commonly survive, breed, and bear their kind, and the world moves on.

It is hard to say which kind of case makes the surgeon worry more—the semi-alcoholic good fellow or the overfed prediabetic. Here is another group of facts of varying proof and worth that add to the rapidly growing mass of data in the human audit. Science is attacking the problem of human-life management and distinguishing facts from proverb and preachment.

Architecture-Human. - Hitherto all our information has been provided by the record of the seeker at the shrine of health. Now it is time to look at the man himself. First, we look at his body structure, for the structure of a man is both historic and prophetic. So in houses. They show infinite variation. They vary in original plan from Gothic to Renaissance, in height from cottage to skyscraper, in quality of material from granite and steel to paper and paste, in distinction from one of a row of "Buy your own" homes to the product of an architect's carte blanche. In short, they differ as the hovel and the lordly modern hotel. And you may be assured there is a similar wide difference in the living within them, for the internal fittings are akin in quality to the exteriors. So with bodies.

Houses bear signs of past experiences. The exterior is discolored here, the shingles are coming off, the porch is "rickety," one side bulges, a window is broken; or, on the contrary, everything is trim and in good repair with scars of wear well hidden. So again in human frames.

Every day a practical builder is asked: "How long will this building last? What must I do to keep it up! And he can give a good answer, upon which you can place your confidence

and invest your money. His verdict, of course, depends upon how much you wish to spend there is always an "if." The physician looks upon the human structure in the same way and gives the same kind of answer.

There are a host of fascinating dataexplorations in this field. It is a new adaptation of the science of anthropology to the service of the health prophet. For example, here is a shallow Harrison's groove across a manly chest. That did not merely "happen." It was caused by illness in the first two years of life which kept the bones soft, the belly bulging and pushing out the lower ribs, while baby sat like a Buddha. He could not crawl about; he was late in walking, early in talking, and got over his feebleness by dint of cod-liver oil and care, or in spite of soothing syrup. He won, for he is here to-day. But at a cost. Now we know from the Harrison's groove his general class. His genus and species will be determined later.

Add to this one sign eighty to a hundred and sixty more which are commonly to be noted, and a thousand others which can be found by the initiated, and you have a science in itself.

As a part of organized, scientific medicine this is new; as a speculation it is as old as Hippocrates himself. Laycock, Di Giovanni, Kretschmer abroad, Lewellys Barker and George Draper in this country have pushed forward the subject of clinical anthropology toward a field of brilliant usefulness. Draper has found distinct structural differences between those who are susceptible to gastric ulcer on the one hand and gallbladder disease on the other. A most significant sign is the breadth of the angle made by the lower border of the ribs across the abdomen. One with

a narrow subcostal angle, from 24 to 55 degrees, has an 80 per cent chance of being a member of the ulcer group; with an angle of from 55 to 75 degrees he enters the nephritis or hypertension group, while with a subcostal angle of 75 degrees his chance of pernicious anæmia increases. When we see these angles we see tendencies but not certainties, and we know what to look for and what to guard against.

Endocrines. Much if not all of human structure, as we find it, has been due to the potent influences of the endocrine glands. Endocrinology is a medical science still in its awkward adolescence. It deals with the newly discovered functions of the pituitary, thyroid, adrenal, and other glands of internal secretion. Good team-work of these glands during development makes a well-balanced human structure.

Seldom, however, are their various balances even. The glands vary in power and leadership. They influence, if they do not direct, growth and development, and determine the type of adult human structure. Lincoln and Wilson, for example, were typical "pituitaries." Most of our outstanding financiers are similar in type, although we also find thyroid or adrenal types who make tremendous successes in their own thyroid or adrenal fashion. Each type has its weakness, strength, immunities, susceptibilities, as characteristic as its structural appearance.

Endocrinology has implications that run through the destinies of men and nations. It needs (and is getting) exact methods and long-continued research with anthropology, medicine, chemistry, sociology, and education combining to reap the huge rewards that are clearly

ahead.

Taking an old pseudoscience and

squeezing out the wine of truth is one of the most productive and fascinating methods of modern research. Even astrology has a basis of truth in the fact that those who are born in the spring, like the young of beasts and birds, have a whole summer to establish themselves to meet the strains of winter.

The country doctor has his perennial battle with the stork family in the early spring. With the improvement in houses, more recent biologically, other months have their birth survivals born out of seasonal rhythm.

Palm-reading is very old and has scant scientific foundation. Yet a book has been written on "The Hand and Disease," which classifies the hand type according to disease potentialities. Here is a real contribution which articulates with recent studies in constitution. Froelich has clearly shown that the pointed conical fingers with little fat dimples at the knuckles reveal a deficiency in pituitary influence which accompanies a peculiar type of body, a laxity of the joints and muscles and a tendency to asthenia and asthma. It is the opposite of the well-knuckled long fingers of the intellectually and physically vigorous. Cheek-bones, eyebrows, the angle of the jaw, skin color, texture, moisture, and temperature provide data for the prophecy and life-guide of the oncoming medical scientist. To keep from being blown away by the gusty winds of speculation, however, he needs firm footing on the sane, solid earth of standard medical knowledge, though he need not be buried alive therein.

The fascinating prophetic data of structure gathered from the dawn of mankind and reaching into the long future are supplemented by tests of your applicant for longevity as a going physiological concern. We have been con

cerned with the machine; now we wish to test the quality of its operation.

The voices of bodily operation reveal body condition. The heart has a song as varied as speech. It speaks sweet, confident, vigorous regularity, labored weariness, or defective mechanism as clearly as an automobile engine. There are big, booming, strong hearts, quick, fidgety hearts-some stumble, others trip; some are muffled, others are as clear as a flute. The hearts of brothers are often more alike than their noses, but they all tell their story, historical and prophetic. The lungs, also, may slide smoothly, with a rhythmic whisper of serene health, or hoarsely proclaim

their hidden discomforts.

The signs and sounds of present illness are familiar to the physician. The preclinical signs of illness and the varying degrees of health and vigor are more subtle, and new methods are required.

Physiological Assay. One of these is the blood-ptosis test, a readable vital index of physical condition. It tells whether you are well or sick and how sick you really are. It will distinguish between perfect condition and staleness in an athlete, between the beginning and the end of a day's work. It will reveal the descent into sickness and the happy progress of recovery. It has been used by the scientist, the New York State Ventilation Commission, for example, to test the effects of various systems of ventilation on the human body. It is used by athletic trainers in the selection of the personnel of athletic teams, and can give advance evidence of the physical condition of the pugilist. In the argot of science, "it tests the efficiency of the sympathetic control of the blood distribution," the function upon which life itself depends every flying

second of existence. The blood-ptosis test is an example of the new range of physiological tests.

But the most dramatic part of the health audit is the search for the presence or prospect of unnoticed disease.

Heedless Humanity.-The human race is not yet perfect. It exhibits peculiarities in conduct which, when viewed in the pure light of reason, are absurd.

Most of us are like a slightly deaf man walking on a railroad-track. He enjoys the scenery, sunshine, and fresh air. He makes progress over the rather rough going underfoot to which he gives most of his attention. You warn him of the danger of his course. He looks at you with a superior smile and remarks: "I'm all right. I'm getting ahead. I have no pain. Why should I worry? The more trouble you look for, the more you find." Abashed, you slink away. But the rails begin to sing; a train is coming. You shout: "Hey, you fool! Don't you know a train is coming?" He replies with dignity: "Sir! Your news is unwelcome. I have followed this course for some time. I know my own business. There certainly has been no train on the pathway since I have trodden it. You annoy me." And he resumes his perilous path. As the train approaches, it whistles. You try to pull him off the track. Too late! A sickening crunch—! He waited for a pain and he got it.

This happens every day, everywhere. The modern physician is the onlooker. He would shout more loudly and much more effectively if he were not held back by a sense of propriety called "medical ethics." Besides, he is so busy with his regular job of repairing people who have already been damaged by trains of symptoms and disease.

Disease gives forewarning. Chronic

illness grows underground for years before a symptom sprouts. Those who come to the doctor with heart or kidney disease, or high blood pressure, have had the condition for a long time without knowing it. There is no way that he could know that he was on the road to illness. There are no sign-posts, "Twenty miles to Kidney Hollow," "You are entering Cardiac Corners"—at least, none that the traveller himself can see. Preclinical Signs.-Medicine, however, can see signs of oncoming illness. They are called "preclinical signs." The term is a new one and marks the beginning of an era, but only the beginning. Some preclinical signs have been already definitely tabulated; not all are clear. Many are in the probable class, but some are sure signs. The few we know, if applied, would increase the expectancy of men a decade and greatly prolong their capacity for the fight and frolic of life. They apply to every age and a hundred fascinating examples

could be told.

Fathers and Sons.-Here sits John Robinson, aged forty-four. He had his examination two weeks ago and now, a complete convert, brings his two sons, nineteen and twenty-one. John is a model father, except for his arteries. Three factors, at least-constitution, colon, and focal infection—are responsible for his deterioration, of perhaps 60 per cent. We can hold him there, however, probably for years and keep him a provider for his fine family longer than you would think.

Now we have his sons. They look like the father from the outside-tall, rangy, powerful. Their tissues feel, look, and transmit light as their father's. The heart-sounds are nearer alike than their voices. But their arteries are absurdly, pathetically made out of

the same kind of material. The sons' are 40 and 50 per cent hard, the father's 60 per cent. The father's blood pressure is 200, the sons' the "text-book normal," 120-as yet.

There they sit, the man of forty-four, the sons half his age. We see the father's early years in the sons and confirm the constitutional element in the father's blood pressure. The arterial condition has developed for twenty years. We should have liked to have the father in hand twenty years ago, but we have the sons. We see what is going to happen to them, and we see how we are going to prevent it. Or, at least, we know how to try, for who to-day will

claim to soften hard arteries? What time will tell depends upon the success of our research.

We should like to have the records

of one hundred thousand clinical fathers and two hundred thousand preclinical sons. We could guarantee big returns to the human race and to every one of the fathers and sons as well. The study of this is only in its infancy.

At present we know no sure preclinical signs of diabetes before the blood sugar content rises. There are a few most promising claimants for the dishonor-roll, however, which go back several years before the appearance of sugar in the kidney output. This is not the place to talk about them, for every one who would read the list would have a tendency to adopt diabetes as a possibility and worry. And worry is one of

the chief causes of trouble.

Preclinical signs are the aristocrats of medical diagnosis. They are refined, subtle, and, as yet, as difficult to harness as an unbroken thoroughbred colt, but they must and will be harnessed to the medical chariot.

Evident but unnoticed signs of

pres

ent illness, however, are commonplace, though not always of easy observation. It requires only ordinary medical skill to go over the human frame and distinguish the many varieties of illness which, in our dim ignorance, afflict us. Any skilful physician can find and recognize the signs of present illness that pass unnoticed because they do not give pain. It requires only time and painstaking care. This is the field usually covered by the common health examination, at present confined merely to a search for signs of disease. This is important, indeed, but only a part of the prophetic medicine.

A Wise Physician.-For example, here is a man of fifty-four, a prominent physician who decided to have a "health" examination. Yes, he had a complaint, the rather common complaint of being tired and sleepy in the afternoon. He had had thirty years' long labor in his profession, rising to an honored position and competence. He had a soft, neglected body. Despite unfailing regularity, an intestinal stasis was present. He had unknowingly allowed himself to poison his body for many years, and his kidneys were showing the first faint signs of protest. In another few years he would be a "case" he would be a "case" of chronic nephritis-"Bright's disease." This when well established is incurable. It brings a constant struggle against high blood pressure, swelling abdomen and feet, headaches and malaise. "You are a lucky man," he was told. "Now we are ahead of it all. We can manage our margin to your every advantage. Your weariness will disappear. You will feel ten years younger, and your prospect of living long will be quadrupled."

The Human Ostrich.-There are one hundred thousand men in Amer

ica over fifty years of age in similar case. They can be saved if they have a good examination and follow instruc

tions.

Perhaps one-third of these men lack knowledge. They have never heard that a health examination is desirable and necessary. They do not know that it saves lives, it saves lives, although newspapers, health-extension institutions, life-insurance companies, and medical societies have spread the gospel.

Another one-third have been convinced that a health examination is a good thing. It certainly ought to be done, and "some time" they will have one, but they never do.

Many know the values of the health examination, who yet refuse to have one. They belong to the human “ostrich" type. They are brave, rather than courageous. "Where ignorance is bliss, 'tis folly to be wise." "If anything is wrong with me, I prefer not to know it." They hide their small heads in the sands of ignorance their bulky bodies exposed to approaching danger. A hint is not enough; they wait for a kick and they get it.

Of the small remainder who take their health examinations, some will fall into the hands of a busy, hurried physician who has his whole attention on curing disease. He makes a cursory, rapid examination in a crowded office hour, slaps his man on the back and says: "There is absolutely nothing the matter with you. You can get a $100,ooo insurance any day." This may be partly true, but it is wofully misleading.

Some will get a thorough examination and decide that all these precautions are foolishness. They disregard the disagreeable instead of facing it and fighting through.