its nutritive factors to the primitive nutritions. Tooth decay is not only unnecessary, but an indication of our divergence from Nature's fundamental laws of life and health. (See Chapter 16 for primitive menus.) The responsibility of our modern processed foods of commerce as contributing factors in the cause of tooth decay is strikingly demonstrated by the rapid development of tooth decay among the growing children on the Pacific Islands during the time trader ships made calls for dried copra when its price was high for several months. This was paid for in 90 per cent white flour and refined sugar and not over 10 per cent in cloth and clothing. When the price of copra reduced from $400 a ton to $4 a ton, the trader ships stopped calling and tooth decay stopped when the people went back to their native diet. I saw many such individuals with teeth with open cavities in which the tooth decay had ceased to be active.

In undertaking to make practical application of primitive wisdom to our modern problems, the field is so broad that only a limited number of items may be included. It is important to emphasize the difference between the procedures used in the preparation of boys and girls for life in many of the primitive groups, and in our modern social organization. Few people will realize the remarkable training given the primitive children, with the fathers and mothers as tutors. To illustrate, among the Indians of the far North in Canada near the Arctic Circle, the girls rather than the boys select a companion for life. This is done with the help of her parents. Before a boy is considered worthy of consideration he must demonstrate that he can build the winter cabin, provide the firewood for maintaining the home of the parents, and all of the provisions of wild game, during the trial period of several weeks. After an adequate demonstration of bravery as well as of skill, in which the boy must kill a grizzly bear, he is accepted into the home for a period of trial marriage. The girl has the privilege of making her choice by trial, but when the choice is made there is complete faithfulness on the part of both. Girls are prepared for life's duties by being taught to make clothing, prepare food, care for children and assist in the maintenance of the home. I have seldom, if ever, seen such happy people as these forest Indians of the far North.

In Chapter 10, in discussing the Australian Aborigines, I have similarly described the preparation of boys for the responsibility of manhood. No modern college graduate has to win his spurs under more exacting examinations and tests than do those boys.

In Africa several specialties call for special training. The medicine men spend several years under the training of a tutor. Each boy must provide a specified number of cattle per year which are eaten by the group.

Probably the most indelible impression that is left by my investigations among primitive races, is that which came from examining 1,276 skulls of the people who had been buried hundreds of years ago along the Pacific Coast of Peru and in the high Andean Plateau, without finding a single skull with the typical marked narrowing of the face and dental arches, that afflicts a considerable proportion not only of the residents in modernized districts in Peru, but in most of the United States and many communities of Europe today. I know of no problem so important to our modern civilization as the finding of the reason for this, and the elimination of the cause of error. Perhaps few will recognize the significance of this important point. This may be the reason why the prospect is not encouraging.

One of the important lessons we should learn from the primitive races is that of the need for maintaining a balance beween soil productivity, plant growth and human babies. Even in a country with so low a fertility as obtains in the greater part of Australia, the Aborigines for a very long period were able to maintain this balance. Their system of birth control was very efficient and exacting.

A survey made by a committee appointed by the League of Nations indicates the need per capita of approximately one-half acre of land for wheat, two acres for dairy products, and ten acres for beef producing pasture for the supply of meat. When we realize that Ohio has been occupied by our modern civilization for only one hundred fifty years and that it is estimated that during that time approximately half of the topsoil has been lost through water and wind erosion we realize that Nature's accumulated vegetable enrichment has been greatly reduced in this area within a short time from this one source alone. In Chapter 20 I have shown that there is only enough phosphorus in the top seven inches of agricultural land for approximately fifty crops of high-yield wheat or one hundred crops of moderate-yield. Other grains make similar drafts upon the land. I have given data indicating a relationship between progressive soil depletion and progressive increase in heart disease.

It is apparent that the present and past one or two generations have taken more than their share of the minerals that were available in the soil in most of the United States, and have done so without returning them. Thus, they have handicapped, to a serious extent, the succeeding generations, since it is so difficult to replenish the minerals, and since it is practically impossible to accumulate another layer of topsoil, in less than a period of many hundreds of years. This constitutes, accordingly, one of the serious dilemmas, since human beings are dependent upon soil for their animal and plant foods, for body-building. The minerals are in turn dependent upon the nutritive factors in the soil for establishing their quality. The vitamin and protein content of plants has been shown to be directly related to availability of soil minerals and other nutriments. A program that does not include maintaining this balance between population and soil productivity must inevitably lead to disastrous degeneration. Over-population means strife and wars. The history of the rise and fall of many of the past civilizations has recorded a progressive rise, while civilizations were using the accumulated nutrition in the topsoil, forest, shrubbery and grass, followed by a progressive decline, while the same civilizations were reaping the results of the destruction of these essential ultimate sources of life. Their cycle of rise and degeneration are strikingly duplicated in our present American culture.

Various therapeutic measures in use today have come to us from primitive peoples. One of the greatest scourges of the world is malaria fever. Everywhere it has been fought successfully with quinine. Indeed, many parts of the world would not have been tenantable for whites without it. Yet few people realize that quinine was the gift of the ancient Peruvian Indians.

In Chapter 15 I presented data regarding the treatment used by several primitive races for preventing and correcting serious disturbances in the digestive tract. This consisted in the use of clay or aluminum silicate which modern science has learned has the important quality of being able to adsorb and thus collect toxic substances and other products. Important new light is now thrown on the probable role of this substance in the primitive diet and its possible application in our modern problems of sensitization reactions or allergies. In the first volume of my work on "Dental Infections," I presented data relating toxic sensitization reactions to dental infections. These were shown in both animals and human beings. I discussed the relation of these reactions to histamine and emphasized their similarity to the effect produced by inocculation with histamine. An important new chapter has recently. been added to this problem by the work of Dr. C. F. Code for which he has received an award by the American Association for the Advancement of Science. He reported his findings before the Association meeting at Richmond, Virginia, in December, 1938. Dr. Code has apparently discovered that histamine is the actual product responsible for the symptoms of the various allergies. Its excess accumulation in the blood is the actual cause of the symptoms whether expressed as asthma, hay fever or skin eruptions such as produced by pollens, various foods, dust and other sensitizing agents. He has shown that the eosinophils, a type of white blood cell, are the source of excess histamine in the blood. It is accordingly indicated that the primitive treatment by the use of kaolin, aluminum silicate, as an adsorbent was used directly for controlling such symptoms. It is now further indicated that this treatment can be helpful for the prevention of modern allergies. Previous investigations have shown that histamine is produced in the alimentary tract as a putrefaction product of proteins by the action of certain micro-organisms of the colon group.

Modern science boasts the discovery of vitamin C, lack of which took its toll of thousands of the white mariners through hundreds of years with scurvy. The first recorded cure of that disease was made by the Indians in Canada when the British soldiers were dying in large numbers. The Indians taught them to use a tea made from the steeped tips of the shoots of the spruce. When I was among the Indians of the far north I asked a chief why the Indians did not get scurvy. He then proceeded, as I have related in Chapter 15, to explain to me how the Indians prevented scurvy by the use of special organs in the animals. While it is true that we have come to associate the absence of vitamin C as the causative factor in scurvy, we do not know how many other affections may be due to its absence in adequate quantity in our foods. Almost weekly, new diseases are being associated with vitamin deficiencies in our modern dietaries.

One of our modern tendencies is to select the foods we like, particularly those that satisfy our hunger without our having to eat much, and, another is to think in terms of the few known vitamins and their effects. The primitive tendency seems to have been to provide an adequate factor of safety for all emergencies by the selection of a sufficient variety and quantity of the various natural foods to prevent entirely most of our modern affections. Their success demonstrates that their program is superior to ours. An important advance in modern international relationships provides for exchange of professorships and, thus, interchanges of wisdom. We have shown a most laudable and sympathetic interest in carrying our culture to the remnants of these primitive races. Would it not be fortunate to accept in exchange lessons from their inherited knowledge? It may be not only our greatest opportunity, but our best hope for stemming the tide of our progressive breakdown and also for our return to harmony with Nature's laws, since life in its fullness is Nature obeyed.

As I have sojourned among members of primitive racial stocks in several parts of the world, I have been deeply impressed with their fine personalities, and strong characters. I have never felt the slightest fear in being among them; I have never found that my trust in them was misplaced. As soon as they had learned that I was visiting them in their interest, their kindness and devotion was very remarkable. Fundamentally they are spiritual and have a devout reverence for an all-powerful, all-pervading power which not only protects and provides for them, but accepts them as a part of that great encompassing soul if they obey Nature's laws.

Ernest Thompson Seton has beautifully expressed the spirit of the Indian in the opening paragraph of his little book "The Gospel of the Red Man":

The culture and civilization of the White man are essentially material; his measure of success is, "How much property have I acquired for myself?" The culture of the Red man is fundamentally spiritual; his measure of success is, "How much service have I rendered to my people?"

The civilization of the White man is a failure; it is visibly crumbling around us. It has failed at every crucial test. No one who measures things by results can question this fundamental statement.

The faith of the primitive in the all-pervading power of which he is a part includes a belief in immortality. He lives in communion with the great unseen Spirit, of which he is a part, always in humility and reverence. Elizabeth Odell in the following lines seems to express the spirit of the primitives,

Flat outstretched upon a mound
Of earth I lie; I press my ear
Against its surface and I hear
Far off and deep, the measured sound
Of heart that beats within the ground.
And with it pounds in harmony
The swift, familiar heart in me.
They pulse as one, together swell,
Together fall; I cannot tell
My sound from earth's, for I am part
Of rhythmic, universal heart.

REFERENCES

JACOBSON, A. C. Genius (Some Revaluations). New York, Greenburg, 1926.
BRASH, J. C. The etiology of irregularity and malocclusion of the teeth. Dental Board of United Kingdom, London, 1930.
Waverly researches in the pathology of the feeble-minded (Research series, cases XI to XX). Mem. Am. Acad. Arts & Sci., 14:131, 1921.
DRUMMOND, J. C. The Medical Aspects of Decline of Population. J.A.M.A., 110:908, 1938.
BREHM, W. Potential dangers of viosterol during pregnancy with observations of calcification of placentae. Ohio S. M. J., 33:990, 1937.

THE END