UNIVERSITY OF CALIFORNIA AT LOS ANGELES "V HEALTH AND SOCIAL PROGRESS BY RUDOLPH M. BINDER, PH.D. Professor of Sociology, New York University NEW YORK PRENTICE-HALL, INC. 1920 COPYRIGHT. 1920 BY PRENTICE-HALL, Inc. A NON-MEDICAL BOOK v , \ Dedicated to the Medical Profession The only one which has never used its knowledge for inflicting wounds on Mankind, but always for healing them; and is now to an ever-increasing extent applying '. that knowledge to the prevention of disease and the * promotion of Health and Happiness. Man's rise from the level of the animal to that of a civilized human being has been due chiefly to his own efforts. While he depended on nature at first, owing to his limited intelligence, he rose higher in pro- portion as he used his mind in making it his servant. Proofs to this effect are accumulating every day. Cli- mates which were deadly once, are now becoming fruit- ful places for his enterprise. Fears which once terrorized him have been relegated into the realm of superstition. Diseases which once were deemed unavoidable now yield to scientific treatment. In the air and in the water, from the Arctic to the Antarctic, from the cradle to the grave, he becomes increasingly the master of nature and of his own fate. CONTENTS PACK PREFACE i PART I I. INTRODUCTION 3 II. MEANING OF HEALTH 15 III. HEALTH AND RELIGION 32 IV. FACTORS OF HEALTH . . . . .43 V. HEALTH AND CIVILIZATION .... 53 PART II VI. HEALTH AND ANCIENT GREECE ... 81 VII. HEALTH AND ANCIENT ROME . . . 106 VIII. EFFECTS OF ILL HEALTH ON THE CLASSICAL WORLD Ill IX. HEALTH AND THE TROPICS .... 124 X. HEALTH AND WORLD-PROGRESS . . .142 XI. HEALTH AND WORLD- PROGRESS (Continued) 178 XII. HEALTH AND WORLD- PROGRESS (Concluded) 208 XIII. HEALTH AND ORIGINALITY .... 241 XIV. RESULTS AND PROSPECTS .... 272 INDEX 293 PREFACE THE population of the earth in 1800 was approximately 600,000,000; in 1900, it was about 1,600,000,000 an in- crease of nearly 270 per cent. If, during the twentieth century, there should be a similar increase and the indi- cations are all in that direction the population in the year 2000 will be about 4,320,000,000. The question arising then will be, Where shall we get food? The time will not even then have arrived when, accord- ing to Fourier, our scientists will be able to turn the rocks of our mountains into bread and cakes, or the brine of the oceans into most delicious lemonade. The question will have to be faced in a matter-of-fact way instead of dreaming about it in a romantic fashion. Roughly speaking, two forms of answers have been given that of the pessimist and that of the optimist. Among the pessimists we may reckon all those whose profession or attitude compels or inclines them to look backward. They have paid a heavy price for doing so, since no one can look into the past constantly without getting a wry neck and having his thought twisted. These people gloomily predict an increasingly more severe struggle, since, if it is only with the utmost difficulty that the present population maintains itself, what must happen if the population is nearly three times as large ? Civiliza- tion will be doomed, or be confined to a few favored spots ; anarchy will prevail, and the second state of man- kind will be infinitely worse than the first, because men have learned how to do more harm than ever before. The optimist believes in human nature. He, too, looks i ii PREFACE backward, but his eye is not glued to the past. True, things are bad; but the study of the past has taught him that they were worse before. Man has not only evolved, he has developed. His struggles in the past have taught him the all-important lesson of cooperation. He is not dismayed by a growing population, because he finds that men in 1900 are better fed and clad, more sympathetic and helpful to each other than they were in 1800. Density of population is a purely relative term. There were never more than 1,000,000 Indians in the territory now occupied by the United States. Yet, the few Indians found the land too small, and waged constant wars for hunting grounds. The hundred million Americans are on the whole satis- fied, and engage only in wars of words about the best methods of improving things. The optimist believes with good reason that with increasing intelligence and good will, problems will be solved as they arise. But more than that. He tries to shape events in such a manner that they shall produce certain results. And he points to the achievements of man in the past and present, and confidently hopes that more will be accomplished in the future. In other words, the difference is that between the believer in the supremacy of natural law and the student of it for the purpose of utilizing it. The animal and the savage are subject to natural law, civilized man has liberated himself from it to a considerable extent by studying it. And he hopes that with a more intimate knowledge of nature he will construct a social system and build up a civilization, which will be able to support a very much larger population in a better manner than at present. Man has always conquered when he has gone to work PREFACE iii intelligently and persistently about a problem. Only when he believed that some natural force was superior to him, was he defeated. Our whole civilization is unnatural in the sense that it has been wrung from parsimonious nature by the persistent application of human intelligence. To believe that with increasing knowledge we should be less capable of solving our problems, would mean to despair of ourselves and condemn our whole development. The scientist may say with justice that he is not con- cerned with the whither of his findings, that the facts alone matter, irrespective of whether they are encourag- ing or discouraging. That is true ! But he must then take a sufficiently large number of facts into considera- tion. Psychic experiences are facts as much as rain and sunshine. The will to conquer is as important as the natural fertility of a valley. Just because civilization has been largely determined in the past by natural condi- tions, is no reason why it should always be so. If the tropics have been uninhabitable in previous ages owing to certain diseases or climatic conditions, we need not despair of making them serviceable to the teeming mil- lions of the future. This brings us back to our original question. Where are the billions of the future to get their food ? We have pushed north nearly as far as we can go. Ice-clad Siberia and snow-bound Alaska are giving us their products in food and minerals. But we shall soon have to turn south to the tropics, where nature rewards even the most inefficient labor with rich harvests. And the problem will arise, how are we going to conquer that vast territory from whence a large amount of our food must come ? In the past man had no solution, because he was both ignorant and cowardly. And his ignorance has exerted a vast influence upon the history of civilization. iv PREFACE It was chiefly in the line of protecting himself against srtain diseases that he was deficient. We have just begun to master these, and with this mastery the con- quest of the tropics is certain. Health, in other words, has been the most important factor in the development and extension of civilization. In looking beneath the surface of historic events we find that only those nations which enjoyed at least fair health, have been able to make some permanent contri- bution to the welfare and enlightenment of their con- temporaries and of future generations, because they alone had sufficient energy to procure more than the immediate necessaries for themselves. Other nations merely ex- isted ; and in many cases we know of them only through their contact with the healthy and vigorous peoples who usually had no difficulty in enslaving them. It would be impossible to treat the effects of every disease known to modern medicine upon the nations of the past. An interesting book might be written about the influence of tuberculosis on civilization, especially since people began to gather in cities. The so-called " social diseases " have undoubtedly played a large role in the fall of Egypt, Greece, and Rome. But these diseases, widespread as they were, affected after all only indi- viduals, and not whole populations. They could, more- over, be guarded against by living in the open air and by living a moral life. Two diseases malaria and hookworm have accord- ingly been selected for showing the influence of poor health upon many races. They have always existed in historic times at least, and have been a drawback to by far the majority of the people living in the tropics, sub- tropics and the lower latitudes of the temperate zones. Estimates place the number of people living today in the PREFACE v malaria and hookworm zones at approximately one bil- lion. These diseases have been endemic in this large area from times immemorial, and are responsible for the low vitality prevailing in those regions. Being endemic, there was but little chance for anyone in that territory to escape their ravages. Three factors favored the practically un- checked course of these diseases. In the first place, but few people died directly as a result of contracting one or both of them ; thus little was done by men to protect themselves against an attack, as they did, however inadequately, against epidemics. In the second place, there was the general religious and philo- sophical tendency of the people to look upon diseases of any kind as a visitation from some deity whose wrath had been provoked by their disobedience. In the third place, these people had in the vast majority of cases no r , idea of the true nature of disease and, consequently, no conception of how to cure and prevent it. The specific for malaria quinine has been known to Europeans only since the seventeenth century, and the knowledge of its curative properties is even now confined to civilized peoples. There was, therefore, no escape for individuals and races living in the infested territories. With the beginning of the twentieth century an entirely new page opened in the history of mankind, for we not only know now the nature of these and other diseases, but also the remedies to cure and the means to prevent them. We have learned, moreover, that health and long life, which were looked upon as gifts of the gods, are matters having a relation to cause and effect, and are dependent on the proper observance of hygienic rules and on the establishment of sanitary precautions. There is no longer any excuse now why there are probably at all ) times 3,000,000 people ill in the United States, making vi PREFACE an average of thirteen days of illness per annum for each inhabitant, or why 600,000 persons should die prema- turely from preventable diseases. This means not only a tremendous economic loss, but much needless suffering for both the patients and their families. Of other bearings on good health, mention need only be made of the fact that any other gift or talent we may have, loses much of its power to make us happy if our V health is below normal. A man may have the wisdom of oSolomon, but with poor health his usefulness is reduced one-half. A few men of exceptional ability have done valuable work notwithstanding poor health; they were, however, surrounded and assisted by others who took every burden off their shoulders. This was the case with Herbert Spencer and Charles Darwin. Of what value good health would have been to these men, they themselves have repeatedly and emphatically expressed. The view that there is generally a close connection be- tween poor health and low morals is becoming more permanently established on the basis of scientific investi- gations. A better and more intelligent pursuit of health would, consequently, assist in solving some of our moral problems. Another case may be mentioned. During the winter of 1913-14 New York and other large cities had many un- employed men and women. A careful examination of 2,000 of these men in the Municipal Lodging House of New York brought out the fact that about seventy-five per cent of them were below the normal in health, not as a result of exposure or chronic starvation, but of poor constitution. During the winter of 1914-15 an estimated number of unemployed of 400,000 resulted in the creation of a committee on unemployment, headed by the Mayor and some of the most influential business men. Very PREFACE vii little has been heard of its efficiency in procuring jobs for these people. But if the total percentage of low-vitality men among these " out-of-works " should be only fifty per cent reckoning those in the municipal lodging house to have constituted the lower strata of the unemployed it would seem rather useless to provide jobs for people who cannot hold them. Many men are unemployable not because they are unwilling to work but simply because their vitality is too low to stand the strain of regular application to work. It would seem that an investigation into the physical fitness of these people would be getting nearer the root of the trouble than more or less futile attempts to procure work for them which after a few brave but vain efforts they cannot perform. There is always a large amount of unemployment during the winter, owing to season work and other causes. But the healthy worker will save a little during employment, his lodge and his friends will help him out, and under normal conditions he is able to tide over the winter. Only when abnormal industrial conditions swell the number of the unemployables by large numbers of healthy employables, does the situation become acute. If the low-vitality men and women should number only 200,000 in New York City, the inference seems justified that they are supported by their families all the time, and are thus responsible for the depressed financial condition of these families. This inference is borne out by a study of the One Hundred Neediest Cases of New York, published by the Times for several years. An analysis of these cases shows that fully fifty per cent of them are due either directly to disease or to low vitality. Better attention to health and sanitation would tend to solve this problem to a considerable extent. Our educational systems are failing to meet the ex- viii PREFACE pectations of the more advanced members of the com- munity, especially those of physicians, because they at- tempt to convey much useless information to children whose prime need is better health. The British govern- ment spends about 15,000,000 a year on education. In many of the colonial schools colored children, suffering from malarial enlargement of the spleen, are taught the dates of the succession of the Plantagenet Kings, while little or nothing is done for their health. Other countries are doing more in this direction, notably Sweden, Germany, and the large cities of America. The culture of health has, however, nowhere been given the central position which it should occupy in a rational educational system. Yet that is necessary for a wholesome national development. That this statement is true may be inferred from the facts presented herewith. Dr. S. Josephine Baker published the following statis- tics in The Ladies' Home Journal, for May, 1918 (page 89). " There are in the schools of the United States today approxi- mately 20,000,000 pupils. It is estimated that: "300,000 to 400,000 of these have organic heart disease. " 1,000,000 at least have now, or have had, tuberculous disease of the lungs. " 1,000,000 have spnial curvature, or are flatfooted, or have some other deformity serious enough to interfere to some degree with health. " 1,000,000 have defective hearing. "5,000,000 have defective vision. " 5,000,000 are suffering from malnutrition, in many cases due in part at least to one or more of the other defects enumerated. " 6,000,000 have enlarged tonsils, adenoids, or enlarged cervical glands which need attention. "10,000,000 (in some schols as high as 98 per cent) have PREFACE ix defective teeth which are potentially if not actually detrimental to health. " Several millions of the children possess, each, two or more of the handicapping defects. " 15,000,000 of the school children in this country are in need of attention today for physical defects which are partially or completely remediable." For New York City, we have the following data : In 1917, 247,735 children were examined by school physicians; 86,311 of these were found to suffer from various defects; 104,587 were found to suffer from de- fective teeth exclusively. This makes a total of 190,898, certainly a very high percentage of the children ex- amined. The cost of health supervision of the children in the schools of New York was 42 cents per child in 1915. This is a very small amount of the total per capita cost of educating a child, which is $40 per year. These few figures show that we are not spending nearly as much on health in our schools as we should. Much of the perverse thinking and acting both among children and among adults is undoubtedly due to low vitality, or actual physical defects. A brain that is poorly nourished readily becomes the host of all kinds of wild ideas and the country has to pay for it in various forms of expenditure for these misfits in society. The importance of one of the diseases considered in this book has been brought home to our generation by two facts of the present world war the Allied Army in Macedonia, and the building of the cantonments of the American National Army. Considerable surprise, if not annoyance, has been ex- pressed at the comparative inactivity of the army in Macedonia, consisting of aooroximatelv 750,000 men, x PREFACE Measured by what has happened on other fronts of the world war, this army has done practically nothing. Sur- mises of every possible nature have been advanced as an explanation for this lack of activity. Those who were in that field knew the reason, but it seemed hardly credible to people not familiar with the ravages of malaria. Lest the author be accused of exaggerating, a quotation from a man who has studied these conditions will be given in order to show that the most dangerous enemy of that army was neither the Turk nor the Bulgar, but the malaria-bearing mosquito. Herbert Corey gives the fol- lowing description of the effects of this endemic disease in the National Geographic Magazine for May, 1917. " the malaria-bearing mosquito is a really dangerous en- emy. Last year the Allied troops did not realize what the Macedonian mosquito can do, apparently. They were not pre- pared. In consequence fully one-half of their strength was out of action because of malaria. "During one period more men were invalided home than arrived on ships. I heard of battalions with 75 per cent of their men on their backs, and of companies in which only five men were fit for duty." It will take time and skill to remove this enemy, because Macedonia is malaria-ridden, just as Greece is today and has always been since the time of Pericles. For the cantonments of our National Army the best sites available from the point of view of health and sanitation were selected in 1917. It was, nevertheless, necessary in all cases to spend large sums of money in perfecting such arrangements, and in all the cantonments located in the Southern States to pay special attention to malaria. Around Camp Pike, near Little Rock, Arkan- sas, an area of about seventy miles had to be rendered mosquito free, although it is located approximately 200 PREFACE xi feet above the river plane. This great care shows that our experience in the Panama Zone has not been for- gotten, and that our army surgeons are fully aware of the danger lurking in malaria against the efficiency of an army. Whatever aspect of society we may consider, whether it be the arts of peaceful civilization, or the clashing arms of war, or the depressing problems of social in- efficiency or the future of the nation, we are always led back to health as a fundamental factor in social progress. RUDOLPH M. BINDER. New York University, *. November, 1919. PART I GENERAL RELATION OF HEALTH TO SOCIETY CHAPTER I INTRODUCTION HEALTH has been the greatest factor in the history of man, since it is the strong and healthy nations which have in the end conquered their richer and, perhaps, more civilized neighbors. For man had to contend not only with man in the struggle for existence, but with beasts and parasites. The battle against the beasts was decided long before the historic period, but that with man and parasites still continues. In his fight against disease germs man has frequently succumbed. Whole tribes and even nations have been wiped out by the plague, cholera, and even less virulent diseases. And even to this day, in his battle with man, the parasites play an im- portant role, since the nation which knows how to control, or at least, change the activity of dangerous micro- organisms has an advantage of great importance over its enemy. In times past, when no such knowledge existed, the nation which lived in regions comparatively free from parasites, was always able in the course of time to defeat its more numerous, richer, and more civilized enemy. History is hardly more than an endless repetition of victories by peoples coming from the north or the mountains localities less infested with disease germs over peoples living in rich and fertile plains, where these germs found more favorable conditions for breed- ing. From another point of view health has been of the utmost importance, that of civilization. Why have the 3 4 HEALTH AND SOCIAL PROGRESS tropical and sub-tropical countries never attained to a permanent civilization? In almost every part of the world have civilizations sprung up around the latitudes of the Cancer and of the Capricorn, only to flourish for a short time, and perish when conditions were apparently propitious for a higher development. Reasons of vari- ous kinds have been assigned for this short life, im- morality, luxury, infidelity, degeneracy, political oppres- sion, and almost everything else which the fertile imagina- tion of past and present day writers could conjure up. All these reasons undoubtedly had something to do with the ruin of ancient civilizations, but they operated only indirectly, and were themselves results rather than causes. It is only recently that medicine, with its study of tropical diseases, has revealed the true cause, ill- health owing to the inability of former generations to combat disease-breeding parasites. For without physical health, no high and no permanent civilization is possible. If ill-health attends a people day after day, it lacks the ability to build up strong and vigorous bodies and large, sound brains. It is, consequently, compelled to reduce its activities to the absolutely necessary minimum, since a sick man does not act or think any more than he is compelled to in order to preserve life. No civilization can be built up, however, in that way. It requires great physical activity, and, above everything else, a clear and vigorous brain to invent schemes for freeing man from the thraldom of physical toil. For only in propor- tion as man succeeds in making nature do his work, is he able to attain leisure and to save time and energy for the development of art, science, philosophy, and litera- ture. Civilization has, consequently, a mental basis even in its material aspects of machinery and other labor- saving devices, and consists essentially in the ability to INTRODUCTION 5 enjoy free mental activities along lines which give men pleasure, just because they are not needed for physical maintenance. These activities are, however, wholesome in proportion as the body is sound and vigorous, since out of the poorly nourished brain of a chronic dyspeptic or the disordered brain of a maniac all kinds of strange fancies proceed, which are neither sound nor sane. Physical health is, therefore, an essential element in the origination and maintenance of civilization. This fact has been almost entirely overlooked by his- torians, theologians, philosophers, and even some sociolo- gists. Human beings have been treated as if they were minds without bodies. Writings dealing with the history of man in its various aspects contain almost no references to health or disease except occasionally in very detailed biographies or when a war or an epidemic carried off thousands of people. This silence is, of course, due to the supposed independence of mental states from bodily conditions, survivals of which we have in the various forms of mental or faith healings of modern times, and in our attitude toward morality. Moralists and theologians require conformity and obedience to rules which are plainly intended only for well men. Kant's dictum, " Thou canst, because thou must ! " is evidently teaching of this kind, because, by implication at least, the person who recognizes a duty is able to impose his will upon even a weak and diseased body, and make it do the work of one that is well and strong. This attitude has passed over into our legal codes, and we often punish a man by confinement in jail or prison, when we ought to send him to the hospital or to a colony for the feeble-minded. Health seems to be either assumed or to be ignored in the treatment of man. The Puritan considered a 6 HEALTH AND SOCIAL PROGRESS reference to his physical condition as sinful or at least indelicate, while most historians were either silent about the body or treated it with more or less open contempt. Some writers openly expressed their views regarding the body as an obstacle to the mind's progress. " O wretched man that I am ! Who shall deliver me from this body of death?" says St. Paul (Romans 7:24). In Schiller's " Ideale und das Leben " the body is depicted as " sink- ing, sinking, sinking," as the mind now freed from its heavy encumbrance rises higher and higher. This neg- lect and contempt of the body goes back to ancient times, and it will be necessary to treat the attitude of past generations in regard to this problem at least briefly. It is certainly strange that such an important fact as physical health should not only have been neglected, but in many cases distinctly discouraged. Religion and philosophy have been the greatest sinners in this respect through their mistaken notion that the body was the seat of sin and hence an obstacle to the development of the spirit, while science has always taken a lively and sympa- thetic interest in fine, healthy physiques. Savages have, as a rule, paid more attention to the body than civilized peoples, because the exigencies of their condition always called for whatever physical strength, skill, prowess, and endurance they could muster; hence the great pains taken with the physical education of boys, and the care taken by the warrior of his health that he might either attain the chieftancy or retain it. Since efficiency was measured in warlike qualities, it was neces- sary that the body should be made chiefly an instrument for fighting; this involved, however, incidentally an all- round development and a certain amount of hygiene. The comparatively few children who survived the hard INTRODUCTION 7 conditions of life were the most vigorous, and perpetuated their strength through their own offspring. The Hebrews are conspicuous from this point of view chiefly for their laws concerning physical cleanliness and purification the effects of which are noticeable to this day, since a race has been created with strong physical tenacity and a high vitality, notwithstanding the confining life of the Ghetto. Among the Greeks, the Spartans stand out prominently in this respect, since they trained both men and women with the greatest care ; the former to be efficient warriors, the latter efficient mothers. The Athenians undertook physical training primarily for the sake of enjoyment ; it was a disgrace for a gentle- man to be sick, since he must be at least secondarily a good soldier. It may be said that health-culture was raised to the level of a fine art among the Greeks, which partook as did all arts with them of the nature of religion. They emphasized the element of health for the sake of proper enjoyment in conformity with the ideal of their gods, as the Hebrews insisted on cleanliness and purity in obedience to the ideal of Jehovah. Later Greek development was a decidedly retrograde movement. Platonism introduced the idea of the op- position of mind and matter mind being conceived as the formative principle, matter as the chaotic and un- formed. This doctrine placed matter in a position of inferiority, since it hindered the development of mind. When this idea was added to the Hebrew conception of sin, and both were intensified by Christianity the result showed itself in a deprecation of the body in every respect, especially since it came to be looked upon defi- nitely as the seat of sin and the obstacle to the free development of the spirit. It took but a short time to 8 HEALTH AND SOCIAL PROGRESS develop the " unwashed saints," Simon Stylites, and other exponents of perverted views of life. " I die here Today, and whole years long, a life of death. Bear witness, if I could have found a way And heedfully I sifted all my thought More slowly-painful to subdue this home Of sin, my flesh, which I despise and hate, I had not stinted practice, O my God ! " Modern Christianity has not taken a definite attitude in this respect. Its advance agents exhibit a progressive tendency, chiefly for the sake of interesting young men and women. It may be said, however, that religion whether Jewish, Christian or otherwise can never ren- der the service it should render, unless it adopts the scientific view of matter as spiritual, and returns to the primitive Christian ideal of the body as " the temple of the Holy Ghost." This view is, moreover, decidedly in favor of viewing God as immanent rather than trans- cendent a movement which is gaining a firm foothold in the churches owing to the influence of science. The neg- lect of the body and the conception of a transcendent . kingdom of God have retarded a true civilizational move- ment considerably, since physical health, which is the only basis for mental wholesomeness, was deprecated, and the " other-worldliness " of the Kingdom kept men from exerting themselves to improve conditions in this world. Science, especially medicine as the science of health, has always favored a proper view of the body. Owing to the imperfect development of its auxiliary sciences, e.g., chemistry, physiology, and bacteriology, medicine was un- til recent times more or less haphazard guesswork at curing diseases, but has now developed to a remarkable INTRODUCTION 9 extent, and is gaining new knowledge almost daily con- cerning the nature of diseases. With this knowledge has come the conception of prevention as the true sphereX v of medicine, rather than mere cure. The prophylactic work of hygiene in its different aspects has produced remarkable results. Medicine has, moreover, joined hands with the engineer and the physical culturist in various successful attempts at sewage disposal, sanitation, ventilation, and a more systematic development of the body. Biology and psychology deal chiefly with life as it is actually found, but work indirectly for betterment of health, because only normal and healthy individuals in- sure, as a rule, progress. Sociology is concerned with the causes of the progress and decline of nations. It is par excellence the advocate of health physical, psychical, political, social, and in- dustrial since the efficiency of nations and races de- pends on the maintenance of health. Eugenics, finally, is a new branch of biology and soci- ology, and attempts to solve the problem of racial health by proper mating of the physically and mentally fit, and by the elimination of the unfit through prohibition of mating. These various efforts have produced many important results in lessening the amount of sickness, improving health, and chiefly in changing our whole attitude toward the body as the instrument of the mind. In no period of history was health considered of such great importance as it is in our own times. In practically every sphere of life, people take the greatest interest in their physical and mental well-being. Individuals, schools, voluntary associations of various kinds, even governments have taken up this question with a zest 10 HEALTH AND SOCIAL PROGRESS that augurs well for the future. The number of books which have been written on this topic, is literally more than the proverbial legion. From the platform, in lec- tures and pamphlets, in newspaper and magazine articles, we are told how to keep well. The numerous health- -resorts, sanatoria, and similar institutions which promise to build up broken-down constitutions are filled to their utmost capacity and new ones are established every year. What is the reason for this great interest in health? Are we more ill than our ancestors, or are there special causes in our times, which demand greater consideration of health? Whether we are in better health than our ancestors is a much debated question among sociologists and need not be entered into here. Data will be given in a later chapter (see page 28) to answer the question in the affirmative. The reasons, however, for our great interest in health are plain, and they may be divided into social and scientific. Whatever the ultimate relation of mind and body may be, no person denies the tremendous importance of a sound body as an instrument of the mind, especially in relation to social life in its various aspects. Our indus- trial life has created conditions which make a close inter- dependence of one man upon another an absolute neces- sity. Formerly when a man was ill, his work could wait until he was well, and no one else was inconvenienced ; but if an employee in a factory is unable to perform his duty, hundreds if not thousands of other employees have to stop work owing to the dependence of one operation upon every other. The financial loss is, of course, too great to do that, and the sick employee must be replaced by an- other. Again, if a farmer while driving to town gets dizzy and falls from the wagon, his horses may run away and he may break his neck, but the damage is con- INTRODUCTION 11 fined to himself and family. If a locomotive engineer suffers from a similar affliction and runs his train at full speed into an open switch, hundreds of people may be killed or maimed for life. These are but two out of many cases in which modern conditions differ funda- mentally from those of former days or from those in our own times where a man still works singly. Hence the importance of health in modern industry. Briefly stated, health in relation to modern conditions may be viewed from five aspects: (1) The proper per- formance of one's work and duty is impossible without at least fair health. A man may force himself, but in that case his work will be done poorly, or the wear and tear on the constitution will be so enormous as to bring about a considerable weakening, thus predisposing the worker to disease, or at least lowering the power of resistance. (2) Apart from the mere performance of work is that of exactness and accuracy. A man enjoying good health is less apt to make mistakes than one who is below normal. That means an immense saving in time, money, friction, mental wear and tear to himself and to the establishment, since such work needs less supervision and scarcely ever a doing-over. (3) Ease and cheerfulness at work is another important aspect. There is a tremendous difference between a worker whose body is ready to per- form, craving an outlet for its abundance of energy, and one whose body protests almost at every step taken, and still more against the continuous exertion during work. The former will work with ease, sing and joke; the latter will watch the hand of the clock and sigh with relief when it strikes six. (4) When the two leave the shop, the dif- ference between them still continues in their recreation. The present tendency is everywhere for shorter hours so as to give the worker more leisure. But what can a man 12 HEALTH AND SOCIAL PROGRESS do with his leisure when he is so tired out that he is scarcely able to drag himself up the steps of his house. He is unable to use it for reading or social intercourse; the chances are that he will seek a stimulant to create an artificial cheerfulness. The other man has at least the opportunity to improve his mind by reading, going to a lecture, or through social intercourse. (5) The purelyV. social value of good health is, perhaps, more important than any other. Exuberant spirits and robust health are distinct social assets. We all feel instinctively drawn toward a cheerful, pleasant-spoken person; his very presence is a blessing, his smile contagious, and he is welcome wherever he goes. The father returning from work with a cheerful smile and a pleasant word for wife and children, is anxiously looked for, because he spreads sunshine in the house. The man who is wearied through work, owing to low vitality, is inclined to find fault with everyone and everything, and is shunned, be- cause he spreads gloom by his very presence. From a dramatic and literary point of view " Rebecca of Sunny- brook Farm " may be inferior, but from the social point it is a distinct asset, because it proves the value of good health and a cheerful disposition. The scientific reasons for fostering health are some- what more remote, but none the less real. The rapid expansion of the natural sciences, especially of biology, during the nineteenth century, contributed many elements toward a change in our attitude toward the body, since the doctrine of evolution depends primarily on the good health of the various species. The survival of the fittest meant in the animal realm and for a long time in human history, the survival of the physically fit, because only the organism endowed with strength, fleetness, or other physical characteristics insuring superiority had a INTRODUCTION 13 chance to survive and propagate. These qualities are, however, reducible to health, since without that they could not be developed; nor are they, if developed, of much use without it, since the swiftest wing or foot, the strongest jaw or claw would be incapacitated by disease. An animal might react promptly and efficiently hundreds of times in escaping its enemies, but the parasites in its own system it could never escape. Hence there is no natural death among the majority of animal species, be- cause when the bacteria have lowered vitality, even the swiftest and the strongest fall a prey to their enemies. The interest in biology led in its turn to the various attempts to explain man's nature on the basis of his environment, and as a result of this new view of life, Buckle wrote his History of the Civilization of England, and Ratzel his Anthropo-Geographie. " Man can no more be scientifically studied apart from the ground which he tills, or the lands over which he travels, or the seas over which he trades, than the polar bear or the desert cactus can be understood apart from its habitat. Man's rela- tions to his environment are infinitely more numerous and complex than those of the most highly organized plant or animal. So complex are they, that they con- stitute a legitimate and necessary object of special study. The investigation which they receive in anthropology, ethnology, sociology, and history is piecemeal and partial, limited as to race, cultural development, epoch, country, or variety of geographic conditions taken into account. Hence all these sciences, together with history, so far as history undertakes to explain the causes of events, fail to reach a satisfactory solution of their problems largely because the geographic factor which enters into them all has not been thoroughly analyzed. Man has been so noisy about the way he has conquered nature, and nature has UM 14 HEALTH AND SOCIAL PROGRESS been so silent in her persistent influence over man, that the geographic factor in the human equation has been overlooked." * These studies led to an investigation of the disappear- ance of nature-peoples, and it was found that their decay and extinction was due not so much to the cruelty of the " white man," as to various endemic diseases, some of [which had existed among them for many generations and became more virulent under new conditions of life, while others were introduced by civilized man on his advent in < >- / new countries. Jt is no exaggeration to say that the fate of many nations and innumerable tribes has depended on various diseases; and chiefly the endemic, because epi- demics caused as a rule great mortality, and thus by attracting attention, produced measures to combat them, / while endemics worked insidiously and more injuriously, leaving the people in ignorance of their dangen The Greeks and the Romans, for instance, were never aware of the danger which threatened them through malaria, and took no measures to counteract its ravages. The study of the disappearance of nature-peoples through disease created a new interest in health among civilized peoples, especially among physicians who had worked in tropical countries. CHAPTER II MEANING OF HEALTH WHAT is health? In defining or even describing health much depends on the point of view. The average man considers himself healthy when he is not ill, and many a person who is suffering from an endemic disease, e.g., malaria or hookworm, considers himself well, just be- cause he is not seriously sick. The physiologist would consider health as a normal functioning of the cell, be- cause he takes that as the unit of his investigation. The sociologist, on the other hand, looks upon the body from the point of view of action, and he must describe health in terms of the whole man as he reacts upon the various stimuli which come either from within or from without. These reactions are, however, ultimately mediated in the brain or in the mind, and they will be the more perfect and economical, the less friction there is in the physical organism. Hence we may say that a person ts healthy , when he w, except incidentally, unconscious of his body. The definition may seem strange at first sight, but it im- plies all the elements which enter into a full description "* of health. It means the state of body which enables it to perform every function which can reasonably be ex- pected of it, to accommodate itself to each ordinary task, and to be equal to some exertion without painful sense of fatigue. This implies as external signs erectness and firmness ; as internal requisites, good construction, ability to adapt itself to widely divergent conditions of life or of climate without deterioration of energy; endurance, re- 15 16 HEALTH AND SOCIAL PROGRESS sistance to morbific influences ; and finally, it means self- control mental, emotional, and sexual ; briefly, a balance between organs and organism, so as to produce a coordi- nated whole, well equipped for action. This description does not refer to robust health, but merely to a person who is well. It may be illustrated briefly as follows : The healthy man wakes in the morn- ing without any recollection of what happened since he went to bed, since he has had a continuous, unbroken, re- freshing sleep. He is ready to get up and has no desire to linger in bed; his toilet is performed without delay, for he is hungry, and has visions of breakfast. When this is over, he proceeds to the business of the day at once, whatever that may be, since he loves his work. This he does with all diligence and dispatch, because his body answers to the summons of the mind with ease and accuracy. Hence he will not be exhausted when the day's work is done, but will have some energy left over for exercise, friendly intercourse, or mental improvement. Then he goes to bed, and is soon asleep. This man has scarcely been conscious of his body either by night or by day except incidentally when washing, dressing, and eat- ing. If he had any sensations at all about it, they were pleasant, at least mildly so, since the sense of organic well-being is one of diffused pleasure. He enjoys his meals, but never has to care what becomes of the food afterward, since his digestive organs perform their work automatically ; he may perhaps remember his meals again through an increase of strength and well-being. Perhaps the best thing about good health is the fact that work does not weary us, but helps to develop our various faculties. Hence the day's work always leaves us in better condition than it found us ; it has opened new possibilities before us, has given us opportunities MEANING OF HEALTH 17 for exercising our various powers and for spending our surplus energy. The healthy man is able to make every movement graceful, effective, and adaptive; and the profit from the day's experience will enable him to do tomorrow's work better. He re-creates himself con- stantly. It is not necessary to point out that good health is not identical with athletic strength or endurance. The tasks of life differ, and each task requires a slightly different physique, as Aristotle observed in his Politics (Book I, Chapter VI). The health and strength of a hod-carrier must be different from that of a professional man; the former needs a well-developed muscular system, the latter an especially fine brain and nervous system. If each is able to perform his particular work well and without exhaustion, he fulfills his destiny, and renders not only a social service but gets profit and pleasure from it." Health may be identified with good vitality, or surplus energy. Good vitality means simply a reserve fund be- yond what is immediately needed. The greater this re- serve, the better prepared is the organism to meet all kinds of exigencies with ease, and to stand shocks with- out serious injury. " Two men undergo operations of the same character in a hospital. The same surgeon does the work. The conditions are identical. Equal care is exercised in each operation, and each is successfully performed. Yet one man recovers, the other dies. "There is a tremendous business pressure which does not let up for months. It puts men under terrible strain. One man goes to pieces and his business is wrecked. He cannot keep the pace; he loses control of himself. His rival has no better brains than he perhaps not so good yet he pulls through suc- cessfully. 18 HEALTH AND SOCIAL PROGRESS " We say that there is a difference in vitality ; that one man has more of it than the other. " I once saw a man in a hospital who was suffering from five fatal diseases ; and yet he would not die. He kept on living year after year in spite of everything. He refused to succumb. " We find the same thing illustrated every day. In a ship- wreck there are many who seem to give up their lives without a struggle, without any power to resist. Others cling to an open raft for days without food, almost frozen, constantly whipped by the waves, but for some reason they survive. The vitality in them is strong. " Notice how rapidly and surely one man recovers himself after a nervous breakdown, while another drags along through years of semi-invalidism. Notice the results upon two men of a long, cold drench of rain. One of them comes down with pneumonia; the other suffers no ill effects. How is it to be explained ? " He has a reserve somewhere, an inner power of resistance, an aggressive something that will not be downed and we call it vitality. A man cannot have a more valuable asset than that. It means joy instead of dumps, success instead of failure, life, perhaps, instead of death." 2 No one will contend that under the circumstances just quoted, a healthy man is unconscious of his body ; but these men were sick for the time being, and their cases are cited merely to show that men who enjoy good health store up surplus energy or vitality which stands them in good stead in an emergency. At such times there is still a vast difference between the man in good health and the one in poor condition. When special stress is to be borne calling for great exertion, the man in poor con- dition will dread the necessity, become apprehensive, and thus spend his energy ineffectively; while the well man will look forward with confidence to the trial of strength and react efficiently. He is able to do this because when he becomes clearly conscious of his body, he is aware of his strength and power,' his whole organism seeks MEANING OF HEALTH 19 relief from the tension of stored-up energy; while the other, always more or less conscious of its existence, now becomes more than ever aware of its weakness and slender resources. Under normal conditions the well man is, however, as a rule unconscious of his body, unless it be an awareness of diffused organic well-being. This fact may be illustrated in other ways. A healthy child who laughs and runs and romps, acts spontaneously, not deliberately. When he has to be urged and coaxed to do these things, he is not well ; he is conscious of an effort, he must exert himself, and the more he does so, the more conscious he becomes of his weakness. A young dog who for no reason whatever will run up and down the avenue as fast as he possibly can is unconscious of his body. Only after he has spent his surplus energy and needs rest and food is he aware of his legs and stomach. Health means, then, spontaneity and freedom of action. " It is as ' the outward sign of freedom, the realization of the universal will ' that health may be set at once as sign and goal of the harmonious operation of the whole system as sign and goal of the realization of life." 3 A healthy man is able to turn his energy in any direc- tion desired, because his body responds promptly and efficiently ; its energy is always ready to be expended. It is usually the man in poor health who has to " make up his mind "/{ the one in good health is able to decide quickly, because with a clear brain and efficient nervous system he can instantly " feel the situation," devise a plan immediately, and say " yes " or " no." The other man must in reality get his body ready ; he has too little energy to meet the new situation at once, and asks for delay in order to " think it over " when he is not other- wise occupied. To conclude, then, health means frecdont : 20 HEALTH AND SOCIAL PROGRESS of action because it implies being unconscious of the body owing to surplus energy. This principle may be proved by a reference to the meaning of disease. In health all life-functions proceed without any friction and self-assertion on the part of the organs, hence the individual is normally unaware of his body. But let some organ get out of order, and we soon become aware of its existence. The very fact that pain is a danger signal implies that generally the operations of a well-ordered body proceed smoothly and unconsciously. Pain means, therefore, that a particular part of the organism is unable to carry on its work unconsciously; while usually so contented to serve the organism in ob- scurity and oblivion, it asserts itself vigorously the mo- ment it can no longer do so, and notice is given to the whole body through the nervous system that help is needed. For pain is merely the cry of nerves that are either starved, poisoned, or throttled. And the finer the organism is constructed, and the more delicately balanced the various parts are, the better is the signal service of danger organized. Hence the higher species of animals and the more finely grained human beings are more sus- ceptible to the slightest disturbances. The ox-cart of a Montenegro peasant will render fair service after many parts are out of repair and some even broken ; but the automobile of fine construction will " go out of commis- sion " the moment one small screw is loose or lost. So the savage will bear a fracture of an arm or even a slight one of the skull with comparative equanimity after the first shock; he usually recovers quickly without medical attendance: the finely grained European may suffer intensely and take considerable time for recovery ; he cannot even witness pain in other men or animals with- out sympathy, or suffering with the other. Homer un- MEANING OF HEALTH 21 consciously intimated that the Greeks were more highly civilized than the Trojans when he said that the former felt pain more keenly as witnessed by their outcries, while the latter were mute even when wounded severely. The "same principle applies to Mars, of whom we are told that he roared with pain when struck by the spear of Dio- medes, for as a divine being his nervous system would naturally be more highly organized.* In the anxiety to avoid injury, i.e., to disturb the balance between the various parts, nature has devised innumerable schemes through division of labor in order to scent danger before it actually reaches us. This princi- ple is most ingeniously elaborated in the case of the curious antennae, or feelers, which are thrust out from the surface of the body in animals of all sorts, especially in insects. Its most striking development is the well- known whiskers of the cat, and the less familiar, but much more highly developed, tactile hairs about the head of the bat. These feelers extend from half an inch to an inch from the body in order to warn it of approaching danger through the sense of touch. In more highly organized animals the senses of sight, hearing, and smell are, in part at least, intended to be guards against danger, extending their sphere over much larger areas. The reason for this extraordinary sensitiveness to pain and these precautions against danger is the extreme care which the organism takes in preserving its integrity or wholeness. For if the danger signal is to be of any value, it must be accurate so as to report the slightest de- viation from the normal, and must be placed as far in * Iliad 5 : 855 ff : " Bellowed brazen-throated Mars, loud as nine thousand warriors, or as ten joined in close combat. Grecians, Trojans, shook, appalled alike at the tremendous voice of Mars, insatiable with deeds of blood." 22 HEALTH AND SOCIAL PROGRESS the foreground of the battle as possible so as to give time for measures of avoidance. Accuracy in interpreting danger signals is, however, possible only in good health, whether the danger is from within or from without. An organ which is in poor con- dition asserts itself so peremptorily and constantly, that other organs may be neglected or are made to suffer, and thus become unable to do their work properly. The nose is a useful organ and performs valuable services to the organism all more or less unconsciously to ourselves; for while it is in a sound condition we act promptly on the information it gives us, and are hardly aware of its existence for weeks at a time. A cold in the head very quickly changes this relation. Our sense of smell suffers almost instantly and we are less able to judge accurately of the information received from that quarter. But that is not all. This organ asserts itself so vigorously at such a time that we are but little able to do anything else than attend to it. Neighboring organs are likewise af- fected, e.g., the eye, which becomes watery, and the ear, which becomes less acute and discriminating we hear noises rather than distinct sounds, and fewer of them. The three main sentinels against external danger are thus invalidated. And what happens to the organism? It is more or less out of working order, less aggressive, less capable, perhaps incapacitated. Why? Because the nose asserts itself so vigorously that most of the energy produced by the organism is drawn into service for re- pairing the breach made in its wholeness. For the sys- tem must be whole if it is to function properly in the various exigencies of life. If a more important organ is hurt, we call ourselves sick and go to bed, so as to give the organism an opportunity to attend to its repair work exclusively for & least some time. MEANING OF HEALTH 23 Health means, moreover, economy of expenditure. While there is much friction in the organism during sick- ness in performing even the most elementary work, there is hardly any during health. We simply go ahead, un- mindful of our body. It is a ready instrument of the mind, and we realize its existence only at night when tired out. That feeling of lassitude is simply a signal to stop and rest. It is not an unpleasant, but rather an agreeable feeling to relax and go to sleep. A few hours of rest are sufficient to restore our energy, and we wake up automatically, ready to go to work again. Compara- tively little food is needed to keep a healthy person in good condition, because no repair work is needed and the power of assimilating all nutrient elements is strong. A physician said a few years ago concerning a patient who suffered from consumption of the throat, that her food had sufficient nutrient values to keep seven ditch-diggers in good health. Still, that young woman could hardly move in bed without severe pain. We are surprised when we read of the black bread, a piece of cheese, and the small amount of sour wine, which keep many Euro- pean peasants not only in good health, but literally in good working condition. There is no secret about it, though ; the system does not waste anything, and new energy is quickly supplied by simple food and sleep. The China- man with his handful of half-cooked rice is even a better example. He works hard and continuously on this scanty food, and seems to be untiring. Such energy can be explained only on the basis of good assimilative power and high vitality, as seems to be indicated also by his resistence to high fevers and by his bluntness of nerve which enable him to recover rapidly from terrible injuries. This economy of expenditure has a very important 24 HEALTH AND SOCIAL PROGRESS effect upon the development of the higher faculties. When there is little or no friction in the organism and assimi- lative powers are good and work is not too exhausting, a surplus of energy is easily produced. This energy can be used for experimentation along various lines, either through play or through more serious attempts at inven- tion in abstract thinking, imagination, and actual recom- bination of mechanical contrivances. There is no need to discuss the theory of play here ; 4 suffice it to say that a certain amount of unused energy must exist in the organism if play is to be indulged in. No doubt instinct directs play along certain lines, and nature selects only animals which play efficiently and which thus prepare themselves better for the more serious duties of adult life but no animal or human being will play when fully exhausted. He may fight his teasing friends with his last ounce of strength for the right to rest or sleep, but he will not play. He may change his occupation from reading to walking, and thus rest his tired eyes and brain while exercising his unused legs, but when he is tired all over, he will rest if he possibly can. If he attempts to force himself, the result is as a rule pitiful. We are familiar with the official smile and joke at the President's re- ception and elsewhere with its mirthless laugh and forced friendliness. It deceives only the gushing girl who cannot distinguish between spontaneous humor as the result of abundant vitality and the make-believe in- / terest of a tired man who wants and ought to be in bed. This surplus energy enables those who direct it properly to develop both mentally and physically, and leads thus to an enrichment of life with the possibility of arriving ^jat ne_w_and possibly useful variations. The theory of the leisure class in social science is based on such a surplus. It is, however, not so much a greater supply MEANING OF HEALTH 25 of goods than is needed for the maintenance of life, as it is a greater amount of vitality for the ordinary duties of life, that is of real importance. It is, in other words, not so much a question of wealth as the economists and sociologists would maintain, as it is a question of health. This may be proved briefly in two ways. A rich patient confined to bed more or less all his life consumes, but rarely creates wealth, while a poor man with surplus energy will study, write, experiment, and produce some- thing beneficial for society. Again, the fact that many inventors have come from the better class mechanics and that many discoveries have been made by teachers in col- leges and universities is explained better on the theory of health than on that of wealth. For after all, there is nothing that interests the man of low vitality except his own condition, and he could not as a rule make use of extant knowledge as a basis for extending it, even if he would. Why not? Because such men do not develop any surplus energy. A brief consideration will make this clear. We have seen that even a less serious defect in one or another organ causes the whole organism to divert its energy toward the ailing part and interferes thus with its general functions of being a good working machine for the mind. To give one more illustration. Adenoids are not a serious defect in themselves. Yet this slight derangement of normal breathing may have serious ef- fects upon the mentality of a child, because it diverts the functions of the body from their usual and mutually helpful character to a particular organ in order to remove the obstruction. The organism becomes thus self -cen- tered, so to say, instead of being an unconscious agent of the mind. That means that no surplus energy can be developed while the obstruction lasts, since whatever 26 HEALTH AND SOCIAL PROGRESS energy is developed goes first of all into the main- tenance of the vegetative functions, and secondly into the removal of the obstruction. The body as a whole is thus not properly nourished. This explains on the one hand the proverbial fertility of the poorly nourished part of the population, since nature is bent on the con- tinuation of life at all costs and every ounce of surplus energy is turned into reproductive activities ; on the other, the many cures which the organism effects without medi- cal aid, since it must work with the least friction possible and as a whole, if it is to work well. But some parts must suffer from this under-nutrition. The nervous sys- tem and the brain are the ones which do not receive proper nourishment under these conditions. They are kept at the lowest minimum possible for regulating the organism ; but they cannot be alert, accurate, and aggres- sive : neither can they be finely wrought and sensitive. The associative centers or the cortex suffer most from this lack of proper nutrition, hence they cannot exercise the necessary control over the body, and the latter acts in an erratic manner; that is, without properly valuing its actions in proportion to their importance to the organism as a whole. Lack of unity of action is the result, and mentality remains at a comparatively low level. It is evident that a person in that condition is unable even to organize new information received, or much less to originate anything new by recombining the elements of knowledge already in his possession. It is different with people in good health. Just because they are well nourished, the brain has at least an oppor- tunity to be kept in proper condition owing to the surplus energy of the organism. Whether an individual will use that energy for building up his brain or his muscle, is, of course, a different question. He may prefer to exercise MEANING OF HEALTH 27 his muscles and build up an athletic body, or to use his brain more and perfect its functions. Whichever he does, the law of the growth of the most used part holds, and that part will develop correspondingly in power. If it is the brain he exercises most, its ability to form new adaptations and combinations quickly and accurately will increase, and the individual may contribute something new to society. The question whether there is an in- crease in the mass of the brain through exercise is not yet definitely settled ; the increase in power by means of more numerous and better organized association-paths is, however, undisputed. It seems a natural inference that a higher brain power draws more nutrition from the body as a whole. Whether that is true, is still unsettled ; experience seems to point that way, since people with massive brains finely organized and capable of much hard work rarely belong to the high vitality class, but usually to the medium, according to Professor Giddings. 5 The body of the great thinker is, in other words, organ- ized for action along a particular line that of mental exertion in poetry, art, philosophy, science, statesmanship, administration, or similar vocations where facts have to be seen from a new angle or to be classified under new generalizations. We have thus far considered chiefly the lack of proper power of action of the organism due to more or less serious illness or defect. In each case the body was deficient through the self-assertion of some organ. Mal- nutrition has the same effect, but more continuously. The body in that case is unable to supply the various parts, particularly the brain, with proper power, and hence the whole organism suffers from inability to act properly and efficiently. And just as the sick man be- comes self-centered, so does the man of low vitality. 28 HEALTH AND SOCIAL PROGRESS He is continually conscious of his inability to adapt him- self to new conditions and is reminded of his failures. His mental attitude is self-centered ; he looks inward, not outward ; he is always concerned with himself, and must of necessity be so, as long as his body is an inapt agent of the mind. A healthy man is as a rule a social man; a sick one is usually unsocial. If a well man is self- centered, he is so deliberately ; but one in poor health is so by necessity, since he is always conscious of the limita- tions of his body. Sickness or malnutrition may, however, happen to a whole race. Many savage tribes and many poor classes among civilized nations suffer from the latter defect and are unable to rise to a higher mental life because of poorly nourished brains, or to a higher social level owing to the inherent social limitations of men of low vitality. The larger part of mankind has, however, suffered from diseases of various kinds. If these were malignant or epidemic, men died, and only the strongest remained. If they were benign and endemic, a gradual deterioration took place, since just as in a serious illness the energy of the organism is diverted from its proper uses to the repairing of " broken down ramparts," so in endemic diseases there is a constant endeavor merely to ward off danger and to build fortifications against invading ene- mies. Among nature-peoples malnutrition and endemic diseases often combine, and the organism is unable to resist the double strain. Hence hundreds of tribes have succumbed, and only a few have survived. These were generally so exhausted from the struggle that their power of resistance was very small, and any new disease that might be introduced would kill them. Whether as in- dividuals or as a race, people with low vitality have poorly nourished brains, small power of adaptation and any new MEANING OF HEALTH 29 strain or exigency will upset them completely; hence they either perish or spend proportionately so much energy, that a more serious exhaustion results, and this prepares the way for a further loss of power of re- sistance, since there is no way to create surplus energy. Whether in the case of the individual or in that of a race, low vitality produces an attitude which centers in the individual rather than in society. High vitality produces, as a rule, social action. " The natural glowing fire of health superb health is seen and felt. It is magnetic. It makes for itself place and fol- lowing. It is constructive. It is initiative. It is happy. It is humane. It is beautiful. It radiates strength and brightness. It agitates for the good of others. It com- pels pleasantly to be and do one's best." 6 There is an sive quality about good health which we realize only when in the presence of a man abounding in vitality good-natured and buoyant. Such a man is always master of himself, because he is unconscious of his body. Not having any ills of his own, he is happy, and his happiness is contagious, because it is spontaneous. He not only radiates peace and contentment, but wants to see others happy and cheerful. Being always master of himself, he is tactful and spares the feelings of others. If he has the gift of humor as he usually does it is good-natured and not sarcastic or sardonic like that of the dyspeptic who trusts nobody because he is not sure of his own power. The healthy man wants a well-ordered environ- ment, since his own mind and body make a harmonious whole. He generally succeeds, too. For he who is master of himself is best abk to bring order out of chaos among those around him. He has few, or no, troubles of his own, and his abounding energy seeks an outlet in helping others. His whole activity is directed outward 30 HEALTH AND SOCIAL PROGRESS toward conquering difficulties which he attacks with zest and vigor because they furnish good practice for his various powers. He is, in other words, not merely moral, but social, for sociality rises above morality. " Objectively viewed, morality consists of that ' walk and conversation ' which the community as a whole approves. It includes not only acts, well adapted to the achieving of those ends that on the whole are held to be good, but also outward expressions of thought and feeling, so far as these are ap- proved. Subjectively, morality is self-respect, and that desire for the good opinion of others, and that endeavor to deserve it, which Mr. Spencer has called ego-altruism. . . . " As the name itself implies, sociality comprises those quali- ties of mind and character, of disposition and conduct, which are eminently and characteristically social. " Objectively viewed, sociality is a cheerful and efficient par ticipation in the normal comradeship and cooperation of society. " Subjectively viewed, sociality is altruism thoughtfulness for others, sympathy with others, kindliness and helpfulness toward others, even at some cost of self-sacrifice, and happiness in the companionship of one's kind." 7 , A person with low vitality may be moral ; by precept and training he may be able to overcome the tendencies toward self-centering activities to which he is naturally inclined ; but it takes a positive, and sometimes a strong, effort to do so. This fact is well and frequently illus- trated by numerous people who, cursed with a low vital- ity, sometimes make herculean efforts to reform, only to backslide after many failures. They may be charged with moral delinquency or even depravity ; but the blame for their failures should be laid at the door of low bodily vigor or some physical defect. Where vitality is some- what higher, we still have only a limited morality. A rich person may refrain from definitely unsocial or im- moral acts ; he may even give from the abundance of his MEANING OF HEALTH 31 possessions to poorer people out of self-respect or to maintain the good opinion of others ; but he cannot give cheer, hope, buoyancy, and efficient service, because he needs whatever strength he has for himself. The sour- faced man may solemnly declare in a prayer meeting that he loves his fellowman with his whole soul, but the fulfill- ment of his promise is not in his power, since in his case the spirit may be willing but the flesh is literally weak; and no man can give what he does not have. It is the same way in larger matters. A person of low vitality may be willing to lay down his life for his country; he will not go far before he is in need of Red Cross nurses. The Athenian of the times of Philip of Macedon avowed his patriotism in the strongest possible terms, but Demos- thenes informs us that Athens talked about hiring 10,000 or 20,000 soldiers ; for this malaria-ridden Athenian could not take the field like his ancestor of the previous century. He was not a hypocrite in protesting his love for Athens, while preferring to stay at home; he simply could not take the field owing to low vitality. Lack of health al- ways confines one's good intentions within narrow limits. CHAPTER III HEALTH AND RELIGION WHETHER the origin of religion is to be attributed to fear as with Lucretius, to a feeling of dependence as with Schleiermacher, to the dread of ghosts as with Spencer, to awe before the Great Dreadful as with Giddings, or to other less definite qualities of modern theorists, there is ultimately just one thing back of them all an attitude of helplessness on the part of man to do what is necessary or desirable. This goes back to low vitality, if not to poor health. A man may be ignorant and not trouble himself about the explanation of things. But if he is well, he will be able to satisfy the few wants which primi- tive man feels. Fear is apt to grip the weak man who is left behind and is unable to provide for himself, but not the hunter or the warrior who delights in action. It was the " squaw man," roughly speaking, who had time, and, maybe, good reason to begin crude speculations on how to escape his often intolerable position, and who has expressed his attitude in all the earlier or negative re- ligions. The limitations imposed by poor health have been the cause of our slow advance in civilization. We have progressed only in a self-centered manner. Our religious and our moral codes are all self -centered, and could not be otherwise under past and present conditions. In the past man has always sought merely relief from evil. This has given our morality an almost purely negative char- acter, and to our civilization one of pessimism. For 32 HEALTH AND RELIGION 33 civilization was dominated by religion, and we have not yet fully escaped from its negative ideal. What, then, is the ideal of religion ? Relief ! Which- ever way we turn, the various forms of religion always have to do with that. It is either relief from physical dangers, or from spiritual enemies, or from ourselves, that is sought. Whether we are told that sickness is a visitation from God, or that evil power may tempt us, or that individuality itself is evil and that we must seek coalescence with the infinite in Nirvana, it is always re- lief that is held up before us, i.e., a purely negative ideal an ideal in other words, which was conceived by and intended for sick people, or at least those of low vitality. Such an ideal is essentially self-centered. The religious man whose chief concern is to save himself, is still acting only morally and not socially, for he is occupied princi- pally with himself. This fact is strikingly illustrated in TEe vaTtous monastic ideals which plainly inculcate as the first duty salvation of oneself expressed, however, in the more euphemistic terms of love and service toward God. The Golden Rule, whether in the negative form of Confucianism or in the positive of Christianity, is a self-centered principle, since action is based on self- regard, one might almost say, of personal advantage. The chief virtue of Christianity is charity relief from distress ; and its principal form is almsgiving " laying up treasures for yourself in heaven." Is, then, the religious or charitable man selfish ? Not at afi: He has a finely organized nervous system for feeling pain and suffering, and is therefore often more sympa- thetic in the literal sense than well people sometimes are. This is significantly expressed by the fact that the older form of charity almost confined itself to the relief of pain and suffering. That gives it a certain social value 34 HEALTH AND SOCIAL PROGRESS and ethical character. It does not, however, relieve sym- pathy from its fundamental character of being self- centered, since the sympathetic pain experienced by the almsgiver, or the possible reward of almsgiving, are at least subconsciously motives to action. This could hardly be different under a civilization whose characteristic fea- ture was suffering politically, from oppression, hence submission to duty ; economically, from constant deficits as proved by numerous famines, hence the worship of various deities, like Ceres, who were supposed to give bountiful harvests; physically, from almost constant diseases and under-feeding, hence the low tone of morality based chiefly on utilitarianism of a narrow type. The whole object of life was one continuous attempt on the part of the individual and society to escape from intolerable conditions. Is it any wonder that morality was not and could not be buoyant and social, but had to be negative and self-centered ? Uncertainty what the day might bring forth politically, economically, or for personal well-being, kept the people in constant turmoil and made them think of themselves and their safety of life and property. At such a time the relief of suffering was of necessity a great virtue, since the individual was unable to think of others, even though reminded that he himself might soon need help. Take as an illustration the treat- ment of slaves. It was on the whole good, not primarily for economic reasons, but chiefly for sympathetic reasons, since in the constant political changes no one knew who might be a slave tomorrow even though he be a master today. In the constant political changes, empires were often overthrown during a few days, and the ruler of today might be dragged behind the chariot of a victorious enemy tomorrow, irrespective of whether he came from within or from without. Even the proudest nations of HEALTH AND RELIGION 35 antiquity were sooner or later reduced to a .condition of servitude, and some of the greatest men suffered the humiliation of being made the butt of vulgar remarks on the part of the victorious mob. A few words may, perhaps, be necessary here to avoid misunderstanding in regard to the moral ideals of Christianity. The statement has just been made that its morality was self-centered. This is true as far as its de facto statements are concerned. The Golden Rule, while a good principle for a narrow morality, is neverthe- less self-centered and only incidentally social, since the individual is asked to act or refrain from action on the basis of the effect it would have on him; this rule in- volves, consequently, a calculation of ultimate effects. But this is exactly what a man of low vitality always does and has to do. Being always conscious of his limitations, he must ask himself what the ultimate effects of his actions will be. And he does that even while his vitality is still fair. A man like Cassius with his " lean and hungry look " always thinks too much about himself, and never rises above that level in his ethical motives ; neither does the average man who is firmly convinced that " hon- esty is the best policy." When a man's vitality has sunk lower still and he has become more self-conscious, he acts from more narrowly selfish motives; i.e., he schemes with great cunning to get what he wants; or in a blind rage, when a particular organ has become the center of his gravitation and is uncontrolled by the brain, he goes ahead and takes what he wants. This man of lower vitality acts in a decidedly unethical manner, while the other, still able to calculate, may keep within the limits of the permissible. This is, however, not social action, be- cause it is too largely self-centered. True social action can come only from an abundance of vitality, plenitude 36 HEALTH AND SOCIAL PROGRESS of power, and the happiness of high tension. Such a man must act because he has a desire for function; and he must act socially, because his actions are not self- centered; he is usually unconscious of his body. He is full of joy and confidence, and imparts these to others not deliberately, but because these qualities are con- tagious. When he becomes clearly conscious of these powers, he recognizes that they involve a responsibility, and he deliberately controls his actions in such a manner as not only to avoid harm, but to increase joy and happi- ness among his f ellowmen. He inverts Kant's categorical imperative, and says to himself : Thou must, because thou canst ! no matter what others may do. It seems to me that the true ideals of Christianity are identical with those of the healthy man. When Christ said : " For this purpose have I come into the world that they might have life, and have it more abundantly," or when we are admonished to become " co-workers with God" (I Cor. 3:9), we have a positive ideal placed before us ; an ideal not only moral because such action is best, but social because the abundance of life and power within us seeks an outlet in action which is wholesome and implies cooperation with God the source of all be- neficent power according to Christian teaching. Unfortunately this positive ideal has never had much sway in Christian ethics, and could not have under the universally prevailing conditions of low vitality. When everybody has less vitality than his own needs demand, individuals as well as societies must form ethical codes of a negative character or a narrow morality, based primarily on utilitarian principles, such as the Golden Rule. With increasing health through better food and better control of germ diseases, such a code proves in- creasingly less satisfactory. Men in good physical and HEALTH AND RELIGION 37 mental health want positive action, not merely escape from evil or from illness, since they are not conscious of any lack of power as the ill or underfed man always is. They are confident and self-reliant, and feel capable of coping with the difficulties in their path ; indeed, they rejoice in matching their physical and mental strength against obstacles. If this theory is true, it ought to ex- c plain three facts in the modern world declining church attendance among more vigorous men, continued attend- ance among the less vigorous, and the separation of phil- anthropic movements from the churches. That church attendance is declining, is almost a uni- versal complaint among the clergy, and the fact that various devices are adopted to attract men, furnishes the proof for its truth. These absentees are, however, no longer considered wicked, or even atheistic, for many good and capable citizens belong to this class. They will, moreover, send their wives and children to church or Sunday-school, give money toward its maintenance, and perhaps admit its necessity. What, then, is the reason for their non-attendance? It is not hostility, but simply a lack of interest in what the church offers. It offers them help, but they do not feel any need of it ; it proffers relief, but they are whole; it promises forgiveness, but they have no sense of sin. ^In short, the church proposes to give them what they believe they already have. They are, or think they are, able to look after themselves, and are confident that if they do all in their power to make the world better, they will be taken care of in the here- after. They favor church attendance for others, but feel no need for it themselves. All the various attempts to interest them seriously and personally fail, because no positive action is demanded of them. Hence many churches have adopted the device of giving these men 38 HEALTH AND SOCIAL PROGRESS something specific to do to organize a boys' club, teach a class of unmanageable boys, look after some weaker brothers, and other things ; but the interest lasts only as long as the task is unfinished, since they feel that religion as constituted in the past and largely at present, is based on the acceptance of something which they claim to pos- sess wholeness. Fortunately the church begins to realize that these most valuable men have to be treated differently and a field for positive action is now offered to them along various lines. Church attendance is still good on the part of less vigorous men who feel the need of every possible as- sistance in their effort to become strong. It is this par- ticular class which is intensely religious at times, just because it is aware of its own instability and lack of self- mastery, due to low vitality. In his discussion of the religious temperament Sir Francis Galton says: " The result of all these considerations is to show that the chief peculiarity in the moral nature of the pious man is its conscious instability. He is liable to extremes now swinging forward into regions of enthusiasm, adoration, and self-sacrifice ; now backward into those of sensuality and selfishness. Very devout people are apt to style themselves the most miserable of sinners, and I think they may be taken to a considerable extent at their word. It would appear that their disposition is to sin more frequently and to repent more fervently than those whose constitutions are stoical and therefore of a more symmetrical and orderly character. The amplitude of the moral oscillations of religious men is greater than that of others whose average moral position is the same." 8 It is in harmony with this reasoning to find that the most orthodox churches are the only ones that grow, because they promise the weak man every possible help. When seeking relief from his own instability, a man will HEALTH AND RELIGION 39 not stop to inquire into the ability to make valid the claim of assistance, but grasp at any proffered aid. The in- cantations of the medicine man are as good for this purpose as the unintelligible philosophy of so-called Christian Science, which owes its rapid extension pri- marily to its ability to cure people from imaginary ills and has received into its membership chiefly, if not exclu- sively, those who sought relief from some ailment. Many articles have been written on church attendance; but the fact remains that the denominations which promise most in the way of relief are increasing more rapidly than others which demand work." The separation of philanthropic movements from the churches is increasing constantly. Not so very long ago the church was the only agency which administered relief to the various kinds of afflicted people. Now the State has taken up that function to a large extent, and numer- ous semi-public organizations look after every possible need. It may be said, with good reason, that the church initiated most of these movements, that they are still managed chiefly by religious people, and that it is not her function to do the work of the community. All this is true. Yet it is significant that the church has failed to keep these men and movements within her borders in all countries except Belgium and the Roman Catholic part of Germany, where the work is chiefly that of relief. Under the guidance of modern philanthropy, assistance to those in " need, sorrow, sickness, or any other adversity," has not only passed from the church, but has changed in character; it aims primarily at prevention instead of cure, hence the innumerable movements to make people more intelligent, more moral, and more healthy. The public baths, the play-grounds, the medical attention for school children, the school luncheons, the shorter hours 40 HEALTH AND SOCIAL PROGRESS for factory employees, the improved sanitary conditions in the factories, the larger wages all tend to better health, although perhaps unconsciously on the part of those who promote them, since health has not yet been recognized in all its bearings. The reason for this change in philanthropy is not far to seek. Well-doing does not come to the social man as a duty, but rather as an opportunity to exercise his powers, which he delights to do ; hence he is not satisfied with the relief which has to be repeated tomorrow. He looks into the future, because his abundant vitality prompts him to devise ways and means for increasing joy in the world ; and this attitude leads inevitably to prophylactic meas- ures. The older civilization was characterized by the saying : " Sufficient unto the day is the evil thereof," because it could not possibly cope with other than im- mediate needs ; the newer joyfully takes up the fight for the future. This is truly a new civilization, since in every direction we see prophylaxis taking the place of cure in medicine, in conservation of natural resources as well as the health of human beings, in the lessening of human toil through machinery, in the attempt of the various " Sunshine Societies " to spread joy in the world. It is perhaps this attitude of modern man which explains the strong social- istic tendencies both among the rich and the educated in England and America, since socialism offers the most complete program of any party for prophylaxis along every line, and oh, how a healthy man hates patch work; he would rather cut out of the whole cloth. This new attitude is possible only on the basis of better health, i.e., freedom of action through surplus energy, which expresses itself in all kinds of experimentation. HEALTH AND RELIGION 41 The old attitude was conditioned by low vitality, because people were, and perhaps had to be, self-centered, since they were always conscious of their bodies; hence they had to content themselves with preserving what they had, and to ward off evils or seek relief from them. They lacked, in other words, aggressive health, and con- sequently aggressive mentality. For the two are, to a certain extent at least, identical. The modern world has generally adopted the saying of the classical world, mens sana, in cor pore sano; but what was formerly only an inference from observation has been established as a scientific truth by modern medicine. Almost every day produces new proofs to the effect that a poorly nourished or a diseased hnAyi*jfr* tmcf nf J^w_or erratic mentality. TheTmfld of a "Healthy man need not be that of a genius ; it is, however, balanced and open to all good influences, because based on aggressive vitality which seeks an outlet for action. But an active, circumspect, clear-visioned mind is more important from a social and economic point of view than the acerbities and vituperations of a great intellect, clad in pompous and often unintelligible sen- tences. As a rule, the best work of the world in philos- ophy and science has been done by men in good health. An attempt will be made to prove this statement in a later chapter. The theory of mens sana, in corpore sano is, moreover, independent of any particular metaphysical doctrine. If, according to the theory of parallelism, body and mind are independent, the body is still the medium through which the mind must express itself; if the ma- terialists should be right, the mind would be merely a special product of matter, and would be dependent on the proper functioning of the organism ; if the idealists are correct, the body would be a special form of mind, but still its only known agent for manifesting; itself. Even 42 HEALTH AND SOCIAL PROGRESS the idealist Emerson said : " Give me health and a day, and I will make the pomp of emperors ridiculous." * Lack of aggressive, or even good health, has had an important bearing on civilization, since man has nowhere risen much higher than savagery where conditions were unfavorable to the development of at least medium vital- ity. What then are the factors of good health? * The change from the old to the new religious attitude is strikingly illustrated in the history of the Young Men's Chris- tian Assocation. Not long since its diluted evangelism was looked upon with mild tolerance by the more vigorous men and women. Then a genius, discerning the signs of the times, brought about a change to an active and aggressive Christianity. At once the Y. M. C. A. leaped into the respect and admiration of the community, as is shown by the two campaigns for money in 1917. One of the wealthiest church organizations in the U. S. finished a year's active compaign for n. pension fund for ministers, and raised $8,000,000 instead of $5,000,000. The Y. M. C. A. got $53,000,000 in a week, and $7,000,000 more in the weeks following. Business men were enthusiastic about its positive and practical religion, and subscribed liberally. CHAPTER IV FACTORS OF HEALTH THE first factor of health is food. Nature-peoples are, as a rule, poorly fed. Their meals are irregular, generally poor in quality, and often insufficient in quantity. The roots, berries, and other foods which nature furnishes, are usually poor in nutritive qualities. Hence the savage is habitually underfed, since the system is starved even though large quantities of coarse food be taken. This simply means that the digestive organs are burdened with material which does not nourish, and causes a distension of the abdomen, as may be witnessed almost anywhere among the poorer classes of China, India, Turkey, Rumania, Russia, and some parts of Austria-Hungary, not to speak of countries in which savagery still prevails. When a good meal can be had, as after a successful hunt, the savage eats voraciously and without proper mastica- tion ; hence digestion is interfered with in a different way. The system is in a chronic state of starvation, and no proper vitality can be built up. This is true even in civilized countries among the poorer classes whose food supply is deficient in quality and quantity. The second factor is housing; that is, anything that is necessary for protection against the inclemencies of nature. Little clothing may be needed in the tropics owing to the heat, but protection is necessary against the numerous disease-carrying insects. The Eskimo is well provided in regard to clothing, but his igloo or snow-hut compels him to live in vitiated air a great part of his 43 44 HEALTH AND SOCIAL PROGRESS life, similar to the overcrowding in the tenements of large cities. The third factor is salubrity of climate. Where en- demic diseases exist, the good effects of food and housing are often nullified. A region may be fertile and produce all kinds of food, the climate may be mild, but endemic diseases, e.g., malaria and hookworm, will keep vitality at a low ebb. The fourth factor is heredity. With the inheritance of a good constitution a man may often be able to over- come the adverse conditions of the other factors, although he is likely to keep merely alive and refuse to succumb. With low hereditary vitality, a man is always handi- capped, even though the other three factors be favorable. This is proved by the fact that life insurance companies will refuse policies to people in whose families certain diseases have occurred. When the other three fee- tors are unfavorable, heredity is likely to be very poor. The question concerning the relative importance of these factors is not decided, and is, perhaps, of more academic than practical interest. Biology is apt to lay stress on heredity, geography on environment, including food, climate, and housing. These two factors have been on the whole the chief agencies in developing man. Heredity has been the variable factor shifting, plastic, progressive, or retrogressive ; environment has been the constant factor persistent, continuous, omni- present, immutable. Man is always under the influence of his environment; it never sleeps. Yet all the influ- ences of environment will not explain the difference be-, tween the Greeks of today and those of antiquity. The human factor surely claims attention, even though it be gnly a variable influence over against the immutable one FACTORS OF HEALTH 45 of nature. The French had to give up digging the Panama Canal, because malaria and other tropical diseases killed about one-quarter of their employees every year. When the Americans went there in 1905, the Canal Zone was still the area of pest-ridden seaports, jungles, and marshes which it had been from time immemorial. Yet we have built the Canal by reducing the death rate to that of the healthiest cities in the United States. The variable human factor has triumphed over the immutable one of nature. It is in vain, then, to deny the efficacy of either factor. Each plays its role in the making of human history. But each enters into the problem of health, since that depends on both heredity and environ- ment. Suppose that environment be granted all that its advo- cates claim! Wherein does its influence ultimately con- sist ? A valley may abound in the most varied and nour- ishing foods and in perennial sunshine; it will yet be uninhabitable for human beings if its soil sends forth all kinds of poisonous germs. A country may be bleak and cold, still people will live there if they are able to provide the minimum of food. The geographical factor resolves itself ultimately into one of health ; and this has been the most important factor in man's rise above the state of nature. The effects of vitality on civilization are both numer- ous and significant. Whatever the causes may be, low vitality means either low or erratic mentality. We are concerned here only with the former; the latter will be considered in the chapter on Health and Originality. Low vitality always means inability to adjust oneself to one's environment, or to control it. Even adjustment to unfavorable conditions implies, however, low men- tality ; the animal and the savage are ruled by their en- 46 HEALTH AND SOCIAL PROGRESS vironment, civilized man controls it. Why this differ- ence? Animals have perfected certain instincts which are, as a rule, sufficient guides to their actions, and keep them, when in a normal condition, in fair health. They act with almost automatic precision, and thus save the ani- mal a vast amount of useless expenditure of energy in mere trials to do something in a new way. But just be- cause the reactions of animals are fixed, progress is barred and further development practically impossible. The honey bee is a good illustration in this respect. It has perfected the division of labor and everything is provided for the welfare of the hive. The arrangements for a communal life excite our admiration owing to their efficiency. Yet, there is no progress, because the various impulses which form the series of which each instinct consists are so fixed in their order that the bee cannot act differently without disaster. In other words, the bee has become a sort of living machine to do a certain kind of work ; it functions without choice, hence there is very little power of adaptation or chance for variation. This is strikingly proved by the facts that the workers stultify themselves to feed the queen and the drones; that they rear hundreds of males instead of a dozen or two ample for the function they are to perform and that they have repeated the same actions without any material changes since time immemorial. They are slaves to their instincts, subject to the food which a comparatively small environ- ment provides, and progress is barred. It is similar with higher animals, although the instincts are a little more elastic, giving a slightly larger sphere for choice and individual satisfaction. With this greater elasticity of the instincts was given the possibility of mind, and in proportion as we advance in the animal scale, mind be- FACTORS OF HEALTH 47 comes more prominent, until we come to man with his very much larger mentality. Just when and where this transition took place, is an unsolved problem, and may always remain so. Suffice it to say, that under unusually favorable circumstances the transition was made, and mind became for the first time an important item in evo- lution. For man, being equipped with but few and com- paratively inefficient natural weapons, had to depend on the development of his mind if he was to live. This was the more necessary, since the gain he had made was dearly bought it cost him the inerrancy of his instincts. Being no longer compelled to react in certain prescribed ways, he had to think, plan, and scheme. But that re- quired relatively greater vitality or a surplus of energy, since the loss of the inerrancy of his instincts had de- prived him of the more economical and frictionless ex- penditure of energy. Thinking in its early stages in- volves more or less useless expenditure, since it must proceed by the wasteful method of trial and error; this is the case even today, a good illustration being furnished by a new medicine, salvarsan, also called " 606 " by its inventor because the previous 605 experiments had failed to yield the desired results. High vitality could not be developed, however, in the tropics where endemic dis- eases were constantly counteracting the favorable factors of an ample food supply and mild climate. Hence only one course was left open migration northward into more v salubrious regions. In these migrations, only those who had the relatively highest vitality could engage. They were, like the pioneers of later times, the strongest and most active and most intelligent. (See chapter on Health and the Tropics.) This was the first and most primitive method of controlling nature by migration a method whi^h animals share in to a certain extent, These migra- 48 HEALTH AND SOCIAL PROGRESS tions opened up new possibilities to man. He had to meet new situations in the way of enemies, adapt himself to new conditions of food, cross mountains and rivers, and in a hundred different ways develop new aptitudes. Every successful attempt opened up new vistas before him, and every new contact with nature or other men sug- gested new developments. In proportion as he pro- ceeded into higher latitudes, his vitality rose, and he was thus better able to meet the demands involved in getting a living under the less prodigal climate of the temperate zone. He increased his control over nature, and became through increasing civilization less dependent on his im- mediate environment. The peoples who were unable or unwilling to migrate north, continued to live, but were hardly able to develop, and have remained in a stage of savagery or barbarism until today. And they are still almost entirely dependent on nature for all necessaries of life. Along with this control of nature through the develop- ment of the intellect went a liberation of himself from the thraldom of instincts which still survive in him, e.g., for food and sex. These are practically inerrant in animals living in the state of nature, and are thus con- tributory to individual and social welfare. When, with the origin of man, mind assumed a more prominent part in evolution, it was at first primarily an abundance of feeling and imagination, controlled but little by reasoning ; hence the numerous and often revolting orgies engaged in by savage and barbarous peoples. Occasional abun- dance of food, due to success in war or in the chase, al- ways led to extraordinary exhibitions of excesses in both of these instincts, and were frequently continued even in higher civilizations, e.g., among Phoenicians and in India, when the food supply was regular. The poor nutrition FACTORS OF HEALTH 49 of the savage produces an unstable mentality which io- dines to extremes of excitement and joy, or of depression and melancholy. With an increasingly regular and bet- ter food supply, the physical organism becomes more stable and more capable of self-control, and at least the worst irregularities in the satisfaction of these instincts disappear. This statement is borne out by the fact that modern medicine looks upon too pronounced irregulari- ties along these lines as due to malnutrition, if not disease. A brief consideration of morality will bring further corroboration of this reasoning. As his intelligence increased, man soon recognized the injurious effects of excessesboth upon himself, and upon those surrounding him. He formed, consequently, a crude code of ethics, put chiefly in the form of prohibi- tions, and enforced conformance to them by various punishments. But there were always those who could not be prevented by any kind of penalty even the most severe from acting contrary to ethical demands. Were they unwilling or unable to obey ? The punishment meted out to them clearly shows the attitude of older civiliza- tions in regarding them unwilling and therefore responsi- ble; the modern attitude on the part of the enlightened just as plainly indicates that their shortcomings are con- sidered due to physical defects. " At the end of the best part of a life spent among prisoners, a prison surgeon declares himself to be mainly impressed with their extreme deficiency or perversion of moral feeling, the strength of the evil propensities of their nature, and their utter impracticability ; neither kindness nor severity availing to pre- vent them from devising and doing wrong day by day, although their conduct brought upon them further privations. Their evil propensities are veritable instincts of their defective nature, acting, like instincts, in spite of reason, and producing, when not gratified, a restlessness which becomes at times uncontroll- SO HEALTH AND SOCIAL PROGRESS able. Hence occur the so-called ' breakings out ' of prisoners, when, without apparent cause, they fall into paroxysms of excitement, tear their clothing and bedding, assault the officers, and altogether behave for a time like furious madmen." 10 The criminal is not necessarily endowed with bad quali- ties, but he lacks the coordinating power of a well-func- tioning brain. The defect may be due to some specific malformation, disease, or to malnutrition. Poor func- tioning in the case of the two former is so evident to any observer, that it need not be discussed. Concerning mal- nutrition, a few words are needed. The brain grows at a much smaller ratio than the other organs ; this seems to indicate that the vegetative functions demand an increas- ingly larger share of the nutrition furnished. 11 The organism must, first of all, live; whether its life is to be well-directed and efficient, is a secondary consideration. This is well illustrated by the fact that idiots, if protected against adversities, may live to middle age ; and that after the stage of active thinking and reasoning is passed in the case of some old people, the vegetative functions continue sometimes for a number of years. Hence the inference would seem justified, that the brain receives only such nutrition as is not absolutely needed for the maintenance of life. In other words, where general vitality is low, the brain is likely to suffer first and most ; and the cortex is likely to suffer most severely, since both the sensory and motor centers are needed for the mere maintenance of life. The power of coordination must, consequently, be small in persons of low vitality. And it is this particular ability which the immoral classes lack. They are unable to coordinate their actions to each other, hence the more or less pronounced impulsiveness of their behavior ; they generally react on the stimuli of a particular organ, rather than on the demands of the system as a whole, i.e., they FACTORS OF HEALTH 51 are under the sway of an organ which demands and re- ceives more attention than it would receive in a well- balanced healthy organism; e.g., in the drunkard and dyspeptic, the stomach ; in the nymphomaniac, the sexual appetite. These people lack, consequently, the power of coordination, and act in a self-centered manner. And from that condition to selfish action, there is only one step. In the case of those suffering from malnutrition with its consequent low vitality, it is either a special organ that is at fault, or a general lack of vigor on the part of all organs, making impossible a proper nourishment of the brain; hence a general lack of coordination, or hasty reaction on some external stimulus, due to the small in- hibitory powers of the brain. For the unity of the organ- ism not only suggests that the improper functioning of one organ affects all others, but also the special part of the brain with which it is in sympathy. " The internal organs are plainly not the agents of their special func- tions only, but, by reason of the intimate consent or sym- pathy of functions, they are essential constituents of our mutual life." 12 Summing up, then, we may say, that the moral element is an essential part of a complete and sound character, and is based on a sound body ; it is the ability to coordinate one's actions to each other, and to those of other people. When this ability is of a high order, we have sociality. For sociality demands not only that the individual should correlate his actions to those of other people, but that he should do so in a vigorous and efficient manner. Nega- tive morality is still too frequent, and is the only possible thing for people of low vitality, as was shown above. Positive morality or sociality is possible only to those who, pwing to large surplus energy, are able to coordinate in 52 HEALTH AND SOCIAL PROGRESS a comprehensive manner, accurately and quickly; and who have sufficient energy to infuse enthusiasm into others, and make them cooperate. A moral man may suggest new plans of action; the social man alone can unite the many in cooperation by virtue of his energy, which enables him to plan, scheme, and work for those whose vitality requires them to confine themselves to the most necessary activities. It is the vocation of these men to procure more goods than needed for immediate con- sumption, to provide some leisure for at least a small por- tion of the community, and eventually for all. CHAPTER V HEALTH AND CIVILIZATION IN the course of history, the problem of leisure was solved through the warriors at first, or through the institutions of militarism and slavery. It was a crude and barbarous solution, but the only one that could be resorted to at that time. It is not a part of this discus- sion to show how slavery produced a leisure class and accustomed the vast majority of men to give up their wild and roaming life for that of continuous toil and labor under the lash of task-masters. 13 Our only concern is the fact that the most vigorous men physically were the agents of progress along this line. Whatever one may think about mere physical strength in modern titties, it played a distinctly beneficial role in antiquity; and even Aristotle admits " that the conqueror is always superior in respect of some good or other; hence it appears as though force were never dissociated from virtue." 14 It is, of course, not to be expected that the savage who was physically strong, would work for others, since he was not sufficiently advanced in morality and sociality to do that. He made others work, and profited by their labor. This gave him some leisure. In many cases this was ill used ; in a few, well used. The chief results Were an increase in the number of the leisure class and a conse- quent division of mental work among its two principal sections the warriors and the thinkers. The warriors, generally the physically strongest and most active, devoted themselves not to war only, but to 53 54 HEALTH AND SOCIAL PROGRESS the development of industry and politics. They wanted military pomp and splendor, rich feasts and large estab- lishments ; in order to procure them, they had to develop whatever industrial resources were at their command, or call them into existence. King Solomon is a good illus- tration of this class, with the building of the temple and palaces at Jerusalem and summer cottages in the country. This industrial expansion necessitated political alliances, and so he formed a treaty with King Hiram, and estab- lished friendly relations with the kings of Egypt, Arabia, and other rulers to procure the products of their countries and protect his fleets and caravans. He is one of the few kings noted for his wisdom if that is not merely attributed to him by the historians and courtiers who credited him with other men's wise achievements ; for apart from the seventy-second psalm which bears his name, we have nothing direct from his pen ; and the authorship of that is denied him by Biblical scholars. The chief work in mental development devolved, how- ever, upon the priests and upon the scholars the latter being for a long time associated with religious institutions and having gained their independence only lately and only in the most civilized countries. These men made the art, poetry, philosophy, and science of those times. They were always a leisure class and in comparatively affluent circumstances, but rarely as strong and vigorous as the warriors. According to Professor Giddings, the scholars have as a rule medium vitality, while the warriors gener- ally belong to the high vitality class. 15 The vast majority of the people, being slaves and toilers, poorly fed and housed, had low vitality. This fact explains such vic- tories as those at Marathon, where a handful of intelli- gent and vigorous Greeks defeated a large army of igno- rant slaves with low vitality, since one hundred slaves. HEALTH AND CIVILIZATION 55 with systems habitually on the defensive and without energy to strike a vigorous blow, were no match for even one Greek. The health and intelligence of the latter created confidence and a circumspect attitude, the low vitality of the former a craven spirit which was ready to yield at the first onslaught. This division of mental work produced other results. With the low vitality of primitive groups due to poor food, there could be no great enterprise. They merely wandered about to find food and avoid, as far as possible, encounters with other groups. When, owing to slavery, the warriors were better fed, their enterprise increased; they began to love exploits and battles ; they deliberately set out on far journeys into unknown regions, because their surplus energy gave them confidence and self-re- liance in any circumstances. These war-like expeditions, whether they resulted in permanent settlements or were only of a temporary nature, became the means of mixing and amalgamating various peoples. It gave the kings and leaders larger visions, and the conception of world- empires arose in the minds of the boldest. Very nearly every one of the conquerors of antiquity had the ambition to include all peoples under his sway. The numerous failures at last suggested the idea of international law, the jus gentium of the Romans, and, consequently, that empire enjoyed a greater stability than any of its prede- cessors. This law was the direct result of conquests and of the endeavor to retain the fruits of victory as far as land and other possessions were concerned. A more important, because more permanent, result was the mix- ing of peoples which took place in the Roman empire. In this process of assimilation various new traits were formed, most of which were good when not too divergent types mingled as was the case until approximately the 56 HEALTH AND SOCIAL PROGRESS beginning of the Christian era; later, when types of all kinds mixed, they were socially bad, because the lower people infused their low vitality into the already depleted stock of the Romans, who had lost their ablest men on various battlefields. This has been the case with every nation that has engaged in too protracted warfare. On the whole, the effects of mixture were, however, good, since more vigorous races resulted, and the mind of man was tremendously stimulated. It was through this pro- cess that means were eventually found for liberating a larger number of people from the hardships of manual toil. This was through the invention of machinery. Modern industry is possible only through the inven- tion of machinery, and this was dependent upon the leisure of the few procured through slavery. It is not necessary to go into any details about the successive and wonderful inventions and discoveries in science and in- dustry; suffice it to say that whatever objections may be raised against machinery, it has procured comparative leisure for a much larger number of the population, has been the means of improving health, and has thus made civilization possible on a much wider scale. For civ- ilization has always been threatened chiefly by poor health. What, then, is civilization? Civilization means the translation of the subjective good into the objective good ; or, to be more exact, it is the process of transforming the subjective conception of the good into objective practical good. This means simply that civilization is the attempt to ameliorate hardships, improve conditions, and eventu- ally eliminate the worst evils, so that every man may live a life worthy of a human being. Or, to use Pro- fessor Patten's phrase : " It is the transition from a pain economy to a pleasure economy." HEALTH AND CIVILIZATION 57 Two things only need special notice in this definition: the conception of the good, and its translation into objec- tive good. The first depends largely on the mental state of the individual. If he is ill, or at least in poor health, relief will seem the greatest, if not the only, boon to him, and he will conceive civilization as a process of relief or redemption from evil. Again, if his mentality is narrow, he will conceive it as applicable only to his clan, tribe, or nation. Finally, if his mind is of a low type, civilization will mean to him only creature comforts. The second item, i.e., the translation of whatever conception of civilization one may have into objective good, is primarily a matter of economic and industrial conditions, based on science. A few words concerning these points may be appropriate here. There could be no true civilization in the past, since at best only a few of these conditions existed in any nation. As has been mentioned before, the history of the past has been largely dominated by the conception of relief or redemption from evil, because the health of the people was generally poor, and they lacked therefore a sense of confidence and self-reliance. Civilization was conceived in negative terms. This is evident when we look at the Hebrew and older Christian ideals. The Jewish theocracy pictured the Hebrews as utterly de- pendent on Jehovah; hence any misfortune coming to them was attributed to Him as a punishment for their sins, while any good fortune was looked upon as a reward for obedience to His laws. The two dominant notes of the Old Testament are, consequently, a sense of sin and one of gratitude. " Hear the prayers of Thy people, O Lord ! and when Thou hearest, forgive." " Oh, give thanks unto the Lord, for His mercy endureth for- ever ! " The Christian ideal has been dominated in the 58 HEALTH AND SOCIAL PROGRESS past chiefly by the spirit of the Litany : " Good Lord, deliver us ! " The religion of the Greeks was the only one which was comparatively free from this negative conception. They had many gods, and if one or two of them were hostile, others would be friendly. None had the monopoly, and if any serious difficulty arose about Achilles or Odysseus, the matter had to come before the council of gods. It is true, these deities were not models of purity and holi- ness, and were protie to pursue the lives of gentlemanly loafers, but they were at least whole and healthy, and represented to the Greeks beings of fairly unified char- acters. They were full of the joy of life, and gave men the means of enjoyment through arts and sciences. May this not be the reason for the positive development of Greek culture? A healthy and, therefore, active race con- ceived civilization not merely as relief from evils, but as a positive joy, full of achievement and daring action, as the myths of Hercules and Prometheus amply prove. That health was the predominant cause in this blossom- ing of art and science may be shown by a reference to the later Greeks. With the introduction of malaria, health began to decline ; productiveness ceased, and the character of their deities changed almost at once. The Greek no longer looked to Olympus and its gods endowed with perpetual youth, and no longer hoped for his own pos- sible endowment with that quality as a demi-god; he exchanged the mountain of the gods for implacable Fate, and the joyous wholeness and unity of the human being for the dualism of Plato's " spirit and matter." This conception of Plato was introduced into Christi- anity, and, after being assimilated with the Hebrew sense of sin, has dominated western civilization until now. .It is from this negative ideal that string and healthy m HEALTH AND CIVILIZATION 59 are turning away at present; the reason of their indif- ference to the churches is not antipathy to the moral and spiritual teachings of Christianity, but rather apathy to a life of comparative inaction. For the man who is accustomed to depend on himself and to cultivate self- reliance for six days of the week in nearly every sphere of his life, finds it irksome on the seventh day to submit meekly without the right of cross-questioning, to the teach- ing of another. He finds, moreover, that the sciences, and medicine in particular, are working for a positive civiliza- tion, containing joy and happiness a condition of things which will enable him to realize that he is not here merely to prepare for a future existence, but that this life is worth living for its own sake and ought to be improved as far as possible for everyone, instead of being made merely endurable. To this end he endeavors to introduce prophylactic measures into every department of life ; to improve conditions in accordance with an ideal to be attained in the future and not with that of some " golden age," irrevocably lost in the distant past ; to do and to achieve something that is worth while not be- cause he is bidden to do so, but because action of a whole- some social nature is what he craves and best expresses his desire for an expansion of life. The narrowness of mental ideals has played a large role in the past. Whatever the best thinkers of any people pictured as a desideratum in national ideals, was always reserved for their own people, and others were excluded, unless it was for the purpose of serving their masters. " It is meet that Greeks rule over barbarians," are the words of Aristotle. Other nations were more narrow even than the Greeks. Such a conception of civilization was, however, not only narrow, but moribund, because no country is sufficiently equipped with all the 60 HEALTH AND SOCIAL PROGRESS necessaries or comforts of life, or a full equipment of mental resources, to enable at least the majority of its inhabitants to develop their faculties. Hence, intercourse with other nations is imperatively necessary; it is, how- ever, impossible without the recognition of other people's rights, and a narrow national ideal always implies a denial of those rights. But people whose economic and emotional resources are small owing to poor health, are apt to be narrow in their political conceptions. We thus come back to the question of health from another point of view. Finally, if a man's mind is of a low type, civilization will mean primarily creature comforts. We have seen that a sickly or an undervitalized man cannot produce an active and vigorous brain, that he is self-centered and must confine himself to the most necessary activities. This means that such a person must of necessity seek creature comforts ; owing to his inability to gain pleasure from vigorous and wholesome action, he must seek relief from his pains, or at least discomforts. For instance, lacking the good appetite of a healthy man, he must seek, if not delicacies, at least more choice and better prepared food. In regard to clothing, he must be more warmly dressed in winter, and must expose himself less to the inclemen- cies of the weather, than the well man. All this leads in- evitably toward a self-centered disposition and the seek- ing of comforts. It is true that we read occasionally of persons who even during illness do not forget the rights of others and are considerate of others' comfort. This is, however, always looked upon as an extraordinary exhibition of fortitude, due to an exceptionally well- trained will, or to social conventions. Just as the Indian under torture does not cry out owing to his training, so the sick lady or gentleman will be most anxious to avoid HEALTH AND CIVILIZATION 61 laying any extra work on the nurse. We are neverthe- less certain that they suffer, and we double our attention to spare them any pains and tactfully avoid even the sem- blance of making efforts for their comfort. The very fact that we praise such persons for their restraint and fortitude proves that the normal thing under suffering is the seeking of relief and comfort through others, and that a self-centered mental attitude is unavoidable. The headaches, the nervous irritability of those in poor health are all continuous witnesses of this self-centered attitude. The pioneers, whether as scientists or missionaries or a& pathfinders in new countries, prove this contention from a different point of view. They are usually men in good health, and seek, either through love of truth or of their fellowmen, or out of sheer abundance of vitality, to in- crease the world's useful knowledge and good will, and are rarely self -centered as far as their attitude is con- cerned. They act on the maxim, " It is more blessed to give than to receive," not because they are bidden, but owing to an inherent need and desire to express them- selves in socially useful action. A well man does not call on others for services ; he considers it a glory to be in- dependent and a privilege to help others. The conception of what good means, is thus necessarily dependent on one's health. In regard to the second point, the translation of this good into practical, objective good, a few words will have to be said. This depends, as was said above, on science as the basis of a higher industrial and economic system. The philosopher and the poet may tell us in glowing pictures what they conceive to be a social ideal of beauty and of perfection along every line, and they may stir our imagination with a desire to realize it; but it is the scientist who makes possible its translation into 62 HEALTH AND SOCIAL PROGRESS objective reality. He needs, however, good health, since his senses must be keen and he must have a fine sense of balance and coordination. He cannot shape his system according to a priori principles and proceed to erect a structure of logic and plausibility upon it ; he has to " check up " his ideas constantly by reference to new facts, and keep his mind open for other facts still to be discovered. His attitude has to be that of open-minded- ness, patience, ability to balance, willingness to change his conclusions and to retrace his steps. All these quali- ties demand good health. The irritable and " inspired " poet may, with a few strokes of his pen, give us a most entrancing ideal of what the future will bring forth in the way of beauty, truth, and goodness the scientist alone, with his ability to stand shocks and disappoint- ments, to begin all over again, and to labor for years at a single small problem, is able to help us realize them, because he helps furnish the material basis for all cultural accomplishment and civilizational achievements. That such careful, patient, and often tedious work demands not only a fine nervous system but general fair health, will be discussed more fully in the chapter on Health and Originality. This attitude of the healthy man toward objective social action indicates the transition from a pain economy to a pleasure economy. Nature demands the satisfaction of certain physical wants, because these are necessary for the fulfillment of the functions of life. It is true that this furnishes a certain amount of physical pleasure, but it is very elementary and is more on the level of the animal than of man. When, for instance, the savage half starved and more or less exhausted succeeds in getting an ample food supply by killing a deer, he does not ob- serve any niceties about eating, but swallows the meat HEALTH AND CIVILIZATION 63 half raw and without much attention as to mastication. Nature imperatively demands food, and the savage meets that demand and so fulfills a natural function. The pleasure is rudimentary and animal, just as in the case of a hungry dog. Compare with that eating the feasting of a modern man the elaborate preparations, the clean table linen, the attractive china, the flowers, the cheerful company, perhaps music, the dishes gathered from almost every corner of the globe and you have a natural func- tion satisfied plus a purely human pleasure, because the physical has been raised through the accompanying men- tal satisfaction to a higher level which the animal can never attain. It is the same way with other things. Most men need shelter and clothing for protection against inclemencies of weather; but what a difference between the cave or the rude hut of the savage and the mansion of civilized man, or between the dried and hard skin of animals used by the barbarian, and the artistic clothing of a woman of fashion serving the purpose of protec- tion much more successfully while at the same time satisfying an aesthetic demand. The savage may dream about feasting and whatever he considers fine clothing or a pretentious abode, but he is bound down to fulfilling nature's demands in the most primitive manner. It is civilization that has enabled mankind to advance from that stage of a pain economy to one of pleasure. And civilization is the result of health. We saw above that a man of low vitality can do but little Thore than take care of himself, i.e., provide for his most elementary needs, because there is no energy left for any attempt to improve his condition by planning, or experimentation. It was the leisure class, the vigorous, well-nourished individuals who had enough energy left after their daily work to scheme, plan, and experiment in 64 HEALTH AND SOCIAL PROGRESS order to husband and increase nature's provisions and to raise life to a higher level through the development of art, science, and philosophy that produced civilization. The sick man even today is largely in the position of the savage; he eats, because he has to and takes no pleasure in meeting nature's demand. And he cannot contribute anything toward improving either his own or other people's condition ; he consumes but does not pro- duce. Where there is, however, a large number of people who consume without producing, civilization is impossible; and where only little more is produced than necessary, it is in a precarious condition; because the translation of the conception of the subjective good into objective good means in terms of economics a greater production than is necessary for immediate wants, and thus the procuring of leisure or exemption from too ex- hausting toil. It is plain that the sick man cannot do that, and it takes but little reasoning to see that the undervitalized man cannot do it either. The latter works uneconomical!/, because he has to force himself, and is thus soon exhausted, and mighty glad to stop when his immediate wants are met. The advance of civilization is, thus, always dependent on the health of the people. This may be illustrated by a few references to nature- peoples. They are seldom regularly and sufficiently fed ; it is usually a case of starvation or of over-indulgence when plenty is to be had; the Igorots of the Island of Luzon consider it bad manners to leave any eatables for tomorrow. Under these circumstances no higher or even medium vitality can be developed, and consequently no surplus energy for an advance socially or mentally. En- demic diseases are another cause of keeping vitality down to its lowest level, and nature-peoples are, as a result, condemned to a pain economy. Being constantly faced HEALTH AND CIVILIZATION 65 with starvation, and therefore always more or less surly and morose owing to poor health, it is small wonder that many nature-peoples have invented barbarous methods of getting rid of the aged or of superfluous children. Their morals are merely a result of their poor health. A hungry man knows no mercy, and a sick one no com- passion. Whatever of song and of poetry, art and social- ity existed among nature-peoples, was produced at the rare times of plenty when men were happy because the craving for food had been satisfied and when, conse- quently, a slight excess of energy had been produced. No people has ever succeeded in rising above the level of savages unless it possessed at, least fair health; where either economic or climatic conditions prevented health, no civilization could arise; and -where it had arisen it was doomed whenever new conditions arose which under- mined health. Health is, thus, the principal index to civilization, be- cause it shows control over nature by society as a whole, and ability on the part of the individual to utilize these means of control for his own benefit. This control im- plies the ability to secure a suitable supply of food as regards quantity and quality, to counteract or avoid the effects of endemic diseases, and thus to lay up a store of surplus energy. This control of nature demands work, i.e., the per- sistent and intelligent application of physical and mental energy toward a clearly conceived social end. Where human energy is not applied persistently but by " fits and starts," we have the wasteful expenditure of the savage who will dance for two or three days with but few intermissions until the point of utter exhaustion is reached. If he is not engaged in warfare at the time, well and good; he can sleep and rest for a week or two, 66 HEALTH AND SOCIAL PROGRESS until restored to his normal condition. If he has enemies, they will watch for just such an opportunity and over- come him easily. It seems to me that this is the explana- tion of the numerous cases where often a handful of men defeated a large army, generally after a period of orgies and carousals when energy had been fully ex- hausted, so that new emergencies could not be met. Such orgies preceding an attack are directly mentioned as a cause of defeat in a number of cases, e.g., Belshazzar's fall, and the victory of Frederick the Great at Rossbach. Where the application of energy is not intelligent, we have mere toil which exhausts but produces very small returns ; slave labor and so-called " unskilled " labor is of that nature. It gives very little mental satisfaction. Where, finally, the end is not clearly conceived as social, we have either misdirected energy, as in the case of the older Japanese craftsmen who wasted several years on the production of an intricate toy, or the well-directed energy of the selfish exploiter who seeks satisfaction in domination over others. Another case is possible, namely, that of the pleasure seeker in abnormal excite- ment. A few words concerning each of these cases will be necessary. The persistent application of energy requires a good stock of vitality, since it is the continuous although less strenuous application that is tiring. Even such easy work as bookkeeping demands more energy than the average savage possesses. Such well-distributed expenditure over a long period of time requires an excellent control over one's whole body, and that is possible only with good vitality. The savage neither has the vitality owing to undernutrition or malnutrition, nor has he a sufficient control over his body, owing to his poorly constructed nervous system. Hence savages, barbarians, and even HEALTH AND CIVILIZATION 67 semi-civilized peoples have never been able to work, and wherever they were forced to do so by stronger men, they succumbed in a short time. This is the primary reason for the rapid disappearance of nature-peoples when com- ing in contact with civilization, since, being deprived of their former means and methods of living through the chase, and unable to create a sufficient amount of energy suddenly, they were unable to adapt themselves to new conditions and rapidly fell victims to exhaustion or diseases. Volumes have been written by well-meaning persons on the deliberate cruelty of civilized nations in killing off those on lower levels of civilization. The proc- ess of extinction is, however, inevitable, unless nature- peoples succeed in creating a larger amount of vitality which will fit them for work. It is not the gun of the white man which has exterminated the red and many of the brown races, but their inability to work, as may be seen by a comparison with the Mongols who, although not particularly well fed, have long ago acquired the habit of work, and are now becoming the competitors of the white man successfully, too, wherever they are able to get better food owing to higher wages. The unintelligent application of mere physical energy is toil, and gives but little satisfaction to a human being, besides being unremunerative. We find, therefore, that countries like the Balkans and Russia in Europe, and large parts of China do not produce any high type of men among their peasantry ; because there is no satisfac- tion in merely meeting the demands of nature to live. A man must have something more than mere animal pleasures if he is to rise to a higher level of civilization; he must take pleasure in his work, and express himself through it. That cannot be done through mere toil ; hence the absence of inventions for the amelioration of 68 HEALTH AND SOCIAL PROGRESS economic conditions and the proverbial poverty of those countries. In England, Germany, France, America, and in Australia, men enjoy their work because there is a keen pleasure in mastering an intricate problem which taxes one's ingenuity ; these countries . have succeeded in re- lieving their people from mere toil by having it per- formed through machinery. True, there is a new danger lurking here, since many working men have become an- nexes to the machines which they attend. The remedy has, however, already been found in shorter hours and more varied means of enjoying leisure, both made pos- sible by the greater production of machinofacture over manufacture. The man who works only with his hands, rarely produces more than he needs ; it is the machine which helps us to produce a surplus, and thus to create leisure. We are already meeting this problem of the possjble deterioration of our working classes through the monotony of their employment by encouraging them to follow an avocation during their leisure hours, and thus developing those qualities which are not exercised in their occupation. Ideally, vocation and avocation should coincide, and man should find his greatest satisfaction in his work, and his keenest joy in making it more effective for himself and others. As yet, we are far from that goal ; but we have at least come to recognize it as attain- able. The more or less useless work of the Japanese crafts- man is a thing of the past even in his own country, and it has rarely existed in modern Europe or in America. We are, however, threatened with a similarly useless, if not unsocial, form of expending energy. Many women and some men among our rich people are seeking pleasure in more or less abnormal excitement, and some men and women among the poorer classes imitate them. That HEALTH AND CIVILIZATION 69 such expenditure is harmful, is obvious; that it is based on an insufficient state of health, is more difficult to prove. The attempt will, nevertheless, be made. In introducing the subject of health above, it was stated that the human body is a machine for action in order to preserve and improve life, and that the mind is the guide of actions along those lines. Hence, " as a matter of necessity, man is an agent. He is, in his own apprehen- sion, a creature of unfolding impulsive activity ' tele- ological ' activity. He is an agent seeking in every act the accomplishment of some concrete, objective, impersonal end. By force of being such an agent he is possessed of a taste for effective work, and a distaste for futile efforts. He has a sense of the merit of serviceability of efficacy and of the demerit of futility, waste, or incapacity. This aptitude or propensity may be called the instinct of work- manship." 10 Wherever man violates this law of effective and useful action, and wastes his energies in futile effort his faculties will decline in power and the wrongfully used organs will deteriorate. And that is exactly what has happened to our American " idle " class, more par- ticularly to the newly and ultra rich women. They are supplied by their husbands with everything that money can provide ; they have no responsibility, no inducement for useful effort of any kind, and nothing to occupy their ample leisure except amusement. Is it any wonder that their nervous systems deteriorate, and that more ex- citing pleasures are being sought by them so as to re- move that sense of tccdium vita: and of vacuity with which they are oppressed? Having refused in many cases to become mothers in order not to interfere with their bridge and opera parties, they have at last become unable to bear children, as Mrs. Olive Schreiner so ably argues in her Woman and Labor. The result is an 70 HEALTH AND SOCIAL PROGRESS increased nervousness and restlessness, since no one can violate nature's laws with impunity, and the sense of having failed to fulfill any mission in life leads to still further cravings for excitements which violate the ordi- nary social laws. Hence an increasing number of in- discretions and scandals as reported by the daily press. At the other end of the social scale we have a similar nervousness for different reasons. Working girls get over-fatigued, and instead of seeking rest for their aching nerves, they attempt to drown their weariness in amuse- ments for which they are unable to pay. The result is increased excitability, depression, and eventually degener- ation. The only desire which these women both rich and poor have, is to out-do somebody else in extrava- gance, no matter what the cost. They must, consequently, be failures as wives and mothers, and this must eventu- ally affect the husbands who, unable to pay the ever in- creasing bills, take to drink or run away. And the cause of it all is refusal to do useful work. The rich are beginning to recognize the danger threat- ening them, and are commencing to take a more vital interest in life, as the book of Townsend Martin on the Passing of the Idle Rich shows. The increased politi- cal activity of these women is to be welcomed from this point of view, because it gives them a new sphere of activities more wholesome than mere amusements. The more energetic women of this class, while single, are talking of definite work either in settlement or religious occupations, because they do not want to degenerate in the vacuities of so-called social life. Work is, thus, both the basis and the preserver of civilization. There remains one more type to consider briefly, i.e., the man who applies his energy both persistently and intelligently, but unsocially and for the exploitation of HEALTH AND CIVILIZATION 71 others. If what has been said above is true, not much need be said about him. The healthy man we found to be social in his activities, due to his abundant vitality. Just because his body is a well organized and efficient unity, he organizes his work intelligently ; he has to work per- sistently owing to the necessity of giving a proper outlet to his surplus energy. There is, consequently, no waste- ful expenditure of energy in his case, but well-directed and effective activities along lines which seem worth while to him. His social nature impels him, however, to assist others, and his abundance of energy enables him to do so ; he will never resort, consequently, to the exploita- tion of others; that would not be in harmony with his nature and contrary to everything that gives him joy. If this be true and it can be verified by observation every day there is only one conclusion possible con- cerning the selfish exploiter that he is not a healthy man. He may display tremendous energy in varied and fever- ish activities, but the balance of good health is lacking. There is a peace and contentment, a joy and happiness about the healthy man, which the selfish and feverishly active man does not possess. It seems as if he wants to get something which he lacks, not knowing exactly what it is ; hence his incessant and carefully planned activity. The goal of his ambition is usually power, in whatever form that may exist in a particular society. Since he lacks the balanced harmony within himself, he seeks it in the control of, others. The means for power and control vary in different societies, but the type is always the same, although the same type may be esteemed differently at different periods. Take the miser, for instance. In olden times Midas represents the type the grasping, greedy king who would turn everything into gold to satisfy his lust for power. But it was deemed a 72 HEALTH AND SOCIAL PROGRESS vice in a king in those times to lust for power in the form of gold; power through the feat of arms was the socially accepted means for power, and a king who sought it that way was never caricatured as was Midas. An- tiquity has only praise for the Hannibals, the Alexanders, and the Caesars. During the Middle Ages the socially accepted means of seeking power was the church, and anyone seeking it through warlike exploits was censured unless it was in the service of religion ; the man who sought it in gold, was held up to public scorn at least, if he was not persecuted. Shylock is the picture of the selfish man of this period. In our own country the ac- cepted means of power is gold ; and lo and behold ! what a change in popular esteem. The financier is no Midas, much less a Shylock ; but the man who saves the country in times of panic, barely escapes a public funeral, and certainly has many encomia written after his death. The type of the selfish man is always the same, i.e., he is the man who seeks power through well-planned action by exploiting others ; if they are incidentally benefited by serving as his tools, he does not object. The point is that he seeks a balance and harmony in dominating over others, because he lacks these qualities. The interesting thing from our point of view is that in some way the Volksmund always caricatured these men by ascribing to them some physical defect. Midas is thin, haggard, poorly fed, and certainly mad. Shylock is old, almost doubled over from weakness, and certainly obsessed by money-madness. The financier of today, being the man who has chosen the accepted means of wielding power, is supposed to be sleek, well groomed, and the gentleman par excellence who favors kings and emperors with his visits. It is the warrior and the priest w r ho are ill-favored by popular opinion. Anyone familiar with the popular HEALTH AND CIVILIZATION 73 press of Europe will recall the numerous and varied forms of ridicule to which they are subjected and the caricatures which almost invariably intimate some more or less hidden physical defect. The type has not changed psychically. As Alexander used the soldiers as tools to satisfy his selfish ambition for power, Napoleon used the French people for the same purpose ; and it is rumored that certain war-lords of Europe would do the same if the means of seeking power had not changed from the mailed fist to the hand that signs checks.* If the type is psychically unchanged, may there not be some truth in the popular opinion that there is some physical defect lurking somewhere in the makeup of selfish men, indi- cating lack of health and balance? Health is, conse- quently, the basis of true social work. Civilization is, then, possible only on the basis of work well planned, persistent, and intelligent. Only where work is recognized as the proper activity of every man, can there be true civilization. This work need not be manual labor, nor industrial or commercial pursuits. Any activity which is intelligent, and is directed toward raising society to a higher level, is work. And any society and individuals who recognize the necessity of work for the fulfillment of man's destiny here on earth, should be called civilized, no matter how poor they may be. The motive for work must not come, however, from the recog- nition of its necessity only ; it must be an impulse from within urging man to exert himself intelligently and persistently. Where man works only because necessity compels him, he will never do more than meet that de- * This passage was written before the recent war broke out in Europe. It would be interesting to study the health of the leaders in this movement. Concerning one it is definitely known that he has a poor heredity, is very excitable and erratic, and suffers from megalomania. 74 HEALTH AND SOCIAL PROGRESS raand, and will remain on a low level of civilization. \/Where he seeks an outlet for his surplus energy in well directed activity for social ends, and where he finds his joy and satisfaction in work, a surplus of goods will soon be produced, and the leisure which that makes pos- sible will soon enable him to create means of culture through art, science, and philosophy. Such activity is possible, however, only on the basis of good health. The sick man can evidently not engage in work. The undervitalized man may try hard and perhaps wear himself out in his endeavor, but his work will be ineffi- cient. As a matter of fact, the so-called incompetents consist largely of this class. Only healthy men have the true impulse for work; only they work efficiently, and only they produce more than is necessary for their own needs. And only such workers can enjoy a true self- respect. The man who lives on other people's work is a parasite, whether he is a tramp or a millionaire; he is, consequently, dependent on the exertions of others, and that deprives him of the ability to be self-respecting. The man who does not " pay his board to the world " must get someone else to pay it for him. That means that the wheels of progress are retarded to that extent, be- cause that board must be paid. The parsimony of nature must be overcome, and it can be overcome only by paying a price in human effort with physical and mental energy. If a community has many parasites, it loses that much in actual work and puts a heavier burden on the others than they ought to bear. Worst of all, though, is the lack of development on the part of the idlers, since effort is necessary for development direct, personal effort alone will unfold our powers, since this cannot be done vicariously. Our development is, moreover, the only thing worth while in life, and everything worth while must be HEALTH AND CIVILIZATION 75 paid for, and the price in this case is exertion. Where the energy for work is lacking, there may be exertion, but it will either be ineffective or so costly to the indi- vidual that development becomes impossible. Hence we come back to the necessity of health from another point of view. What do we mean by development ? The development of an individual means, briefly stated, his growth into a social person. Professor Giddings says: " The true social nature is susceptible to suggestion, and imitative and thereby capable of learning from fellow-beings. This capacity is sufficient to make the social individual desirous to live at least as well as the fairly successful members of his community. He desires to enjoy what others enjoy, to do what others do, and to act as others act. " The social nature, however, is to some extent originative. It not only learns from others ; it also teaches others. It makes new combinations of imitations ; it makes inventions in the sphere of thought and conduct, and sets new examples. This it is enabled to do, because, by varied contact with many phases of life, made possible by wide association, it enjoys many different experiences which inevitably combine in peculiar ways with peculiar results in the life of each separate individual. " The social nature is judicious. It is satisfied that, on the whole, the average judgments of mankind -are justified by ex- perience. It cannot, to be sure, be perfectly satisfied with any judgment, much less with all judgments. It is at all times ready to criticize, to direct, or to devise ; but this it does in no cranky, captious, or quixotic way. It assumes that, for the purposes of social unity and cooperation, men must respect one another's judgments; and that new beliefs can be made practically avail- able only as large numbers of men are converted to them. The individual, protesting alone against the opinions of his fellow- members of society, may possibly be right, and they may be wrong; but not until they are convinced of error can he wisely or rightly undertake to put his views into practical operation. " The social nature is tolerant. It has learned through social experience to give the same opportunities, immunities, and en- 76 HEALTH AND SOCIAL PROGRESS joyments to others that it claims for itself. And not only as a matter of judgment has the social individual decided that toleration is wise, he has learned also to feel as an experience of his emotional nature that it is desirable and agreeable. " The social nature, however, is not merely tolerant in the negative sense of being non-aggressive ; it is positively sym- pathetic, companionable, and helpful. It enjoys comradeship, communication, social pleasure, and cooperation. It would be unhappy in isolation and dissatisfied if at work in an absolutely individual way, without relation to the industry and patriotism of other men." 17 The only persons who can meet these descriptions are healthy men and women, since only these engage in spontaneous activity, enjoy the expansion of opportunity, and experience a keen pleasure in the increase of their power. This activity is not self-centered, just because their abundance of vitality enables them to share with others their own joy and happiness ; they would, indeed, be made miserable if they had to live in an atmosphere of gloom. Hence by virtue of their own nature they cheerfully scatter sunshine wherever they go. Their sur- plus energy enables them to associate with many people, enter many and varied activities, and everywhere to learn something new, . because of their receptivity. The devitalized man must conserve his energy, is more or less concerned about himself, and he cannot with the best intentions " get away from himself." If under special cases of excitement he forgets himself, he mani- fests that somewhat boisterous hilarity which with women borders on and usually precedes hysteria. The friends of such people are not deceived, since they know that such expenditure of energy is sure to bring about ex- haustion and collapse. The healthy man increases in power as he associates with an ever larger number of people; since growth of personality is possible only HEALTH AND CIVILIZATION 77 through exchange of views with others and through the polishing off of the sharp corners and edges of our individual nature. Applied to civilization this means interdependence of peoples ; for, as individuals must learn to abide with each other by the circular movement of " give and take " in order to grow, so must nations enter into relations with each other on the basis of fair ex- change of their mental achievements as well as indus- trial. But travel, whether for commercial purposes or scientific investigation or for the pleasure it affords, is ultimately dependent not so much on the means of com- munication as on the health of the travelers and on that of countries. Persons of low vitality cannot risk many journeys, because they depend too much on the comforts of home ; healthy people do not visit regions infested with typhoid, malaria, or yellow fever. The Panama district was never visited by pleasure tourists until the last few years when the Zone had been made salubrious by Dr. Gorgas. Unhealthy regions prevent, moreover, the pro- duction of anything else than raw material, and thus even the commercial traveler is not attracted to them. Finally, owing to their dependence on others, devitalized people never develop that sturdy belief and confidence in them- selves, which are so characteristic of the healthy man and which are so necessary for new exploits as well as the undismayed pursuit of more usual activities. From whatever point of view we look, consequently, at the individual or society, the problem of health always confronts us ; and we may now sum up our results in a few principles. 1. Law of Progress: Progress is possible only with a surplus of vitality over the immediately necessary activi- ties of life. 2. Law of Work: Work in the sense of telic endeavor 78 HEALTH AND SOCIAL PROGRESS and of the wisely controlled expenditure of energy is possible only with good health. 3. Law of Social Personality: The individual can grow into a social personality only in proportion as his health permits him to enter into mutually helpful and sympathetic relations with others. 4. Law of Civilization: Civilization progresses in direct ratio to the interdependence of persons and peoples ; i.e., on the interchange of mental and industrial products which result from a healthy individual and social life. 5. Law of General Development: Individuals and soci- eties develop in proportion to their growth in self-reli- ance ; and this depends upon their ability to attain health with the resultant confidence in their ability to control nature and their own destiny. PART II SPECIFIC CASES OF HEALTH IN RELA- TION TO SOCIETY CHAPTER VI HEALTH AND ANCIENT GREECE MAN is bound to earth. Like Antaeus of old, he gains strength every time he touches her; and like Brutus, he must recognize her as the mother of us all. In proportion as she is kind and liberal with her gifts, he prospers and develops, and in proportion as she is niggardly, he be- comes stunted in mind and body. Some mothers give too much, and spoil their children ; others give too little, and hinder their development ; others again give -enough but not too much, and thus favor the development of initiative through "mental and physical activity. So nature is a " lady bountiful " in some places, in others a hard step- mother, in others again a wise and kindly mother who knows that over-indulgence is evil and that niggardliness may prove disastrous to the welfare of her children. But however nature may treat her children, they are always her offspring, and bear the marks of her different attitudes in the tropics as much as in the arctics ; for they can never completely free themselves from the in- fluences which she is constantly impressing upon them. This dependence upon natural influences has led social scientists to the conclusion that happenings in the social and political sphere are not the result of chance, of indi- vidual impulse or caprice, nor of the direct interference of an infinite, and often arbitrary power. History in our times is not written as that of Herodotus, or of the Chronicler among the ancient Hebrews, who ascribed every happening to the good or ill will of God. We 81 82 HEALTH AND SOCIAL PROGRESS have learned that nature is orderly because ruled by law ; and so we are learning that social happenings occur in an orderly and law-abiding manner, just because man is nature's offspring. We have not yet proceeded far enough in this new field to foretell with the exactness of astronomy the future of social events, but we know that the origin, growth, decay, or retardation of institutions may be aided or hindered by man according to his knowl- edge of nature's laws. In proportion as we realize this fact, shall we succeed in shaping our own destiny, " to see in order to forsee " as Comte said, to avoid harmful things and provide for advantageous ones. Man's dependence on nature might be illustrated from many points of view, as Buckle, Ratzel, and Huntington have done. The only point with which we are concerned is that of health, and the Greeks and Romans will serve as a sufficient proof of its importance for national wel- fare. This statement should, of course, be understood just as it stands importance for national welfare since no attempt will be made to explain Greek and Roman genius from geographical conditions, because explanations of that kind are, to say the least, one-sided and forced, as the theories of Buckle and Ratzel prove. With our present imperfect knowledge of the relation of body and mind, it is premature to attempt an explanation of civili- zation on the basis of any one factor. Life is, after all, not a theory, but a bundle of facts. Until we know at least the majority of these facts scientifically, our theories will always be colored by our philosophies, and these represent distinctly individual views and not generally accepted theories of life. That health is necessary for civilization, the Greeks and Romans prove abundantly since no other peoples believed so strongly in the theory of Mens sana in HEALTH AND ANCIENT GREECE 83 corpore sano. Their training aimed at the best possible development of the body, and for a long time they suc- ceeded. Then a disease entered their countries, and attacked them, and as they were unable to cope with it, they lost virility and buoyancy of body and mind; the surplus of energy which had been stored up was soon exhausted, and the decadence of their civilization com- menced almost immediately. This disease was malaria/ There were undoubtedly other diseases, both individual and social, which contributed to this result ; but we are unable to lay our finger as definitely upon them as on this particular disease. In an attempt to prove this theory, six questions must be answered: (1) Does malaria produce such deleterious results as the theory calls for? (2) Was there any marked deterioration of the Greek character at a par- ticular time? (3) Is there any specific cause that can be assigned as a reason for such a result? (4) If malaria was the cause, when was it introduced? (5) How did it affect the Greeks? (6) Why were the effects so disastrous? The first of these questions has a general application, and the answer of modern medicine covers any people. (1) Does malaria produce such deleterious results as the theory calls for? A full statement by a physician, William H. Deaderick, who has been engaged in private practice in country dis- tricts, in the home of the severer forms of the disease in Arkansas, will serve the purpose of proving the disastrous character of malaria better than a discussion by a layman. " Malaria has been one of civilization's greatest foes, both in time of war and in peace. Where shot and shell have slain their thousands, malaria has slain its tens of thousands. Malaria is the chieftain of the army of disease. Even Napoleon acknowl- 84 HEALTH AND SOCIAL PROGRESS edged its supremacy when he wrote his minister of war on the occasion of the disastrous English Walcheren expedition : ' We are rejoiced to see that the English themselves are in the morasses of Zealand. Let them be kept only in check, and the bad airs and fevers peculiar to the climate will soon destroy their army.' It is said that the French crowed over the expedi- tion ' with the force of reason, the bitterness of sarcasm, and the playfulness of ridicule.' How accurately Napoleon's pre- diction was verified is well known. " In the tropics, the man who works the soil digs his own grave. Gigantic commercial enterprises have been undertaken and then abandoned on account of the havoc wrought by this scourge. Only recently has it been recognized that the medical man must precede and prepare the way for the engineer and the laborer. " But warring and canal digging are not the only conditions under which the malarial tragedy is enacted. Within the family, at home, the disease appears in a varied succession of forms, rapidly fatal or slowly sapping the vitality, influencing the birth rate, longevity, and even the intelligence and morality of entire countries. " In highly malarial regions, as the mortality increases, natality diminishes on account of abortions and sterility. Premature senility is frequent and advanced age is not so commonly attained. " Malaria, leaving its subjects anasmic and neurotic, is re- sponsible for inertia, loss of will power, intemperance, and general mental and moral degradation. Jones, who maintains that malaria was a potent factor in the decline of Greece and Rome, concludes that ' malaria made the Greek weak and in- efficient ; it turned the sturdy Roman into a bloodthirsty brute.' Monfalcon attributed abortion, infanticide, universal libertinism, drunkenness, want of religion, gross superstition, assassina- tion, and other crimes to the direct influence of malaria. " Malaria costs the South incalculable wealth. Besides loss through untilled acres, diminished earning capacity, loss of time, and death, it produces in its victims a disinclination for work whose influence cannot be estimated in money. A conservative computation of the loss to the Southern States through malaria is fifty million of dollars, annually. "The importance to the world at large of the subject of HEALTH AND ANCIENT GREECE 85 malaria is evidenced by the fact that two of the seven Nobel prizes in medicine which have been awarded have been granted for discoveries in malaria, to Ross in 1902, and to Laveran in 1907." 18 A third Nobel prize was awarded to a malaria specialist in 1906, namely Golgi. This general description of the effects of malaria may be supplemented by its special effects. These vary some- what according to climate, physical susceptibility, and type of fever. Quotations from Sir Patrick Manson will again best serve the purpose of showing the nefarious character of malaria. " But, as there may be an infinite variety as regards the num- ber of parasites present, individual susceptibility, concurrence of several species (mixed infection being far from common), or of several generations of the same species of parasite maturing at different times, there may be a corresponding variety in the clinical manifestations." 19 Of the " bilious remittent " form of malaria he says : " These bilious remittents are very common in the more highly malarious districts of Africa, America, the West Indies, India, and, in fact, in all malarious countries. They are not specially nor directly dangerous in themselves, but they result usually in profound anaemia, and are often but the prelude to chronic malarial saturation, bad health, and invaliding." 20 Concerning " adynamic remittent " our author says that there are : " Cases which are characterized by fatuousness, restlessness, nervous depression, intense muscular and cardiac debility, pro- found and rapid blood deterioration . . . and a marked tendency to local gangrene." 21 Among the " pernicious attacks " there are various " cerebral forms " which are generally dangerous. 86 HEALTH AND SOCIAL PROGRESS " Seizures of this description, if not fatal, may eventuate in permanent psychical disturbances. Temporary debility or even complete loss of memory may succeed severe malarial infec- tion." 22 Similar statements are made about other types of malaria. The blood is attacked by the parasite and we have a deterioration and diminution of the red cor- puscles. Among the results of malaria Sir Patrick Man- son mentions enlargement of the spleen and liver, de- generation of the heart, and other after-effects. Dr. Deaderick thus describes persons suffering from malarial cachexia. " The cachectic usually presents a singular appearance. The emaciated limbs are in marked contrast to the big belly, and the features are aged beyond the years. The most pronounced phenomena are the ansemia and the enlarged spleen. The red blood-cells may be reduced to seven or eight hundred thousand per c.mm." 2S The true mortality from malaria is difficult to esti- mate, because of the variety of forms which malaria assumes and its complications with other diseases. Dr. Deaderick states that out of 5,109,001 cases, 148,055 or 2.89 per cent ended fatally. These figures report evi- dently light cases, since according to other figures given by him there were 7,205 fatalities out of 27,039 cases, or over 26 per cent; while different writers whom he quotes state the mortality from some forms of malaria to be as high as 50 per cent, and even higher. 24 Concern- ing mortality from malarial cachexia; he says: " The mortality varies unaccountably from year to year, some seasons evincing a series of mild cases, others an appalling mortality. In a certain parish of Louisiana in 1867, many cases are said to have occurred, of which not less than 95 per cent HEALTH AND ANCIENT GREECE 87 died. Fisch, who placed the mortality on the Gold Coast at 20 per cent, states that until two or three decades previously nearly all who were attacked died." 2B Another dangerous characteristic of malaria is the impossibility of acquiring immunity from it, since very few individuals even among the negroes in Africa are absolutely immune, and this freedom from the disease is not hereditary. The negroes, the Chinese, the Malays, and other dark-skinned races enjoy comparative immun- ity, while " The inhabitants of the malarious districts of Italy, Corsica, Greece, Turkey, and other South European countries have in- herited no marked immunity from malaria in virtue of the thousands of years during which their ancestors lived in malari- ous districts." 26 Children up to three or four years harbor almost without exception malaria parasites. The proportion of infected children gradually becomes smaller until ado- lescence is approached, when the blood becomes prac- tically free from parasites and partial immunity is estab- lished. This process is, however, bought dearly, since the mortality in children native to highly malarious countries is very great. Concerning the health of the immunes authorities differ. Manson says : " It has often been remarked that these dark-skinned children, with enormous spleens and a rich stock of malaria parasites in the blood, run about fever-free, and apparently in rude health." 2 * Major Ross, however, says: "An intensely malarious locality cannot thrive. The children are wretched, the adults frequently racked with fever, and the whole place shunned whenever possible by the neighbors. The 88 HEALTH AND SOCIAL PROGRESS landowner, the traveler, the innkeeper, the trader fly from it. Gradually it becomes depopulated and untilled, the home only of the most wretched persons." 28 Even if immune children enjoy rude health, their enormous spleens indicate a serious disturbance in the physical system, sufficient, perhaps, to prevent the build- ing up of a fine-grained nervous system which is neces- sary for the creation of a higher civilization. Of greater significance is local immunity, since these islands of malaria-free localities are important, as will appear later. Bermuda, Argentina, New Zealand, and the Sandwich Islands are remarkably exempt from this disease. Even in malarial countries such as India, im- mune localities are found, e.g., Kherwara in Rajputana. Generally speaking, high altitudes are relatively exempt even though surrounded by malarial lowlands. A few hundred feet in altitude may show a more marked dif- ference in the prevalence of malaria than as many miles in latitude. In the tropics where even high elevations do not have a low temperature, malaria may be found at elevations of 6,000 or 7,000 feet, and other circumstances may annul the advantages of elevation. " In Italy there are many malarious spots high up among the hills ; the same is the case in India, and elsewhere in these elevated valleys which are also narrow, imperfectly ventilated and imperfectly drained." 20 With the exception of these few localities, malaria is prevalent all over the tropics and in most parts of the temperate zones. Its debilitating influences have, in other words, been spread over the larger part of the habitable globe, as will be seen from the geographic distribution given by Dr. Deaderick. 30 Summarizing this report, we find malaria to be very prevalent in the southeastern por- HEALTH AND ANCIENT GREECE 89 tion of the United States, less prevalent along the At- lantic coast south of New York with increasing fre- quency as we go south. The Mississippi valley along both shores to the extent of hundreds of miles, is very malarious, as are all the Gulf States.* In New York, Pennsylvania, and New England autochthonous cases are found, while the shores of the Great Lakes and the Central States are comparatively free, with the exception of the lowlands. On the Pacific coast malaria is not frequent, but all the river valleys harbor numerous in- fected mosquitos. In Mexico severe forms of malaria occur, particularly in the low coast regions. The Atlantic side of Central America is most unhealthy owing to malaria, and the Pacific coast is only slightly less so. In South America the larger part of Brazil, Venezuela, Guiana, are highly malarious; Bolivia, Paraguay, and Uruguay are less infected, while Argentina is almost entirely free. The deep valleys of Peru, Ecuador, and of some portions of Chile are malarious centers. All of the islands in the Greater and Lesser Antilles are malari- ous, while Bermuda is practically free from this disease. In Europe, Great Britain is now free from malaria, and Germany has infrequent cases along the Rhine and Danube valleys; but Holland has many cases, both in its northern and southern portions, particularly on the island of Zealand. The valley of the Danube in Austria and Hungary has many cases of malaria, and many other portions of Hungary are heavily infected. In France, malaria is found chiefly in the marshy land along the west coast and in the south ; Spain and Portugal have *The State of Mississippi reported 158,000 cases in 1917. But this is only a small part of those occurring, since only about ten per cent of the physicians answered the questionnaire of the United States Public Health Service, and many more cases not attended by physicians. 90 HEALTH AND SOCIAL PROGRESS numerous cases in the coast regions and the larger river valleys. In Russia, malaria is encountered along the coasts of the Black Sea and the rivers which issue into it. Bulgaria is very malarious in its southern part, along the Danube and coast regions. Practically all parts of Italy, Sicily, and Sardinia are afflicted with this disease, and some portions of southwestern Switzerland. Greece is severely scourged with malaria, and in some parts scarcely any inhabitants escape. Few countries of Asia are free from this disease ; Asia Minor, Arabia, and Persia, the swampy regions of Afghanistan and Beloochistan have many and severe cases of malaria. The presidencies of Bengal and Bom- bay, the foothills of the Himalayas, and other parts of India are intensely malarial. Ceylon is endemic terri- tory, and so are Burmah, Siam, the Malay Peninsula, and French Indo-China. Some parts of China are intensely infected; Japan, Formosa, and the Philippines give rise to malaria. In Africa, the territory between the Senegal and Congo rivers is headquarters for a malignant type of this disease, while further south the cases become less frequent and severe. All along the east coast from Delagoa Bay to Eritrea is malarial country, including the larger part of Madagascar and Mauritius. The interior of Central Africa, excepting the high plateaus, is all malarious country. In the Nile valley the inundated portions are very malarious, and the disease abounds along the coast and in the marshes of Algeria. In Australia, malaria occurs all along the coasts, dimin- ishing towards the south. The whole of Canada, Norway, and Sweden, are practically free from the disease. These localities are always looked upon as healthy, and are frequented by 91 many visitors; and the inhabitants are usually energetic and well advanced in education. ir The zone of malaria is almost coincident with the tropics and the larger portion of the temperate zones ; it has, consequently, been a danger and enemy of man since early times. The relief felt by physicians when this obstacle to good health was removed by the epoch- making discovery of Ross, and when the possibility of exterminating the disease was in sight, is perhaps best expressed by a quotation from Dr. Deaderick. " Undertaking the work at Hanson's suggestion, and after several years (1895-1898) of toil and discouragement, Ross proved conclusively that certain species of mosquitos are con- cerned in the dissemination of malaria. The debt owed him by mankind was acknowledged by the gift of a Nobel prize ; his own feelings over the discovery are expressed in these lines which he wrote: " ' This day relenting God Hath placed within my hand A wondrous thing, and God Be praised. At His command " ' Seeking His secret deeds With tears and toiling breath, I find thy cunning seeds, Oh million-murdering death. "'I know this little thing A myriad men will save; Oh, death, where is thy sting, Thy victory, O grave ? '" 31 The first question having been answered, we may now proceed to the second in regard to the deterioration of Greek character at a particular time. (2) Was there a deterioration of Greek character at a particular time ? 92 HEALTH AND SOCIAL PROGRESS In order to simplify the discussion of this question, a caution should be inserted at the very beginning. Whether malaria existed in other parts of Greece prior to 500 B.C. is still a problem waiting for solution. That it did not exist in Attica is fairly certain, owing partly to its location and partly to the absence of references to this disease by Athenian writers. The testimony of the latter will be taken up later, but a brief statement must be made here about the location of Attica as favoring the theory that it was free from malaria. Attica was most probably one of those favored locali- ties just mentioned, which, owing to its situation, was free from this disease. The advantageous features of this situation are from the present point of view, two : a comparatively dry climate, and a location off the main road of travel between north and south. The former feature would be unfavorable to the development of indigenous malaria, the latter to its introduction from other regions. " In ancient Greece the fruitful plains of Thessaly, Bceotia, Elis, and Laconia had a fatal attraction for every migrating horde ; Attica's rugged surface, poor soil, and side-tracked loca- tion off the main line of travel between Hellas and the Pelopon- nesus saved it from many a rough visitant, and hence left the Athenians, according to Thucydides, an indigenous race. 32 Athens will consequently be the only part considered in this discussion, since it is to her that we owe practically all the arts and philosophy, which have survived into modern times. Galton states that Athens built up, by a system of unconscious but judicious selection, a magnificent breed of men, which produced in the space of a century 530 to 430 B.C. the following fourteen illustrious men. HEALTH AND ANCIENT GREECE 93 " Statesmen and Commanders. Themistocles (mother an alien), Miltiades, Aristides, Cimon (son of Miltiades), Pericles (son of Xanthippus, the victor at Mycale). " Literary and Scientific Men. Thucydides, Socrates, Xeno- phon. " Poets. ^Eschylus, Sophocles, Euripides, Aristophanes. " Sculptor. Phidias." 33 His argument is that a free-born population of about 90,000 persons, within a century, produced an exceed- ingly large proportion of prominent men. This is cer- tainly true. But it is interesting to note that not a single man is included in that list after 430 B.C. He might, of course, have added Aristotle, Demosthenes, and a few others who lived later. In his mind he sees, however, a sudden drop in the production of great Athenians about this time. And he proceeds to give his reasons for this result. " We know, and may guess something more, of the reason why this marvelously-gifted race declined. Social morality grew exceedingly lax ; marriage became unfashionable, and was avoided, many of the more ambitious and accomplished women were avowed courtesans, and consequently infertile, and the mothers of the incoming population were of a heterogeneous class. In a small sea-bordered country where emigration and immigration are constantly going on, and where the manners are so dissolute as were those of Greece in the period of which I speak, the purity of a race would necessarily fail." 8 * This quotation assigns two reasons as the cause of Greek degeneration : moral laxity and loss of social purity. The first reason has generally been employed by his- torians and moralists, and yet it is not true to the facts. Mental and moral degeneracy is an effect rather than a cause. People become mentally and morally unstable through loss of physical balance by means of illness and 94 HEALTH AND SOCIAL PROGRESS disease, and immorality simply hastens dissolution al- ready begun. Lack of physical health is always the primary and principal cause, if we are to trust modern scientific investigations.* The second reason is more true to the facts, but the cause assigned for it is wrong. It is a sociological principle that men of a superior race do not marry women of an inferior race, unless women of their own race are not available ; only inferior men marry women of an inferior race when women of their own race are available. It may be granted that a number of Athenian women preferred the free life of hetaerae, but their number must have been small. The very fact, moreover, that they preferred that life, is an indication of their lack of physical and, consequently, moral balance. Breeding from them would only have hastened the process of de- generation. We have to fall back, therefore, on the argu- ment from lack of physical balance or low vitality which resulted from a disease newly introduced into Athens. It was the inability to account for the decay of Athe- nian genius on any other basis, which induced Mr. Jones and Major Ross to seek for some specific disease, in- troduced about this time, that might explain the decline of Athens. Mr. Jones found that immorality did not increase between 500 and 300 B.C., but that the character of the people changed home-life taking precedence over civic life, sentimentalism replacing robust feeling in art, and pessimism supplanting optimism in philosophy. * The grave injury of sexual immorality is due chiefly to venereal diseases, and of these syphilis is the more injurious owing to its hereditary and pervasive character. It was, how- ever, unknown in Europe before 1495 and cannot be charged with the extensive deterioration among the Greeks and Romans, although both were, at least in their later history, grossly im- moral. (See The Nation's Health, by Sir Malcolm Morris, M.D., New York, 1917, pp. 12-15.) HEALTH AND ANCIENT GREECE 95 " There does not appear to have been any increase of immo- rality between, say, 500-300 B.C. But, nevertheless, morality changed. Home life took precedence of city life, patriotism decayed, and lofty aspirations almost ceased to stir the hearts of men. In art there appeared a tendency to sentimentalism ; philosophy in many quarters became distinctly pessimistic. Some schools of thought actually regarded ' absence of feelings ' or ' absence of care ' as the highest goal of human endeavor. Dissatisfaction and querulousness are marked characteristics of the age. By 300 B.C. the Greeks had lost much of their manly vigor and intellectual strength. " The cause of this change appeared to the present writer to be partly the decay of religious feeling, and partly the growth of the human intelligence, which resulted in dissatisfaction with existing institutions. Doubtless both of these tendencies were factors in the change, but they did not seem at the time of writing the earlier essay, and they do not seem now, to be sufficient by themselves." 35 Whatever one may think of the reasons assigned for the decay of Greek genius, degeneration is admitted to have begun about the year 400 B.C. This fact is, more- over, borne out by evidence of contemporaries, of whom Demosthenes may serve as a good example. In the first Philippic, delivered in 352 B.C. he thus addresses his fellow-citizens. " When, then, O Athenians, will you be about your duty ? Will you always roam about the public places asking one of another: What is the news? Ah! How can there be anything newer than the sight of a Macedonian conquering Athens and dominating Greece? I say, then, that you ought to equip fifty galleys and resolve, if necessary, to man them yourselves. Do not talk to me of an army of 10,000 or of 20,000 aliens that exist only on paper. I would have only citizen soldiers." In the third Philippic (341 B.C.). Demosthenes had reason to chide the Athenians for their continued in- action, " When the Greeks once abused their power to 96 HEALTH AND SOCIAL PROGRESS oppress others, all Greece rose to prevent this injustice; and yet today we suffer an unworthy Macedonian, a barbarian of a hated race, to destroy cities, celebrate the Pythian games, or have them celebrated by his slaves. And the Greeks look on without doing anything, just as one sees hail falling while he prays that it may not touch him. You let him increase his power without taking a step to stop it, each regarding it as so much time gained when he is destroying another, instead of working and planning for the safety of Greece, when everybody knows that the disaster will end with the inclusion of the most remote." An address of this kind would have been impossible in 490 B.C., when 10,000 Athenian citizen soldiers routed the much more numerous Persians at Marathon ; or even in 400 B.C. when 10,000 Greeks marched through the whole Persian empire and lost only 2,000 men within a year of constant fighting against treacherous enemies and hostile elements. In about 50 years the character of the Greeks had deteriorated sufficiently to call for the sharp rebuke of Demosthenes. (3) Is there any specific cause that may explain this result ? Modern times have witnessed the wholesale de- struction of many nature-peoples, e.g., the Caribbeans and the Indians. Their extinction was due not so much to the arms of the white men, as to the introduction of new diseases, which, although comparatively mild ordi- narily among the whites, assumed the character of a plague among people whose constitutions were unpre- pared for these particular forms of disease. " I have heard that not so long ago a third of the Andamanese Islanders were swept away by measles. Whole populations have disappeared before smallpox and syphili?; and I suspect that HEALTH AND ANCIENT GREECE 97 tuberculosis has had a marked, but as yet undetermined, effect on the world's history." 36 Malaria is not considered a virulent disease in modern times, because we have a specific in cinchona. Among nature-peoples, it often proves very disastrous, especially when newly introduced. " A fever visitation about the year 1830 was officially esti- mated to have killed 70,000 Indians in California, while at about the same time a malarial fever epidemic in Oregon and on the Columbia river, ravaged the tribes of the region and practically exterminated those of Chinookan stock." 37 Dr. G. Archdall Reid attributes the disappearance of most nature-peoples to the epidemic effect of diseases, introduced among them by civilized men, among whom they are endemic. ^The virulence of a disease among a people is in inverse ratio to its racial training for it. 38 """From the facts cited it is evident that diseases like malaria, which are newly introduced into a population are epidemic in character, and therefore virulent, causing great mortality. They become endemic in the course of time and, while not responsible for many deaths directly, gradually undermine vitality and produce degeneracy. It is necessary now to prove that these conditions existed in ancient Greece. (4) When was malaria introduced into Greece, or rather Athens? Modern Greece is exceedingly malarious ; the per- centage of infected persons varies from almost zero in a few localities to almost 100 in others ; in the Greek army the lowest percentage was 27.8 in 1902 and the highest 44.8 in 1898 during the decade 1896 to 1905. 39 " Modern Greece is intensely malarious. In the Copaic Plain, examined by me last year, I estimated that quite half the children 98 HEALTH AND SOCIAL PROGRESS were infected, even in June before the annual malaria season had commenced. The Attic Plain is, and probably always was, much healthier owing to its dry climate ; but numbers of other plains and valleys are certainly as bad as the one I studied. The Grecian Anti-Malaria League has collected excellent sta- tistics on the subject, and these have been published by Drs. Savas, Cardamitis, and others. For instance it has been esti- mated that in the unhealthy year 1905, out of a total population of only about two and a half millions, nearly a million people were attacked with malaria, and nearly six thousand died. Blackwater fever, the worst form of malaria, is exceedingly common. I have never seen, even in India and Africa, villages more badly infected than Moulki and Skipou in the Copaic District. The Greek Army is as heavily infected as was the Indian Army until the last few years." 40 The malarious character of modern Greece does not, of course, prove that ancient Greece was likewise in- fected. Two conditions are necessary to make a coun- try malarious, the presence of mosquitos of the species anophelines, and the existence of malarial parasites in human beings. Without either of these conditions malaria is impossible. Sir Patrick Manson describes the introduction of this disease picturesquely. " Imagine an island in mid-ocean, far away from any malarial continent. It has its own special insect pests, mosquito among them, but there are no anopheles. Malaria therefore is un- known. On an evil day for the island a fast-steaming ship arrives and introduces perhaps as larva in a water-tank, or in a neglected water-bottle in some unoccupied passenger cabin, or otherwise the cursed insect. The hydraulic and climatic conditions are favorable and the anopheles multiply apace. Presently in some coolie laborer from India or China, or in some native returned from service in a foreign country, or in a sailor, or traveler, malarial gametes come on the scene. The anopheles, now numerous, become infected, the inhabitants get malaria, and the island, formerly noted for its salubrity, becomes a byword for unhealthiness. HEALTH AND ANCIENT GREECE 99 This is no fancy picture. For centuries after its discovery and colonization Mauritius was noted for its beauty, its de- lightful climate, and for its salubrity. There were no anopheles there in the days of Paul and Virginia. Situated in the middle of the Indian Ocean, far away from continental influences, it enjoyed an equable climate well suited to recruit the broken- down, anaemic constitution of the victim of tropical disease. So high was its reputation for salubrity that up to the early sixties, in times when Europe was not so accessible as it is at the present day, it was used as a sanitarium by the British in India. Of course many of the invalid soldiers and civilians who visited the island and many of the imported Indians who labored on the extensive sugar plantations for which Mauritius was famous, must have introduced, since without number, mala- rial parasites. In those happier days, there being no anopheles present, any imported parasites did not spread, they died out. But about the time I mention, that is to say, in the early sixties, anopheles were introduced ; how, is not known. Gradually they spread over the island, carrying the malarial germ with them. A big epidemic was the consequence, and now malaria is endemic in Mauritius, and large areas of this former sani- tarium are extremely unhealthy. " With the increasing opportunities of these modern days foi* rapid travel and communication, many islands and isolated dis- tricts at present healthy will at no distant date share the fate of Mauritius unless, before it is too late, effective measures are taken to prevent the introduction of anopheles." 41 The island of Mauritius proves that a definite date may be fixed for the introduction of this disease ; the specific year as given by Major Ross is 1866. 42 Can an equally definite, or at least approximate, date be given for the entrance of malaria into Attica? Opinions are divided on this point. Deaderick seems to incline toward a belief of the early existence of the disease in Greece. 43 Manson, too, is of that opinion, since " The history of malaria goes back to times of remotest antiquity. Already in the fifth century B.C., Hippocrates recognized the existence of periodic fevers, ajnd divided them into quotidian, tertian. 100 HEALTH AND SOCIAL PROGRESS sub-tertian, and quartan. Galen, Celsus, and other Roman writers also gave accurate descriptions of these fevers." 44 Jones, who has worked particularly on this problem, inclines toward the introduction of malaria into Athens about the year 425 B.C. But, suppose the disease had existed from early times ; that would not necessarily prevent good health of the Athenians, since the cases might be few and mild owing to particular circumstances. Major Ross argues this point as follows: " Suppose that the anophelines have been present from the first, but that the number of infected immigrants has been few. Then, possibly, some of these people have happened to take up abode in places where the mosquitos are rare, others may have recovered quickly ; others may not have chanced to possess parasites in suitable stages when they were bitten. Thus the probability of their spreading the infection would be very small. Or, supposing even that some few new cases, infections, have been caused, yet by our rough calculations in section 12, unless the mosquitos are sufficiently numerous in the locality, the little epidemic may die out after a while . . . for instance, during the cold season. And, if the number of infected persons intro- duced from outside remains small, this state of things may continue for years or centuries . . . the disease will fail to make headway and will die out. Now, suppose that the number of infected immigrants is suddenly greatly increased. Then much larger numbers of mosquitos will become infected, and may in their turn infect more healthy people than the recovery rate will compensate for. Endemic cases will begin, will in- crease ; at first slowly, then rapidly, until suddenly there will be a widespread epidemic." 45 Mr. Jones bases his argument for the comparatively late introduction of malaria as a prevailing disease on four facts. I. The absence of references to malaria by non-medical writers prior to 500 B.C., excepting two doubtful cases. One of these occurs in the Iliad, XXII. 31 under the name of " fever," and may be explained HEALTH AND ANCIENT GREECE 101 by a reference to the coast of Asia Minor. 46 The other is found in Theognis (550 B.C.), under the name of " ague." This may refer to Megara, where the poet lived as a supporter of the oligarchical party, or to Asia Minor. 47 II. On the increasingly frequent refer- ences to malaria by both medical and non-medical writers after 425 B.C. The first of these is made by Aristo- phanes in the Acharnians (425 B.C.), and the second in his Wasps (422 B.C.). 48 Plato in the Timccus (between 380-360 B.C.) speaks of quotidian, tertian, and the quartan fevers. Aristotle's works contain numerous references to malarial fevers. Hippocrates (born about 460 B.C.), treats of malaria both in the Corpus, and in the Airs, Waters, Places, and gives the division of malaria quoted previously by Manson. III. The introduction of the cult of ^sculapius in 420 B.C. at Epidaurus, which, by the way, is very malarious today, having in some parts nearly 100 per cent of its population infected. 49 This cer- tainly implies that ill-health was common. The suggestion that it was caused largely by malaria is strengthened by the frequency with which the votive offerings of the Greeks, after illness, took the form of a representation of the abdomen, since the malarial spleen, which not infre- quently reaches the weight of 70 or 80 ounces, over against 5 to 7 ounces for the normal, would be very noticeable, and the consequent enlargement of the ab- domen would certainly make a great impression on the non-medical mind. 50 IV. The more numerous points of contact of the Athenians, both through war and com- merce, with other nations. They undertook the disastrous expedition into Egypt one of the ancient malaria plague- spots in 450 B.C. During the first Peloponnesian War (431-404 B.C.) their armies and navies were to be found in nearly every part of Greece and of the ^Egean Sea. 102 HEALTH AND SOCIAL PROGRESS In 425, they were in the island of Sphacteria which, at least at present, is one of the worst malaria centers in the Mediterranean. From 415-413 they were at Syra- cuse, where this disease existed, and sickness and want caused them muc'h distress. In 399 the Ten Thousand reduced to 8,000 returned after their march through many malaria infected parts of the Persian Empire. Ihe case of Mauritius, cited above, illustrates how easily this disease may be introduced into a hitherto healthy com- munity, although the contacts with the outside world were not nearly as varied and numerous in this case as those of Athens during these fifty years. Hence the con- clusion that malaria was introduced into Athens during this period as a prevalent disease, seems very probable. Once introduced, it would have its baneful effects. General Gorgas also holds that Greece was free from malaria prior to 500 B.C. for reasons similar to those of Mr. Jones.* (5) How did malaria affect the Greeks? Under the first question a number of injurious effects from malaria were cited ; these may now be supplemented in the case of the Greeks. " The degradation of those who inhabit malarious places was carefully recorded by Hippocrates. He states that those who live in low, moist, hot districts, and drink the stagnant water, of necessity suffer from enlarged spleen. They are stunted and ill-shaped, fleshy and dark, bilious rather than phlegmatic. Their nature is to be cowardly and averse to hardship, but good discipline can improve their character in this respect." 51 Plato, in the TIWMEUS, declares " that the humors of acid and salt phlegms, and such as are bitter and bilious, when no outlet for them from the body can be found, * The Scientific Monthly, August, 1916, p. 133, " Ronald Ross and the Prevention of Malarial Fever." HEALTH AND ANCIENT GREECE 103 befog the soul and produce manifold vices peevishness, melancholy, rashness, cowardice, f orgetf ulness, and stu- pidity." 62 Jones makes this statement about Greece after the fourth century before Christ: " Gradually the Greeks lost their brilliance, which had been as 'the bright freshness of healthy youth. This is painfully obvious in their literature, if not in other forms of art. Their initiative vanished; they ceased to create and began to comment. Patriotism, with rare exceptions, became an empty name, for few had the high spirit and energy to translate into action man's duty to the state. Vacillation, indecision, fitful outbursts of unhealthy activity followed by cowardly depression, selfish cruelty, and criminal weakness, are characteristic of the public life of Greece from the struggle with Macedonia to the final conquest by the arms of Rome." 53 The children are the worst sufferers from malaria until at least the age of adolescence, when they become partially immune. The effect which these repeated attacks of an everlasting and ubiquitous incubus must have on a people is well described by Ellett. " It would seem that this disease with its constant drain upon the resources of the growing body, must put a check upon the development, physical and mental, of each successive rising generation. Viewed from an entirely medical standpoint, the question can admit of no doubt. The succession of febrile attacks would alone be a serious tax upon the growing child; while the consequent anaemia, which so soon makes its appear- ance, must make the child incapable of prolonged application, and rob him to a large extent of his powers of mental recep- tivity. It is only too evident that in a few generations a type of man possessing extraordinary mental and physical powers, may become under this scourge of malaria greatly altered and debased. If it be that the malarial parasite was introduced into Greece during the fifth century B.C., it is quite possible for the disease, running a practically unchecked course, to have 104 HEALTH AND SOCIAL PROGRESS produced the profound deterioration which occurred in the Greek character during the next century and a half." 54 (6) Why were the effects so disastrous? The pernicious effects of a newly introduced disease have been explained previously under the third question. In the case of the Greeks there were special and addi- tional reasons why malaria should assume such a virulent character. The great plague of 429-427 B.C. was an indication that sanitary measures in Athens were inade- quate. These conditions were favorable for the breeding of mosquitos, and all that was needed was a number of infected persons coming from infected regions to spread the disease rapidly. During the Peloponnesian War, At- tica was invaded and laid waste almost constantly, and the country-people had to take refuge in the city; food had to be imported from abroad. These facts brought about a crowding of the population, and a few infected persons would suffice to spread malaria quickly. This was espe- cially the case during the latter part of the war, when the Spartans had permanently occupied Decelea in 413 B.C., and the country people had to live not only in the Piraeus where they were constantly subjected to new infections, but between the long walls. The food supply must often have been scanty, and this may have been a predisposing factor to cause a greater virulence of the disease, since the power of resistance would be less. Another factor was the absence of a specific. Cinchona is absolutely necessary in the treatment of malaria; and this was introduced into Europe in 1640. It was prized very highly, since Louis XIV, who was attacked with a rebellious and severe intermittent malarial fever in 1679 and cured by Talbot with a concentrated vinous tincture of the bark, paid 48,000 pounds sterling for the secret and gave a life annuity of 2,000 pounds to Talbot. 55 HEALTH AND ANCIENT GREECE 105 The Greek peasant of today values quinine almost as much as his bread, and the government has formed a monopoly to insure its purity at a moderate price. 56 Without this specific Jthe ancient Athenians had but little chance to combat the disease, since they did not apply the only other possible remedy the draining of swamps and the elimination of small pools sufficiently, because they, while being aware in a general way of the relation between malaria and swamps, had no idea of the role of the mosquito in the transmission of the disease. Hence they were not only in both these respects handi- capped, but also unable even to know what to do to fight the disease effectively. CHAPTER VII HEALTH AND ANCIENT ROME IT is not as easy to fix the date of the introduction of malaria into Rome as it was in the case of Athens. Jones 57 gives the second Punic War (218-204 B.C.) as a possible date. Thomas Ashby, the Director of the British School of Archaeology at Rome seems inclined to an earlier date. " What had previously, it seems, been a well-peopled region, with peasant proprietors, kept healthy by careful drainage, became in the fourth and third centuries B.C. a district consist- ing in large measure of huge estates (latifundia) owned by the Roman aristocracy, cultivated by gangs of slaves. This led to the disappearance of the agricultural population, to a decline in public safety, and to the spread of malaria in many parts ; indeed it is quite possible that it was not introduced into Latium before the fourth century B.C. The evil increased in the later period of the Republic, and many of the old towns of Latium sunk into a very decayed condition . . . Cicero speaks of Gabii and Fidenae as mere ' deserted villages,' and Strabo as ' once fortified towns, but now villages, belonging to private individuals.' Many of the smaller places mentioned in the list of Dionysius, or the early wars of the Romans, had altogether ceased to exist, but the statement of Pliny that fifty-three com- munities (populi) had thus perished within the boundaries of Old Latium is perhaps exaggerated. By the end of the Re- public a good many parts of Latium were infected, and Rome itself was highly malarious in the warm months." 58 Evidence from contemporary writers is, however, suf- ficiently plain to make the existence of malaria certain. 106 HEALTH AND ANCIENT ROME 107 Plautus (died 184 B.C.) in the Curculio refers to it with the question : Did a fever leave you yesterday or the day before? And Terence (died 159 B.C.) refers to quo- tidian fever in the Hecyra. M. Porcius Cato (died 149 B.C.) has left a treatise " on agriculture " and speaks in Chapter CLVII of what to do " In cases of black bile and swollen spleen." The conjunction of black bile and enlarged spleen are fairly clear symptoms of malarial cachexia. "From Cato to Cicero (106-43 B.C.) is a long interval, and one which has left us but a few fragments of literature. It may, however, be noticed that Q. Fabius Maximus, who was consul in B.C. 121, suffered from malaria, if we may trust the story told by the Elder Pliny. But in Cicero is found frequent mention of tertians and quartans, and his contemporary, Varro (118-29 B.C.) declares that in marshy places ' crescunt animalia quaedam minuta, quae non possunt oculi consequi,' and that these minute creatures, entering the body by the mouth and nostrils, produce ' difficiles morbos.' From the time of Cicero most writers mention malaria in unmistakable language, and it certainly had become, by the Christian Era, a disease with which the Romans were perfectly familiar. The physician Celsus (about 50 A.D.) almost confines his discussion of fevers to the intermittents, so that in his book, febris is practically equivalent to malaria." 59 The prevalence as well as the existence of malaria in ancient Latium is, then, an indubitable fact. Even if it existed there prior to 200 B.C., there are many features in Roman history, which point to an accentuation of the disease after that time. Rome commenced her permanent expansion beyond the borders of Italy with the second Punic War; she sent her armies into Africa, Carthage, Egypt, and various parts of Asia, and occupied Greece and Sicily. But all these countries were malarious; some of them were badly infected. The armies wou!4 return home with the disease, spread it, and in a short time it would become endemic. The prisoners, too, com- ing from many infested districts, would help in spreading the disease, especially in the country districts where many of them went as slaves. It was, perhaps, in this manner that the large estates of the Roman gentry became so thoroughly infected that many parts of Latium became uninhabitable. Economic and political causes assisted in the spread of malaria. The creation of the large estates brought many small landowners to Rome, where they helped in increasing the ranks of the plebeians. The result was that the city became constantly more congested, and the country districts depopulated. The colonists who were sent out into the newly conquered provinces were the more energetic and enterprising farmers, and that de- prived the country districts of the best elements. The remainder went to the city and increased the rabble in the metropolis. Without occupation and without regular means of support, these malaria-stricken people sank lower and lower still ; they became the followers of every demagogue who promised pattern et circenses, or rich booty from the slaughter of the patricians and the conquered peoples. In the course of time the upper classes were infected, and a general deterioration of Roman character commenced. A debased vitality is the only explanation of the atroci- ties of the continuous civil wars, of the butchering of conquered peoples during the first century B.C., the crucifixion of slaves for seeking even a semblance of human rights, and the shamelessness of the women at and around the court of the first emperors. " Every now and then the modern world is shocked by atroci- ties committed by white men in tropical regions. Humanity and HEALTH AND ANCIENT ROME 109 justice seem to be forgotten; civilization and education are powerless to prevent furious outbursts of savagery. How much of this is due to the baneful influence of malaria is known only to those who have an intimate acquaintance with the disease. Something of the same kind happened in Rome. Malaria made the Greek weak and inefficient ; it turned the sterner Roman into a bloodthirsty brute. The terrible pictures of life in the first century A.D., as painted by Tacitus and Juvenal, show that Roman society was not only wicked but diseased. The extrava- \ gant cruelty, the wild desire for excitement, the absence of soberness and self-control, all point clearly to the same physical defect." A change in the fundamental characteristics of a people is much more serious than any other, and such a change is exactly what malaria will produce. Just because it is a disease only occasionally fatal when endemic, it is neg- lected, and exerts its harmful effects insidiously upon many individuals, and through them upon the life of society and of future generations by reason of poor heredity through lowered vitality. Continued through a...;,, number of generations, this process must bring about ex- tinction. A disease of this kind slowly saps the energy and vitality of a people, until there are none left to continue the struggle. For while other diseases, like the plague or acute attacks on single organs, brace a people by weeding out the unfit, a slow disease like malaria seizes all, fit and unfit alike, until a greatly depleted vitality must end in extermination. NOTE: Just as this manuscript was going into the printer's hand, a new book by Ellsworth Huntington, World Power and Evolution (New Haven, 1919), appeared. While its author tries to establish the climatic theory to be discussed in Chap- ter X as the chief cause of the rise and fall of nations, he admits on pages 200 and 201 that malaria was a serious con- tributory factor in the change of the Roman character, accept- ing the theory first propounded by W. H. S. Jones. It is of interest to notice that he places the climatic change which started the decline of Rome at about 225 B.C., which would coincide 110 HEALTH AND SOCIAL PROGRESS with Dr. Ashby's date and precede that of Jones by seven years. In discussing the backwardness of Turkey he likewise admits the importance of malaria as a cause and suggests the elimina- tion of it as a remedy (pp. 223-6). This seems to be incon- sistent with the climatic theory as the chief cause since climate is beyond our control, while malaria is not. CHAPTER VIII EFFECTS OF ILL HEALTH ON THE CLASSICAL WORLD THE effects upon the classical world of this sapping of vitality are fairly clear, even though the argument be not strictly conclusive in every respect. There were certainly other factors which contributed to the downfall of Greece and Rome. These were, however, secondary rather than primary. For as long as a people preserves its vitality and abounds in health, it will not accept its doom at the hands of others without an attempt at resistance. It is the sick man who resigns himself to his fate ; it is the de- feated party that invents a theory to account for the result. The well man will struggle to preserve his ideals and his individual and political identity ; he will, if he philosophizes at all, think out a course of action to de- flect the blow and to avert the evil, and, perhaps, later, return thanks to the gods for his deliverance. It is only on the basis of a greatly depleted vitality and of greatly diminished numbers, that we can explain the attitude of the Greeks toward their misfortunes. To take up the last point first. The internecine conflicts of the Greek communities, the deadly struggles of the various factions in the ma- jority of the cities, and the numerous wars with foreign powers, had obliterated vast numbers of the old race of free citizens by the beginning of the Roman period. The extermination of the Plataeans by the Spartans and of the Melians by the Athenians during the Peloponnesian War, in 112 HEALTH AND SOCIAL PROGRESS the proscription of Athenian citizens after the war and the massacre of the Corcyraean oligarchs by the demo- cratic party, the slaughter of the Thebans by Alexander and of the Corinthians by Mummius, are only a few of the more familiar instances of the catastrophes which overtook the civic element in the Greek cities. Just how greatly the free citizens had diminished in numbers by the close of the first century after Christ, may be judged from the estimate of Plutarch that all Greece could not furnish more than 3,000 hoplites. All this must be admitted; it is nevertheless not the true, at least, not the full explanation. The strife of factions in cities and internecine wars had existed before, and been perhaps more sanguinary, if we may judge from the razing of conquered cities ; yet the number of free citizens did not diminish, but rather increased from the time of Homer to that of Pericles, if comparisons of military strength are to be trusted. Homer credits the united Greek forces with 100,000 men; in 415 B.C., the Athenians alone were able to send after losing, according to Grote, 4,400 hoplites in the plague of 430 B.C., and after sixteen years of almost continuous fighting in the Peloponnesian War 36,000 men, including 5,100 hoplites to Syracuse, and reenforce this army with 5,000 hoplites two years later. This force was almost completely lost, yet Athens continued the struggle; and even after the slaughter of 3,000 of her soldiers by Lysander in 405, she resisted Sparta for another six months, and only a few years later Xenophon had no difficulty in collecting 10,000 men for an expedition into Asia at the invitation of Cyrus. All these losses through war were heavy, but they are not the full explanation of the later submissive attitude of the Greeks toward their conquerors. We must, then, look for another cause to explain the ILL HEALTH AND THE CLASSICAL WORLD 113 decay of Athens. A people that had blended the ideals of manhood and of national renown, and of national and personal integrity; that had produced the greatest number of famous men in every field within so short a time with such a small population; that had taught the lessons of restraint and imbued its members with a sense of willingness to surrender for the sake of these ideals so many opportunities and pleasures, according to the funeral oration of Pericles a people, in short, that had conceived a clear ideal of what a man and a State ought to be and had proved its validity on many a battlefield, must have been healthy both physically and mentally. The average Athenian was joyous, but did not abandon himself to pleasure, because a healthy body enabled him to keep the balance which his philosophy taught him to constitute frue manhood. This man knew how to com- bine action with contemplation ; how to use the facts of life for enriching his personality and becoming a more useful citizen. He had leisure, but he used it for the State and not for self-indulgence. It was this combina- tion of a proper amount of action and contemplation, or of the Dionysian and Apollonian ideal as Nietzsche called it each enriching the other that gave the Athenian of Pericles' age the self-control and harmony, which en- abled him to become highly efficient in all lines both as an individual and a citizen. Yet, but a hundred years later the "Philippics" of Demosthenes went unheeded by the Athenians who were justly stigmatized as consisting in great measure of salaried paupers. They talked about what they were going to do, but preferred to dwell in contemplation of the glory of their ancestors. Apollo had completely re- placed Dionysius in the affections of the Greeks. Such a radical change could not have taken place within so short a time unless for physiological reasons. The policy of paying small salaries to the citizens to en- able them to give their time to public affairs, may have been instrumental in producing a deterioration of char- acter. A healthy man will, however, render some service for such salary. The very fact that he is content to take something without rendering a quid pro quo is an indication that he is a pauper a physically and mentally diseased person who has lost his self-respect and is con- tent to live on the labor of others. It is evidently a case of physical degeneration. How was that brought about? Major Charles E. Woodruff has expounded an inter- esting theory in his book The Effects of Tropical Light on White Men. It is briefly stated as follows : Every animal and race of men has a zoological zone, in which they develop and prosper, but which they may not leave with impunity. The actinic or short rays of the sun- light destroy living protoplasm ; these short or violet rays are more numerous in strong or tropical light ; hence skin pigmentation was evolved for the purpose of excluding these rays. The zoological zone of the blonde, tall, long- headed type is northwestern Europe, chiefly Scandinavia, where the conditions were most favorable for its develop- ment a dark, cold, severe climate. Coldness and severity taxed the ingenuity of the early inhabitants of these re- gions, and developed brain-power; the darkness and cloudiness made superfluous the development of pig- mentation. This highly intellectual people is responsible for all the civilizations from India to England, since it spread in every direction owing to the pressure of sus- tenance, and became the ruling class everywhere by sub- jecting the native races. But they could not survive in lower latitudes owing to the lack of pigmentation, and died out before they could acquire it. The ideas upon ILL HEALTH AND THE CLASSICAL WORLD 115 which their civilization was based, survived, however, at least for a time ; but soon became mere dead formulae in the hands of the darker indigenous peoples, and civili- zation decayed. The Greeks and the Romans were both of this stock, coming from the north at different times, and creating the respective civilizations on the basis of slavery. They were unable to acquire sufficient pigmenta- tion and became literally extinct, since the modern Greeks and Italians are, according to Major Woodruff, the de- scendants of the older, brunette type of man which was unable even to continue the civilization created for him by his fair-haired and blue-eyed northern masters. The problem of Greek and Roman degeneration would, according to this theory, be solved by complete extinction, owing to inevitable decay out of one's zoological zone. It would take too much time to criticise this theory in detail. Two questions only need be asked. Why was it, that Scandinavia, the original home of these peoples, was the last country in Europe to be reached by modern civilization, if this Scandinavian or Teutonic type of man was the only creative genius of mankind ? Again : how was it possible for this hardy race to survive the southern climate for at least a thousand years in Greece and about seven hundred years in Italy, and then sud- denly collapse within a century? For Major Woodruff places the earliest Teutonic migration about 2000 B.C., that of the Dorians about 1200 B.C., 61 and that of the Romans about 800 to 700 B.C. 62 That both people de- generated rather rapidly, the Greeks after 400 B.C. and the Romans after 200 B.C., seems to admit of little doubt after the proofs which have been furnished. Even admitting Woodruff's theory, there must have been an- other cause at work to explain the rapidity of degenera- tion, or perhaps extinction, 116 HEALTH AND SOCIAL PROGRESS The introduction of a new disease, epidemic at first and then endemic, which gradually undermined the vitality of the people, seems to be the only explanation. Malaria has that effect and was introduced into Athens about 75 years before the decline of Greek character be- comes noticeable. If this theory is accepted, the decline of Greek civilization can be readily explained. Greek civilization was built on slavery. There was the numerically small but physically and mentally strong class of free Greeks, who devoted themselves to intellectual and warlike pursuits, and were of a superior race. This was evident from the fact that in Sparta the ruling class consisted of only about 9,000 families who held in check and exploited the Helots numbering about 200,000, and drew tribute from the Perioeci numbering about 120,000. A Spartan must, therefore, as a fighter, be as good as ten slaves. In Athens we have a similar situation. Dur- ing the time of Pericles there were in Attica about 90,000 free-born Athenians, 300,000 slaves, and 40,000 Metics or resident foreigners who paid for the privilege of residence. A census taken in 309 B.C. by Demetrius of Phalerum gave the numbers as 21,000 citizens, 10,000 Metics, and 400,000 slaves.* The significant feature in this change is the reduction in the number of Metics. What had become of them ? Had they departed with the decline of Athens, or had they replaced native Athenians ? The latter alternative seems the more probable, because the number of free Athenians had not changed appre- ciably, since 21,000 citizens in 309 B.C. is approximately equal to the 90,000 free-born population of the time of Pericles. The explanation may be found in the fact that * The number of slaves cannot be ascertained definitely, since the state was not interested in them, but only in citizens and taxpaying Metics. Henct there are only estimates, which run all the way from the figures given to as low as 180,000. ILL HEALTH AND THE CLASSICAL WORLD 117, a larger number of Metics had received citizenship than was provided for by the reforms of Cleisthenes in 509 B.C. Owing to the large mortality of Athenians in war and through disease, the number of citizens had become very small, and the depleted ranks could be filled only from the Metics and to some extent from the slaves. That means a considerable change in the constituency of citizens, although it need not surprise those who are accustomed to similar changes in New York, Boston, and Chicago through immigration. In each case an older population was supplanted by a new, and in the case of Athens, by an inferior, race. Whereas formerly citizenship was conferred only in rare cases on foreigners who were exceptional individuals, and the high standard of civic efficiency was thus maintained, the new situation called for naturalization on a large scale. The question is still to be answered, however, why the ranks of the native Athenians were depleted and not those of the Metics and slaves. Two answers should be given. The citizens were drawn into military service and suffered heavily during the numerous wars as has been indicated before. The Metics and slaves suffered hardly at all from this source. The more important factor is, however, that which concerns disease. The Metics were mostly Asiatics, and the slaves were mostly Asiatics or Africans and only to a small extent of Hellenic origin. The Asiatics and Africans came from regions where malaria had long been prevalent, and were at least to some extent immune ; they suffered, consequently, much less from this disease than the native Athenians. A disease, as explained before, always causes more sickness and greater mortality in a population which is not accus- tomed to it. This is well illustrated in Mauritius, where malaria was responsible for 30,000 deaths in 1867 out 118 HEALTH AND SOCIAL PROGRESS of a population of about 310,000 in 1861 whereas cholera, a more mortal but more usual disease in that island, killed only 17,000 persons in 1854 in a slightly smaller population. 63 There is no record, of course, of a similar mortality in Athens, but the ravages of malaria must have been severe and the ultimate effects far- reaching, if one may judge from what is known about that disease. In order to fill up the depleted ranks of citizens, Athens became less discriminating in conferring citizenship and admitted many Metics and slaves to its rights. The citizens of the time of Demosthenes were, consequently, a largely non-Hellenic body ; or, if Hellenic, so weakened by malaria that they had lost the buoyancy and confidence which were such marked characteristics of their forbears. The situation about the third century B.C. was, con- sequently, very different from that of the end of the fifth. The citizens of Athens consisted largely of 'foreign, that is, of inferior stocks. The more energetic Greeks had emigrated to other parts along the Mediterranean where they spread their culture. It is remarkable that so many Greeks flocked to Alexandria in the third century and that this city became famous for its culture in so short a time. An explanation may, perhaps, be found in the fact that it was a healthy city and that Greek emi- grants found here a climate not too radically different from their own. For Strabo (63 B.C. to 24 A.D.) tells us that, notwithstanding its location, it was free from marsh-fever even in his time. 64 The radical change in the character of the population, brought about by disease, explains to a large extent the shallow productions of the later Greeks. Menander (342-291 B.C.) wrote not only immoral, but stupid and insipid plays. " If there be any moral lesson conveyed by the picture* we have here of ILL HEALTH AND THE CLASSICAL WORLD 119 Attic society, it is this: that the slave and the prostitute were not only more intelligent, but less immoral than their masters." 65 This stricture would certainly apply more to Asiatics, such as the Athenians had largely become, than to the descendants of the victors of Marathon and Sala- mis. The Asiatics were the fittest to survive in this particular environment; but the best under conditions of this kind was but poor material. The crab apple lives and thrives in Siberia ; it is, however, a poor substi- tute for the luscious pippin of the Mohawk valley where the climate is better. The more serious Greeks were driven into anti-social philosophies at home, the more active men into mercenary service abroad, while the most energetic men had emigrated to Alexandria. A mob, recruited partly from the Metics and partly from the slaves, ruled Athens; and the follies and violences of stupid and corrupt demagogues were directly responsible for the disastrous conquest by Mummius. Small wonder, that this new type of Greeks was held in contempt by the Romans. It was a race of degenerates. It could not produce, so it began to comment. It could not originate, so it began to traffic in the knowledge of Plato and the poetry of Homer. The homines still lived but the znri were dead. The case was somewhat different with the Romans!- They have always been more coarse, physically and mentally. Their decline was, therefore, less rapid, but not less certain. An important feature in their longer life as a nation was the larger extent of their country, and the consequent greater number of malaria-free spots. Greece has even today some of these. But they were of no help to the Athenian, since he could not leave his own little City-State without trespassing on foreign and hostile ground. Owing to the size of his country, the 120 HEALTH AND SOCIAL PROGRESS Roman could go north and south ; he could, in any case, go into the mountains and escape the most dangerous attacks of malaria. Thus the custom arose among the wealthy Romans of having villas in the Apennines, whither they would retreat during the summer and autumn. This was, however, only a temporary relief con- fined to the rich. The vast majority had to stay in the valleys and in Rome, where the air was not only hot and humid, but full of mosquitos, carrying the malaria para- sites from person to person. The infection soon produced its effect upon the Romans. They became a tainted and debased folk, penned up within the walls of the city. The average Roman deteriorated physically to such an extent, that, as Strabo tells us, the legions had to be recruited from Liguria because of the massive physique of these people. 66 When these were infected and had deteriorated, the Romans looked beyond the borders of Italy, and Gauls, Spaniards, Istrians, and Germans were enrolled in the legions. A number of prominent men of letters were foreigners; during the first century A.D., there were, for instance, four Spaniards, Lucan, Martial, Seneca, and Quintilian. The foreign-born emperors increased in number. This new blood from malaria-free countries, was infected in time, and every new infusion shared the same fate, till the Roman Empire fell to pieces. Again, as in Greece, there were other factors; but this disease was the original reason of Roman decay and gave fuller scope to other disintegrating factors. The frequency with which German conquerors were attacked and killed by fevers in Italy during the Middle Ages needs merely to be mentioned here as a well-known fact. Time and again important events were decided by an attack of fever which either killed or caused the hasty removal of the leader to Germany. ILL HEALTH AND THE CLASSICAL WORLD 121 The final result was that the builders of the Roman Empire either died out, or degenerated, and were replaced by foreigners. In subsequent centuries the population grouped itself chiefly with respect to its power of re- sistance to malaria. The southern parts were settled chiefly by the Mediterranean races which came from regions where malaria was endemic, and who were, owing to their partial immunity, able to maintain fair health in these highly infected regions. The northern parts less infected were settled chiefly by various Alpine races and to some extent by the Teutonic race, and were able to maintain good health* In between these were representa- tives of both races, health depeno'ing partly on the par- ticular locality, and partly on the degree of civilization. The point which these facts bring out is the necessity of good health, especially freedom from endemic diseases, for a progressive civilization. In the north of Italy, certain cities, e.g., Turin, Milan, Genoa, Venice, Bologna, Florence, and Pisa, have for centuries stood for art, science, literature, advanced agriculture, and manufac- ture. From here have come during the nineteenth cen- tury, the greatest Italians Cavour from Turin, Gari- baldi from Nice, Mazzini from Genoa, and Victor Em- manuel from Savoy. Rome owes its importance largely to artificial factors, historical, administrative, and ecclesiastical ; it has, how- ever, become practically free from malaria owing to better drainage and sanitation, and to more efficient medi- cal supervision. Southern Italy is, as far as anything pertaining to progress is concerned, practically unknown. This backwardness may, of course, be due to racial factors. If so, it is the more important that these races should be liberated from the endemic diseases which have in all probability made them what they are. 122 HEALTH AND SOCIAL PROGRESS The Greeks and the Romans degenerated through malaria. If more highly gifted races lose their creative power, or even their health through malaria, it is evident, that those who have always been subjected to its in- fluence, can never rise to the full power of either of those races. It is impossible that a race whose children are infected regularly every one or two years after birth, and are subjected to the drain of this insidious disease, its long succession of febrile attacks and constantly in- creasing anaemia, should develop well-balanced individ- uals. They may be immune to malaria after adolescence, but the drain on the growing body is, as a rule, too heavy to permit of full, buoyant, joyous health, which is needed for higher mental pursuits. A weakness, making the nervous system highly sensitive, will always remain ; persons afflicted in this way may become very receptive, but they cannot become creative because there is not a sufficient surplus of vitality stored up. Only those who have closely watched or experienced the ravages of malaria can possibly know the lack of freedom from which the patients suffer. They vary constantly between elation and depression, hence are always under the sway of physiological conditions and emotions. They cannot be self-controlled, because they have no surplus energy; hence the particular feeling always controls, whether it is elating or depressing. It could indeed hardly be other- wise. When the system is constantly on the defensive, and is attempting, so to say, to fill in a bottomless hole, it cannot develop that surplus of vitality, so necessary for control by the whole organism. The chief function of such a system must be to stop leakage, and that means inability to develop poise and balance. In Plato's terms, the particular organs claim too much attention in propor- tion to the importance of their function, This is the ILL HEALTH AND THE CLASSICAL WORLD 123 chief damage which malaria and other low fevers inflict upon the race and the individual, and consequently upon civilization; since races, thus handicapped, can never be creative or progressive. CHAPTER IX HEALTH AND THE TROPICS AFTER viewing the effects of malaria, particularly on the classical world, it will be necessary to consider another endemic disease in a larger field, hookworm in the tropics and sub-tropics. This will enable us to get a better idea of the devastating effects of such a disease, since we can study them in a much larger field. The tropics have always been unhealthy, and the Germans have succinctly expressed this fact in the state- ment : " Unter Palmen wandelt niemand ungestraf t." Formerly these unhealthy conditions were attributed chiefly to the heat and, more recently, to the actinic rays of the sun. 67 Physicians, studying conditions on the spot, v have found, however, that endemic diseases are chiefly responsible for the unsanitary character of the tropics. The hookworm is, in addition to malaria, one of these, and its discovery is one of the most important events not only in the annals of medicine but in the world at large. The hookworm disease (anchylostomiasis or unci- nariasis) has been definitely known as to symptoms for three centuries. As early as 1648 Piso spoke about it in Brazil, Father Labat in Guadeloupe, 1748, and Bryon Ed- wards in Jamaica, 1799. But not until 1838 were the worms found by Dubini in Milan and their connection with the disease suggested, although similar worms had been found in the badger by Goeze in 1782 and named hookworms or uncinaria by Froehlich in 1789. Since then the disease has been extensively studied by many 124 HEALTH AND THE TROPICS 125 physicians, among whom may be mentioned as the most prominent : von Siebold, 1845 ; Bilharz and Griesinger in Egypt, 1853 ; Wucherer, supported by Brazilian physi- cians in Bahia, 1866; Paletti and Maliverria in Italy, 1877-78, also Grassi and Parona, 1877. In America the disease was referred to as early as 1808 by Joseph Pitt, and by J. L. Chabert in 1821, both of whom described the desire for dirt eating on the part of whites and blacks, although neither was aware of the hookworm. In 1834 Geddings noticed similar symptoms in the anaemic and cachectic " sand-lappers " of Carolina. The dirt eaters of Florida were described by Little in 1845, and similar cases in Alabama by Sir Charles Lyall in 1849. James B. Duncan gave a fuller description of cases in Louisiana in 1849. None of these men were aware that they were dealing with an extensive disorder. In 1866 the worms were noticed by Dr. Joseph Leidy who thought they might infect man and cause anaemia. In 1891 Dolley called the attention of physicians to the fact that the disease was prevalent in the South, and other physicians reported several cases from 1894 to 1901, notably Allen J. Smith in Galveston who studied the ova in 1901. On May 10, 1902, Dr. Charles Wardell Stiles discovered a new species of the worm, Uncinaria Americana or Necator Americanus. Major Bailey R. Ashford suspected and proved the disease in Porto Rico in November, 1899 and published, with Dr. Walter W. King, a report of 100 cases in American Medicine, Sept. 5th and 12th, 1903. In 1904 a government commission was appointed for the study and treatment of the disease in Porto Rico. Meanwhile Looss, through investigations carried on in Cairo, Egypt, had proved in 1898 that the larvae penetrated the skin of human beings, and thus pathology and treatment were made much easier." 126 HEALTH AND SOCIAL PROGRESS The range of this disease is very extensive. The in- fection is rather prevalent in a zone about 66 degrees wide, extending from parallel 36 degrees north to parallel 30 degrees south ; it occurs less frequently in higher lati- tudes, the extremes being 51 degrees north, and nearly 40 degrees south. Practically all countries lying within the zone of the 66 degrees mentioned, are heavily in- fected, while north and south of it cases are found chiefly among miners, for instance, in Hungary where 95 per cent of them were infected, or in Belgium where 10,000 miners near Liege had the disease in 1903. The Rocke- feller Sanitary Commission received reports from 54 foreign countries stating the presence of the disease; in Wales, Germany, Netherlands, Belgium, France, and Spain, it is confined to miners and is found in few localities ; but in 46 countries the infection is general and widespread. The more important of these countries are : Egypt with about 90 per cent of hospital cases in Cairo due to hookworm and about 50 per cent general infec- tion among the laboring population ; Algeria, where there is a considerable amount, although the percentage is un- known; and along the east and the west coast down to the Cape, in Uganda, Mombasa, Mozambique, Zanzibar, Madagascar, and Mauritius. In Cameroon 70 per cent of the population are infected. In the interior, Natal and other parts are seriously infected, although figures are not available. Asia has many seriously infected areas; in Ceylon about 90 per cent of the people suffer from the disease ; in India, between 60 and 80 per cent are infected ; in China, the infection is variously estimated from 25 per cent for the city population to 75 per cent for the country popula- tion. In Cochin China the disease is extremely prevalent, and in the Malay states at least 60 per cent of the people HEALTH AND THE TROPICS 127 have hookworm. In Korea, about 70 per cent of the farmers and 50 per cent of the entire population suffer from the disease; in Japan cases of hookworm are fre- quent, but of a mild character. Burmah, Siam, Borneo, and Java have numerous and severe cases ; according to some estimates the percentage in Java runs as high as 90 per cent in some localities. In the Pacific the disease occurs in many islands, on Samoa 70 per cent are suffer- ing. In the Straits Settlements about 10 per cent, and on the island of Sumatra as high as 95 per cent have hookworm. In Australia the disease is found chiefly in the Johnstone River district of Queensland, where in one school 90 per cent of the children were infected. Going over to South America, Argentina has but few cases ; in Paraguay they become more numerous ; and in Brazil hookworm is exceedingly prevalent. In the Guianas the estimate of the infected is about 50 per cent of the population. In British Honduras the percentage runs as high as 70. The Central American republics are severe sufferers from the disease Panama, for instance, having 20 per cent of infected people. Concerning Colombia, the Rockefeller Commission reports as follows : " In general, it may be stated that, with the exception of that portion of Colombia situated at a greater altitude than 3,000 feet, the entire country is infected with hookworm, and that within the infected areas about go per cent of the inhabitants are victims of the pest." 69 In Mexico the disease is very prevalent, especially in the mining districts. Coming to the United States and its outlying terri- tories, we find that the Philippine Islands are seriously infected, the percentages in different provinces varying from 15 to 74 of the population. Porto Rico with a 128 HEALTH AND SOCIAL PROGRESS population of about one million in 1904 had about 800,000 cases, while among the workers on the coffee planta- tions, the infection runs about 90 per cent. In Con- tinental United States, all the states from Virginia to Florida and Texas, and as far west as California, are sufferers from this disease, particularly Alabama, Arkan- sas, Georgia, Louisiana, Mississippi, North and South Carolina, Tennessee, and Virginia ; but cases are found in Kentucky, and other states along the Mississippi River. The 46 foreign countries in which the infection is widespread, comprise 14,464,158 square miles, with 919,- 858,243 people. To this should be added 11 of our own states with an area of 510,149 square miles and a popula- tion of 20,785,777. This means that about 940,000,000 out of the 1,600,000,000 people on the globe live in countries where hookworm disease is prevalent. 70 These figures are, perhaps, too high ; but even if they should prove to be somewhat lower, they would, nevertheless, be sufficiently high to act as a serious menace to the inhabitants of those countries, especially since in most of them, malaria is likewise very prevalent. These people live and multiply, but they lead miserable lives, and are unable to develop high vitality and fine brains. The physical effects of hookworm disease are both numerous and serious. In moderate infections a lower- ing of physical and mental strength occurs. School chil- dren are seriously retarded by the disease, and are rarely able to accomplish more than 60 per cent of the required work. " The worst cases are those in which there is a heavy infec- tion. . . . Even well-to-do subjects become severely infected, but among the underfed the results are most serious. Either the patient becomes rapidly anaemic with digestive disorders, sometimes severe diarrhoea with hemorrhages, anasarca [dropsy], HEALTH AND THE TROPICS 129 and extreme debility, or the conditions may be more chronic. Indolence and weakness lead to careless habits, reinfection occurs from time to time, often the whole family becomes affected more or less seriously." 71 Dr. Charles W. Stiles says : " The injury to patients results from the following factors, (i) Sucking of blood by the parasites, which is a constant drain on the system; (2) Loss of blood into the intestines through the minute wounds made by the parasites, the factor which also tends to deplete the system; (3) The wounds form points of attack for bacteria, hence increase of the chance of bacterial infection as well as toxic infection from poorly digested and decomposed food ; (4) The wall of the duodenum and jejunum becomes thickened and degenerated, and its function is thus decidedly interfered with; (5) The parasite in all prob- ability produces a poisonous substance which acts upon the patient." 72 The drain upon the system is so severe in many in- stances that in cases of long standing, the patient is un- developed physically and mentally. Physical growth may be retarded to such an extent that a boy or girl between the ages of 12 to 14 may present the appearance of a child 6 to 8 ; even young men or women of 18 to 22 years old may have the development of children from 12 to 16 years ; and the appearance may be either childlike or senile, especially like that of elderly dwarfs. The re- productive powers are seriously interfered with and their development is very much delayed, especially in the case of women. The mental effects are naturally more serious. Dr. Ashf ord says : " Over all the various symptoms with which the unfortunate jibaro (peon) infected by uncinaria, is plagued, hangs a pall of drowsy intellect, of a mind that has received a stunning blow. There is, to us, no one symptom at once so characteristic and 130 HEALTH AND SOCIAL PROGRESS so pitiable. A benumbing influence seems to be exerted on the mental faculties, even before anaemia and heart changes are noted. There is a hypochondriacal, melancholy, hopeless ex- pression, which in severe cases deepens to apparent dense stu- pidity, with indifference to surroundings and lack of ambition." 73 In some cases the disease leads to insanity; in many, for instance in Australia, a prevalent craving for dirt eating and severe moral degeneration is reported. 74 The moral effects of hookworm disease are more seri- ous still, although less easily pointed out. Not much can be expected of a people whose vitality is so low that it averages only 40 per cent of hemoglobin and runs in some cases as low as 8 per cent, whose red blood cells number less than 2,000,000 in many cases, and in a few even less than 1,000,000, instead of the normal 5,000,000 per cubic millimeter. There is a vicious circle of disease, inefficiency, and poverty ; a lack of ambition and of buoy- ancy. The patient has only one intense desire that of deliverance. Unable to help himself, he turns eagerly to anyone or anything promising relief. He loses his feel- ing of independence and responsibility, simply because he is unable to locate and cure this trouble, and his mind is filled with the wildest fancies. Under these con- ditions he falls an easy prey to " medicine men," charla- tans, patent cure-alls, and old women who pose as medical oracles and whose ignorance is exceeded only by their temerity. He is subject to all kinds of superstitions the more weird and grotesque, the more acceptable. Witchcraft and voodooism are the natural product of such an unregulated imagination. Lack of control is a characteristic of the hookworm victims, and any stimulus from within or without is acted upon unrestrainedly. Mentally and morally he rarely passes the stage of the moron. The vegetative, self-preservative, and reproduc- HEALTH AND THE TROPICS 131 tive functions are the only ones which have any interest for him. The economic effects are more readily and accurately gaged. One illustration will, perhaps, best serve the purpose. California has only light infections, yet Dr. Herbert Gunn, the special inspector for the State Board of Health, reports : " There is no question that the general efficiency of the men is noticeably impaired. At one mine, employing about 300 la- borers, it was stated that a reserve of about 25 men had to be available to replace those who, on account of sickness, did not appear for work. Quite a few of the men have to lay off every now and again to recuperate. Several who were unable to work stated that when they arrived in Jackson, they were perfectly strong and well. A large number of these men were encountered on the streets, some of them presenting marked degrees of anaemia. The greatest loss to mine operators is occasioned by the large number of those moderately affected. ... A loss of 20 per cent in efficiency of those infected would be a con- servative estimate. That would mean in Mine No. 2, for in- stance, where over 300 men are employed at an average of about $2.50 per day, and estimating the number of those infected as low as 50 per cent, a loss of over $20,000 a year." 75 The general social effects of the disease are best de- scribed by Wickliffe Rose, the Administrative Secretary of the Rockefeller Commission. " The sharp contrast between heavily infected communities and communities practically free from infection affords the most striking illustration that I have seen of the physical, intel- lectual, moral, social, and economic results of hookworm disease on a community. " Such a contrast we saw near Dr. Fisher's home. Lying a few miles northeast from Emerton in Richmond County and extending over the border into Northumberland and Westmore- land Counties is a large scope of country which for generations has been inhabited by a people set apart by marked characteris- 132 HEALTH AND SOCIAL PROGRESS tics from the people surrounding them on every side. The people are called ' Forkemites,' . . . and for generations the name has been a byword. Lack of energy and thrift has brought to the Forkemites extreme poverty with the inevitable mental and moral results." 76 This quotation not only illustrates what havoc the disease may work, but shows that it alone is responsible for such results. These people live under the same climatic conditions, they belong to the same stock of Virginia, and are of the same faith as those who live nearby but are more fortunate in living in areas com- paratively free from uncinariasis. Just as in the case of malaria, so in that of this disease there are numerous " islands " which are free from the infection, owing to conditions of soil, water, and sanitary conditions estab- lished by the inhabitants. It will be necessary to estab- lish this point a little more firmly by details. Both the Rockefeller Commission and the Porto Rican Commission found a remarkable improvement in the people who had been cured. Dr. Fisher reports one school at Totus Key, Va., where 38 out of 40 children were infected. It was a hard school and could not keep its teachers. After a year's treatment the children had been transformed those who were dull and listless were active and alert; and those who could not study, found joy in learning. Coming from anaemic parents, they were infected in infancy, and after being cured their cheeks showed the glow of health for the first time in their lives. The transformation also manifests itself by a new light in the eye, an elastic step, and a hopeful outlook on life. External conditions had not changed with these children, excepting that a few sanitary measures had been intro- duced into the school and community ; the victims had been cured of the disease, and this meant a tremendous 133 change. Or when we read of case after case in which dull, hopeless, anaemic, thriftless, illiterate people have been changed into bright, alert, active, and industrious persons during a few months living in the same houses, on the same farms, without any changes except being cured of this disease we must come to the conclusion that the only drawback from which they suffered was ill health. 77 If the cases were not well attested by com- petent physicians and scientists, one would imagine that an advertisement of " a patent cure " was being read. These rapid changes in improvement have their obverse in rapid deterioration. The report of Dr. Gunn, quoted previously, states that several of the sick men were per- fectly strong before they entered the infected mines. Dr. Dock confirms this statement from his own observation. " If we were to select the strongest people in the country and place them in conditions under which these patients are now living it would be only a generation or two before even a race of athletes would be in the same condition as the people under discussion." 78 We have here cases of rapid deterioration analogous to those discussed in previous chapters (6, 7, and 8) as due to malaria; and these cases furnish corroborative evidence for what may have happened to the Greeks and Romans after the introduction of malaria. In order to prove the disastrous effects of uncinariasis in a particular country as we showed those of malaria in Greece and Rome it may be best to select Porto Rico as an illustration, because the disease has been studied there -extensively from its various aspects. The island has an area of 3,606 square miles, with a popula- tion of about 1,120,000. Tbc chief products are sugar, tobacco, coffee, and fruit. There is little manufacturing, 134 HEALTH AND SOCIAL PROGRESS and about 75 per cent of the labor is agricultural. This means that the welfare of the whole island is largely dependent on the labor capacity of those engaged in tilling the soil, that is, on the health of the jibaro or peon. Formerly coffee was the principal crop, having a value of $7,492,453 in American gold in 1897; sugar in that year was valued at $2,456,898, and tobacco at $732,117. In 1910 the values had changed to $23,545,922 for sugar, $5,664,128 for tobacco, and $5,669,602 for coffee. During the years 1895-97 the coffee crop formed 70 per cent of the value of all exports, in 1910 it had dropped to about 14.5 per cent. Whence this change? A few words on hookworm disease will be sufficient to explain it. The disease seems to have been introduced from Africa with the slaves about 1530, since Columbus reported of the original inhabitants that they possessed fine stature, and were " people of beautiful presence." 79 In all later reports the common white people are characterized as lazy, and indifferent to all improvements. In a descrip- tion of Porto Rico in 1834 we read : " Most of these colonists are inconceivably lazy and indiffer- ent. Lying back in their hammocks, the entire day is passed praying or smoking. Their children, isolated from the city, without education, live in social equality with the young negroes of both sexes, acquiring perverted customs, only later to become cruel with their slaves." 80 But the more accurate observers state that these people were anaemic with a dead white, yellow, or greenish hue ; that the negroes and mestizos, when sick, were of an ashen gray color. These descriptions fit those suffering from uncinariasis, both as to complexion and supposed moral turpitude. The latter was, of course, nothing but HEALTH AND THE TROPICS 135 the result of physical lassitude and low vitality, owing either to hookworm, malaria, or to both. Writers of former centuries in describing the whites in the tropics and sub-tropics laid the blame for this lassitude on moral grounds, because they did not know enough about the effects of endemic diseases upon the body. Dr. Ashford refutes this charge in these words : " We cannot believe that vicious idleness comes natural to the Spanish colonist, even in the tropics, for the very reason that we have seen these descendants at their very worst, after the neglect of four centuries of their mother country and after the laborious increase of an anaemic population in the face of a deadly disease, whose nature was neither known nor studied, work from sunrise to sunset and seek medical attention, not because they felt sick, but because they could no longer work." fel These men were sick and could not work, and this fact explains the change in the decline of coffee values. Coffee is usually planted on small farms on the hill- sides, and requires much shade and moisture thus af- fording ideal breeding-grounds for the parasites of this disease. Sugar, on the other hand, requires a dry soil, sun-baked, and bereft of shade a rather poor culture ground for hookworm. After the American occupation capitalists opened up large sugar plantations equipped with modern machinery, paid fair wages, provided better housing conditions, and introduced various sanitary measures among their laborers, who were chiefly negroes and relatively immune to uncinariasis. Under these conditions the sugar crop increased rapidly, while that of coffee decreased because the laborers were not so well protected. That is, however, not the whole story. The coffee planters are much more numerous, and are the most exposed to the hookworm disease. Sugar and tobacco can be planted only in the coast regions, and by 136 HEALTH AND SOCIAL PROGRESS far the larger part of Porto Rico must be given up to coffee. Thus the majority of the population is exposed to the dangers of the hookworm disease. " The picking of coffee is all too frequently done in the pouring rain, for the harvest coincides, as we have seen before, with the wet weather. The vast majority of the pickers now, and all before the campaign against anaemia began, are bare- footed. They work from a little after dawn to near dark, and are thus employed for about three months, the number of almudes picked getting scarcer as the ripened berries arc gath- ered in. These plantations are heavily shaded, indeed doubly so, for the coffee bush, itself affording a dense shade, is further shaded by light guavas or trees about the size of a maple. Here in this shade the sopping wet ground is befouled by the multi- tude of sick each day, and the ripening ova give rise to an infinity of nests of active larvae into which several days there- after the same or other workers must tread. The result is that uncinariasis has its great breeding place in the coffee plantations of Porto Rico, and here a barefooted people pollute the soil and are infected and reinfected by it until the life of every man, woman, and child is punctuated by a vast number of re- infections, casual yet common in the nine months of ordinary work, certain and continuous during the coffee harvest when no worker escapes who is without shoes. Therefore it is small wonder, with constantly arriving reinforcements to the little army of parasites that thrive at the expense of the laborer, that we find a sick workingman in the country." 82 Previous to the American occupation a still larger percentage than at present were engaged in coffee grow- ing, and the infection was correspondingly more preva- lent. How much this disease must have affected the condition of the Porto Ricans we can only surmise when we read that " It cripples industrial effort, limits mental expansion, weakens the body and depresses the spirit, until many laborers in a country where agriculture is the chief source of revenue, are enervated, despondent, with- HEALTH AND THE TROPICS 137 out hope of betterment, and without the power to save themselves. Sometimes a man cannot earn enough to feed his family, and he is driven to eat the crudest gifts of a bountiful nature in the wild fruits of Porto Rico." 83 It cuts down man, woman, and child of every age, and causes diminution in earning capacity of 50 per cent or even more. In light cases, having over 60 per cent hemo- globin, a previously vigorous individual finds his strength and energy waning, becomes dyspeptic, disinclined to work, and generally " run down," and has a faint pallor. In moderate cases, averaging between 30 and 60 per cent of hemoglobin, the individual becomes anaemic, with low mental and physical activity. The patient looks and feels definitely sick. Mere disinclination to work has changed to partial inability, since any exertion brings on palpitation of the heart, and sudden changes of position cause dizziness. He is pale and half narcotized. In in- tense cases, with hemoglobin below 30 per cent, the patient has dilation of the heart, extreme pallor, and a fatal termination of the disease may occur at any time. When we remember that the population of this island was about 1,000,000 in 1904, that about 800,000 of these were estimated to be infected, and that the infection would run as high as 90 per cent on the coffee planta- tions, we must conclude that no high state of mental, moral, and social conditions was possible with people who suffered from a disease, the symptoms of which have just been described, especially if we find that about 30 per cent of the cases coming under the observation of physicians were " intense," 45 per cent " moderate," and only 25 per cent " light." Hookworm is, however, not the only curse of this island. Porto Rico has also suffered from malaria. No definite figurelflFre available in regard to this disease, as 138 HEALTH AND SOCIAL PROGRESS they are for uncinariasis, which was made a matter of several special reports. The " Report of the Governor of Porto Rico for 1913 " contains, however, some signifi- cant figures, which will enable us to draw some con- clusions in regard to the prevalence of malaria. On page 113, about 60 per cent of all deaths are listed as possibly due to malaria. This is certainly an exaggeration, since out of the total number of deaths, (26,034 during the fiscal year 1913) all cases of diarrhoea and enteritis claimed 5,372, tuberculosis of the lungs 1,536, hookworm 1,347, i.e., anchylostomiasis 383 and anaemia chlorosis 964, and malaria 1,073. 84 This comparatively small number of deaths does not, however, argue a rare occurrence of malaria, since Colonel Gorgas explains the infrequency of deaths from this cause as perfectly compatible with its prevalence. He says : "The best measure of the working efficiency of a force, as far as health is concerned, is the daily number of sick. For instance, in a force such as we have at present, we might have 1,500 cases of pneumonia, which would average ten days each in hospital, and give us 500 deaths. Fifteen hundred cases of malaria would average seven days in hospital, and give us not more than thirty deaths. The deaths from malaria, therefore, represent a very much larger nonefficiency from disease than do the deaths from pneumonia. Two deaths from malaria would mean that too men had been sick for seven days ; that is, that 700 days had been lost from malaria during the year. Two deaths from pneumonia would only mean that 6 men had been sick for ten days, and, therefore, represent only sixty days lost from pneumonia." 85 The 1,073 deaths attributed to malaria would on this basis represent at least 53,650 cases of seven days' dura- tion. This is, of course, too low a figure, since Colonel Gorgas argues from conditions as they exist in the Canal Zone where the employees are carefully watched and HEALTH AND THE TROPICS 139 instantly taken to the hospital when they show any symp- toms of disease. In the larger part of Porto Rico, that is impossible, owing to the scarcity of properly trained physicians ; and many cases of malaria are not diagnosed correctly so that the cases linger on for weeks and months, and deaths are attributed to other causes. It seems therefore safe at least to double the number of cases of malaria in this island, and to sextuple the number of days of illness. This would give approximately one malaria case in ten of the inhabitants, and a loss of 42 working days per patient. That would give us with a population of over a million at a conservative estimate 100,000 cases of malaria with a loss of 4,200,000 working days per year. The small number of deaths from malaria during 1913 is, however, only a part of those which occurred previous to the sanitary work which was inaugurated after the American occupation, since very little was done in a scientific way to combat the disease. Just how many cases there were, it is impos- sible even to estimate, as, due to the illiteracy of 80 per cent of the people and to the scarcity of competent physicians, no accurate records could be kept. That there was much sickness and mortality is certain, as may be shown from the retardation of increase in the popula- tion after 1765 to 1775, when the decennial rate of in- crease was 57 per cent, which dropped to 16 per cent in 1887-89, and rose only to 17.3 per cent from 1899- 1910, notwithstanding the great work of sanitation and medical supervision introduced by the government during the latter part of this period. This increase has taken place in the face of a very high death rate in a dense population approximately 300 to the square mile. The year 1899 may serve as an example of these high rates, because the birth rate exceeded a death rate of 40 per 140 HEALTH AND SOCIAL PROGRESS 1,000. Another fact points likewise in the direction of a decreased vitality. The population of this island below 10 years of age has a percentage of 30.9, a greater per- centage than that of any civilized country, e.g., 22.2 per cent in the United States ; yet in the latter country 13.8 per cent are 50 years of age or over, against 9 per cent in Porto Rico. The decreased birth rate and the shorter span of life point toward lowered vitality a condition which could not be overcome by the various ameliora- tive and preventive efforts of the government in a few years. The enormous number of deaths from tuberculo- sis and from diarrhoea, as well as the 13,441 deaths from all diseases of those under age in a total mortality of 26,034 merely corroborates this statement, since low vitality alone can explain such mortality. Even if we should take the lowest estimate of 300,000 for those who suffer from uncinariasis, and figure only 100,000 for malaria patients, we are nevertheless face to face with a serious condition, since we have over one-third of the population ill as the effect of two diseases ; the other diseases combined would add at least 17, and this would make at least 50 per cent of the total population patients more or less constantly ill as against about 4 per cent of permanent sickness in the United States. The relation of malaria and uncinariasis is interesting from another point of view. The former attacks princi- pally children before and up to the age of puberty, and i then gradually releases its hold ; the latter attacks chil- dren comparatively seldom, but is most virulent after puberty. Out of a total of 29,219 patients treated for~ hookworm in 1906-07 we have 1.09 per cent less than 5 years of age; 8.90 per cent from 5 to 9; 20.80 per cent from 10 to 14; 37.45 per cent from 15 to 29; 24.15 per cent from 30 to 49; 7,49 per cent over 50. 89 It seems, HEALTH AND THE TROPICS 141 therefore, that no sooner does the jibaro get over the age when Scylla threatens his life, than Charybdis is almost sure to attack and kill him. In this brief discussion of the case of Porto Rico, stress has been laid on hookworm disease, with a brief mention of malaria. There was no intention of claiming these to be the only diseases in the island, but simply the endeavor to show that of the 152 diseases enumerated as the causes of one or more deaths, these two were responsible for a high percentage, and were the pre- disposing cause of many more by depleting and devitaliz- ing the body. Tuberculosis of the lungs and diarrhoea with enteritis were mentioned as the cause of more deaths than malaria and uncinariasis ; neither of these diseases, however, kill people in vigorous health, but more usually those with low vitality. Malaria and uncinariasis under- mine the constitution, and thus predispose toward other diseases. They are responsible, moreover, for that low mentality, small initiative, and lack of ambition, which are reported by observers. This should cause small sur- prise if the meaning of health (see chapter two) con- sists essentially in a natural and irresistible desire for activity owing to surplus vitality. Healthy men can strive, plan, devise ways and means to improve their condition ; ill men are content to leave things as they are, because they have no energy to spare for the new exer- tion required for experiments. Their principal desire is for relief ; and the whole attitude of mind becomes plaintive, passive, and negative. The inevitable result is a static civilization. CHAPTER X HEALTH AND WORLD-PROGRESS THE facts brought out in the last chapter have a signifi- cance which cannot be over-estimated. For what is true concerning Porto Rico applies to the tropics and sub- tropics, and, if malaria be included, to a very much wider area indeed to the larger part of the temperate zone. If the facts as to disease and its bearings have been cor- rectly explained, they ought to elucidate conditions as to progress in the past, and to throw some light on the future movements of mankind. An attempt will be made in this chapter to explain some of these problems. I. THEORIES ADVANCED TO ACCOUNT FOR PROGRESS Explanations of the progress of man from the stage of his primitive ancestors may be roughly divided into five classes. 1, the transcendental; 2, the historical or accidental; 3, the natural or geographical; 4, the anthropological; 5, the actinic ray theory of Major Woodruff. 1. The transcendental theories of various kinds, e.g., the mythological, theological, and philosophical, which have determined the thinking of past ages until recent times, are, of course, unscientific. The philosophy which looked upon Cyrus the Great as the executive of Jehovah to punish disobedient people, is no more taken seriously as an explanation of the movement of mankind toward a certain goal, e.g., of universal peace, than are the de- feats and victories of Israel as results of disobedience 142 HEALTH AND WORLD-PROGRESS 143 or of obedience, respectively, to Jehovah. This view has dominated the whole of Christendom, and whether true or not is not open to objective proof. The so-called " principle of the dialectics of history " propounded by Hegel is not more satisfactory from a scientific point of view. " Reason is the innermost substance of history, which is logic in action." " The victorious State is truer, nearer to the ideal State, better, in a word, than the vanquished State. The very fact that it has triumphed proves this; its triumph is the condemnation of the principle represented by the vanquished; it is the judg- ment of God. Thus interpreted, history resembles a series of divine reprisals directed against everything that is finite, one-sided, and incomplete ; it is an eternal dies iroz, which nothing earthly can escape." 87 All that needs to be done by a nation in order to be successful is to become a true embodiment of the State- Idea, and it becomes that in proportion as it defeats its enemies, since its victories are a perpetual proof of its approach to the true purpose of the world-spirit. This brings us back to the theory of Aristotle that victorious people always represent more virtue than the vanquished. Neither of these philosophers tells us, though, why one conqueror has approximated the true idea of the State more than another, except that the God of history has successively chosen the Egyptians, Assyrians, Greeks, Romans, French, and the Germans as temporary and privileged organs. Whether these respective nations were literally " chosen " and later on rejected as was Cyrus the Great, or whether they gradually evolved a truer idea of the State and then lost it, we are not told. Victory is the proof of superiority in ideas, defeat of inferiority; but why or how either victory or defeat can be thus ex- plained is an impenetrable mystery which the God of his- 144 tory has not chosen to reveal ; and all we can do is to stand in awe and worship the Hegelian idol. 2. The historical or accidental explanation of the progress of mankind does little more than put its seal on facts. Professor Boas claims that there is no essential difference in the ability of various peoples and that the earlier civilization of certain races was an accident. To quote his own conclusion : " Several races have developed a civilization of a type similar to the one from which our own had its origin. A number of favorable conditions facilitated the rapid spread of this civili- zation in Europe. Among these, common physical appearance, contiguity of habitat, and moderate differences in modes of manufacture, were the most potent. When, later on, civilization began to spread over the continents, the races with which modern civilization came in contact were not equally favorably situated. Striking differences of racial types, the preceding isolation which caused devastating epidemics in the newly dis- covered countries, and the greater advance in civilization, made assimilation much more difficult. The rapid dissemination of Europeans over the whole world destroyed all promising be- ginnings which had arisen in various regions. Thus no race except that of Eastern Asia was given a chance to develop an independent civilization. The spread of the European race cut short the growth of the existing independent germs without regard to the mental aptitude of the people among whom it was developing. On the other hand, we have seen that no great weight can be attributed to the earlier rise of civilization in the Old World, which is satisfactorily explained as a chance. In short, historical events appear to have been much more potent in leading races to civilization than their faculty, and it follows that achievements of races do not warrant us in assuming that one race is more highly gifted than the other. " 88 If the earlier development of European civilization is an accident or a chance, no attempt at an explanation can or need be made, and we are where we were before HEALTH AND WORLD-PROGRESS 145 facts are facts and all that we can do is to accept them and put our seal of approval on them. This is what Hegel did, and found this world the best of all possible worlds. 3. The natural or geographical theories try to explain the progress of certain races as a result of topography, climate, and other factors of nature. The Ratzel-Semple theory the latest in this field distinguishes four funda- mental effects. I. direct physical effects of environment ; II. psychical effects ; III. economic and social effects ; IV. effects upon movements of people. (I.) Physical effects. Under this head are enumer- ated: stature, dominant activities, and pigmentation. After giving numerous examples under each sub-division, Miss Semple admits the inadequacy of geographical con- ditions to account in full for the effects cited: " The geographer must investigate the questions when and where deeper shades develop in the skins of fair races; what is the significance of dark skins in the cold zones and of fair ones in hot zones. His answer must be based largely on the conclusions of physiologists and physicists, and only when these have reached a satisfactory solution of each detail of the prob- lem can the geographer summarize the influence of environ- ment upon pigmentation. The rule can therefore safely be laid down that in all investigations of geographic influences upon the permanent physical characteristics of races, the geographic distribution of these should be left out of consideration till the last, since it so easily misleads." 89 It is not our purpose to explain the origin of pigment of the skin, but the physiologist referred to by Miss Semple might get some hint from the physician who in case after case describes the complexion of hookworm victims as " very pale," " extreme pallor," or an " extreme pallor of a dirty, waxy color " ; or when we read that pel- 146 HEALTH AND SOCIAL PROGRESS lagra causes the skin to thicken and become pigmented. And so might the anthropologist in attempting to account for stature when he finds that these victims at 12 or 14 years of age present the appearance of children of 6 to 8 ; or young men and women of 18 to 22 that of children of 12 to 16 years. Or when he reads of brothers, one with light infection, 17 years of age, weight 156 pounds; the other with heavy infection, age 18, weight 74. Or when he finds that a boy of 16 years with very heavy infection and ill for 8 years, weighed 62 l / 2 pounds on July 29, 1911, and 79 pounds on September 16, 1911 a change due solely to an improvement in his blood after the expulsion of the hookworms, since on August 3, his hemoglobin was 14 per cent and his red corpuscles num- bered 1,050,000; while on September 16, after the ex- pulsion of the last parasites on the 9th of that month, the figures stood 55 per cent and 4,572,000, respectively. 90 Definite facts like these should outweigh general theo- ries of what nature tends to do or what the influence of this or that hazy factor is supposed to do. For they should be taken in their full bearing. If certain endemic diseases have been acting for untold generations upon certain peoples, the effects become cumulative, and it may well be that an explanation of " the significance of dark skins in the cold zones and of fair ones in hot zones " can be found. Or if a people is habitually sub- ject to such a disease, the average stature must of neces- sity become low in the course of time through heredity. Illustrations of the effect upon complexion and stature of only one disease have just been given. Malaria has, however, similar effects. And it was shown in chapter 9 that at the lowest estimates about 50 per cent of the people of Porto Rico were more or less constantly ill from the effects of these two diseases. There are others HEALTH AND WORLD-PROGRESS 147 with even more disastrous results, e.g., venereal; and new ones may be discovered, which, if local, may account for many peculiarities now vaguely attributed to " race " or " climate." If the influence of food and occupations should, moreover, be studied by physiologists, a further explanation could, perhaps, be made concerning these peculiarities. (II.) Psychical effects. Among the influences of geography upon the mental life Miss Semple mentions the direct and indirect; among the former chiefly the enrichment of the vocabulary owing to local environment, e.g., of mountain, valley, river, sea, and dependent occu- pations, as the chase, herding, navigating and a broader effect upon the religion and mythology of peoples. Among the indirect influences mentioned are the general trend of thought given to man's mind by the conditions which affect him as an active agent, challenge his will by furnishing motives for its exercise, give purpose and direction to his activities conditions which mold his mind and character through the media of economic and social life. All this is sufficiently vague to be alluring, although Miss Semple does not see that richness of vocabulary is but another name for poverty in power of generaliza- tion, since a more civilized man expresses the same ideas by qualifying adjectives and modifying adverbs instead of having, for instance, four different terms for various kinds of mountain passes. She also overlooks the fact that this richness in vocabulary is due rather to occupa- tions than geographic conditions ; e.g., the Samoyedes, who have eleven or twelve different terms to designate the various grays and browns of their reindeer, are nomads. A golf or hockey player going to that country would most likely continue to use his vocabulary acquired 148 HEALTH AND SOCIAL PROGRESS in Scotland or America notwithstanding the difference in geography, and an engineer would continue using English, German, or French terms in his work and not trouble himself about the different words for grays and browns of reindeer. Occupation determines the mental life more than environment, as is well illustrated by the fact that the nation which excels in any one line of activity creates a vocabulary for the whole world, since language is only the outward form of ideas. We still think in terms of Greek philosophy, and try to cast our scientific terms in Greek or Latin vocabularies simply because these peoples excelled us in creating a rich treasure of words owing to their varied activities. France was preeminent in automobile manufacture, and the terms invented in that country in connection with all that this vehicle implies, have gone around the globe with the machine. An Arab, accustomed to the fleetness of his steed, might at first liken the speed of an automobile to that of his favorite horse, but he would soon find out the inadequacy of his comparison owing to the ability of the machine to maintain a high speed all day, and so he would be reduced to the necessity of speaking in terms of the speedometer. When travel on foot was the general method of locomotion, the Germans expressed distance in terms of time, e.g., two hours, ten hours; now that trains and automobiles have made travel more varied, they express it in kilometers. The next town may still be four hours away to the villager, but the distance to Berlin is 300 kilometers. Examples might be multiplied ad infinitum to show that geographical environments merely gave figures of speech to describe activity or express ideas, but did not influence mental life any further. The hell of the Eskimo may be a place of dark- ness, storm, and intense cold, that of the Jew one of HEALTH AND WORLD-PROGRESS 149 eternal fire; in both cases the description of the future place of punishment is borrowed from local conditions; but the idea of punishment both present and future is independent of them, and will arise simultaneously in the tropics and in the artics because it is an expression of social needs. In proportion as numerous and varied activi- ties create more individual and social needs, they have to be expressed in terms of language, and naturally enough in words and similes of the environment, because men- tality is insufficiently developed in lower civilizations to coin a new general or specific term. Activity depends, however, on health, and only the direction it takes will be somewhat influenced by the environment. The South Sea islander will naturally be a seafarer, because that is the only way he can find an outlet for his energy; the Kirghis w r ill be a hunter or a shepherd, because that occu- pation alone is open to him to make a living. But whether Samoan or Samoyede, a sick man wants to be disturbed as little as possible, and hence develops only the language of the sickroom moans and groans ; neither the broad- ness of the sea nor the beauty of the mountains can stir his preoccupied mind to invent anything else, unless it be maledictions, at least while still an unsophisticated heaitien. l^/This inadequacy of accounting for man's mentality by geographic factors may be seen better by Miss Semple's reference to " The great man in history " where she mentions Daniel Boone, " that picturesque figure leading the van of the westward movement over the Allegheny Mountains, who was born of his frontier environment and found a multitude of his kind in that region of back- woods farms to follow him into the wilderness." 01 Not a word here about the intense vitality of this man who, notwithstanding all his hardships and privations, lived to 150 HEALTH AND SOCIAL PROGRESS the age of eighty-five years; nor any word about those who owing to poor vitality had to lag behind, but who were just as certainly the result of their " frontier en- vironment " as Boone. The men who left New England villages for the Middle West and the Far West had been just as much exposed to the geographic environment of New England as had those who stayed behind; they had been brought up under the same climatic conditions. Yet, there was a difference between the two. Wherein does it consist? The difference is one in health. The pioneers of every kind have almost always enjoyed good health, and they sought an outlet for their abounding vitality in new fields and under difficult conditions, be- cause they felt confident that they could master any circumstances. This confidence is always bred by fine, abounding health, as anyone may witness for himself if he compares his own hesitancy and timidity in times of indigestion or general low vitality with his courage and determination when he is well and strong. (Ill and IV.) The economic and social effects, and ef- fects upon movements of peoples owing to geographic environment, mentioned by Miss Semple, do not call for special comment, since the purpose of our remarks was not to prove those theories to be untrue, but rather to be inadequate and vague. That natural barriers, like moun- tains and the sea, affect the economic systems of peoples, is undoubtedly true ; but that they are the determining in- fluence, is just as undoubtedly false. If some islands are barren and support a scant population, others equally barren, e.g., Malta and the rocks of Tyre and Sidon, may support a compact and teeming population whose influ- ence may be felt all along the Mediterranean and down the ages of history to the present time. If mountains are an obstacle to travel for a primitive people, this is so HEALTH AND WORLD-PROGRESS 151 only for those of low vitality ; since from the mountains have come the conquerors of the world from immemorial times, at least as far as history records them. Rivers and other favorable conditions may help, but do not de- termine the migrations of peoples. Those of low vitality stay home no matter how favorable circumstances may be ; no river will tempt them to leave, and every hilltop becomes a Himalaya. Peschel refers to the influence of physical environ- ment upon man's religion. This is exercised through the terrors of nature, influence of food and of the desert. He points to the fact that the founders of the great mono- theistic religions of the world, Zoroaster, Moses, Buddha, Christ, and Mohammed, belong to the sub-tropical zone. This zone is one which contains marry vast deserts. " Every traveler who has crossed the deserts of Arabia and Asia Minor speaks enthusiastically of their beauties ; all praise their atmosphere and brightness, and tell of a feeling of invigoration and a perceptible increase of in- tellectual elasticity ; hence between the arched heavens and the unbounded expanse of plain, a monotheistic frame of mind necessarily steals upon the children of the desert." ** On the other hand, " Buckle believes that the sublime and terrible aspects of nature in India, exerting their depressing influence upon the minds of the inhabitants for many centuries, have been a considerable factor in the development of all that is inconsistent and supersti- tious in the Hindoo culture. The threatening aspects of the external world have filled the minds of the people with images of the grand and the terrible which they have striven to reproduce in the dogmas of their theology, in the character of their gods, and even in the forms of their temples. The ancient literature of India shows evidence 152 HEALTH AND SOCIAL PROGRESS of the most remarkable ascendancy of the imagination. Most of their works on grammar, on law, on medicine, on geography, on mathematics, and on metaphysics are in the form of poetry. There is an excessive reverence for antiquity." 93 He believes that man is affected by four classes of physical agents climate, food, soil, and the general aspect of nature. The dryness and brightness of the atmosphere of the deserts mentioned, the consequent comparative freedom from disease germs, and the resulting feeling of invigo- ration and perceptible increase of intellectual elasticity, are likely to have more to do with a monotheistic con- ception than the arched heavens and the unbounded ex- panse of plain. Else, why did peoples in other plains, such as the prairies, steppes, and pampas, not develop monotheistic conceptions? And why did sea-faring na- tions, like the Phoenicians and the Greeks who had a more broadly arched heaven and a wider expanse to deal with, develop the polytheistic systems of religion with the greatest diversity of gods? The possible ob- jection that the Greeks had a variegated landscape to live in, does not hold, since that objection could be raised against Zoroaster, and all the other founders of mono- theistic religions, because all of them were living in countries where plains and mountains changed the land- scape. Of Moses we are told, moreover, that he was fond of mountains, since he " saw God on Mount Sinai " and received the Ten Commandments there ; and before he died he " went up from the plains of Moab unto the mountain of Nebo, to the top of Pisgah," evidently be- cause the much broader expanse from a high elevation with the varied scenery of all the land of Judah unto the utmost sea, seemed to him more like the dwelling place of Jehovah than the hot, sandy, and dusty plain. Neither HEALTH AND WORLD-PROGRESS 153 was Jesus averse to mountains, since He preached His first sermon there, was transfigured there, and captured there. The fact that both lived in the desert for a while as did Elijah who by the way " went to Horeb, the Mount of God " and others, like Mohammed, need dis- turb no one, since such a short time would not suffice to turn polytheists into monotheists, unless Peschel is will- ing to concede miraculous powers to the " arched heavens and the unbounded expanse of plain " in some particular parts of the globe. Concerning Buckle's statement about the mind of the Hindoo, it may be more profitable to refer to the humble mosquito and the hookworm, as the causes of malaria and uncinariasis, respectively, than to the " sublime and terrible aspects of nature in India." In a country where between 60 and 80 per cent of the people are infected with anchylostomiasis and perhaps an equal number with malaria the blood thus never being normal the imagi- nation is apt to become rather lively and unrestrained, so that the following tale may not appear incredible to the average Hindoo. An eminent man " lived in a pure and virtuous age, and his days were indeed long in the land, since when he was made king he was a million years old ; he then reigned six million three hundred thousand years ; having done which, he resigned his em- pire, and lingered on for one hundred thousand years more." 94 This man was the first king, anchorite, and saint. But even common mortals lived on an average 80,000 to 100,000 years. We found that the jibaro of Porto Rico is equally superstitious and unrestrained in his imagination, and that voodooism may be on the same level as the jugger- naut or sacrifice of children to crocodiles, for in such countries life is made almost unendurable owing to en- 154 HEALTH AND SOCIAL PROGRESS demic diseases and occasional epidemics, so that relief from such a condition would be welcomed at any price. Buddha, born in the Himalayan piedmont where ano- pheles and uncinaria flourish, and fighting the lassitude induced not so much by heat and humidity, against both of which there is protection through shade and rest, but by endemic diseases against which there is no protection except quinine and thymol, may well have pictured his heaven as Nirvana, the cessation of all activity and in- dividual life. For low vitality produces aversion to activ- ity and begets veneration for the past, since all progress has to be bought with the outlay of energy which must be abundant if new ventures are to be entered upon. Diseases of the kind discussed are more important as a cause of low vitality and enervation than heat, as is proved by the fact that the sufferers from hookworm in Tennessee and the neighboring States with their mild and salubrious climate are undergoing the same process of degeneration as the Hindoos, although in the one case the trouble was formerly laid to the heat, in the other to laziness and shiftlessness. We know now that this disease is one of the principal causes of decadence. " Is it ' laziness ' or disease that is this very day attracting the attention of the United States to the descendant of the pure-blooded English stock in the Southern Appalachian Range, in the mountains of Carolina and Tennessee, the section of our country where the greatest predominance of ' pure American blood ' occurs, despised by the negro who calls him ' po ' white trash ' ? " 95 If results of this kind are found in a temperate climate, in States which are fast filling up with health resorts, and among a stalwart population which left England less than 300 years ago, one can easily figure out what they must be where this disease usually connected with HEALTH AND WORLD-PROGRESS 155 malaria and most likely with other forms of sickness has been exerting its noxious influence upon untold gen- erations under less favorable climatic and civilizing con- ditions. While it would be wrong to exclude the heat of India as a factor in the mental and physical degeneracy of the Hindoos, it can certainly no longer be looked upon as the principal cause when similar results are noticed on a superior people under really favorable climatic conditions. There has been a strong tendency to lay the blame for all the shortcomings of white men in the tropics and sub-tropics upon the heat, instead of looking for exact causes. Among the latter we find social and moral causes as well as those of climate. It has not been taken into consideration that many a supposedly moral man is kept from wrong-doing in his old home by all the props which civilization, family history, association with better men, and the whole social system, provide. When this man is sent to a people on a lower plain of civilization, perhaps in a position of authority with all the tempta- tions implied, and all props removed, the inevitable result is the revelation of his true nature. He will commit deeds for which at home he lacked power and opportunity ; but we sympathetically lay the blame on the climate, especi- ally in the tropics. When a Sicilian, well-behaved at home, turns " black hander " in New York, the climate is not blamed, since we lay the cause to poor moral training at home, poor police service, or economic con- ditions. Only when the Italian tries to make an honest living by hard work but fails to do so and goes insane, is the climate of New York or New Jersey held responsi- ble ; whereas we ought to look for the cause in his poor physical and mental condition, which makes it impossible for him to cope with a new and complex social environ- 156 HEALTH AND SOCIAL PROGRESS ment. In the past Providence was looked upon as the ultimate cause of our failings ; now we are inclined to make climate the scapegoat. That is neither fair nor scientific. We should look for individual causes. Lord Clive gathered treasures for himself in India, Lord v Kitchener did not; many men have given the general low moral tone in African communities as an excuse -''< for their failings ; Livingstone, fever-stricken and gaunt """from exhaustion, but still in possession of a good Scotch constitution and conscience, maintained a high moral standard. If we try to blame the climate, definiteness of statement is necessary ; but that is generally lacking, and a vague term is used to cover a multitude of sins. We know that in the case of disease certain forms of physical and, inferentially at least, mental derangements take place; repeated, as in the case of endemic diseases, in hundreds of generations they must produce at least -grave enfeeblement of body and mind. [Would it not ? be better to blame diseases, local or general in the tropics, rather than climate? / Two books by Ellsworth Huntington have appeared recently, which have a special claim for more extensive remarks in this connection.* While Buckle and Peschel never adduce any but the most general arguments in sup- port of their theses about the influence of geographical and climatical conditions, Dr. Huntington is, at least in the first part of his book, very specific. It may be best to have the author speak for himself. He says, (pp. 9 and 10) : " The hypothesis, briefly stated, is this : Today a cer- * Civilisation and Climate, by Ellsworth Huntington, Ph.D., Yale University Press, 1915; also World Power and Evolu- tion, ibid., 1919. References are to the first work only, since the second contains no new principle. HEALTH AND WORLD-PROGRESS 157 tain peculiar type of climate prevails wherever civiliza- tion is high. In the past the same type seems to have prevailed wherever a great civilization arose. Therefore, such a climate seems to be a necessary condition of great progress. Hfis not the cause of civilization, for that lies infinitely deeper. Nor is it the only, or the most im- portant condition. It is merely one_of jseveral, Just as an abundant supply of pure water is one of the .primary conditions of health. Good water will not make people healthy, nor will a favorable climate cause a stupid and degenerate race to rise to a high level. Nevertheless, if the water is bad, people cannot retain their health and strength, and similarly when the climate becomes unfit, no race can apparently retain it's energy and progressive- ness. This does not mean that we are hopelessly at the mercy of the changes of climate which any century may bring forth. On the contrary, if our diagnosis is correct, we may at last hope to be free from the withering blight which has overtaken every race from which the stimulus of a good climate has been removed. Here, again, the case is like that of a water supply. Suppose that a com- munity had for generations been subject to repeated visitations of a dread disease which decimated the popu- lation. Suppose that it should be discovered that the disease arose from the drinking water. Finally, let the community learn that the water is infested with the bac- teria which cause typhoid fever. If no other water sup- ply were available, would there be reason for despair? The disease would be no worse than before, and there would be hope of finding some way of protecting the water from contamination. So it is with climate. For ages the world appears to have been suffering because one of the many conditions of progress has changed re- v peatedly from century to century. The disease has been 158 HEALTH AND SOCIAL PROGRESS clear enough, and we have devised many helpful ways of treating the patients, although none has as yet proved highly satisfactory. This does not mean that the treat- ment has been wrong, or that we cannot ultimately suc- ceed. It merely means that the neglect of one particular phase of the matter has prevented the other helpful measures from producing their full effect. If nature does not provide the stimulus which seems so effective elsewhere, man must himself provide it." The case for endemic diseases as the cause of the retardation of civilization could not have been stated more clearly than by Dr. Huntington. We have dis- covered the " bacteria which cause typhoid," malaria, and hookworm disease, and have made formerly unhealthy regions inhabitable by man, and intolerable climates en- durable. The uncertain factor of " climate " has been brought down to something specific, and has been con- quered, and will be subjected to an ever greater degree of control in proportion as we let generalities go and search for details. That is the whole thesis of this book. Man has progressed in exact proportion as he has made himself independent of certain factors in his environ- ment. Disease is one of these, and the most important. For not even Dr. Huntington claims that we shall be able to change the heat of the tropics or the cold of the arctics. He admits (p. 285) that the climatic hypothesis seems depressing, because to the dweller in less favored regions the death knell seems to have sounded for any progress, while to the inhabitant of present centers of great activity a most disquieting vision of possible retro- gression is disclosed. He proceeds, however, to dispel these fears. In our factories we may introduce changes in tempera- ture to imitate those of nature where she does not provide HEALTH AND WORLD-PROGRESS 159 them. Work ought to be regulated according to the " seasonal curve of energy," and machines should be made to run slowly in winter, faster in the spring, less fast in summer, very fast in the autumn. We should each one of us go to Florida or Southern California in the winter; the Russian peasants might be transported to Mesopotamia for a sojourn between October and May to help the Turk till his fields, and in the tropics houses might be cooled just as we heat our houses in winter, or people might have one house in the lowlands and an- other in the uplands, varying their residence between the two seasonally or even weekly. The thought of the ex- pense does not deter the author in the least, since the farmers in the tropics will be two or three times as pro- ductive as European peasants are at present (pages 289- 293). This may be possible some time ; at least, we may hope so. But how about the disease germs? Are they going to disappear with these changes in residence and in varia- tion of the temperature? Or are tropical diseases likely to affect a larger number of people than now? There is only one thing to do to make the tropics healthy by eliminating the diseases as far as possible. Wherever modern methods have been applied the three most preva- lent and pernicious of them have been conquered yellow fever, malaria, and uncinariasis. It has been done in places as far apart as Ismailia, and Stephansort, New Guinea ; Port Said and the Federated Malay States ; Khartoum and Italy ; Greece and Panama ; Cairo and Porto Rico ; Hong Kong and Sierra Leone. There is no need to wait ; we have the means, and we shall soon have more. The testimony of physicians of the reputa- tion of Major General William C. Gorgas and Sir Ronald Ross cannot be gainsaid. One of the worst 160 HEALTH AND SOCIAL PROGRESS regions on the whole globe has always been the West Coast of Africa. Ross reports * that statistics covering the period 1881 to 1897 showed a death rate of 75.8 p~r 1,000 among the European officials on the Gold Coast, and 53.6 for Lagos. In 1911 it was 13.9 for the whole of the British West African Colonies ; and the invaliding rate was only 25.2 per 1,000. No one will claim that changes in temperature are not beneficial, nor that too protracted heat or cold are not injurious; and Dr. Huntington is evidently right in call- ing our attention to them. But if it is in our power to improve health in the tropics now, why wait for that golden day when the dwellers in Mesopotamia will be glad to entertain ten or fifteen millions of Russian peasants during the winter in order to give them a neces- sary change of air? Healthy men make their own ar- rangements ; it is the sick who need to be told what to do. It is only fair to state that Dr. Huntington puts forth his hypothesis with hesitation, and freely admits that other factors have been important as promoters of civili- zation. The theory itself concerns us only indirectly. . Ut is briefly as follows: Climate temperature, humidity, and storminess either promotes or retards health. If there is a proper temperature " mental optimum of 38 degrees F. and physical optimum of 60 or possibly 65 degrees F." (p. 129) with a certain amount of humidity suitable to different localities, and a fair amount of storminess to insure sufficient daily and seasonal changes, we have an ideal climate. Variations from this desidera- tum are possible, but not too far in either direction, if the best, or even good, results are to be obtained. On the basis of these three features the author constructs a * Health Preservation in West Africa, by J. Charles Ryan, With preface by Sir Ronald Ross, London, 1914, HEALTH AND WORLD-PROGRESS 161 map of human energy with different degrees of intensity, (p. 142). The "very high" areas cover the British Isles, Germany, France, Austria, the Baltic provinces, Denmark, Southern Sweden and Norway, Northern and Central Italy, and the larger part of the United States. These areas are surrounded by others of " high " in- tensity, to which are added a few isolated regions, e.g., Japan, New Zealand, Patagonia, Tasmania, and some smaller ones. The " medium " areas include most of Asia, the southern coast of Australia, Mexico, the larger part of Canada, the southern part of South America, the northern part of Africa, the eastern and southern coast of Africa, and a few other smaller areas. The " low " areas include the northern and southern parts of Asia, the larger part of Australia, the northern part of Canada, and the islands of the Indian Archipelago. The " very low " areas take in most of South America and Africa, and a few other small regions. He claims that only in the " very high " areas does a high civilization exist at present, because only there are climatic conditions favorable. Perhaps no exception can be taken as to the actual present conditions. His infer- ence is that similarly favorable conditions must have ex- isted in the past wherever a high civilization arose, and in order to prove its correctness, he has originated a theory called " pulsations of climate," covering from one to several centuries each. He admits it to be only an hypothesis, not accepted as yet by meteorologists for historic times, at least. Yet he proceeds to apply it to history. Whether there were changes of climate in prehistoric times does not concern us here, because we are interested only in historic man. Of the Neanderthal man we know nothing except that he lived and that his intelligence was comparatively low* Our civilization has 162 HEALTH AND SOCIAL PROGRESS not benefited from him in the least. It may be best to take up some of Dr. Huntington's historical illustra- tions. Mesopotamia, (p. 257 ff.) the author claims, had a high civilization, and was invaded successively by various peoples, each of whom became civilized. According to ,his hypothesis they owed this power at least in part to the favorably stimulating climate. But how can that be? It these peoples were living in a healthier climate, had better food and houses, and more advanced means of offense and defense, and were generally stronger and more intelligent owing to their higher civilization how could another people, inferior in all these respects, permanently conquer them? And how, in turn, after acquiring all the advantages of their subjects, could they be reduced to the condition of slaves or vassals by an- other inferior people ? It would be a unique phenomenon in the annals of history, since according to hypothesis the climate did not change from around 3000 B.C. to ap- proximately 500 B.C. the period in which we have these successive invasions. Nowhere in history do we find an analogous case. The Huns, the Mongols, and the Avars invaded Europe, but they were thrust back after a short occupation of parts of it, and perhaps few of them remained in the conquered territories. The Moors, it is true, occupied Spain for approximately 600 years. It is, however, a question whether their energy and civili- zation were inferior to those enjoyed by the various tribes inhabiting Spain during that period. Everywhere we find that a physically healthy and mentally capable people succeeds in subjugating a disease-ridden, although per- haps more civilized, nation. Mesopotamia was no ex- ception to the rule. There, as elsewhere, the people from the mountains and highlands, after having acquired strong HEALTH AND WORLD-PROGRESS 163 vitality in comparatively disease-free regions, swooped down upon the cities and villages in the germ-laden plains, and easily subjected the inhabitants. An efflorescence of a higher mental and civilizational life was inevitable in a healthy and gifted but undeveloped people under the stimulus of contact with a higher civilization, and a life of leisure based on slavery. The subsequent infection and low vitality in the course of time was just as in- evitable. No theory of a change of climate is necessary to account for the civilization of Mesopotamia or Egypt, which has been similarly ruled by outsiders in historic times. Another interesting illustration of the hypothesis of Dr. Huntington is that of the civilization of the Mayas in Yucatan (p. 239 ff.). These remarkable people at- tained many achievements of high degree in a tropical country. How is it to be explained ? Only by a " climatic change such that the dry conditions which prevail a / little farther north prevailed in the Maya region when these people attained eminence " (p. 242). In the drier parts of Yucatan where some of the ruins of the Mayas are located, there lives even today a fairly prosperous agricultural people ; fevers prevail, but are comparatively mild. The Guatemalan highlands with fairly favorable conditions are only a hundred miles away. Does this not suggest a solution which is almost world-wide in applica- tion the migrations from the highlands to the low- lands by a strong and energetic people ? What happened in Mesopotamia and Egypt would naturally happen here, too, and successive invasions would account for the dif- ferent periods in Maya history. Dr. Huntington admits that the civilizations of Peru, Southern Arabia, Rhodesia, Ceylon, Java, and Indo-China cannot be explained on the basis of a shifting of climatic 164 HEALTH AND SOCIAL PROGRESS zones, and admits that those of Ceylon and Indo-China may be due to migrations from higher latitudes. The strongest objection to his theory, Dr. Huntington states himself (p. 276 if.). The North American Indians lived mostly in the very high or high energy area, and yet never passed beyond the lower stages of semi-civiliza- tion. He frankly admits the insolubility of this particu- lar case, and falls back on the absence of other factors contributory to civilization chiefly the lack of iron and of great men with inventive ability. This is a candid acknowledgment of the failure of his own theory. Other peoples started out with a similar lack of both, and were climatically less favorably situ- ated, e.g., the Incas and Aztecs, who were, moreover, of the same racial stock. The only explanation is that which we have found to apply elsewhere. Most of these Indians lived in the belt which includes both malaria and unci- nariasis. If these diseases can work so much havoc today in the Appalachian Mountains among a formerly sturdy people, the inference suggests itself that the aborigines must have suffered more. The most highly developed tribes were the Five Nations who suffered from malaria only; just how severely no one can tell. They were, moreover, handicapped in another way. As will be shown later, local civilizations can never rise very high, because the contacts between individuals are too few and too similar to stimulate the mind by divergent sugges- tions. In other words, the areas that are comparatively free from endemic diseases must be fairly large, or must permit intercourse with many nations by the use of the sea. The Five Nations were an inland people, and while they occupied a very much larger area than the Greeks, they were shut off from contact with other nations. The prevalence of malaria not only kept vitality low, but HEALTH AND WORLD-PROGRESS 165 prevented an increase of population to a point of density where contacts might be fairly varied and numerous even among themselves. Contact with the sea is no longer necessary in a world-wide civilization, because we have the railroads and other means of communication. Hence this handicap has been removed, and the hinterlands of continents have already been developed, and are likely to see a higher civilization in the future. The idea of geographers that, just because plateaus are removed from the sea, they are incapable of sustaining a fairly high civilization, has already been corrected by our artificial means of communication. In the past they were isolated ; now they are brought into contact with the rest of the world.* One point more must be mentioned. Dr. Huntington testifies (p. 39) to the ravages of malaria on mind and body in torrid countries, and claims that tropical diseases will always prevail there, owing to the prohibitive ex- * It is risky to be a prophet, and it is difficult to foretell what will happen in the plateaus and other areas removed from the sea. In America we have succeeded in overcoming the natural handicaps of isolation. Similar success is likely to be attained elsewhere, e.g., in the plateaus of China and in the plains of Siberia. Huntington (p. 145) puts the blame of the backward- ness of Siberia on climate, yet admits (p. 201) that the isolation and newness of the country has much to do with it. Professor E. A. Ross in a report of a six months' trip through Russia and Siberia claims that social factors are responsible for the mental inertness of Russian exiles. They have no stimulating intercourse, no large libraries, and above all no incentive for action and exertion owing to their more or less strict confine- ment. They have no opportunity to study facts at first hand, and rotate around the adolescent formula? which they took with them (" Studies in Social Progress," June 1918). Other regions now densely populated and highly civilized were once similarly looked upon as given over to barbarism. Oesar and Tacitus certainly never imagined what civilization there would be in Gaul, England, and Germany in the twentieth century. Human factors are not omnipotent, but they are powerful agencies for overcoming natural handicaps, and are becoming increasingly more so every day. 166 HEALTH AND SOCIAL PROGRESS pense of extirpating them. This point will be taken up in detail in chapters 12 and 14. In his latest work he admits malaria to have been a factor in the decadence of ancient Rome and in modern Turkey, as explained in the Note to chapter 7. 4. The anthropological attempts to explain progress are based (a) on the weight of the brain, (b) on the form of the skull, (c) on other physical characteris- tics. The weight of the brain is no longer considered of fundamental importance, since we find that some men of genius have had smaller brains than the average of their nation. The brain of Helmholtz weighed only 45 ounces, and that of Doellinger only 37.7. While the white race has a generally higher brain weight than the black, the differences among the lowest and highest Europeans are greater than the average between the white and black. After an examination of 2,100 male and 1,034 female adults, there is, according to Karl Pearson, " no evidence that brain weight is sensibly correlated with intellectual ability. Of the five races investigated by the biome- tricians, the English have the smallest brain weight. The mean of the adult Englishman is 27 grams less than the Bavarian mean, 57 grams less than the Hessian mean, 65 grams less than the Swedish mean, and 120 grams less than the Bohemian mean." 96 Other brain specialists and anthropologists concur in this verdict, e.g., Boas in his discussion of " The Mind of Primitive Man," where he quotes (p. 24) another passage from Pearson to the same effect. Donaldson says : " Size, therefore, has a meaning, but it is by no means entitled to dominate the whole interpretation of the central system." 97 There is no need of carrying the argument further, since the burden of proof rests on those who a priori regard an HEALTH AND WORLD-PROGRESS 167 association of brain weight and high intelligence in- separable. The form of the skull is considered still less funda- mental, since the same head form is found among the most backward and the most advanced peoples. The cephalic index of the Bushmen is 75.9, that of the Swedes of the central provinces is 76.0, both being sub-dolichoce- phalic; both the natives of New Ireland and the Dutch of the province of Groeningen have a cephalic index of 81.0 on the living subject. Similar comparisons might be multiplied indefinitely, but would only prove the un- tenability of the theory more fully. Other measurements have likewise yielded unsatisfactory results. " I think all the investigations that have been made up to the present time compel us to assume that the characteristics of the osseous, muscular, visceral, or circulatory system, have practically no direct relation to the mental ability of man." 98 5. Major Woodruff's theory of the actinic rays is an attempt to explain the progress of civilization on the basis of a high type of man developed in the Baltic provinces. In regard to the various attempts to explain high men- tality on anthropological grounds he says : " It should be remarked in passing that there is absolutely no rela- tion between complexion or skull shape and intelligence. We have wonderfully high types of man of every con- ceivable complexion and every head form. It is only where we take huge numbers and compare types that we find the average of the blond type of white men to be so much more intelligent than all others as to have been the ruling element in Europe since historic times, and even long before/' " He advocates a theory propounded by Schmaedel at Munich in 1895. The theory main- tains that there is a definite relation between the distribu- 168 HEALTH AND SOCIAL PROGRESS tion of light and color of man and animals. If we dis- tinguish in the sun's rays those of heat, light, and actinic power, we find that coloration is intended to protect the organism against the dangerous short rays, also called actinic and ultra-violet, because these have the power to destroy protoplasm and to obstruct metabolism. The coloring is, consequently, in proportion to the amount of light dark, brown, brunette, blond; and he claims that the human races are distributed according to this principle the dark races living in the tropics where the sun rays are direct and burning; the brown in the sub-tropics where they are pretty direct, and in the arctics where light is strong by reflection; brunette in the lower lati- tudes of the temperate zones; and blond in the higher latitudes, provided there is sufficient protection from the light by forests, moisture or other agencies. The " evolution of blondness required, then, a cold, dark, northern country probably a cloudy, rainy, misty, forest country the exact conditions needed for the evolution of the brain by natural selection and the exact conditions of the countries where we have placed the origin of the Aryan or Teuton. What a strange outcome that these three words should become synonyms Aryan Teuton Blond." 10 The law is de- duced that " the blondness of a European nation is pro- portional to the cloudiness of its country." 101 The Baltic people spread from their original home in different direc- tions and were the originators of all civilizations, e.g., Greek, Roman, even Egyptian and others ; since other races could develop civilizations only to a certain degree, and needed the contact with and guidance of the brainy blonds to rise higher. But in each case they died sooner or later, because they had wandered out of their zoologi- cal zone. HEALTH AND WORLD-PROGRESS 169 This is the briefest possible statement of Major Wood- ruff's theory. In criticism I should like to offer the fol- lowing considerations. In the first place, Woodruff admits the existence of high intelligence among other peoples than blonds, as is evident from his own quotation given above. Teutonism or blondness is, therefore, not responsible for intelligence. In the second place, the severe struggle for existence does not necessarily evolve high brain power, as Woodruff constantly maintains, else this ought to have developed elsewhere under similar conditions. In order to show how emphatic he is on this point, one quotation may be given from his later work on Expansion of Races, " Cold and severe climates are the best for this evolution (of the nervous system), because they cause a more intense struggle for existence, and the survival of the fittest is here the survival of the most active and intelli- gent, just as in the terribly severe glacial times only the most intelligent survived, and there occurred a rapid evolution of brain." 102 That this struggle should have developed a high brain power only in the Baltic area, not elsewhere, is imposing too much upon our credulity, unless we fall back on blondness as an addi- tional reason an argument rejected by himself. In the third place, it would be difficult to prove that this race of men was the only one to develop a high type of civiliza- tion in historic times. How can, for instance, the history of Peru and of Mexico with their Incas and Aztecs be explained on that theory? There was certainly no blond- ness of Teuton origin there. What Major Woodruff's theory really means is this. / The actinic rays are destructive of protoplasm ; hence all organisms living in light countries have to protect them- selves against these rays by graded pigmentation ; but 170 HEALTH AND SOCIAL PROGRESS some of these rays will always penetrate the skin not- withstanding coloration, and a high vitality is, conse- quently, impossible ; the permanent necessity of avoiding the direct or reflected light makes, moreover, continuous work and with it civilization, impossible. Thus stated and it seems to me the only logical interpretation his theory reduces itself to a question of health. Whether the actinic rays have the injurious influence ascribed to them, is, of course, another question ; the evidence pro and con not being sufficient to decide the matter. Major Woodruff's proofs taken from the decadence of blonds in southern climates and in light northern countries like Colorado are susceptible of a different interpretation, as we shall see later; and the experiments carried on in the Philippine Islands are insufficient both as to number of men and length of time, to confirm or to refute the actinic theory. It may be well to quote the conclusion of the commission appointed to investigate this problem. After stating the number of men under observation 500 blond and 500 brunette soldiers with at least 20 months' service, and 568 officers of Philippine Scouts, Constabulary, and Manila police force, with an average of 5.5 years' con- tinuous tropical service the results are stated under five heads : relative amount of sickness, symptomatology and dietetic habits, invalidism to United States, character and behavior, and relative frequency of insolation. " General summary. It is well known that heat and humidity in an experimental chamber, and in the absence of light, can produce symptoms similar to those occur- ring in a milder degree among residents of the tropics. We think it probable that these two factors, combined with infections, nostalgia and monotony, account for most if not all of the injurious effects seen in tropical lands. To explain the conditions met with in the Philippines HEALTH AND WORLD-PROGRESS 171 there seems to be no need for invoking the aid of the actinic rays of the solar spectrum. Protection against these rays by orange-red clothing was found to be of no benefit. It is by no means proved that pigmentation per se is beneficial in the tropics. In our investigation of blonds and brunettes the evidence was conflicting, some facts being in favor of the fair and others in favor of the dark-complexioned men. This is what would be expected if there were actually no difference between the two types as regards their resistance to tropical influences. From a consideration of all the data it appears that blonds are quite as well able as brunettes to withstand the influences of the Philippine climate for a period of two years and probably for a period of five and one-half years. In case of residence beyond the latter period we are not in a position to express an opinion based on ex- tensive personal observation." 103 In his refutation of this criticism Major Woodruff calls attention to the fact that he had advised brown and not orange-red clothing as a protection against actinic rays, dwells on the admitted inadequacy of the experiments particularly as to time, and refers to the invalidism of the commissioners them- selves shortly after having signed the report. 104 The final objection to the actinic theory, or rather to the application which Woodruff makes of his theory, may be stated as follows: If true, then civilizations of the past were always the resultant of the forces of decay and degeneration ; and civilization would always depend on the men from the Baltic region, and could never spread far beyond that region for any length of time. True, he admits that the source of stalwart men from that region will never cease flowing, and civilization is there- fore not in danger of ever disappearing. But what would happen if the climate of the Baltic region should change 172 HEALTH AND SOCIAL PROGRESS as that of Iceland has done within recent years? This may be a groundless fear, but it should nevertheless be taken into consideration. Whether every civilization is the result of decay is an entirely different question, which will be discussed more fully later. Suffice it to say here that Woodruff is fully convinced of that fact. " His- torians are now pretty well agreed that at the period of the greatest literary glory of Greece, 500 B.C., the deca- dence of the Greeks was already evident, and it is even said that it was complete. It is possible for such neurotics to be possessed of great literary, artistic, or military skill, as at the present day, and the decadence of the Greeks was probably the cause of their art. A wonderful con- firmation of this view is afforded by a study of ancient Greek statuary which faithfully copies the stigmata of degeneration found in modern degenerates, just as though their best models from the aristocracy were defective. A famous head of Juno has arrested development of the lower jaw of marked degree and is the head of a dying race. It confirms what we know from all sources, that the climate of Greece, practically in the latitude of Mary- land, required but seven centuries, or thereabouts to destroy its blonds." 105 Since Major Woodruff does not quote any historians to support his claim, it is rather difficult to find out who they are. One historian may be quoted, though, to show that Greek degeneracy began later than 500 B.C. Mahaffy, in speaking of the numerous plots and revolu- tions started by exiled Greeks in their native city-states, ends the discussion with these words : " These scenes of violence play so large a part in our Greek histories that you will wonder how any such people could be a model to others in methods of politics, and it is for that reason that I think it necessary to notice the matter. When HEALTH AND WORLD-PROGRESS 173 we look below the surface we shall find that there were elements of order never eradicated, and that the crimes of the leaders of society did not infect the common sense, or destroy the safety of the mass of people, until the general decadence in the days of Polybius and the Roman interference." 108 This happened fully three centuries later, since Polybius was born 204 and died 123 B.C. In regard to the degeneracy of the famous Juno, no date is given, and it is consequently impossible to decide whether it is from the fourth or second century B.C. or even later. The degeneracy of Socrates, Antisthenes, and Diogenes even if real need not be an indication of Greek decadence, since no one would judge Germany of today by Nietzsche, or England by Oscar Wilde. The men who fought at Marathon, Thermopylae, and Salamis were certainly not degenerates, but men of high physical and mental attainments. In a previous chapter, specific and sufficient reasons have been given for the decadence of Greece, even granting now that these men were of the blond Baltic type as Major Woodruff claims. This is, however, not by any means certain, since Ripley is of a different opinion. Speaking of the one hundred or more well-authenticated crania left to us, he says : " The testimony of these ancient Greek crania is perfectly har- monious. All authorities agree that the ancient Hellenes were decidedly long-headed, betraying in this respect their affinity to the Mediterranean race, which we have already traced throughout Southern Europe and Africa. As we shall see, every characteristic in their modern descendants and every analogy with the neighboring populations, lead us to the conclusion that the classical Hellenes were dis- tinctly of the Mediterranean racial type, little different from the Phoenicians, the Romans, or the Iberians." m One more statement should be made before proceeding 174 HEALTH AND SOCIAL PROGRESS to our own theory. The effects of heat and humidity, if coincident, are disastrous ; one without the other not nearly so. As illustrations we may cite the dry heat of some deserts where, notwithstanding a high temperature, people are healthy, e.g., some parts of the Sahara and of Arabia; while the west coast of Ireland, the lake re- gions of England, and the northwestern coast of the United States are likewise healthy, although they are rather wet. It is excessive heat, together with great humidity, that forms a most deadly combination for people not acclimated to it, as the mortality on the west coast of Africa proves. This mortality is generally ascribed to climate, or more particularly to the combina- tion of heat and humidity. But it seems that a different interpretation is possible. If heat without humidity is not necessarily injurious, nor humidity without heat, the combination is deadly because it is only in such a medium that certain disease germs can live. Neither the para- sites of malaria nor those of uncinariasis can live without both heat and moisture; hence people living in places where either of these features is absent, are healthy and strong, other conditions being equal. It is, therefore, not so much the combination that seems to be disastrous to man, as the fact that it provides the necessary conditions for the growth of these parasites ; and if man can protect himself against them as he is now able to do the pros- pects of even these most deadly regions becoming in- habitable to people from higher latitudes, seem at le. cit., p. 286 ff. 278 HEALTH AND SOCIAL PROGRESS campaign had to be carried on in order to show that the work was imperatively necessary for the health and wel- fare of the people. As soon as the results proved the importance of the work done, legislatures became more deeply interested and appropriated money more liberally for the purpose of improving sanitary conditions. The appropriations increased from $255,395 in 1910 to $1,416,111 in 1918. This made possible the treatment of an ever larger number of hookworm and malaria victims, but what is more significant is the reduction in the cost of treatment per patient. In 1910, for hookworm patients, it was $4.66; in 1911, $1.05; in 1912, $0.72, and has since that time been kept low. A striking illustration of the effect of practically rid- ding a community of malaria is furnished by the report of the International Health Board for 1918. The town of Hamburg, Arkansas, has a population of 1,285. In 1916 there were 2,312 physicians' calls for malaria; in 1917, after the Board had been working for one year, there were 259 ; in 1918, only 59. The reduction from 1916 to 1918 was 97.4 per cent. The per capita cost was reduced from $1.45 in 1917 to $0.44 in 1918. The demonstra- tion of the feasibility and economic value was so com- plete that Hamburg took over the entire cost of the work at the end of 1917, having paid only 33 per cent of the expenses in 1916 after an educational campaign had con- vinced the people of the necessity of the work. At $2.00 per physician's call this community paid in 1916 alone $4,624 a sum several times larger than it paid in the two following years to get rid of malaria and the mos- quito as a pest. This case is only one out of many in various parts of the South ; everywhere a comparatively small outlay made under the direction of experts was RESULTS AND PROSPECTS 279 sufficient to practically exterminate malaria by controlling the breeding-places.* " The examinations for hookworm disease made among United States soldiers confirmed in a striking way the board's experi- ence of the last few years, and demonstrated that even light hookworm infections are of great importance," says the report. " Judged by the Binet- Simon and other tests, many full-grown soldiers who harbored comparatively few hookworms had the mentality of persons only 12 years of age. The mentality of 10,000 white men at Camp Travis who harbored the disease was about 33 per cent below normal. Negroes were infected quite as frequently as whites, but they appeared to be relatively immune to the serious effects of the disease and did not show the same predisposition to other diseases or the same reduction in mentality. ' Mental tests of a similar nature among 340 school children in Queensland, Australia, showed that there was an average retardation of approximately two years among heavily infected children. The longer the infection persisted the greater was the retardation. The average retardation of lightly infected cases was nine months. " In Siam, the weights of ninety-nine highly infected soldiers were taken upon their entrance to the army, and again at the expiration of a year. Meanwhile, sixty-nine of these soldiers were treated for hookworm disease, and the other thirty re- mained without treatment. Those who were treated gained an average of 10.6 pounds in a period of one year; those who were not, an average of only i.i pounds. " In Costa Rica sixty-six laborers before being treated for hookworm disease normally cultivated 563 acres of coffee monthly. After being treated for hookworm disease they culti- vated 750 acres, resulting in a net monthly increase in wages of 27 per cent, after allowing for a 15 per cent reduction in unit pay. Moreover, in India, Clayton Lane reports that the amount of work increased 20 per cent on one estate and 50 per cent on another, and on both was of better quality than before * Some interesting results of hookworm disease and its cure are reported by the International Health Board in the " Fifth Annual Report, The Rockefeller Foundation," 1918, pp. 31-33. 280 HEALTH AND SOCIAL PROGRESS the laborers were treated; while reports from British Guiana indicate that the efficiency of the laborers employed by one company increased from 25 to 50 per cent after hookworm measures were put into operation." FOREIGN COUNTRIES In Brazil, the Federal and six State governments made approximately $750,000 available for hookworm con- trol alone in 1918. In India, the percentage of infection among the rural population often ranges from 80 to 100. In the province of Bengal alone 30,000,000 of the 45,000,000 population are infected. From this country the infection is carried to many parts of the world by coolies and travelers. The government has at last recognized the economic im- portance of the disease and has entered into an arrange- ment of cooperation with the International Health Board for carrying out a demonstration in control measures in the province of Madras. In Ceylon many communities and plantations are now engaged in stamping out the disease, and are paying more attention to sanitation and hygiene. Other countries in which work is done for the elimina- tion of hookworm disease are: Siam, China, Java (with an average infection of 93 per cent), Guam, Jamaica, and practically all of the other parts of the West Indies, all of the Central American States, the Fiji Islands, the Seychelles, and Papua. In 1917, Jamaica ap- propriated $12,000 and Papua $5,000 for this pur- pose. It is most fortunate that the International Health Board has taken up the eradication of malaria in connection with that of hookworm, since in most tropical and sub-tropical countries and further north, the two diseases go hand in RESULTS AND PROSPECTS 281 hand, infesting the same persons either simultaneously or successively. OTHER DISEASES The practical elimination of yellow fever, except in a few breeding-places, needs only to be mentioned. Ty- phoid fever is likewise nearly extinct where control is complete ; e.g., in the United States army and navy. For less controlled populations, the results are at least en- couraging. Virginia reduced its morbidity rate from this disease from 14,400 in 1909 to 5,038 in 1917. Among the poor people represented by the Industrial Department of the Metropolitan Life Insurance Com- pany, the death rate from tuberculosis was reduced from 203.0 in 1911 to 172.8 in 1916 per 100,000. Wherever scientific study has been applied to diseases, a diminution of mortality and morbidity rates has re- sulted, irrespective whether it is done in the forest jungles of Brazil or in the steel mills of Pittsburg. The United States Steel Corporation spends vast sums of money on welfare work, chiefly for the improvement of health. The Illinois Steel Corporation finds it economically profitable to spend $1,000,000 a year in the protection of its work- ingmen against disease and accidents. The Metropolitan Insurance Company voted $100,000 to the National Tuberculosis Society a few years ago to establish a " health town " and the result is reported by American Medicine for November, 1919, as follows: " When level-headed insurance directors spend such a large sum of their company's money, they naturally ex- pect it to bear interest, however indirectly it may be. Framingham, Mass., was chosen for the experiment. The leading spirits of the town, level-headed business men, saw a good opportunity for investing the town's money, 282 HEALTH AND SOCIAL PROGRESS and raised the per capita expenditure for public health from 39 cents to $1.00. The purpose of this ex- periment was to show that in many cases sickness and death, particularly tuberculosis, can be eliminated by medical treatment and careful nursing, personal hygiene and adequate health administration. The experiment proved an unqualified success. In 1916 before the ex- periment was begun, 81 babies per 1,000 died; dur- ing the first year of the experiment this was promptly reduced to 61 per 1,000. Previous to the inauguration of health conditions in this town of 16,000 souls, 121 persons died in one year from tuberculosis. In the first year of the test this was reduced to 99 deaths, in the second year to 79, in the third year to 76 and this reduc- tion occurred while the town increased in population. At the end of three years the town leaders were well satisfied that their investment of 61 cents excess tax for health was an exceedingly profitable one. The directors of the insurance company felt that their $100,000 experiment was beginning to pay them better than if it had been sunk in first mortgages. Health towns, it was discov- ered, paid. The health of babies and adults was actually an " asset," which could be measured in dollars and cents. We beg the indulgence of legislators for our carelessness in overlooking these facts and for sentimentally regard- ing the health of babies and adults merely from a humane point of view." Much more needs to be done. If private corporations find such large expenditures for health profitable, the country as a whole will do so, too; indeed, the world as a whole will. For, the world as a whole is concerned in this matter, not excepting our own country. While this treatise has been concerned chiefly with two endemic diseases prevalent in southern latitudes there is no special RESULTS AND PROSPECTS 283 reason why we should be in an exultant mood. Our country received a rude shock when we learned in 1917 that out of about 1,300,000 volunteers for the army and navy only 448,859 were physically qualified, the rejections being 66 per cent. Some of these were later drafted; but even if 50 per cent of our young men should be found physically unfit for military service, the percentage would be uncomfortably high. These figures were later reduced, as will be shown. It was, perhaps, this revelation which started several new movements for improving the health of mankind, chiefly that of the Red Cross. PROSPECTS The International Health Board is planning to extend its activities during 1919. In addition to its work against yellow fever, hookworm, and malaria, the Board will in- clude tuberculosis in France, for all of which an appro- priation of $2,367,130 has been made. Medical education will receive $3,726,504, part of which will be spent in China, and the Medical School of Johns Hopkins Uni- versity has received an endowment of $10,000,000 from Mr. Rockefeller for the study of prophylactic medicine. Work against hookworm and malaria will be done in twelve Southern States and in twenty-one foreign coun- tries. During the draft of 1917 and 1918 about 3,208,000 men were examined, of whom 521,606 or 16.25 per cent were utterly unfit for any military service whatsoever. A comparison of the age groups of registrants showed that 76.89 per cent of those aged 21 were physically fit, and of the age group between 21-30 only 69.17 per cent were fit. Of such a select group of men as college students are supposed to be, one in every four was physically dis- 284 HEALTH AND SOCIAL PROGRESS qualified for full military duty. The obviously unfit and many others who had dependents were, of course, not examined, and the statement made previously that about 50 per cent of all men of military age may not be able to qualify for full military service, seems to be approxi- mately true, especially since nothing is said about those over thirty years of age. What is more important is the fact that the Federal Government has been forced to face the situation of a large amount of ill health in our country, especially among the men who should be most vigorous. Perhaps millions of men with remediable diseases will be restored to health, and other millions will be kept in good health by the introduction of prophylactic measures and systematic health culture. When the mili- tary strength of a country is at stake, the government usually acts, just as the English Parliament acted after a similar revelation during the Boer War. The Red Cross is inaugurating a world-wide movement for public health. An International Committee of Red Cross Societies was organized in April, 1919, with the foremost specialists of the medical and sanitary pro- fessions of Great Britain, France, Italy, Japan, and the United States, as members. Representatives of other countries will be elected as soon as possible. The plan is to have a central office in Geneva, Switzerland, which is to serve as a clearing house on all matters of health and sanitation. Any new discovery in curative or preventive medicine will be communicated to this office and dissemi- nated from there all over the world. Anything else con- tributory to health will receive the closest attention, since the work is to be prophylactic as far as possi- ble. A vigorous manhood is to be built up by telic methods. The results to be attained are briefly as follows : RESULTS AND PROSPECTS 285 First Owing to the close international relations through commerce and migration, diseases are now spread from some obscure corner of the world to other countries. The work proposed would arouse the peoples of every country to a sense of their obligation to their fellowmen, and there would naturally follow in each country an awakening to the needs within its own borders, and a determination to meet them as far as possible. Second It would throw light on the darkest corners of the earth, and would give to all the world the full benefit of scientific study and experience in the cure and pre- vention of disease. Third It would make possible the immediate coopera- tion on the part of various organizations to render aid when necessary in the case of great disasters. If such an organization had been operative in 1917 it is probable that the influenza epidemic could have been confined to its source in China, that several millions of lives would have been saved, thousands of others would have been spared its weakening effects, and untold misery prevented. Whatever aspect of health is considered, it has an im- portant bearing on social progress. The men of genius who have given to the world the vital ideas which have made civilization possible, were healthy men. Progres- sive nations could live only in regions which permitted at least a fair amount of health. The increasingly greater need for food will compel the nations of the north to make the countries of the south sanitary. The many serious ailments from which society suffers, will be largely alleviated, if not removed, by greater attention 286 HEALTH AND SOCIAL PROGRESS to health. It is within human power to turn our social destiny by more diligent application of scientific dis- coveries already made and others soon to come, into paths of health and happiness. A gift of $50,000,000 was announced January 1, 1920, by Mr. Rockefeller for the scientific extension of work on health all over the world. This will enable mankind to apply the medical discoveries already made more widely, and to pursue the search for health more generally. A new era is thus dawning in which health will be considered one of the most important assets of society. NOTES EXPLANATION: The notes throughout the book are numbered consecutively. The numbers have no reference to pages. 1 Influence of Geographic Environment, by Ellen C. Semple; Henry Holt & Co., New York, 1911, p. 2. 2 The Efficient Life, by Luther H. Gulick, M.D. ; Doubleday, Page & Co., New York, 1007; pp. 177 and 178. 3 Secret of Hegel, by J. Stirling, Vol. II, p. 554- * The Play of Animals, by Karl Groos ; D. Appleton & Co., New York, 1808. 6 Inductive Sociology, by F. H. Giddings, p. 252. 8 The Aristocracy of Health, by Mary Foote Henderson; Harper & Brothers, New York, 1906; p. 6. 7 Inductive Sociology, by F. H. Giddings; pp. 257 and 259. 8 Hereditary Genius. Macmillan & Co., London and New York, 1892; p. 271. 9 See Dr. H. K. Carroll's article in the New York Christian Advocate, January 30, 1913, on "Statistics of the Churches of the United States 1912." 10 Body and Mind, by Henry Maudsley, M.D. ; D. Appleton & Co., New York, 1884; pp. no and in. 11 Growth of the Brain, by Henry Herbert Donaldson ; Chap. III. 12 Maudsley, op, cit., p. 38. 13 Pure Sociology, by L. F. Ward ; pp. 267-272. " Politics, Book I, Chap. VI. 16 Inductive Sociology, p. 252. 16 The Theory of the Leisure Class, by Thorstein Veblen ; The Macmillan Co., New York, 1908; p. 15. 17 Inductive Sociology, pp. 259 and 260. 19 A Practical Study of Malaria, by Wm. H. Deaderick, M.D. ; W. B. Saunders Co., Philadelphia and London, 1909; pp. 17 and 19. 19 Tropical Diseases, by Sir Patrick Manson; Wm. Wood & Co., New York; p. 68. 20 Ibid., p. 70. 21 Ibid., p. 70. 22 Ibid., p. 72. 23 Deaderick, op. cit., p. 237. 24 Ibid., pp. 295-297. 25 Ibid., p. 298. 26 Manson, op. cit., p. 109. 27 Ibid., p. no. 28 Malaria: A Neglected Factor in the History of Greece and Rome, by W. H. S. Jones, M.A. ; "Introduction" by Major R. 287 288 NOTES Ross, F.R.S.; "Concluding Chapter" by G. G. Ellett, M.B.; Macmillan & Bowes, Cambridge, England, 1907 ; p. 7. 29 Manson, op. cit., p. 102. 30 Deaderick, op. cit., pp. 31-33. 81 Deaderick, op. cit., pp. 22 and 23. 82 Influences of Geographic Environment, by Ellen C. Semple; Henry Holt & Co., New York, 1911; pp. no and in. 38 Hereditary Genius, by Francis Galton, F.R.S. ; Macmillan & Co., London and New York, 1892; p. 329. 84 Galton, ibid., p. 331. 85 Jones, Malaria and Greek History, pp. 15 and 16. 36 Major Ross, in Jones, Malaria, p. 4. 37 Handbook of American Indians. Bulletin 30 of Bureau of American Ethnology, Washington, D. C., 1910, Part II, p. 286. 38 Sociological Papers, London, 1904; article "Eugenics: Its Definition, Scope and Aims." 39 Malaria and Greek History, by W. H. S. Jones, M.A., University Press, Manchester, 1909; pp. 12 and 13. 40 Jones, Malaria, p. n. 41 Lectures on Tropical Diseases, by Sir Patrick Manson, M.D. ; W. T. Keener & Co., Chicago, 1905 ; pp. 103 and 104. 42 Ross, in Jones, Malaria, p. 7. 43 Deaderick, op. cit., p. 20. 44 Tropical Diseases, p. i. 46 Report on the Prevention of Malaria in Mauritius, p. 51 ; quoted by Jones in Malaria and Greek History, p. vi. 46 Malaria and Greek History, p. 23. 47 Ibid., p. 27. * 6 Ibid., p. 34, **Ibid., p. 16. 60 Ellett, in Jones, Malaria, pp. 94-95. 61 Malaria and Greek History, p. 85. 82 Ibid., p. 97. 63 Ibid, p. 102. 04 Jones, Malaria, pp. 95 and 96. 65 Deaderick, op. cit., pp. 28 and 29. 66 Malaria and Greek History, p. n. 67 Jones, Malaria, p. 41. 58 Encyclopaedia Britannica, nth ed., Vol. XVI, article Latium. 69 Jones, Malaria, p. 66. "Ibid., p. 85. 61 The Effects of Tropical Light on White Men, by Major Charles E. Woodruff; Rebman Company, New York, 1905; p. 224. 62 Ibid., p. 239. 63 Encyclopaedia Britannica, nth ed., Vol. XVIII, p. 915; article " Mauritius." 64 Malaria and Greek History, p. 48. 65 What Have the Greeks Done for Modern Civilization? by John P. Mahaffy; G. P, Putnam's Son, New York, 1909; p, 309, NOTES 289 66 The Races of Europe, by William Z. Ripley ; D. Appleton & Co., New York, 1899; p. 259. 67 The Effects of Tropical Light on White Men, by Major Charles E. Woodruff; Rebman Company, New York, 1905. 68 The Hookworm Disease, by George Dock, M.D., and Charles C. Bass, M.D.; C. V. Mosby Co., St. Louis, 1910; pp. 19-32. 69 Rockefeller Sanitary Commission for the Eradication of Hookworn Disease; Washington, D. C., 1911; Publication No. 6, pp. 26 and 27. 70 Rockefeller Sanitary Commission, etc., 1911 ; Publication No. 5, p. ii. 71 Dock, Hookworm Disease, p. 183. 72 Hygienic Laboratory, Bulletin No. 10, Washington, D. C., February, 1903, p. 45 ("Prevalence and Geographic Distribu- tion of Hookworm Disease in the U. S.," by Charles Wardell Stiles, M.D.). 73 Uncinariasis (Hookworm Disease) in Porto Rico, by Bailey R. Ash ford, M.D., and Fedro Gutierrez Igaravidez, M.D. Senate Document No. 808, 61. Congress, Washington, 1911; pp. 89 and 90. 7 * Rockefeller Sanitary Commission, etc. Publication No. 6, p. 75- 76 Rockefeller Sanitary Commission, etc. Publication No. 6, p. 7. 76 Rockefeller Sanitary Commission, etc. Publication No. 5, pp. 120 and 121. 77 Rockefeller Commission, etc. Publication No. 5, pp. 113- 126. 78 Dock, op. cit., p. 97. 78 Ashford, op. cit., p. 4. 80 Ashford, op. cit., p. 6. 81 Ash ford, op. cit., p. 7. 82 Ashford, op. cit., p. II. 83 Anemia in Porto Rico, Preliminary Report, 1905, p. 25. 84 Report of the Governor of Porto Rico for 1913; statistics on pages 145 to 152. 85 Annual Report of the Department of Health of the Isthmian Canal Commission for 1906, pp. 4 and 5. 86 Ashford, op. cit., p. 205. 87 History of Philosophy, by Alfred Weber ; Charles Scribner's Sons, New York, 1896; pp. 519 and 520. 88 The Mind of Primitive Man, by Franz Boas ; the Macmillan Company, New York, 1911 ; pp. 16 and 17. 80 Influence of G-eographic Environment on the Basis of Ratsel's System of Anthropo-Geography, by Ellen Churchill Semple; Henry Holt & Co., New York, 1911 ; p. 40. 00 Rockefeller Sanitary Commission, Publication No. 5; "Ex- hibits, Photographs," Figures 2, 7 and 8. 91 Influences of Geographic Environment, etc., p. 42. 82 Oscar Peschel, The Races of Man; Appleton & Co., New 290 NOTES York, 1868; p. 317, pages 308 to 318, discussing "The Zone of the Founders of Religion." 83 Social Evolution, by F. Stuart Chapin ; The Century Co., New York, 1913; pp. 160 and 165. 94 The History of Civilization in England, by H. T. Suckle, Vol. I, Chapter II; London, 1857-1861. 96 Ashford, op. cit., p. 7. 96 Quoted by William Thompson, M.D., in Brain and Per- sonality"; Dodd Mead & Co., New York, 1910; p. 51. 97 The Growth of the Brain, by Henry Herbert Donaldson ; Charles Scribner's Sons, New York, 1897; p. 352. 98 Boas, op. cit., p. 24. 98 The Effects of Tropical Light on White Men, by Major Charles E. Woodruff, M.D. ; Rebman Co., New York and Lon- don, 1905 ; p. 265. 100 Woodruff, op. cit., pp. 153 and 154. Ibid., p. 158. 102 Expansion of Races, by Charles E. Woodruff, M.D.; Reb- man Company, New York, 1909; p. 274. 103 The Military Surgeon, August, 1912, pp. 162 to 166. " The Relative Resistance of Blonds and Brunettes to the Harmful Influences of a Tropical Climate." See also " Tropical Sun- light," by Dr. Paul C. Freer, in Popular Science Monthly, Tune, 1912, Vol. LXXX, No. 6. 10 * New York Medical Journal, October 12 and 19, 1912. 106 The Effects of Tropical Light, etc., p. 236. 106 What Have the Greeks Done for Modern Civilization? by John Pentland Mahaffy; G. P. Putnam's Sons, New York, 1909; p. 185. 107 The Races of Europe, by W. Z. Ripley, pp. 407 and 408. IDS Weather Influences, by Edwin Grant Dexter, Ph. D. ; The Macmillan Company, New York, 1904; p. 75. 109 The Races of Mtin: An Outline of Anthropology and Ethnography, by J. Deniker, Sc.D. ; Charles Scribner's Sons, New York, 1907; p. 145. 110 Encyclopedia Britannica, nth edition, article "Malaria," written by Arthur Shadwell, M.D., and Harriet L. Hennessey, M.D. 111 Semple, op. cit., p. 626. 112 Semple, op. cit., pp. 560 and 561. 113 Malaria, by Graham E. Henson, M.D. ; C. V. Mosby Com- pany, St. Louis, 1913; p. 25. 114 Report on National Vitality, by Irving Fisher ; Washington, Government Printing Office, 1909; p. 16. 115 Municipal Government, by Frank J. Goodnow, Ph.D.; The Century Company, New York, 1909; p. 25. 116 The Challenge of the City, by Josiah Strong ; New York, 1909; p. 18. 117 Report of the Department of Sanitation of the Isthmian Canal Commission for 1912; Washington, 1913; pp. 5, 6 and 7. NOTES 291 118 Encyclopedia Britannica, nth ed., Vol. XVII, pp. 464-5; article " Malaria." 119 Encyclopedia Britannica, nth ed., Vol. XV, p. 13, article " Italy," section " Malaria." 120 The Isthmian Canal, by H. H. Rousseau ; Washington, Government Printing Press, 1910 ; p. 45. 121 The Popular Science Monthly, September, 1913, Vol. LXXXIII, No. 3, p. 298. (This magazine has changed its title to " The Scientific Monthly," and should not be confused with the Popular Science Monthly of to-day.) 122 The Survey, October 5, 1912, Vol. XXIX, No. i, p. 47- 123 Health and Longevity Through Rational Diet, by Dr. Arnold Lorand ; F. A. Davis Company, Philadelphia, Pa., 1913 ; pp. 7 and 8. 124 Lorand, ibid., p. 7. 126 Woodruff, Effects of Tropical Light on White Men, pp. 345 and 346. !6 Woodruff, Expansion of Races, pp. 309 and 310. 127 Expansion of Races, p. 309. 128 Walter H. Page, " The Hookworm and Civilization," in The World's Work, September, 1912. 129 "The Sanitary Awakening of a Nation," Presidential Ad- dress by Charles P. Wertenbaker, United States Public Health Service, The Military Surgeon, November, 1912, pp. 491 and 492. 130 The Insanity of Genius, by J. F. Nisbet; New York, Charles Scribner's Sons, 6th ed., 1912, p. 184. 131 Biographic Clinics, by George M. Gould, M.D. ; F. Blakis- ton's Son & Co., Philadelphia; 3 vol., 1903, 1904 and 1905. 132 Life and Letters, p. 107. IBS Weber, History of Philosophy, p. 435- 134 Kuno Fischer, Hegel, Vol. I, p. 214. IBB Nisbet, op. cit., pp. 271 and 272. 186 The Prolongation of Life, by Elie Metchnikoff ; G. P. Put- nam's Sons, New York, 1908; p. 261. 137 The Man of Genius, by Cesare Lombroso ; Charles Scrib- ner's Sons, New York, 1908; pp. 354-356. iss The Physical Beethoven," in the Popular Science Monthly, March, 1914. i3 The Intellectual and the Physical Life," Popular Science Monthly, July, 1913. 140 Social and Ethical Interpretations in Mental Development, by James Mark Baldwin ; Macmillan Company, New York, 2nd ed., 1899; p. 168. 141 Quoted from The City of the Sun, by Lombroso, op. cit. t p. 288. 142 Rogers, Popular Science Monthly, July, 1913 ; p. 55. 143 Pedagogical Anthropology, by Maria Montessori ; Frederick Stokes Company, New York, 1913 ; p. 469. 144 Lombroso, op. cit., p. 353. INDEX Actinic ray theory of Wood- ruff, 114, 142, 169 Adenoids, 25 Alexandria, culture of, due to healthfulness, 118 Altitude and health, 190 Altruism, 30 Anophelines, carriers of ma- laria, 98 Biology and health better- ment, 9 Brain, development of, 27 Brain weight, 166 Cephalic indexes, 167 Christianity, ideals of, 36 Church attendance, 37 Cities, health, 209; growth, 212 Classical world, effects of ill health upon, in Climate, 44, 154 Crime, explanation of, 50 Deaderick, William H., 83 Diet, in relation to energy, 222 Disease, meaning of, 20 Egypt, endemic diseases ex- plain rule by foreigners, 204 Endemics, 14, 192 Energy, 19; diverted by bodily disorders, 25 Epidemics, 14 Eugenics, 9 Food, 23 ; variety of necessary, 222; zones of production, 276 Freedom, relation of health to, 189 Geophagy (dirt-eating), 176 Genius, origin, 241 ; defined, 242 ; relation to health, 245 ; originality, 256 Golden Rule, the, 35 Greece, malaria probable ex- planation of deterioration of, 8, 100 Health, defined, 15; factors of, 43 Health department, need for national, 239 Health habits of ancient races, Hegelian theory of progress, 143 Heredity and health, 44 Hindoos, superstitions of, 153 Hookworm disease, geographi- cal distribution of, 124; physical effects, 128 ; mental, 129; moral, 130; economic and social, 131 ; on Porto Rican coffee and sugar plantations, 135 ; statistics of mental retardation caused by, 279 ; governmental aid for control of, 280 . Housing, 213 Hygiene, prophylactic work of, 9 Ideals, national, 59 Industry and health, 10 Infant mortality, reduced by municipal health measures, 282 Influenza, 285 Instinct, 46 293 294 INDEX International Health Board, 283 International law, origin of, 55 Internationalism, of science, commerce and politics, 235 Leisure, 53 Light and racial development, 114 Malaria, 83 ; geographical dis- tribution of, 88; types of, 85 ; disseminated by mos- quitos, 91 ; effects of, 122 ; extirpation of, 213 Malnutrition and morality, 51 Mentality and health, 26, 41 Migrations, motives for, 199 Morality and sociality, 30, 39 Mosquitos, carriers of malaria, 91 ; yellow fever, 174 Nature-peoples, 14, 43, 64 Nerves, 20 Nutrition, 26 Objectivity, test of sanity in genius, 257 Pain, explanation of, 20 Parasites, factor in man's struggle for existence, 3 Patent medicines, psychology of, 184 Persecutions, explained on basis of health, 191 Peschel, theory of influence of environment on religion, J 5i Pessimism, in subjective ge- ius, 265 Philanthropy and the church, 39 Physical economy, 23 Pigmentation, protective, 167 Play, 24 Population, world's increase of, 218 Porto Rico, hookworm disease in, 133; malaria in, 137 Progress, five laws of, 77 Progress, theories of, 142; transcendental, 142 ; his- torical or accidental, 144; natural or geographical, 145 ; anthropological, 166 ; actinic ray, 167 ; explained on basis of health, 178; continuity and extension of essential, 193 Prophylaxis vs. cure, 40 Psychology and health better- ment, 9 Ratzel-Semple theory of prog- ress, 145 Red Cross, international health movement, 284 Reed, discoverer of yellow fever mosquito, 174 Religion and physical environ- ment, 151 Religions, ideals of, 33, 36 Revolutions, why frequent in tropics, 186 Rockefeller, John D., gift for extension of health work, 286 Rockefeller Sanitary Commis- sion, 277 Rome, malaria introduced into, 106 Ross, discoveries in malaria, 85 Sanitation, in tropical coun- tries, 213 ; conducted by pri- vate enterprises, 273 Sanity, three tests of, 267 Sciences and health, 8 Sickness, racial, 28 Social nature, the, 75 Sociality, 51 Sociology, concerned with health, 9 Spiritual importance of health, 8 Stegomyia (yellow fever mos- quito), 174 Strain, physical and mental, 243 INDEX Superstitions, origin of, 185 Tropics, health conditions, 124; causes of moral laxity, 154; sanitation, 213; government in, 229 Transcendental theory of progress, 142 Uncinariasis (hookworm dis- ease), I24ff. United Fruit Company, sani- tation conducted by, 273 Utility, test of genius, 257, 263 295 sanity in Vital statistics of modern countries, 206 ; increasing span of life, 237 Vitality, 17; necessary for so- cial action, 29 Work, factor in civilization, 65 Woodruff, actinic ray theory, 167 3 1158 00228 7166 UC SOUTHERN REGIONAL LIBRARY FACjLjn A 001 357 096 5 \ n oi CALIFORNIA AT >S ANGELES LffiRARY