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L_ 
 
ANTHROPOMETRY 
 
 AND 
 
 PHYSICAL EXAMINATION 
 
 A BOOK 
 
 FOR PRACTICAL USE -IN CONNECTION WITH GYMNASTIC 
 WORK AND PHYSICAL EDUCATION. 
 
 JAY W. SEAVER, M.D., 
 
 Instructor in Gymnastics and Lecturer on Practical Hygiene in Yale University. 
 Lecturer on Anatomy, Physiology and Anthropometry in the Chautauqua 
 School of Physical Education. Ex-Secretary of the American Asso- 
 ciation for the Advancement of Physical Education. Mem- 
 . S ber of the Connecticut State Medical Society, etc. 
 
 NKW HAVEN, CONN. 
 1890 
 
 "^:;::a 
 

 Copyright, i8go, by Jay W. Seaver. 
 
 PRESS OF TUTTLE, MOREHOUSE & TAYLOR, NEW HAVEN, CONN. 
 

 CONTENTS. 
 
 CHAPTER I. 
 
 THE USES OF ANTHROPOMETRY AND THE EXAMINER HIMSELF. 
 
 The need of physical training for the young. — The inductive 
 method. — The scientific basis of gymnastic work. — Anthro- 
 pometry furnishes a standard of physical excellence and 
 shows actual changes in condition. — The therapeutic value 
 of gymnastics. — The standard for the examiner and per- 
 sonal advice. 9-22 
 
 CHAPTER II. 
 
 APPARATUS TO BE USED AND RECORDS TO BE KEPT. 
 
 A list of instruments with illustrations. — Description of new 
 apparatus and simple methods of taking measurements 
 and tests. 23-38 
 
 CHAPTER III. 
 
 WHAT TO MEASURE AND HOW TO MEASURE. 
 
 The technique of measurement. — The rules and list of items re- 
 commended by the Amer. Assoc, for the Adv. of Phys. 
 Ed. — Criticisms and 'suggestions. 39-52 
 
 CHAPTER IV. 
 
 PERSONAL HISTORY AND EXAMINATION OF SPECIAL SENSES. 
 
 The private record. — Family histor3^ — Exercise. — Results. — Ex- 
 amination of the eyes, ears, etc 53-63 
 
6 Contents. 
 
 CHAPTER V. 
 
 EXAMINATION BY INSPECTION. 
 
 Front, side and rear aspects. — Points that the eye must discover. 
 
 — Table. 64-76 
 
 CHAPTER VI. 
 
 EXAMINATION BY PALPATION. 
 
 Methods and results. — Normal movements. — Abnormal condi- 
 tions. — Tumors 77-82 
 
 CHAPTER Vn. 
 
 EXAMINATION BY AUSCULTATION AND PERCUSSION. 
 
 Methods. — Areas. — Normal sounds. — Abnormal sounds. . . 83-98 
 CHAPTER Vni. 
 
 THE SIGNIFICANCE OF CERTAIN PHYSICAL SIGNS. 
 
 Discussion of the anatomy of heart sounds, normal and abnor- 
 mal. — Tables. 98-106 
 
 CHAPTER IX. 
 
 THE PRESCRIPTION OF EXERCISE. 
 
 Methods of getting an idea of a perfect form. — Removal of causes 
 of debility and deformity. — Respiration. — Nervous cases. — 
 Forms of prescription 107-121 
 
 CHAPTER X. 
 
 GRAPHIC ANTHROPOMETRY. 
 
 Tables, charts, etc 122-128 
 
PREFACE. 
 
 The only reason for the appearance of this little book is 
 the desire to meet to some extent the demand that exists 
 for instruction in the great field of physical education, and 
 thus to put a work of the greatest importance on a higher 
 plane. The organization of schools in this country, for 
 the training of teachers to take charge of the physical 
 education of the people, is a recent development. The 
 demand for competent instructors in this department of 
 work has far outstripped the supply and"^ therefore what- 
 ever will prove a help to instruction is to be welcomed, 
 however meagre and unpretentious it may be. 
 
 The only excuse that can be urged for the imperfect and 
 poorly-arranged character of the work is that it has been 
 done in moments between professional cares and college 
 duties. 
 
 I wish to express my thanks to Drs. Hitchcock of 
 Amherst, Kellogg, Hitchcock of Cornell, Anderson, Sar- 
 gent, Savage, and others, for the courtesy they have shown 
 me in permitting the use of material that has been pre- 
 pared by them at great expense of time and labor. 
 
 Jay W. Seaver. 
 New Haven, Conn., 
 i8qo. 
 
CHAPTER I. 
 
 THE USES OF ANTHROPOMETRY AND THE EXAMINER HIMSELF. 
 
 Educational systems are rapidly being broadened by the 
 new standards that have been set by the advance of science 
 or the demands of social organization. At one stage in the 
 history of civilization the great man was the one who over- 
 powered all others by physical strength. Such a man easily 
 gathered around him a retinue of weaker followers, either 
 as subdued competitors or weak dependants who must 
 seek some strong person for protection. This condition of 
 affairs evolved great physical hardihood and endurance but 
 the limitations of development were reached under ignor- 
 ance of physiological laws and the waste caused by impru- 
 dence. Later on the mental activity of the genius gave him 
 a new weapon in competition, and a new force was added 
 to the growth of civilization. This new element was in one 
 respect at least entirely different from the old dominating 
 force, in that it could be shared with others without loss to 
 the original possessor. Any new invention or craft or idea 
 could be taught to others while mere physical strength 
 could only be directly transmitted through hereditary chan- 
 nels. 
 
 It is safe to say that for the last three-quarters of a cen- 
 tury the history of civilization must record rapid physical 
 deterioration among the families who have been most act- 
 ive in evolving new ideas for the refinement of life and the 
 amelioration of its hardships. Close application in each 
 department of mental activity and a consequent neglect of 
 the physical basis for life, which depends on muscular ac- 
 tivity, have drawn heavily on the surplus vitality stored up 
 by many generations of healthy and frugal ancestors ; and 
 
10 The Uses of Anthropometry 
 
 in too many cases we find prominent names drop altogether 
 from town records and public lists. France has already- 
 reached a point in her history as a people when the natural 
 physical increment barely meets the yearly loss of her pop- 
 ulation, and similar tendencies everywhere are calling the 
 attention of thinking people to the startling limitations that 
 stare civilization in the face. 
 
 Medical science has, by the discovery and promulgation 
 of physiological laws and hygienic principles, done much 
 to avert the disaster by eliminating many of the deleterious 
 influences that act with special potency against the weak- 
 ened and delicate. The beneficent influence on humanity 
 has been partly overcome, however, by the rearing of weak- 
 lings whose career would have been short under less intel- 
 ligent care ; but, neglecting this part of the race that is 
 doomed to natural extinction, we find that medical science 
 has done nothing directly to avert the calamity that has 
 menaced civilization from extreme specialization. 
 
 It is but natural that the evil effects of excessive mental 
 stimulation without a suitable physical basis for the sup- 
 port and expression of nervous phenomena should have 
 first been noticed by educators and those with training in 
 some scientific pursuit. Ling of Sweden gave his life to 
 the study of the needs of the body, and established a system 
 of exercises that would do for the body what the routine of 
 study would do for the mind. His exercises were graded 
 from light, free movements up to complicated work with 
 apparatus, thus forming a complete system of physical 
 education that has been prescribed by law in all the schools 
 of Sweden. What Ling did for Sweden Jahn did for Ger- 
 many, establishing a system of societies where the practice 
 of bodily exercises was the principal feature of .the oraniza- 
 tion, the improvement in physical stamina and the patri- 
 otic zeal that resulted was sufficient to drive Napoleon out 
 in 1810, and since that date there have been efforts to make 
 physical training universal in the German Empire, and with 
 satisfactory results. 
 
and the Examiner Himself. ii 
 
 In France the establishment of the Republic was the time 
 when public attention was first aroused to the needs of a 
 physical education that should proceed hand in hand with 
 the school work of the children ; but factional dissension 
 and the reorganization of a government have taken so much 
 of the interest of the people that French educational mat- 
 ters have not kept pace with the progress in other countries. 
 
 In England there has been no great demand for physical 
 training, for the active outdoor sports that engage old and 
 young have taken the place of the rural occupations and 
 hunting that the early Kelt and Saxon followed — except 
 in the larger cities, and there competent observers like 
 Francis Galton, and Dr. Roth and Mrs. Westlake, of the 
 London School Board, insist that some form of physical 
 education must be adopted. 
 
 In America the development of a matchless territory by 
 a population that is heterogeneous, representing all condi- 
 tions of life placed on a common plane, has given free 
 scope to competition. The large return for labor has in- 
 cited to the fullest expenditure of effort. Wealth has 
 grown enormously. The unnatural distribution of indus- 
 tries, caused by legislative interference with supply, has 
 caused an unnatural and unfortunate location of the peo- 
 ple. Twenty years have seen our urban population more 
 than double, while in the older parts of the country the rural 
 population barely holds its own. The rapid development 
 of complicated systems of business in the scramble for 
 sudden wealth has required the outlay of intense energy, 
 and this demand on the vital force of the people has come 
 before they were fully acclimated to the new conditions of 
 the country. The result has been an excess of nervous 
 diseases and premature breaking down of our people. The 
 time when a large majority of our people worked out in 
 the open air has passed, and now the counting-room and 
 the factory shut in the majority during the hours of sun- 
 light. This strain on vitality is beginning to be felt, and 
 a remedy must be sought at once in all the large cities of 
 
12 The Uses of Anthropometry 
 
 the country. In some way, artificial though it be, some 
 increase of vitality must be found. The sturdy strength of 
 our fathers, that was gained by an active life in the open 
 air, cutting forests, cultivating land, traveling on horse- 
 back, in the service of society, sailing ships, and kindred 
 pursuits, must now be gained by exercise obtained in an- 
 other way. 
 
 In response to this feeling of a need of improving the 
 physical side of our lives there has been a widespread move- 
 ment in the cities of our country toward the formation of 
 clubs for exercise. In the larger cities these clubs have 
 provided large and well equipped gymnasiums for the use 
 of members, and in the smaller towns the Young Men's 
 Christian Associations have been the pioneers in this work 
 of improving the physical status of the young. But in each 
 town where a gymnasium was provided by some organiza- 
 tion there has been an appreciation of imperfect, if not of 
 disastrous, results from the lack of intelligent direction and 
 competent instruction. 
 
 A gymnasium has been compared, by some writer, to a 
 drug store — full of good things if intelligently used, but 
 full of evils if taken indiscriminately. The number of men 
 who were fitted to take charge of a gymnasium even ten 
 years ago was exceedingly limited, and these few were 
 mostly Germans who understood German methods and 
 German needs better than they did American. 
 
 The question, then, has been and is. What use of the 
 gymnasium will be best for the individual case ? Does he 
 need a large or small dose ? 
 
 The physician in treating his patient must recognize 
 every sign and symptom, and then, with whatever histori- 
 cal data he can discover to aid his judgment, he prescribes 
 treatment. It must be so in our management of cases in 
 the gymnasium. We must learn what is the physical pe- 
 culiarity and condition of each pupil. A general system of 
 light exercises can be carried out successfully if the instruc- 
 tor is conservative and careful, without a physical examin- 
 
and the Examiner Himself. ij 
 
 ation as the first step ; but, to do the best with the facilities, 
 there must be intelligent discrimination of work, as so few 
 persons have the same physical requirements even if healthy. 
 The director, then, must know what material he would 
 mould and develop, and he must again examine to see if 
 the results of his treatment are satisfactory or such as he 
 expected, and hence the need of a record of the past condi- 
 tion. A statement of a size or strength in black figures is 
 worth a dozen " opinions." For the imperfect the exam- 
 ination will cause a cautionary signal to " go slowly " or 
 " stop " to be hung out before disaster comes and discredit 
 is thrown on the work, or a new method is prescribed that 
 affords relief. 
 
 Science has taught us that in living organisms functional 
 activity must be kept up, or there will be no development. 
 A part or group of organs unused will atrophy and become 
 useless. Heredity soon stamps a deformity, that has been 
 developed in two or three generations, as a type and suc- 
 ceeding generations that do not possess that peculiarity 
 are looked upon almost as new varieties. This is especially 
 true of physical defects that impair the vitality of the pa- 
 rents. Notice the stress laid upon this law by life insur- 
 ance companies where business interests have no bias from 
 sentiment. The excellent health of the applicant is not 
 enough, if there be a record going back two or three gen- 
 erations of degenerative diseases that have proved fatal, or 
 if the constitutional vigor has been so weak as to let the 
 life go out at about forty-five or fifty years of age from any 
 immediate cause. 
 
 The first lesson that we must learn from this truth is, that 
 health can not exist if vital organs are seriously undevel- 
 oped. 
 
 Health is the condition of harmonious adjustment of 
 all the functional activities. For instance ; a normal pulse 
 rate is from 72 to 76 beats per minute, under ordinary con- 
 ditions of rest, but a pulse-rate of 72 after a half-mile run 
 might be considered abnormal and the ground for solici- 
 
i/f. The Uses of Anthropometry 
 
 tude, — for health would demand an increased activity of the 
 heart muscle to supply increased blood currents to the ac- 
 tive muscles, that waste products may be eliminated and 
 restorative elements supplied. But further : An adjust- 
 ment of the pulse rate is not all that is to be required in 
 the case cited; for there must be a corresponding increase 
 of respiration for elimination and oxidation. And so the 
 perfect activity of any organ — even the brain — may be 
 shown to be dependent on the healthy activity of other or- 
 gans, while the converse may be stated as a physiological 
 truth, viz : that the imperfect action of any organ impairs 
 the function of all others to some extent. A healthy 
 muscle is, then, dependent on a healthy stomach, heart and 
 brain no less than on good food, air, etc., while the more 
 refined intellectual processes are also based on a normal 
 condition of the physical organs. A person may accom- 
 plish much and be a dyspeptic, and so, too, may a cripple 
 walk a long distance on crutches. A healthy child, then, 
 is better fitted for study than a puny one, and health should 
 be the first thing sought in our schools that are educating 
 children for the duties of life. For the education of the 
 body we may with profit pursue the same pedagogic sys- 
 tem that gives good results in mental training. The teacher 
 must know something of the existing powers and acquisi- 
 tions of the pupil, in order to give proper instruction. In 
 schools the daily recitation is an examination into the re- 
 sults of study and previous instruction, and the mind of 
 the pupil is directed into new channels of thought. 
 
 The inductive method of progress (from the simple to 
 the complex), should be followed in the physical as well as 
 the mental training of youth. The body, like the mind, 
 should be taught the simple principles of exercise, and then 
 the complex and intricate movements become easy of mas- 
 tery. Then there will be perfect grace of motion, be- 
 cause there will be perfect control of every muscle and 
 also mental assurance or self-confidence. 
 
 To illustrate the command of the body that results from 
 
and the Examiner Himself. 75 
 
 systematic physical training, from simple up to complex 
 motions, varying for each hand: I have recently been told 
 by a physician — an accomplished gymnast — that after prac- 
 tising on complex movements with the hands and fingers 
 for some weeks he thought he would try to discover 
 whether or not it had given him any new control of the 
 parts for entirely new work. He had a fair theoretical 
 knowledge of music, and played the piano, but had never 
 attempted to play on a stringed instrument. He procured 
 a violoncello and a book of instruction that showed him 
 the theory of the keyboard, the strings, etc. He began 
 practice in his spare time and in two weeks could play with 
 such ability as to receive and accept a position to play in 
 public with an orchestra each week. 
 
 I have repeatedly seen boys, so clumsy and awkward 
 that they could not keep step with a squad, while marching 
 the length of the gymnasium — boys so self-conscious and 
 so lacking in self-control that social life was a burden to 
 them — become fairly graceful and easy in movement and 
 carriage after a few months* work in the development of 
 neglected muscles and the quickening of reflex action by 
 nerve exercise and well-balanced activity. 
 
 A clumsy person is, in a certain sense, a sufferer from 
 partial paralysis. There are undeveloped nerve centers 
 or nerve fibres, that, if not quickened into life, will con- 
 tinue to degenerate and in their decay will involve, or, at 
 least, affect other centers. The process may be slow, for 
 the reflex influence of active parts may arrest the degenera- 
 tion to some extent ; but it is not a healthy organism able 
 to resist the encroachments of disease or the strain of pro- 
 longed work and excitement. 
 
 So practical a business man as the Hon. Thomas G. 
 Shearman says : " I do not underrate the value of pure 
 mental training, especially as that is nearly all which I 
 have myself received ; but my very lack of training in 
 physical labor has led me to observe the great value which 
 it has not merely with reference to bodily health and 
 
1 6 .The Uses of Anthropometry 
 
 strength but for the very purpose of enlarging the mental 
 faculties'' * 
 
 The acquisition of new powers over reflex or complica- 
 ted movements is much more rapid in early life than after 
 maturity. The old saying that " It is hard to teach old 
 dogs new tricks " had its origin in this tendency to per- 
 sistency in any habit of body or mind. A system of edu- 
 cation that has in view the symmetrical relations of men- 
 tal and physical qualities, can not ignore the necessity of 
 beginning physical training with the mental. The child 
 should come under the care of an experienced instructor 
 in physical training from the day of entrance to regular 
 school life. A physical examination should be made that 
 should determine the condition of heart, lungs, spine, mus- 
 cles, skin, eyes and ears. Many a case of incipient dis- 
 ease that eventuates in disaster, would be discovered, and 
 put in the care of a physician, if necessary, or a correct 
 regime of diet, sleep, exercise, etc., inaugurated with 
 the aid of the parents, that would counteract the ten- 
 dency to disease or deformity and save the child as a use- 
 ful member of society. 
 
 Many parents have no idea that there is serious defor- 
 mity that menaces health in their children, until a stranger 
 points it out to them. The worst case of varicose veins 
 that I ever saw in a young person was found in making 
 examinations for a large school, when a son of a physician 
 came under my eye. The case was referred to parental 
 care and advice, and what was my surprise to learn that 
 the father was entirely ignorant of his son's condition ! It 
 may not be the province of the State to see that each child 
 has medical care ; but, so long as the State takes a child 
 from home for five hours out of the day, it is bound to see 
 that no physical harm comes to the child in that time ; and, 
 if education is for public policy or utility, the care that will 
 produce the best citizen is the care that is demanded. 
 
 At the time of this examination a few measurements 
 
 * Rept. of 3rd annual meeting of Amer. Econ. Assoc, Philad., i88g. 
 
and the Examiner Himself. ly 
 
 should be made and recorded for the direct advantage of 
 instructor and child and the aid that all such material will 
 give to science. The age, weight, height, height sitting ; 
 girth of head, neck, chest, depressed and inflated, waist 
 and hips, breadth of shoulders, chest, waist and hips, 
 are all important items. There will be only a very small 
 per cent, of children in the primary grades that can not 
 take the general exercises that will be prescribed, but 
 in higher grades the number will increase, and among 
 advanced students may reach as high as five per cent. 
 Now an advantage of keeping a record of measurements 
 will be, that the actual growth under a given system of 
 exercise can be seen and, if the progress is not satisfactory, 
 the cause may be sought or a new system adopted for 
 these cases. The experienced examiner will be aided in 
 forming an opinion of the needs of a case, by seeing the 
 actual measurements and comparing them with an average 
 or standard, while the beginner will rely on them entirely 
 until he gets an ideal or standard of excellence fixed in 
 his own mind. The child will invariably take more inter- 
 est in exercises if he knows what the exercise is for and 
 can see that he needs it ; or will feel increased pride in 
 keeping ahead of the standard, if he once has passed it. 
 
 After the age of puberty the measurements should be 
 more numerous, and should include tests for strength of 
 various parts. This will show any minor defects in time 
 to modify them during the period of growth ; for after 
 this age the boy or girl will have judgment and inter- 
 est enough to carry out any regulations that shall have in 
 view the strength or beauty of their bodies, and a set of 
 measures, or a graphic chart, or both, that will show them 
 where their small records are, will greatly reenforce the 
 directions that may be given them regarding exercise. 
 Again it will help to eradicate from their minds a false 
 standard of beauty and symmetry and give them an intelli- 
 gent basis of judgment of their own shape. It also enables 
 them to see the actual progress that is made under certain 
 
i8 
 
 The Uses of Anthropometry 
 
 exercises and determines the point of physical maturity 
 when further growth stops. 
 
 It will serve as a check to over-development of any part 
 which may be quite as injurious to the health as undevel- 
 opment ; in short, there is no other intelligent and sys- 
 tematic way of undertaking physical training than by 
 finding out first, what is needed, and second, prescribing 
 exercise that shall build up the weak parts. 
 
 The following simple table has been devised and used by 
 Dr. Anderson. Department of Physical Education of the 
 Adelphi Academy, Brooklyn, N. Y. 
 
 PHYSICAL CONDITION OF. 
 
 GRADE. 
 
 Date. 
 
 
 
 
 Lung 
 
 What it 
 
 
 
 
 Age. 
 
 Height. 
 
 Weight 
 
 Capac- 
 ity. 
 
 should 
 be. 
 
 
 
 
 Age 
 
 6. 
 
 7. 
 
 S. 
 
 9. 
 
 10. 
 
 11. 
 
 12. 
 
 IS. 
 
 14:. 
 
 IB. 
 
 
 Height .. 
 
 46.40 
 
 48.90 
 
 50.17 
 
 52.26 
 
 54-43 
 
 56.86 
 
 57-79 
 
 59-92 
 
 62.53 
 
 64-38 
 
 
 Weight.. 
 
 47-55 
 
 56.44 
 
 58.09 
 
 63.86 
 
 71.42 
 
 76.17 
 
 81.81 
 
 95.20 
 
 105.15 
 
 113. 81 
 
 CD 
 1 •< 
 
 Lung 
 Capacity. 
 
 [64 
 
 80 
 
 88 
 
 106 
 
 124 
 
 144 
 
 ISO 
 
 168 
 
 188 
 
 205 
 
 
 Height .- 
 
 46.11 
 
 47-95 
 
 49.82 
 
 52-03 
 
 53-99 
 
 57.06 
 
 59-17 
 
 60.89 
 
 63.38 
 
 63.12 
 
 9 
 
 Weight.. 
 
 46-55 
 
 50.83 
 
 56.37 
 
 62.32 
 
 71-52 
 
 80.81 
 
 90.68 
 
 99.61 
 
 108 99 
 
 112.80 
 
 Lung 
 Capacity 
 
 f- 
 
 40 
 
 48 
 
 65 
 
 80 
 
 106 
 
 125 
 
 136 
 
 15° 
 
 155 
 
 
 [The above figures show the average height, weight, and about the lung capacity of 
 the pupils in a number of the private schools in and near Brooklyn. They are given 
 only for comparison. It cannot be said of them that they indicate just what the aver- 
 ages should be.] 
 
 Parents are earnestly requested to notify the Physician 
 in charge of this department, of Physical Defects, if any, 
 that exist in their children, that he may regulate the exer- 
 cises accordingly. 
 
 Director Physical Education. 
 
and the Examiner Himself. ig 
 
 And now a word in regard to the examiner himself : 
 It is obvious that a medical training is of very great 
 advantage to the person who is to make such physical 
 diagnosis and measurement as shall be strictly scientific 
 and accurate ; but with the thorough knowledge of 
 anatomy and physiology that can be gained in the 
 Normal Schools of Physical Education, and a little prac- 
 tice under the supervision of a physician who can 
 demonstrate abnormal heart and lung sounds, and a 
 great deal of practice on normal sounds, the beginner 
 need not be lacking in confidence or accuracy of work, 
 as he must never be lacking in care. If the examiner 
 has not a medical education, let him always err on the 
 safe side in a doubtful case and require a certificate 
 from a physician before entering on a course of advanced 
 exercise, or athletic work. But first let him study the 
 case, using all the light that can be thrown on it from 
 books and the history that can be obtained. The examiner 
 must be a student, he must learn, he must study, examin- 
 ing not only the client but books, papers, periodicals. 
 Anything bearing on his subject should be studied and 
 questioned, but not criticised until he is sure of some 
 error ; then let him correct the error by showing its inac- 
 curacy of fact or logic. 
 
 Do not take the statement of anybody as infallible. If 
 it clashes with your own idea examine it and decide who 
 is wrong. 
 
 Do not run after everything new and think that the new 
 apparatus will make exercise a pleasure and relieve you 
 of your work, or the new idea will save you the trouble of 
 thinking. 
 
 Do not go through your work in a perfunctory sort of a 
 way, but be enthusiastic and full of interest in those with 
 whom you come into the relationship of advisor and 
 instructor. 
 
 Be earnest, careful and exact, filled with the spirit of 
 hard work, or move on to some less onerous occupation. 
 
20 The Uses of Anthropometry 
 
 Do not try to find some fault with each person who 
 comes under your care, nor continually decry habits that 
 you believe to be bad. If you believe, as I do, that the use 
 of tobacco is injurious to the majority of smokers, do not 
 tell every person, whose breath "gives him away," that 
 he is " killing himself " by smoking, or that he has the 
 " smoker's heart " and must reform at once if he wishes 
 to rob the grave of an early victim ; for in every such case 
 you will be either informed that the smoker has no desire 
 to go into the business of robbing graves or you will be 
 set down as a bigot whose opinion is good for nothing, 
 and whose advice is worth still less. If a person asks you 
 if you think tobacco has hurt him, and you find no indica- 
 tion of injury, be honest enough to tell him so, and your 
 candor will so establish his confidence in you that the sub- 
 sequently expressed opinion, that tobacco has done him no 
 good, will be likely to set him to thinking. At times you 
 are expected to express yourself freely, as when lecturing 
 on any subject, but do not try to pour a lecture into the 
 unwilling ears of everyone who may chance to fall into 
 your hands. You do no good but make yourself ridicu- 
 lous. 
 
 Establish a record for honesty and ability, and your 
 advice will be sought. Integrity is the largest factor in 
 influence. 
 
 Endeavor to find out the actual condition of each organ 
 and do not be too quick to decide on the cause of any 
 abnormality. If the heart action is imperfect and the 
 person uses tobacco remember that there are occasionally 
 "bad" hearts in those who have never "used the weed." 
 A lateral curvature of the spine also may be due to no 
 muscular inefficiency or weakness but may indicate good 
 muscular action, as in case of a shorter leg on one side. 
 
 Do not be boastful and proudly claim to have discov- 
 ered a new " system " or a " natural " system of exercise 
 because you have by a certain method of life acquired a 
 large biceps or general good physique. Your size of arm 
 
and the Examiner Himself. 21 
 
 may have as little relation to any system as your size 
 of hat. Because Dr. Tanner lived forty days without food 
 he did not establish a system of living without food ; and 
 because some " Prof." can live comfortably by breathing 
 only three times a minute it does not follow that he has a 
 " system " all his own ; a turtle can live all winter on one 
 breath. 
 
 Be conservative and at the same time progressive. Ex- 
 amine all that is new, but before you adopt it test it by 
 every standard that you can bring into comparison with it. 
 Remember that you will probably not discover a great 
 number of new truths, nor will you undermine and over- 
 throw many of the commonly accepted theories and doc- 
 trines that have been enunciated in the past. 
 
 Be modest, then, and learn much from others, claiming 
 very little as entirely new and your own. At the same 
 time it is well to remember that this science and art of 
 Physical Education or Training is in its infancy, in this 
 country at least, and there is much work that is experi- 
 mental and tentative. 
 
 Perhaps in no field of scientific research bearing directly 
 on practical medicine is more to be discovered and demon- 
 strated than in kinetic physiology. The influence of 
 exercise on muscle, bone, nerve and connective tissue is 
 not fully understood — in fact we are only working at the 
 alphabet of the science as it will be developed. Much 
 injury to progress has been caused by superficial observa- 
 tion and extravagant claims for " systems " and methods 
 that had produced fair results apparently with a select 
 few and were then loudly proclaimed as a complete scien- 
 tific exposition of the whole subject when they barely 
 rested on a single correct principle or physiological truth. 
 When the enthusiasm of the originator had died out the 
 illumination was found to be meteoric and a general dis- 
 trust was established. 
 
 A quack in a community injures the reputation of every 
 honest practitioner in it. Be content, then, to work a 
 
22 The Uses of Anthropometry ^ etc. 
 
 great deal and claim very little. Have a scientific theory 
 as a basis of your work but be ready to amend it at any 
 time. Study your material and you will find so many 
 facts to be classified and arranged that you will have little 
 time to electrify the world by some universal specific. If 
 you have no material and do no work you will have all 
 the more time to invent some startling method that shall 
 make you rich with the money of fools but leave science 
 the poorer by a filching of her name and reputation. 
 
CHAPTER II. 
 
 THE INSTRUMENTS TO BE USED AND THE RECORDS TO BE 
 
 KEPT. 
 
 For taking the measures of a person several instruments 
 are needed ; but the outfit may be very simple. For sev- 
 eral reasons the record should be taken and kept in the 
 metric system : ist. It is the scientific standard in use in 
 all countries, and is in use in every other department of 
 scientific investigation. 2d. It enables one to be very 
 accurate without trouble, as the unit is very nearly one 
 twenty-fifth of an inch. 3d. There are no fractions to 
 complicate compilation, or computations, or records. 4th. 
 It helps to introduce an improved system of weights and 
 measures into general use, and, as the ordinary person has 
 no idea whether his record in English units is large or 
 small, but only judges by comparison with the standard, 
 he will get as good an idea by the metric system. 
 
 The record book should be made of the best ledger 
 paper and ruled transversely into spaces enough for all 
 the items to be recorded. The perpendicular ruling can 
 be made to divide the space into six columns, for the 
 records when measurements are repeated. This will 
 enable one to see at a glance what the change has been in 
 any item, from time to time. If the space is economized, 
 there will be plenty of room on the two pages that face 
 together to record the measures of three individuals, six 
 times each, and keep such items of history as should appear 
 in such a book. It is advisable for each examiner to keep 
 a private book for containing information of simply a 
 personal nature, and for the guidance of the instructor in 
 prescribing exercise. 
 
 This private record will give him an amount of material 
 
 BH^£ 
 
2^ The Instruments to be used 
 
 for study and comparison, in a few years. The books 
 should be bound in volumes of about 150 leaves, with 
 heavy leather, as they are handled frequently. A second 
 way of keeping the records, that has advantages in com- 
 piling the figures, or tabulating, has been devised by Dr. 
 F. Swain. It consists of a card, with all the items, and 
 room for two records of measurements. These cards are 
 simply filed in alphabetical order and kept for reference. 
 In tabulating results they are sorted over and placed in 
 piles, according to any standard that may be taken — as 
 height, or weight, etc. It is not a desirable form for a 
 permanent record but, as the personal property of the 
 examiner, is preferable to a book. 
 
 In the form of record book devised by Dr. Gulick, for 
 use in Y, M. C. A. work, the historical data are placed at 
 the top third of the page, the remainder being divided into 
 a column for prescription, and several narrow columns for 
 measures. The number of items measured is smaller than 
 the list prescribed by the American Association for the 
 Advancement of Physical Education. 
 
 It would seem that the card system of record could be 
 used profitably in Y. M. C. A. work, as there is no special 
 reason for permanently keeping the data except at some 
 central bureau, where they can be tabulated for scientific 
 purposes. In schools and colleges a permanent record is 
 very important for history and comparison. 
 
 A method of duplicating a record for the benefit of the 
 person measured has lately been suggested by Dr. E. 
 Hitchcock, Jr., in connection with his graphic chart de- 
 scribed later, and consists of a duplicate page to be inserted 
 under the record page with a sheet of carbon paper be- 
 tween. By writing the record with a stiff pen the figures 
 are duplicated on the chart page. This method saves much 
 work in copying, and gives each man his record at once on 
 a sheet together with the record of an average of 15,000 
 college men. This average represents more men of the 
 student class than have ever been tabulated before, and is 
 
and the Records to be kept. 2^ 
 
 therefore the best standard we now have for this class of 
 cases. Another very satisfactory method of recording 
 measures is by the author's anthropometric table bound in 
 book form, and the measures indicated on it by dots and 
 lines ; or the actual record can be written at top or bottom 
 and the graphic indications marked afterward. This gives 
 a person looking over the record for special cases a com- 
 prehensive knowledge ol the special form of the subject at 
 a glance, where the examination of a list of measures even 
 by an expert would be long and unsatisfactory. The pri- 
 vate record should contain a careful record of personal 
 peculiarities that may have a bearing on health and devel- 
 opment. Any history of previous disease or accidental 
 injury, even if recovery seems complete, should be recorded. 
 Advice in regard to exercise and the results of the advice 
 should be noted. This book should be a history of the 
 person's physical welfare while he is under observation, 
 and thus correspond to a physician's case-book. The 
 examiner will learn more from this record than from the 
 book recording size and strength. 
 
 The following instruments are needed : 
 
 1. A set of scales, with high bar for convenience in read- 
 ing. These are made with metric graduation. 
 
 2. A graduated pole, Fig. i, with a slide moving at right 
 angles on it for taking heights. The arm of the slide 
 should not be over las""^. long. The pole may have the 
 metric system marked on one side, and the English on the 
 other, like the one shown in the cut. A very convenient 
 method of taking heights is by using two meter sticks, on 
 one of which is fixed at the end an arm of metal, 2°^". thick 
 and 18'""°. wide and 125'"'". long. A slide bearing a similar 
 arm is made to run closely on the stick. The height is 
 readily taken by holding the ends of the sticks together by 
 the left hand while the right lowers the slide to the top of 
 the head. Care must be taken to have the sticks perpen- 
 dicular. The height sitting and the height of pubes and 
 knee are taken with the one stick, which is much lighter 
 
 3 
 
 BHi 
 
26 
 
 The Instruments to be used 
 
 and more readily handled than the long pole. The meter 
 stick, with slide, can then be used for taking the breadths. 
 
 t^ ^- ---1 T.,;, prs^ 
 
 B. 
 
 Wijj 
 
 G.TIEMANN&CO. gf 
 
 Fiff. 2. 
 
 Fig. I. 
 3. A pair of slide calipers, Fig. 2, for taking breadths. 
 This must have a capacity of 500™"^. 
 
and the Records to be kept. 
 
 27 
 
 4. A tape measure of steel or cotton, Fig. 3. The metal 
 is uncomfortable to the skin, but does not stretch and can 
 be kept clean. A linen tape stretches on being moistened,, 
 and many subjects will sweat so freely as to wet a cloth 
 tape. A painted tape is about as unpleasant to the touch 
 as one of steel, and for the above reasons I always use a 
 steel tape. 
 
 Fig. 4. 
 
 Fig. 5. 
 A little device is made by the Narragansett Machine Co., 
 at the suggestion of Dr. Gulick, for attachment to the end 
 of a tape to indicate the proper tension, so that the pres- 
 sure may be always alike. It is a good device for the 
 
28 The Instruments to be used 
 
 beginner, but useless after practice has given a habit in 
 making the tension. 
 
 5. Calipers for taking depths, Fig. 4, and, in some cases, 
 breadth of chest. These may be of wood or metal and 
 should have large extremities, so that a slight variation in 
 pressure will not vary the record greatly by indenting the 
 flesh. An index should be on the instrument, for reading 
 while in position. 
 
 6. A capacity spirometer, Fig. 5, for recording the 
 amount of air that can be inhaled and then exhaled, or the 
 complemental, tidal, and supplemental air of respiration. 
 
 Hutchinson's wet spirometer is considered the most 
 reliable instrument of the kind. 
 
 7. A stethometer or pressure spirometer is used by some 
 persons, but is utterly worthless as far as information 
 elicited by it is concerned. A person may blow by means 
 of a rubber tube and suitable mouthpiece into an ordinary 
 steam guage that is made for recording low pressures, or 
 an instrument devised by the author may be used. A piece 
 of glass tubing of 5™™. diameter is bent into the form of a 
 right-angled triangle, having one angle of about 35". The 
 side adjacent to this angle should be about 400'°'°. long 
 and should be horizontal when the triangle is fixed against 
 a flat wall for support. A rubber tube with a glass 
 mouthpiece is attached to the short side, and mercury is 
 drawn in to fill the horizontal part. Now, by blowing into 
 the mouthpiece, the mercury is forced up the hypothenuse 
 of the triangle. 
 
 The graduation is easily made by measuring the perpen- 
 dicular line from the base to any point in the hypothenuse, 
 and affixing a scale to the support back of the tube. The 
 pressure will then be indicated in millimeters of mercury 
 column. 
 
 8. A hand dynamometer. Fig. 6, for taking the strength 
 of the flexor muscles of the forearm. 
 
 There are several forms of this instrument, the more 
 common ones being the oval (Fig. 6) and the form with 
 
and the Records to be kept. 
 
 2g 
 
JO The Instruments to be used 
 
 the two sides always parallel — the resistance being two 
 spiral springs. This second form gives all the fingers an 
 equal opportunity to exert their pressure. 
 
 9. Dynamometer for lifting with the back and legs, 
 and taking the strength of the pectorals and retractors 
 of the shoulders, Fig. 7. This instrument may be replaced 
 for the first two tests by a lifting machine with spiral 
 spring resistance, and a graduated index applied from 
 actual tests. The advantage of this latter form is the 
 quick adjustment to the height of the person. 
 
 10. Parallel bars for testing triceps extensor in " Push 
 up." A short pair of bars, about 750™™. long, attached to 
 a frame with suitable braces, and made to move up and 
 down against the wall, in being adjusted to any height 
 desired, can be used for this test and also for the *' Pull 
 up," or test of flexors of the upper arm. Otherwise a 
 horizontal bar, trapeze bar, or pair of swing rings must be 
 used for this last test. 
 
 11. A stethoscope for listening to heart and lung sounds, 
 etc., Fig. 8. Camman's binaural is a suitable instrument. 
 The soft rubber bell (B) is useful at times to secure perfect 
 coaptation to the surface of the chest. It requires some 
 practice to secure all the advantages that a stethoscope can 
 give, as the pressure of the nib in the ear is a distraction 
 of the attention, and any slight movement of the fingers 
 on the instrument causes vibrations that are not understood. 
 If the examiner wishes to hear the valvular sounds of the 
 heart, without the interference of muscular vibration 
 sounds, he can interpose a thin cloth between the bell and 
 skin, but in general the instrument should be placed 
 directly against the surface of the body. 
 
 In addition to the above mentioned instruments the 
 following are useful at times and for special work : 
 
 12. A sphygmograph, or kymograph, for taking pulse 
 tracings, Dudgeon's instrument is perhaps as satisfactory 
 as any. It is small, easily applied, can be carried in the 
 pocket and used in the gymnasium as well as in the 
 
and the Records to be kept. 
 
 31 
 
 office. It can not be applied to all pulsating surfaces. 
 Marey's instrument is used to some extent, but the pneu- 
 matic kymograph is employed in all physiological labora- 
 tories, and does very satisfactory work. 
 
 13. A laryngoscope, rhinoscope, otoscope and tuning 
 fork, for examining the throat, nose and ears. 
 
 14. A Clinical thermometer. 
 
 15. A Pleximeter and percussor. Figs. 9, 10. 
 
 A 16. Microscope of 20"''". focal distance for examining 
 the skin. 
 
 F 9 
 
 Fig. 10. 
 
 17. A case of urinary tests for sugar and albumen. 
 
 18. Test worsteds, glasses, and charts, for examination 
 of eyes for color blindness and errors of refraction. 
 
 These instruments can be obtained of any first-class 
 dealer in surgical instruments and optical goods except 17 
 which can be obtained of Parke, Davis & Co., or other 
 manufacturing chemists and druggists. 
 
 A universal dynamometer has been invented by Dr. J. 
 
J2 Tne Instruments to be used 
 
 H. Kellogg, which deserves more than a mere mention for 
 it is destined to be used in modified form by every person 
 practicing anthropometry, and by many physicians in 
 diagnosis and determination of the actual progress of cer- 
 tain cases. Its use will supply the place of all the dyna- 
 mometers mentioned above, while its cost will be compar- 
 atively small. 
 
 The instrument may be briefly described in the words of 
 Dr. Kellogg, transcribed from a paper published in the 
 Transactions of the Michigan State Medical Society, 1888 : 
 
 " I. A cistern about two-thirds filled with mercury, the 
 remaining space being filled with water. 
 
 " 2. A glass tube of a caliber of about one thirty-second 
 of an inch and six feet in height. 
 
 '^ 3. A rubber bulb connected by a tube with the space 
 above the mercury in the cistern, and both filled with 
 water. 
 
 " 4. A bottle partly filled with water, placed two or three 
 feet above the cistern and connected with the upper part 
 of it by a rubber tube. A pinch cock controls the connec- 
 tion between the bottle and the cistern. The purpose of 
 this arrangement is to keep the upper portion of the 
 cistern filled with water, and to raise the height of the 
 column to any desired point before applying pressure to 
 the bulb when it is desirable to do so. 
 
 " 5. An adjustable, graduated scale erected beside the 
 glass tube and reaching to the level of the mercury in the 
 cistern. 
 
 *' 6. A framework by which the apparatus is sustained. 
 See Fig. 23, page 16. 
 
 " In use compression is made on the rubber bulb by 
 which water is forced into the cistern displacing an equal 
 quantity of mercury which rises in the tube until a height 
 is reached at which the pressure upon the inside of the 
 bulb is equivalent to that upon the outside. 
 
 " By means of simple arrangements for the purpose, the 
 strength of every group of muscles in the body, except the 
 
and the Records to be kept. 
 
 33 
 
 smallest and most inaccessible, can be readily tested by 
 this apparatus." 
 
 The following cuts will illustrate the method of using 
 the apparatus for some of the common tests. 
 
 Fig, II. 
 
 " Fig. 1 1 shows the method of testing the anterior 
 muscles of the leg. It is simply a double lever moving 
 
 Fig. 12. 
 upon an axis in the center, the bulb of the instrument 
 being placed under one end and the toe of the foot under 
 the other end. The test is made by raising the toe. 
 
34- 
 
 The Instruments to be used 
 
 "Fig. 12 shows the method of testing the muscles of the 
 calf. The bulb is placed beneath a bar secured to two 
 uprights, being supported by a flat piece which rests upon 
 the knee. By raising the leg by the toe, the muscles of 
 the calf are brought into action. 
 
 Fig. 13- 
 
 " Fig. 13 shows the method of testing the muscles of the 
 shoulders. 
 
 Fig. 14. 
 
and the Records to be kept. 
 
 35 
 
 " Fig. 14 shows the method of testing the diaphragm. 
 The apparatus used is seen more distinctly in Fig. 15. It 
 consists simply of a belt carrying two rigid plates, one fixed 
 and the other movable, secured together by rubber bands. 
 The screw which passes through the fixed belt works 
 against another movable plate on the inside of the fixed 
 plate, and furnishes a means of fine adjustment. In use 
 the belt is put around the body so that the movable plate 
 falls just below the ribs. After attaching the belt the 
 screw is turned in until the mercury rises in the column to 
 ten centimeters, then the patient takes a deep abdominal 
 breath. The same instrument may be used for testing the 
 strength of the serratus magnus, by placing it at the side 
 instead of the front. 
 
 Fig. 16. 
 
 "Fig. 16 shows the method of testing the pronators and 
 supinators. 
 
 "Fig. 17 shows the method of testing the force with 
 which the hands can be pressed together. 
 
3^ The Instruments to be used 
 
 11 
 
 Fig. 38, 
 UniTersal MercuriaZ I)ynamometer 
 
and the Records to be kept. J7 
 
 ** Fig. 1 8 shows the method of testing the flexor muscles 
 of the arms. The extensors and flexors of the legs are 
 tested by similar means. 
 
 Fig. 17. 
 
 '' A strap is thrown over the shoulders, with the body- 
 bent forward at an angle of 45 degrees for the purpose of 
 testing the strength of the muscles of the back. A similar 
 arrangement attached to the wall is used to test the 
 anterior and lateral muscles of the trunk, also the muscles 
 of the neck. You can readily see how by a simple con- 
 trivance all the principal groups of muscles in the body 
 may be tested. My instrument has a mercurial tube 10 
 feet long. A much shorter tube will answer the purpose 
 by having the top of the tube closed." 
 
 Some modifications of this machine will adapt it to 
 general use. If a closed tube seven or eight feet long be 
 used the top may be doubled on the main part for two 
 feet to save space and make the apparatus more portable. 
 If the calibre of the tube be small there will be no need of 
 the hydraulic pressure from the bottle of water shown in 
 the illustration, Fig. 23. For ordinary tests there will be a 
 record of less than 200 lbs., except for back and legs. To 
 take these heavier tests a system of levers will be required 
 and can be readily arranged. 
 
 One point in the working of this machine that must be 
 
3S 
 
 The Instrume^tts to be tised. 
 
 secured before perfect accuracy will be reached is the con- 
 dition of similar pressure surfaces on the bulb for every 
 
 Fig. i8. 
 
 test. Then the record can be read in a similar unit for 
 each test and will be absolute. This will enable one to 
 compare or tabulate records made on different machines 
 of the same kind, as we now compare weights taken on 
 different scales. The author has devised an arrangement 
 that will apparently meet this requirement for the majority 
 of tests but must have practical experience with the 
 apparatus before announcing a complete machine. Any 
 new device that will enable one to secure accurate tests of 
 strength will assist greatly in practical anthropometry and 
 the prescription of exercise. 
 
CHAPTER III. 
 
 WHAT TO MEASURE AND HOW TO MEASURE. 
 
 In making a physical examination and measurement it 
 is well to have the subject entirely nude, and consequently 
 the temperature of the room must be kept as high as 75°. 
 A good method of procedure is to take the weight and 
 height measurements, then the lengths, then the breadths, 
 then the depths, then the girths, and finally the strength 
 tests. During the measurement the examiner should be 
 alert in noticing any peculiarity or deformity or disease or 
 external indication of disease. The subject may then dress 
 the lower extremities, and the minute examination of the 
 chest be continued. 
 
 When the examination is made for an institution, and is to 
 include the measurement of many men, the services of a 
 clerk will save at least half of the time and leave the exam- 
 iner free from merely clerical work, and enable him to give 
 all his attention to the examination in hand. With such 
 assistance the fifty measurements can easily be made, after a 
 little experience, in five or six minutes, and from fifteen to 
 twenty minutes should be devoted to each individual ; the 
 latter amount if advice in regard to methods and forms of 
 exercise, and instruction concerning diet, bathing, sleep, 
 etc., is to be given at the time of the measurement. To 
 economize time the specially weak or undeveloped parts 
 should be pointed out to the subject himself and the sim- 
 plest exercises for developing those parts be recommended 
 and illustrated if possible. 
 
 A greater advantage will come from exercise if the ob- 
 ject of the exercise is known than if a routine is simply 
 followed without interest. A muscle will undoubtedly 
 
4-0 What to Measure and How to Measure. 
 
 grow faster if watched and made the object of thought dur- 
 ing its activity, and if attention is turned to it during its 
 period of rest. The reason of this is found in the inter- 
 relation of the trophic and voluntary nerves. 
 
 A proof of the influence of volition over trophic changes 
 has lately been made by Prof. A. Lehmann of Copenhagen, 
 who has employed a thermometer capable of showing dif- 
 ferences of .02° F. When Lehmann or the person who 
 aided him in his experiments, concentrated his mind on 
 the idea of an increased temperature of the hand, it rose 
 .036° to 0.108° F. ; but when the attention was concentrated 
 on the idea of a greater warmth of the fingers alone, the 
 temperature of the hand fell 0.756° to 0.936° F. — Hospital- 
 stidende, No. 3, 1890. Copenhage?i. 
 
 The hygienic instruction can be given by lecture to whole 
 classes, and a case needing special care and supervision 
 can be asked to come to your office at some other hour 
 when you will have time to go over the case thoroughly 
 and examine into all the details of his habits, a knowledge 
 of which will alone enable you to give the best advice. 
 
 If you are examining many cases in succession, you will 
 need to possess a quick memory of faces and facts, or some 
 notes will have to be taken at the time of examination, 
 that will recall the existing conditions in each case. It is 
 well to train the memory in this matter, but to take careful 
 notes to fall back upon. A client will feel that you re- 
 member him and have given his case thought, if you can 
 show him that you know just what his condition was when 
 you saw him last. 
 
 The number of items measured is not of so much impor- 
 tance as the thoioughness of the work done, and the care 
 and judgment displayed in discovering weak parts that can 
 be strengthened, and recommending the proper remedies. 
 But I would advise a strict adherence to the advanced stan- 
 dard of measurements recommended by the American As- 
 sociation for the Advancement of Physical Education and 
 for three reasons : ist, to take this complete list would re- 
 
What to Measure and How to Measure. ^i 
 
 quire only about two minutes longer time than for the 
 method of twenty items. 2nd, the completeness of the re- 
 cord will be a satisfaction to all parties. 3rd, uniformity 
 of methods is of great importance in giving scientific value 
 to work of this kind. Then, if a person has a special de- 
 sire to ride some hobby of his own and take such measure- 
 ments as the horizental length, the occipito-mental diame- 
 ter of the head and the length of the os calcis, all of which 
 points are of some importance and have a bearing on 
 anthropology and practical anthropometry, he is at liberty 
 to do so. 
 
 Below is given in full the report of the committee on 
 statistics appointed by the American Association in 1885. 
 
 Report of the Committee on Statistics, appointed by the American 
 
 Association in iSS^, giving the detailed method of securing 
 
 measurements, tests, and the condition of the human body. 
 
 ANTHROPOMETRIC MEASUREMENTS. 
 
 Number. — In order to secure privacy the individual 
 should be entered in the record book by number. As a 
 means of identification the number can be entered in an 
 alphabetical index book opposite the corresponding name, 
 as : 
 
 Smith, John H., 526. 
 
 For further convenience it is advisable to enter the name 
 in a numerical index book opposite the corresponding 
 number, as : 
 
 526, John H. Smith. 
 
 Date. — Record the year, month, day and hour, as : Jan., 
 '86, 12, 9 A.M. Where perfect accuracy is desired, note 
 should be made of the time that has elapsed since eating, 
 the occupation of previous hours, and of the temperature 
 of the room. 
 
 Age. — Record years and months, as : 21, 9, /. e., twenty- 
 one years and nine months. 
 4 
 
^2 What to Measure and How to Measure. 
 
 Weight. — The weight of the body should be taken with- 
 out clothes. Where this is impracticable the weight of the 
 clothes should be deducted. 
 
 Height. — The height should be taken without shoes and 
 with the head uncovered. The head and figure should be 
 held easily erect, and the heels together. This position is 
 best secured by bringing the heels, the buttocks, the spine 
 between the shoulders and the back of the head, in contact 
 with the measuring rod. 
 
 Height of Knee. — The subject should place one foot on 
 a box or chair of such a height that the knee is bent at a 
 right angle. A box about 12 inches high is suitable for 
 adults. Press a ruler upwards with a force of about one 
 pound against the ham string tendons close to the calf of 
 the leg. See that the ruler is held in a position at right 
 angles to the vertical rod, and measure the height of the 
 top of the ruler from the box. 
 
 Height Sitting. — Let the subject sit on a hard, fiat sur- 
 face about 12 inches high, such as afforded by a box or 
 chair, with the head and figure easily erect so that the 
 measuring rod will touch the body at the buttocks, between 
 the shoulders, and at the back of the head. Measure the 
 distance from the box to the vertex. 
 
 Height of Pubes. — With the subject standing easily 
 erect on the box or floor, measure up to the lower edge of 
 the pubic bone. 
 
 Height of Crotch. — With the subject standing easily 
 erect on the box or floor facing the vertical rod, press a 
 ruler firmly against the perineum (crotch) and measure 
 the height of the top of the ruler. 
 
 Height of Navel. — With the figure and head of the 
 subject erect, measure the height of the centre of the 
 cicatrix. 
 
 Height of Sternum. — With the figure and head of the 
 subject erect, measure the height of the interclavicular 
 notch. 
 
 All girths should be made on the skin itself at right 
 
W/ia^ to Measure and How to Measure. 4.J 
 
 angles to the axis of the body or limb at the point of 
 meas'irement. No oblique measurements are taken. 
 
 Girth of Head. — This measurement should be taken 
 around the head with the tape at the upper edge of the eye 
 brows, over the supra orbital and occipital prominences. 
 
 Girth of Neck. — With the head of the subject erect, 
 pass the tape around the neck half way between the head 
 and body, or just below the " Adam's Apple." 
 
 Girth of Chest. — Pass the tape around the chest so 
 that it shall embrace the scapulae and cover the nipple. 
 The arms of the subject should be held in a horizontal 
 position while the tape is being adjusted and then allowed 
 to hang naturally at the sides. Take the girth here before 
 and after inflation. 
 
 Where it is desirable to test the elasticity or extreme 
 mobility of the walls of the chest, a third measurement 
 may be taken after the air has been forced out and the 
 chest contracted to its greatest extent. To test the respira- 
 tory power, independent of muscular development, pass 
 the tape around the body below the pectoral line and the 
 inferior angles of the scapulas, so that the upper edge shall 
 be two inches below the nipples. Take the girth here 
 before and after inflation. 
 
 Girth of Waist. — The waist should be measured at the 
 smallest part after a natural expiration. 
 
 Girth of Hips. — The subject should stand erect with feet 
 together. Pass the tape around the hips above the pubes 
 over the trochanters and the glutei muscles. 
 
 Girth of Thighs. — With the feet of the subject about 
 six inches apart, the muscles set just enough to sustain the 
 equilibrium of the body and the weight distributed equally 
 to each leg, in gluteal fold measure around the thigh just 
 below the nates. 
 
 Girth of Knee. — With the knee of the subject straight 
 and the weight of the body equally supported on both legs, 
 measure over the centre of the patella. 
 
 Girth of Calf. — With the heels down and the weight 
 
^<^ What to Measure and How to Measure. 
 
 of the body supported equally on both feet, the tape should 
 be placed around the largest part of the calf. 
 
 Girth of Instep. — Measure around the instep at right 
 angles with the top of the foot, passing a point at the bot- 
 tom of the foot midway between the end of the great toe 
 and back of the heel. 
 
 Girth of Upper Arm. — With the arm of subject bent 
 hard at elbow, firmly contracting the biceps and held away 
 from the body in a horizontal position, pass the tape 
 around the greatest prominence. If desirable to find the 
 girth of the upper arm when the biceps is not contracted, 
 the arm should be held in a horizontal position and meas- 
 ured around the most prominent part. 
 
 Girth of Elbow. — Taken around the internal condyle 
 of the humerus while the arm of the subject is straight, 
 with the muscles of the forearm relaxed. 
 
 Girth of Forearm. — Taken around the largest part. 
 The fist should be firmly clinched and the palm of the 
 hand turned upward. 
 
 Girth of Wrist. — With the hands of the subject open 
 and the muscles of the forearm relaxed, measure between 
 the styloid process and the hand. 
 
 Breadth of Head. — The breadth of head should be 
 taken at the broadest part. In taking the breadth meas- 
 urements, stand behind the subject. 
 
 Breadth of Neck. — Taken at the narrowest part with the 
 head of the subject erect and the muscles of the neck relaxed. 
 
 Breadth of Shoulders. — With the subject standing in 
 a natural position, elbows at the sides, shoulders neither 
 dropped forward nor braced backward, measure the broad- 
 est part two inches below the acromion processes. 
 
 Breadth of Waist. — Taken at the narrowest part. 
 
 Breadth of Hips. — Measure the widest part over the 
 trochanters, while the subject stands with feet together, 
 the weight resting equally on both legs. 
 
 Breadth of Nipples. — Taken from centre to centre 
 with the chest in a natural position. 
 
What to Measure and How to Measure. ^5 
 
 Depth of Chest, — Taken after a natural inspiration. 
 Place o.ne foot of the calipers on the sternum midway 
 between the nipples, and the other foot on the spine at 
 such a point that the line of measurement is at right 
 angles with the axis of the spinal column. When it is 
 desirable to ascertain the extent of the antero-posterior 
 movement of the chest, measurements may be taken from 
 the same points after the fullest inspiration and after the 
 fullest expiration. 
 
 Depth of Abdomen. — Place one foot of the calipers 
 immediately above the navel, the other on the spine at 
 such a point that the line of measurement is at right 
 angles to the axis of the spinal column. 
 
 Length of Shoulder to Elbow. — With the arm of the 
 subject bent sharply at the elbow and held at the side, 
 measure from the top of the acromion process to the 
 olecranon. Care should be taken that the measuring rod 
 is parallel with the humerus and not with the external 
 surface of the arm. 
 
 Length from Elbow to Finger Tip. — With the arm of 
 the subject bent sharply at the elbow and the rod resting 
 on back of arm and hand, measure from the olecranon 
 process to the tip of the middle finger. 
 
 Length of Foot. — Take the extreme length of foot 
 from the end of the first or second toe to the back of the 
 heel, about one inch from the surface upon which the foot 
 rests. 
 
 Stretch of Arms. — With the arms of subject stretched 
 out horizontally so that both hands and shoulders are in a 
 line, with one middle finger and the zero end of the meas- 
 uring rod pressed against the wall, note the point to which 
 the other middle finger tip reaches. 
 
 Horizontal Length. — With the heels of the subject 
 pressed hard against a perpendicular wall, with arms at 
 the sides and body resting naturally on a horizontal plane, 
 measure the distance of the apex of the head from the 
 wall. 
 
/j-d What to Measure and How to Measure. 
 
 Capacity of Lungs. — The subject after loosening the 
 clothing about the chest and taking a full inspiration, 
 filling the lungs to their utmost capacity, should blow 
 slowly into the spirometer. Two or three trials may be 
 allowed. 
 
 Expiratory Strength. — As before, the subject after 
 loosening the clothing about the chest and filling the 
 lungs completely, should blow with one blast into the 
 manometer. Care should be taken that no air is allowed 
 to escape at the sides of the mouth, and that in expelling 
 the air all the muscles of expiration are brought into play. 
 
 Strength of Back. — The subject, standing upon the 
 iron foot-rest with the dynometer so arranged that when 
 grasping the handles with both hands his body will be 
 inclined forward at an angle of 60°, should take a full 
 breath and, without bending the knees, give one hard lift, 
 mostly with the back. 
 
 Strength of Legs. — The subject while standing on the 
 foot-rest with body and head erect, and chest thrown 
 forward, should sink down, by bending the knees, until 
 the handle grasped rests against the thighs, then taking a 
 full breath, he should lift hard principally with the legs, 
 using the hands to hold the handle in place. 
 
 Strength of Chest. — The subject with his elbows ex- 
 tended at the sides until the forearms are on the same 
 horizontal plane and holding the dynamometer so that the 
 dial will face outward and the indicator point upward, 
 should take a full breath and push vigorously against the 
 handles, allowing the back of the instrument to press on 
 the chest. 
 
 Strength of Upper Arms, Triceps. — The subject, while 
 holding the position of rest upon the parallel bars, sup- 
 porting his weight with arms straight, should let the body 
 down until the chin is level with the bars, and then push 
 it up again until the arms are fully extended. Note the 
 number of times that he can lift himself in this manner. 
 
 Strength of Upper Arms, Biceps. — The subject should 
 
W/ia^ to Measure and How to Measure. ^7 
 
 grasp a horizontal bar or pair of rings and hang with the 
 feet clear from the floor while the arms are extended. 
 Note the number of times that he can haul his body up 
 until his chin touches the bar or ring. 
 
 Strength of Forearms. — The subject, while holding 
 the dynamometer so that the dial is turned inward, should 
 squeeze the spring as hard as possible, first with the right 
 hand then with the left. The strength of the muscles 
 between the shoulders may be tested with the same instru- 
 ment. The subject, while holding the dynamometer on a 
 level with the chest, should grasp it with handles and pull 
 with both arms from the centre outward. 
 
 PiLOsiTY. — Note the amount of hair on the body and 
 limbs, excluding the head, face and pubes. 
 
 Color of Hair. — Light (Very Fair, Fair, Light Brown, 
 Brown), Dark (Dark Brown, Black Brown, Black). Red 
 (Red Brown, Red, Golden). 
 
 Color of Eyes. — Light (Dark Blue, Blue, Light Blue). 
 Dark (Light Brown, Brown, Dark Brown, Black). Mixed 
 
 (Gray, Green). 
 
 D. A. Sargent, \ 
 
 Edw. Hitchcock, >• Committee. 
 
 Wm. G. Anderson, ) 
 
 The following criticisms of this Report, that now stands 
 as the official list of the Association, are presented, and an 
 effort will be made at the next annual meeting to have the 
 list revised, and the changes here suggested incorporated. 
 
 The height of knee should be a bone measurement, and 
 the most convenient point is to top of the fibula, as the 
 subject is sitting, and this record can be taken immediately 
 before or after " height sitting." The present method is 
 very inaccurate and unscientific, because the length will 
 vary from two to five cm., according to the tension of the 
 hamstring muscles, which are not always under the direct 
 control of the will with the leg in the position indicated 
 and can not be relaxed in every case without great care. 
 
/j-S What to Measure and How to Measure. 
 
 The head of the fibula can be easily found in nearly every 
 case, and in those where it can not be located, the head of 
 the tibia can be found, and the head of the fibula is about 
 ten mm. shorter. The " height of crotch " need not be 
 taken, for obvious reasons, when we have " height of 
 pubes." 
 
 Another height-measurement advised by the Y. M. C. A. 
 committee is the length of trunk which is measured from 
 the buttocks to the point of the seventh spinous process, 
 or vertebra prominens, with the subject in the same posi- 
 tion as for taking the height sitting. It is not always easy 
 to decide with certainty which is the seventh spinous pro- 
 cess ; but it is usually the most prominent one, and of 
 several that seem of equal prominence, it is usually the 
 lowest. 
 
 The length of trunk, depth of chest and breadth of chest 
 are three factors, that, multiplied together, may roughly 
 be considered to represent the "vital capacity" of a 
 person. We can get the length of trunk in another way — 
 by subtracting the height of sternum from total height, 
 which will give the length of head and neck ; and, by sub- 
 tracting this remainder from the height sitting we shall 
 have the length of trunk. 
 
 I can discover no adequate reason for taking the hori- 
 zontal length. It consumes considerable time, is a difficult 
 measurement to take correctly, and exceedingly awkward 
 for the subject ; its average relation to the total height is a 
 matter of anatomical record ; and, in the special case it 
 can easily be estimated by any examiner, of even limited 
 experience, by the amount of lordosis and flexibility of 
 the spine. Each person should take a few measurements 
 of subjects with hollow backs, in order to get an idea of 
 the vai'iation in these cases ; but further than this there is 
 no utility in the recording of this item. In taking girth of 
 elbow the object is to discover the development of the 
 tissues that lie between the muscles measured in the arm 
 girth and those in the forearm girth. The muscles of the 
 
What to Measure and How to Measure. /fg 
 
 forearm have their origin on the internal and external 
 condyles, without the intervention of tendon. A measure- 
 ment over the condyles is therefore essentially the same 
 as the forearm girth and will in practice differ from it by 
 only about two centimeters. We would discover the con- 
 dition of the whole arm, and the elbow girth taken over 
 the condyle adds nothing to our information. On the 
 contrary, if we measure around the smallest part of the 
 elbow we know how well the tissues are developed 
 between the muscles of the arm and those of the forearm. 
 It is not a muscle girth in the latter case ; in the former it is. 
 
 The breadth of shoulders should be a bone measurement 
 as nearly as possible ; for I conceive the object of it to be 
 the determination of the extent of the bone tissue to which 
 the more important muscles of the upper extremities and 
 thorax are attached. If we measure below the acromion, 
 as directed, we give a person credit for broad shoulders 
 simply because he has a thick deltoid muscle and the 
 muscles of the chest and arm add to the record, in such 
 cases, by making the arm hang at an angle instead of per- 
 pendicularly, as expected. It would be nearly as scientific 
 to include the arms in the waist breadth, and then let the 
 subject stand with arms akimbo. 
 
 The breadth of chest is of more importance than breadth 
 of nipples and should be taken at full natural inspiration 
 in the axillory regions, on a level with the nipples. For 
 ordinary cases the measurement can be taken with the same 
 instrument as the other breadths ; but in very fat or muscu- 
 lar persons the calipers used in taking depths should be used. 
 
 The expiratory strength, as ordinarily taken, is mislead- 
 ing and untrustworthy. The intention is to gain some 
 knowledge of the condition of the accessory muscles of 
 expiration ; for, in ordinary expiration there is little or no 
 activity of muscles but rather a letting go or suspension 
 of muscular effort. (See Foster. Phys. ed. 1883, p. 315.) 
 Now, when the subject is asked to blow as hard as he can 
 into the apparatus, and keep the throat open, as in respira- 
 
JO What to Measure and How to Measure. 
 
 tion, he will involuntarily close the pharynx with the 
 back of the tongue and palate, and then bring the muscles 
 of the cheeks and lips into active contraction, and, with a 
 few efforts, acquire such skill as to rival the cornet player 
 in the record secured. 
 
 For those who are making a special study of athletes a 
 measurement suggested by Dr. Savage of the Berkeley 
 Lyceum Gym. is worthy of notice, namely ; the length of 
 the OS calcis ; this being the lever arm of the muscles that 
 extend the foot ; its relation to the metatarsal and phalan- 
 geal portion is doubtless of importance in determining the 
 ability for such exercises as running, walking, jumping, etc. 
 
 Some points in minute anthropometry have been sug- 
 gested by various specialists, but obviously such work 
 should be left to those who wish to study some particular 
 phase of the subject. 
 
 Dr. F. Swain has proposed to measure the height of 
 ear, girth of ankles and hands, depth of pelvis, neck and 
 head, length of hands. Mr. R. J. Roberts considers the 
 girth around the shoulders at point of shoulder breadth 
 of great importance. Dr. E. Mosher thinks that depth of 
 chest should be a double measurement, showing thickness 
 of right and left chest ; and the suggestion is a good one, 
 because, in many cases the sternum is depressed and the 
 record, if made strictly by rule, would be smaller than the 
 subject deserves. In such cases I have put one foot of the 
 calipers on the proper point behind, and brought the other 
 out to a point not quite in line with a ruler laid across 
 the chest. Dr. Mosher's method would show any asym- 
 metry of the chest. 
 
 The French police regulations require a minute measure- 
 ment of the ear and middle finger for identification of 
 criminals if they are arrested a second time. These meas- 
 ures help in classifying the photographs that are taken so 
 that they can be readily found among thousands. Some 
 form of anthropometrical tests can no doiibt be made more 
 serviceable in establishing identity in a " rogue's gallery " 
 
What to Measure and How to Measure. 57 
 
 than photography. The physiological picture of a man as 
 shown on a graphic chart is sure to retain some character- 
 istic feature, whatever may be his condition. 
 
 Photography may be wisely used as an adjunct of 
 anthropometry. Since Prof. Muybridge made his won- 
 derful pictures of animal locomotion by instantaneous 
 process the value of a photograph to show physical defi- 
 ciencies as well as excellence has been established. It 
 makes a record in an artistic way that is made by tape and 
 calipers in a mathematical or scientific way. Already at 
 some of the better equipped gymnasiums, like the Hemen- 
 way in Cambridge, photography is made to assist in pre- 
 serving the record of a man's physical condition. 
 
 The strength tests that may be taken are more in number 
 than the muscle girths taken in the above list and a table of 
 strength tests may be made that would correspond to the 
 author's anthropometric table. The quality of the muscles 
 could be graphically shown on this, side by side with the 
 girths. Uniformity of method in testing strength will soon 
 furnish material for such a table. Care must be used to 
 guard against strain and over-exertion in securing data 
 of strength. 
 
 The tests for accuracy and strength may be made by 
 the record in a series of athletic exercises and show some- 
 thing of the nerve training that the subject has had ; — in 
 other words, the self-controlled power. In a person we may 
 test the strength of fifty groups of muscles acting separate- 
 ly so far as possible and, while our record may be high, 
 we may still have a very inadequate estimate of the coordi- 
 nated power — the real strength of the individual, which 
 may be small. Probably the best exhibit of a man's 
 power is seen in such games as foot ball where the 
 strength of every muscle is tested both as to its own 
 quality and its adjustment to other muscular groups and 
 to mental stimuli. 
 
 An organ may work correctly but slowly. The eye of 
 one person sees at a glance what the eye of a second 
 person would require seconds to reveal, and yet the eye 
 
^2 What to Measure and How to Measure. 
 
 of the latter may be perfect according to every test of the 
 oculist. It is so with hearing. The time required between 
 hearing and perceiving sounds and giving a signal is .12 
 to .18 of a second. Higher tones require slightly less 
 time than deeper ones. Noises are heard quickest.* 
 
 A distinguished teacher recently told me that he had 
 called a certain boy stupid until he discovered that the boy 
 was merely slow in his sense of hearing. Since that time 
 he has studied boys whose perceptive faculties seemed 
 dull and has found that a large percentage of them are 
 deficient mainly in hearing a question that is put rapidly 
 to them. A device that will test the speed of the action of 
 the eye and ear correctly within moderate limits of accu- 
 racy will be of great practical importance in an educa- 
 tional as well as scientific aspect. Physical education 
 must bring up to a higher plane of activity each physical 
 function that is found to be deficient. To do this the 
 examiner must be ever alert to discover undeveloped 
 functions and inventive ability will be frequently required 
 to solve the problems presented. 
 
 Another refinement of anthropometry is taking the 
 specific gravity of a man. This may. not be a feasible 
 addition to practical anthropometry but for minute study 
 may afford an interesting field of investigation. The 
 record can be taken by immersing the subject to the face 
 or any suitable point in a reservoir of water that is situat- 
 ed on a scale for weighing. From the weights of the 
 reservoir full of water, the displaced water and the im- 
 mersed subject in the reservoir the specific gravity has 
 been calculated. The fact has been often noted that men 
 of small girths often show a weight far above what would 
 be fairly estimated, but as yet there has been no scientific 
 study of this class of cases to discover the relation of high 
 specific gravity to health, strength, endurance or longevity. 
 The specific gravity of any body is represented by the 
 quotient obtained b)^ dividing the weight of the body in 
 air by the loss of weight when weighed in water. 
 * Kries and Auerbach, quoted by Thompson. 
 
CHAPTER IV. 
 
 PERSONAL HISTORY AND EXAMINATION OF SPECIAL SENSES. 
 
 The historical data that should be gathered at each 
 examination are of varied character, and of the highest 
 importance. It gives the examiner an idea, not only of 
 the immediate weaknesses that are to be met and combated 
 by proper advice and training, but it places the law of 
 heredity in bold relief, and enables the counsel to be far- 
 reaching in its results. 
 
 For instance : with a record of tuberculosis, extending 
 through two or more generations, there would seem to be 
 sufficient warrant for advising not only the thorough devel- 
 opment of the chest, but the careful avoidance of excessive 
 exercise, such as would be required in many athletic sports 
 that would seem, at first thought, especially suitable for a 
 person of consumptive diathesis. To know a man well 
 you must know his father and grandfather. This negative 
 side of training and physical education has received very 
 little attention from practical teachers outside of the so- 
 called Delsarte system, where it has run riot. The con- 
 servation of force is the foundation of the Delsarte system, 
 but only profound ignorance of the physiologic laws of 
 growth and development could excuse the building upon 
 such a principle. 
 
 Growth and organic perfection are gained only by a use 
 of all the tissues — but use is one thing and abuse quite 
 another. The eye is developed and improved by a repeated 
 use in distinguishing colors, shapes and sizes ; but a long- 
 continued strain of the eyes over a Greek or German text 
 is not exactly beneficial, as the spectacle-mounted noses 
 of our students, especially the Germans, bear witness. So, 
 
^/j. Personal History and Examination 
 
 while a good run in the open air may be beneficial to a 
 person of sensitive or weakened lung tissue, it does not 
 follow that training for a mile run or a " hare-and-hounds " 
 chase would be. 
 
 The condition of the subject during the previous years of 
 his life is valuable in making a prognosis or a judgment of 
 the future history of the case, and in deciding what quality 
 of endurance the subject possesses, for the violent exercise 
 of one man is a mere nothing for another. The boy who 
 comes to school from the farm or workshop may be no 
 better developed than his classmate, who has never known 
 what physical v/ork is, and yet be able to endure twice as 
 much prolonged physical exertion. His life has been 
 spent out of doors, and he takes kindly to outdoor sports, 
 running, foot-ball, boating, etc.; or, if his life has been in 
 a shop where skilled manipulation has engaged his energy, 
 he prefers gymnastic exercises, becomes an adept at club 
 swinging, fencing, etc., or a good performer on the bars, 
 rings and other apparatus. 
 
 The city-bred boy has a latent aptitude for anything, and 
 with proper training is a strong competitor with his 
 country classmate in every line of athletics or gymnastics, 
 but his exercise will need to be progressive, or he will 
 suffer from local strains that may affect vital organs. 
 
 If, on the other hand, the history discloses a previous 
 life of activity and physical hardship, and the plan of life 
 is directed toward sedentary pursuits, the recommendation 
 must be toward retrogressive exercise. A man with benign 
 hypertrophy of the heart is not in the best condition for 
 sitting at a desk all day — there will be too much local con- 
 gestion for good brain work, or the metamorphosis of 
 muscular tissue in the heart itself will end in fatty degen- 
 eration, or softening, and impaired vitality result. This is 
 undoubtedly the reason for the numerous cases of func- 
 tional and organic diseases of the heart that are found 
 among ex-champions. 
 
 The history may also disclose a tendency to disease in 
 
of special Senses. 55 
 
 the subject himself, that will modify the prescription of 
 exercise very materially, if the examiner is alive to the 
 exigencies of the case and informed as to its requirements. 
 
 But, without citing further examples of the advantages, 
 nay, necessity of a full history of each case, let us turn to 
 the question of what points in history should be recorded. 
 
 On the record book, in connection with the measures, 
 the subject's name and birthplace should be kept — there is 
 no reason for secrecy about these matters. — It is also well 
 to add the birthplace of parents and grandparents to this 
 general record, for it makes the material valuable in study- 
 ing the effect of location or environment in differentiating 
 classes or social groups ; the occupation of the father, the 
 resemblance in physical build to father's or mother's family; 
 past exercise in work and recreation, pulse rate, color of 
 hair and eyes, vision and hearing, use of tobacco and stim- 
 ulants. In the private book should be recorded the cause 
 of death of either parent if not living, any disease that has 
 been common in the family (it is better not to use the word 
 hereditary in this connection) such as lung diseases, heart 
 diseases, rheumatism, neuroses, Bright's disease, cancer, 
 scrofula, varicose veins, dyspepsia, diarrhoea, constipation, 
 catarrh, etc. ; also any disease that may be found affecting 
 the subject, as varicocele, rheumatism, synovitis, etc., any 
 deformity and its cause, if discoverable ; any injury in the 
 way of broken bones, surgical operations, strains, etc.; any 
 previous severe illness, such as peritonitis, zymotic fevers, 
 etc.; any tendency to deranged functional activity, as con- 
 stipation, biliousness, indigestion, insomnia, etc. 
 
 In this connection it may be well to call attention to the 
 rule that, if a child strongly resembles in physical build 
 the side of the family that has no hereditary taint, the 
 other side having some pathological diathesis or dyscrasia, 
 the probability of his inheriting the disease is diminished. 
 
 It is well to record the special kind of athletic or gym- 
 nastic work that has been taken, and whether this has been 
 under the personal direction of a teacher or trainer. If 
 
^6 Personal History and Examination 
 
 there is any lesion of the heart or other organs that has 
 been due to or been attributed to athletic or gymnastic 
 work under supervision, look up the instructor and get the 
 previous history of the case. You may find that the so- 
 called instructor or trainer was an ex-prize fighter or 
 dilapidated "bummer," but, if so, use him to discredit the 
 popular trust in ignorance. If he does know his business, 
 he will perhaps be able to enlighten you as to the cause of 
 the trouble. 
 
 The record of color-blindness* should be kept, not as a 
 disease, but as a peculiarity that would render the subject 
 unfit for some occupations. In many cases of supposed 
 color-blindness, the sense is probably simply uneducated. 
 Cases of color-blindness among women are very rare (i 
 in 25,000) and are not frequent among men. The eyes 
 should be examined by a specialrst in opthalmology if there 
 is the slightest indication of nerve irritation, and the super- 
 ficial examination, such as is indicated here, shows the 
 slightest error of refraction or muscular insufficiency.! 
 
 Tests of the hearing may be made, and any dullness or 
 difference in the auditory sense of the two ears should lead 
 to an examination with the otoscope. The channel may 
 be partially or completely occluded with wax or the debris 
 from a previous inflammation or an exostosis of the wall 
 of the meatus. If the opening is normal, the tympanum, 
 or drum, will be seen at a depth of about two centimeters 
 as a smooth, shining, semi-transparent membrane of slightly 
 pinkish-gray color. In cases of inflammation the drum 
 becomes decidedly pink. Slightly below and in front of 
 the center is a white spot as though some white body 
 
 * See page 61 for directions for testing special senses. 
 
 f See the New York Medical Journal iox Januarj' 7 and 14, 1888, and 
 the same journal February 27 and March 13, 1886, containing articles 
 by A. L. Ranney, M.D., on The Treatment of Functional Nervous Dis- 
 eases by the Relief of Eye-Strain, etc. Also the Belgian Prize Essay, 
 by Dr. Stevens, of New York, and the Report of the Stevens Commis- 
 sion, published in The Neurological Journal, 1889. 
 
of special Senses. 57 
 
 pressed the drum slightly forward at that point. This is 
 the end of the bone, the malleus, that conveys the vibra- 
 tions back to the internal ear. In most cases a gray streak 
 can be seen extending upward and forward, which is the 
 body of the bone. Sometimes the drum will appear bulg- 
 ing and convex, from the pressure of serum within, and 
 the vibrations of the drum are prevented, with resulting 
 deafness. Again the drum may appear cupped or concave 
 from the stoppage of the eustachian tube and the subse- 
 quent absorption of air in the middle ear, so that the drum 
 is pushed in by the atmospheric pressure. This is by far 
 the more common condition and only impairment of hear- 
 ing results until the case is of long standing, when com- 
 plete deafness may ensue. Openings in the drum are of 
 frequent occurrence as the result of inflammatory exuda- 
 tion bursting through from the inside, or traumatic punc- 
 ture that has been uncared for. A puncture may not im- 
 pair the hearing to any serious extent. Suppuration of the 
 ear in any part should be the subject of surgical treatment 
 at once, without regard to the whims or prejudices of the 
 person possessing an otorrhoea. The discharge is often 
 looked upon as a necessary aflfiiction, and relief from other 
 woes, but in reality it is a source of debility and impairment 
 of health to the person himself, and a nuisance to others. 
 Cases of impaction require treatment, and the same may 
 be said of the convex drum. The concave drum may be 
 due to catarrh, and if so, that should be treated. 
 
 In this connection it may be well to speak of nasal 
 catarrh and its influence on health. The disease may be 
 considered as a condition of mal-niitrition of the part 
 affected, due to irritation of the trophic nerves. It may 
 appear as an inflammation of the upper air passages with 
 an increased secretion of mucous fluid ; or there may be 
 atrophy of the mucous surfaces and of the harder tissues 
 beneath ; or there may be extensive ulceration, and decom- 
 position of secretions. 
 
 The first form is due to the action of irritants on a super- 
 
 5 
 
jS Personal History and Exainination 
 
 sensitive membrane. The condition can be produced 
 almost instantaneously by the inhalation into the nasal 
 openings of snuff from pulverized tobacco, acrid fumes, 
 dust, etc.; but the hyperaemia is temporary if the irritation 
 is not repeated. The changes of the climate and passing 
 from a warm to a cold atmosphere suddenly do not give 
 the system time for the nice adjustment to environment 
 that enables man to live in every climate where food can 
 be found. The result is a continued irritation of the 
 mucous surfaces of the air passages and a resulting in- 
 flammation with thickening of the superficial tissues until 
 the normal nutrition of the part is lost, and disease be- 
 comes seated. This swelling may close the openings of 
 the eustachian tubes, and impaired hearing is the result. 
 Treatment is usually successful, and hence the importance 
 of examining the nasal chambers if the history discloses 
 any suspicion of defect in this locality. The other forms 
 of catarrh are often quite as distressing without as favora- 
 ble a prognosis, but relief will not be sought in vain. 
 
 The sense of smell in the atrophic and erosive forms of 
 catarrh is often entirely lost, and in all cases is deranged. 
 This sense may be tested by inhaling odors that are bland 
 and unconnected with articles of food as musk, attar of 
 roses, etc. 
 
 The olfactory nerve is perhaps more intimately con- 
 nected with the brain tissue than any other, being appar- 
 ently a prolongation of the brain through the cribriform 
 plate to the nasal walls. As many cases of headache are 
 due to a bad condition of the surfaces where this nerve is 
 spread out we should examine such cases for ulcerations, 
 tumors, malformations and displacements that may cause 
 occlusion or pressure. 
 
 The sense of taste is closely allied with that of smell but 
 is not so important an indication of the condition of the 
 organs with which it is connected. It is a sense with great 
 capacity for education, as it was the boast of Roman 
 epicures that they could tell by the taste of a fish whether 
 
of special Senses. 5p 
 
 it was caught above the Bridge or below. A taste may be 
 acquired for the most nauseating substances. Children 
 have been known to cry for cod-liver oil. But while the 
 sense of taste is not important in its relation to health, 
 the condition of the mouth may well occupy our attention 
 in discovering those facts in a man's condition that make 
 for health or debility. A clean tongue indicates good 
 digestion ; while a coating indicates some abnormal con- 
 dition of the stomach, or liver, or pharynx. A cracked 
 tongue means dyspepsia. The tonsils should not protrude 
 beyond the pillars of the fauces ; the general surface of 
 the pharynx should be smooth and of light pink color ; 
 the teeth should be sound or filled ; the vocal cords should 
 be a light, pinkish yellow ; and the tracheal rings below 
 look like white bands, between which pink tissue can be 
 faintly discerned. 
 
 The temperature should be taken with the bulb of the 
 thermometer placed under the subject's tongue for five 
 minutes. This should be a record of 98.4° F. without a 
 variation of half a degree. If the temperature is below 
 normal note carefully the general conditions and repeat 
 the test at some future time. About one or two per cent, 
 of cases have a subnormal temperature. The instrument 
 should be carefully washed in an antiseptic fluid after 
 using and it is well to have a cup of saturated solution of 
 boracic acid into which the mouth-piece of spirometers, 
 etc., can be placed after taking records with them. 
 
 The tests of urine for albumen and sugar should be 
 practiced until the examiner is sure of his ability. The 
 simple methods now prepared by leading manufactur- 
 ing chemists and druggists leave little except skillful 
 manipulation to the examiner. The record should be 
 repeated if any abnormality is found and the subject 
 placed under the advice of a physician. 
 
 The director of a gymnasium should always recommend 
 some other physician to cases needing medical care. 
 
 The following directions are given for testing the re- 
 
6o Personal History and Examination 
 
 fractive power of the eye and its color sense and also for 
 determining the auditory power : 
 
 Procure of any optician two pairs of spectacles, one with convex 
 glasses, No. + .75 Dioptric (equal to No. + .48 in the old or English sys- 
 tem), and the other with concave glasses. No. + .75 Dioptric. Also 
 obtain a copy of Monoyer's test letters (a card of Dr. Dennett's modifi- 
 cation of Monoyer's test type may be procured of Meyrowitz Bros., 
 opticians, 297 Fourth Ave., New York City), to be hung up at 5 meters 
 distance, and a copy of Green's astigmatic lines, in the form of a clock 
 face, to be hung up at the same distance. 
 
 Test : — Seat the subject at a distance of five meters from the test 
 cards, which should be hung in a good light. Examine each eye sepa- 
 rately, keeping the other covered by a card held in front of, but not 
 touching it. Never press the fingers against the closed lid. 
 
 There are ten lines of letters on the test card, numbered from .1, .2, .3, 
 etc., up to ten loths or i. If now the subject can read the top line, the 
 smallest letters on the card, with the right eye (R.E.) alone, his vision 
 (V.) is recorded as ten loths or i. (V.R.E.=i). If he sees nothing clearly 
 above the fifth line from the bottom, but can read that correctly, then 
 V.R.E.=.5. If he cannot read any of the lines, then V.R.E. = .o. (?. e., 
 less than one-ioth). Whatever the vision without glasses may prove to 
 be, always next put on the convex spectacles and again cover the other 
 eye. If now he can still with the right eye see as well or better than 
 with no glasses at all, and can read the same line as before, he is 
 Hypermetropic (H.) in that eye. For example, if without glasses it was 
 found that V.R.E.=.5, and now after adding the convex glass his V. is 
 improved to .8, the record would be V.R.E.=.5, + H.=.8. But if the 
 vision is neither improved nor made worse by the convex glass, the 
 record will be thus : V.R.E.=.5, + H.=.5. If the convex -glass can be 
 used at all without decreasing the vision, no further testing with this 
 card is needed ; the subject is hypermetropic in that eye. If it is found 
 that the vision of the right eye equals i. without glasses, and then the 
 addition of the convex glasses blurs the letters, the eye is Emmetropic, 
 that is, the vision is normal (V.R.E.=i.). 
 
 If, however, the vision without glasses is less than i., for instance 
 only .3, and the convex glasses make even that line more indistinct, 
 then put on the concave glasses. If now the vision is improved so that 
 a higher line can be read, for instance the eighth from the bottom, the 
 eye is Myopic, or "near sighted," and the record will be V.R.E.;=.3, + 
 My.=.8. Or again, if the vision without glasses in the left eye is found 
 to be .7 and then with the concave glass the top line can be read, the 
 record will stand thus: V.R.E. = .7, + My.=i. After testing each eye 
 separately, place the record of one above the other, for example thus : 
 
of special Senses. 6i 
 
 j V.R.E — I. 
 
 < V.L.E.=.6, + My.=.9. 
 
 This completes the testing for simple hypermetropia, myopia and 
 emmetropia. 
 
 After testing the eyes as above, if the vision has not yet been made 
 perfect in either, leave on the proper correcting glass, the convex if 
 there is hypermetropia, or the concave if there is myopia, or use no 
 glass if there is neither ; then direct the subject's attention with that 
 eye alone, the other being covered, to the card of radiating black lines. 
 If he sees one or more of the lines running in any direction clearer or 
 blacker than those at right angles to them, he is shown to be astigmatic. 
 Either the perpendicular or the horizontal lines usually appear the 
 blacker to the astigmatic person. If the previous record was V.R.E.= 
 .7 and this defect is found, then it will be V.R.E.=.7, + As. Or if before 
 it read : V.L.E.=.3, + My.=.6, and astigmatism is found, it will read, 
 V.L.E.=.3, + My.=.6, + As. Astigmatism may exist either alone or in 
 combination with My. or H. If alone we might have a record thus : 
 V.R.E.^.6, + As.; V.L.E.=.4, + As., or if with hypermetropia thus : 
 V.R.E.=.7, + H.=.7, + As.; V.L.E.=.6, + H.=.8, + As. 
 
 To recapitulate, in brief: if it is found that V.R.E.=r, then the R.E. 
 is Emmetropic or Hypermetropic. If emmetropic, the convex glass 
 will markedly impair the vision ; if hypermetropic it will not. If the 
 V.R.E.=.9 or less, then the R.E. is either h)^permetropic, myopic, astig- 
 matic or amblyopic. 
 
 \st. If it is H. the convex glass will not greatly impair the vision. 
 
 2nd. If it is My, the concave glass will improve V. 
 
 "ird. If it is As. one of the radiating lines is blackest. 
 
 a^th. If neither of these defects exists and the V. is less than .7 then 
 Amblyopia or partial blindness may be recorded. It may read thus : 
 V.L.E.=.6, + Am. 
 
 Caution. — Always try the convex glass. Never try the concave unless 
 the convex glass blurs the vision. 
 
 In the following cases the subject should be recommended to consult 
 an oculist concerning the advisability of wearing glasses : If the vision 
 without any glasses is less than .4 in either or both eyes ; if he com- 
 plains of weak, watery or painful eyes, especially in reading, and any 
 degree of hypermetropia or astigmatism is found to exist. 
 
 Directions for Testing the Color Sense, 
 A reliable set of test worsteds of different colors may be procured 
 for $1.25 of N. D. Whitney, 129 Tremont street, Boston. Among these 
 will be found three large test skeins colored light green, purple (pink 
 or rose), and bright red. To make the examination, spread all the 
 worsteds out on a white cloth placed upon a table. First lay the green 
 
62 Personal History mid Examination 
 
 test skein a little to one side of the others, and then tell the subject to 
 throw out of the pile and lay along side of the test skein all the lighter 
 and darker shades of that color, or all the skeins containing a shade of 
 that color in any degree. Avoid naming the color "green " to him. If 
 he throws out only shades of green or light blues his color sense is 
 normal (C.S.N.) and the test is completed. But if in addition he throws 
 out light grays, or any other shade of gra}', or light yellows, salmons, or 
 pinks, he is color-blind. If he handles or fumbles over those shades 
 a good deal and hesitates, as if in doubt about them, but yet does not 
 throw them out, he probably has " feeble color sense " (C.S.F.). The 
 examiner in these cases must use his judgment in making a certain 
 amount of allowance for the stupidity of some persons in understand- 
 ing what is wanted, especially in the young and uneducated. 
 
 If the subject is found to be color-blind, next la)^ down the purple or 
 rose-colored test skein, in place of the green, in order to determine the 
 nature of the defect. Now tell him to throw out all the different shades 
 of that color. If he only throws out pinks and light reds and shades 
 approaching these he is only partly color-blind. (P.C.B.) But if he 
 throws out decidedly bluish purples, blues, violets, greens, or grays, he 
 is completely color-blind. (C.C.B.) Completely red blind if he throws 
 out the blues, violets, etc., or green blind if the grays or greens. 
 
 No further testing is needed, but as a matter of curiosity and to prove 
 the result, the red test skein may next be tried in the same way. If he 
 matches with it browns or greens and grays he is completely color- 
 blind. Dark brown or green if red blind, and light brown or green if 
 green blind. 
 
 It is not important to record whether the complete color-blindness is 
 red or green blindness. The following classes may be recorded : — 
 Color sense normal=C.S.N.; Color sense feeble=C.S.F. ; Partial color- 
 blindness=P.C.B. ; Complete color-blindness=C.C.B. 
 
 Color-blind individuals should be warned against engaging in any 
 occupation where this defect would prove dangerous or inconvenient. 
 
 Directions for Testing the Auditory Sense. 
 Use an ordinary watch and a tuning fork, letter A. or C, as tests. 
 Seat the subject with his right side toward you, and then while the 
 room is perfectly quiet, see how far off he can hear the watch tick. 
 Having previousl)' learned by a few experiments what is the furthest 
 distance at which the tick can be heard by normal ears, make that num- 
 ber of inches the denominator of a fraction, and the hearing distance of 
 each person examined thereafter the numerator. Having found the 
 normal distance (=H.D.) to be, for instance, about sixty inches, and 
 that of the subject now examined to be, say forty inches, his record for 
 the right ear would then be : H.D.R.E.=t^. If it had been f& or i, the 
 
of special Senses. . 6j 
 
 ear would be normal, f^ would show an abnormally acute sense of 
 hearing. If the watch could only be heard while in contact with his 
 ear, it would be recorded: H.D.R.E. = ^g. If not heard at all, then 
 H.D.R.E.=^-^ Next test the left ear in the same way. Voice sounds 
 in talking will often be easily heard by persons quite deaf to the watch 
 tick, so that the latter is not always a reliable practical test. 
 
 Suppose we have found H.D.R.E.=f§, H.D.L.E.=i, this implies 
 some deafness in the right ear, and the tuning fork will now help us to 
 decide whether the cause lies in some defect of the auditory nerve or 
 internal ear, or in the external or middle ear or Eustachian tube. Strike 
 the fork against some solid substance, and then place the end of the 
 handle against or between the subject's front teeth. If both ears are 
 normal he will probably seem to hear the ringing of the fork equally 
 well in both ears. But if there is a defect in one ear he will either 
 seem to hear it louder or more feebly in the affected ear. If, as in the 
 case we are examining, the fork is heard best in the deaf ear, this tells us 
 that the deafness is due to some defect in the more external parts of 
 the organ, and it can probably be corrected by appropriate treatment. 
 But if it is heard best in the good ear, it goes to prove that the defect in 
 the other ear is more deeply seated and cannot probably be greatly 
 benefited by treatment. This effect of the tuning fork is contrary to 
 what would ordinarily be expected, and it is often a matter of surprise 
 to a deaf person to find that he hears with his teeth apparently better 
 on the deaf side. 
 
 We may now add to our record in this case : T.F. best R.E. If it had 
 been heard equally well in both ears we would record : T.F.=N. (or 
 normal). Where the defect in hearing is at all marked a specialist in 
 ear diseases should be consulted. 
 
 Our record in a normal case might be thus : H.D.R.E.=i, H.D.L.E.= 
 I., T.F.=N. ; or in an abnormal case it might be thus: H.D.R.E.^i., 
 H.D.L.E.=^, T.F. best in R.E. This would imply that the subject was 
 so deaf in the left ear as not to be able to hear the watch tick at all, and 
 the fork held between the teeth could be heard best in the good ear, 
 consequently his trouble is probably seated in the deeper structures of 
 the ear, or in the nerve itself, and treatment would not be expected to 
 help him greatly. The tuning fork need not be tried unless the watch 
 tick shows some defect in hearing. 
 
CHAPTER V. 
 
 EXAMINATION BY INSPECTION AND PALPATION. 
 
 After the measurements of a person have been taken, the 
 work of examination and physical diagnosis should begin. 
 The measurement is mechanical and could be done cor- 
 rectly by any person, after a little practice ; but a physical 
 examination requires the highest product of scientific train- 
 ing backed by sound judgment in order to discover the 
 true condition of organs and determine the real cause of 
 the disordered function or disturbed growth. It may re- 
 quire only a mechanical eye to discover a curved spine, 
 but it must be the mechanical eye, backed by a thorough 
 knowledge of physiology and anatomy, that can discern the 
 fact and the cause. 
 
 The suggestion of remedial agents again pre-supposes a 
 knowledge of therapeutics, and this field is as broad as sur- 
 gery, which rests on a knowledge of the same sciences. 
 The therapeutic side of gymnastics has been more thor- 
 oughly worked out by the Swedes, who, following in the 
 footsteps of Ling, have studied exercise, both active and 
 passive, from a medical standpoint, and have developed a 
 system of gymnastics that has been approved and applied 
 by medical men all over the civilized world. Massage as 
 one part of this system is applied in a rudimentary way to 
 a great variety of cases in this country, but with the best 
 success only by practitioners of foreign education. There 
 is a call then for the most extensive preparation in this 
 field of work, and in no line of medical practice is there as 
 broad a field for original scientific research as in this, the 
 prescription of exercise. The following technique is re- 
 commended to all those who are making a physical exam- 
 ination : 
 
Examination by Inspection and Palpation. 65 
 
 I. — Inspection should be made with the subject entirely 
 nude and standing easily. If a military attitude is assumed, 
 try to get relaxation into the ordinary positions. This can 
 often be done by calling the attention to some trivial matter, 
 as any peculiarity of the hands or feet, or by having the 
 subject step forward or backward a few steps, when he will 
 forget his strained position. From the front notice (i) the 
 general contour or relative breadth, (2) the position of the 
 head, (3) the position of the shoulders and arms, (4) the 
 curves of the trunk, (5) the muscular condition of chest, 
 abdomen, and legs, (6) any malformation, such as tumors, 
 cicatrices, etc. 
 
 From the side notice (7) the antero-posterior or normal 
 spinal curves, (8) the depth and mobility of the chest and 
 abdomen, (9) the position of the shoulders, (10) the relation 
 of the hips to the loins, (11) the relation of the neck to the 
 trunk, (12) the general attitude of the subject. 
 
 From the rear notice (13) any lateral or spiral curvature 
 of the spine and prominence of spinous processes, (14) the 
 condition of the shoulder and scapulae, (15) the waist curves, 
 (16) any tipping of the iliac crests due to one short leg or 
 imperfect bone development, (17) the outline and position 
 of the legs and indications of varicose veins and cyanosis, 
 (18) the muscular condition, (19) the condition of the skin, 
 and (20) any tumor or malformation. 
 
 Of course the examiner will not look up each one of 
 these points in regular order, but he should study each one 
 and after an examination go over the list and see how many 
 points there are on which he has no clear, definite knowl- 
 edge, and then try on the next case to make the list smaller 
 until he will take in everything at a glance, as it were. 
 There are many other matters to which attention might be 
 called, but they are mostly amplifications of the above 
 list. 
 
 We include in (i) the breadth of head as giving some 
 idea of the temperament and vitality of the subject. A broad 
 head at the base is believed to indicate a greater vitality 
 
66 Examination by Inspection and Palpation. 
 
 than is found when the head is long and "top-heavy." There 
 is greater power of resisting disease and less liability to 
 nervous irritability of a pathological character. A thin, 
 weak neck means a bad curve forward at the cervical por- 
 tion of the spine, and a consequent fiat chest in a large ma- 
 jority of the cases. The voice will be uncertain and the 
 throat suffer from catarrhal diseases on the slightest provo- 
 cation. 
 
 Narrow shoulders mean compression of the upper part 
 of the thorax, and less activity of respiration in the apices 
 of the lungs. This, with a history of tuberculosis is unfor- 
 tunate, because tubercular degeneration usually begins at 
 the apex of the lungs and an inactive part is an unhealthy 
 part. This fact has led Dr. T. J. Mays to claim in an ar- 
 ticle published in the " Therapeutic Gazette," May, 1887,* 
 that the wearing of corsets by ladies may be a protection 
 against phthisis, because by compressing the abdomeA and 
 lower part of the thorax costal breathing with a freer use 
 of the apex of the lung was necessitated and a consequent 
 immunity from tubercular degeneration was the result. 
 The fallacy of this theory has been repeatedly shown but 
 by no one so completely demonstrated as by Dr. J. H. Kel- 
 logg of Battle Creek, Mich., whose investigations regarding 
 normal respiration are complete and original. f 
 
 The breadth of chest is one of the three factors in making 
 up the " Vital Capacity," and its relation to the breadth of 
 waist and hips will give a better idea of the natural strength 
 than the size of the biceps. Any depression of the ribs or 
 sternum should be noted. I have seen a case of severe 
 hepatic disturbance that had resisted medical treatment for 
 many months, recover more than ordinary health under a 
 series of exercises that tended to lift two depressed ribs 
 over the liver into a more arched and natural position. 
 
 Notice any elevation of the chest wall in the cardiac re- 
 gion, and any transverse depression at about the sixth rib. 
 
 *See " Med. News," Nov. 27, 1886. 
 
 f Transactions of the Mich. State Med. Society, 1888. 
 
Examination by Inspection and Palpation. 6y 
 
 The elevation may be due to enlargement of the heart or 
 pericardiac effusion. The depression is due to faulty habits 
 of sitting — the person sliding forward in his chair and sit- 
 ting on the sacrum, instead of on the buttocks. This de- 
 pression causes a pressure on the heart and interferes with 
 the circulation and also causes indigestion quicker than 
 plum pudding by restraining the muscular activity of the 
 stomach wich is very marked during digestion. 
 
 Under (2) we should note any position of the head that 
 might denote a shortness of the sternomastoid muscles. A 
 shortness on one side tends to tip the head toward that side 
 and turn the face to the other ; if both muscles are short 
 they tend to draw the neck forward and tip the face up. A 
 narrow thin neck indicates, generally, poor respiratory 
 power and a catarrhal throat with laryngeal sensitiveness, 
 especially if in (7) we find the cervical curve very deep, or 
 the neck slanting forward because of poor support from 
 weak muscles. A strong neck is very desirable. It not 
 only holds important organs in place and insures good 
 circulation in the brain by making the channels direct but 
 it gives an aggressive carriage, and indicates determination 
 and pluck. In (3) we observe the slope of the shoulders 
 and the relation of the acromions to the sternum. If a line 
 be drawn from the acromion tip to the base of the neck, 
 and continued to the spine, it will make an angle with the 
 line of the spine which should approximate to 80°. If the 
 muscles that support the shoulder be weak, they permit the 
 acromial tips to sink, making the angle less, while if these 
 muscles be over-developed they draw the tips up and give 
 a stiff hunched appearance that is ungraceful. If the 
 muscles in front be better developed than those behind, the 
 shoulder will be drawn forward and down, giving an ap- 
 parently fiat chest with sloping shoulders, which is a mark 
 of slack habits and lack of all exercise of a vigorous char- 
 acter. When you get hold of such cases you will feel like 
 taking them by the shoulders and, after giving them a vio- 
 lent shaking, telling them to " brace up." The effect of 
 
6S Exafnination by Inspection and Palpation. 
 
 this posture on respiration will be evident to every person 
 with a knowledge of the elements of anatomy. The per- 
 son has no energy or " sand " because his blood is not 
 properly aerated. The arms hang forward, giving the 
 feeble, helpless attitude assigned by caricaturists to the in- 
 nocent " dude." 
 
 By (4) we mean the outline curves of the waist, which 
 show something of the strength of trunk that may be ex- 
 pected, and the outlines of muscles that give the beautiful 
 curves seen on the athlete. These lines may not be clearly 
 cut in some cases of well developed muscles on account of 
 the adipose tissues immediately under the skin. This last 
 point will help us in estimating muscular condition (5) 
 which can not be judged altogether by size. 
 
 It is well to remember that, in (6), we must not only de- 
 cide as to the character of the malformation but know what 
 the prognosis or probable development will be — what inter- 
 ference with exercise will be caused and what exercises are 
 contra-indicated — what will be the influence on health — 
 what does it indicate as to the physical stamina or consti- 
 tutional strength. For instance, varicose veins may never 
 have given any trouble and may never have been noticed. 
 How long could this condition exist unnoticed and what 
 may be expected from it now ? What exercises should be 
 avoided, etc., etc. ? In surgery the word tumor means any 
 abnormal enlargement of an organ or tissue. 
 
 Perhaps the most frequent form of tumor that will be 
 found is due to rupture or hernia. A hernia is a tumor 
 caused by the passage of a portion of an organ through the 
 bony muscular or tendinous wall that normally confines it. 
 It may be produced suddenly by a severe strain or bruise, 
 or it may be the result of a gradual distension of one of 
 the natural openings of the wall. Cases of intestinal her- 
 nia are frequently found, and among young men will affect 
 two or three per cent, of all, while among those past mid- 
 dle life it will affect as high as six per cent. Among fe- 
 males it is much less frequent. This is due to the less 
 
Examination by- Inspection and Palpation. 6g 
 
 patulous inguinal openings in the female and to less ex- 
 posure in the daily avocations of life. Abdominal hernias 
 are classed as inguinal, femoral, umbilical, diaphragmatic, 
 etc., according to the place where the viscus forces its way 
 from its natural support. 
 
 An inguinal hernia may appear at the external inguinal 
 ring as a round tumor of greater or less extent and is then 
 called " direct," while if it appears first at the internal ring 
 and passes down the canal it is called " oblique." The lat- 
 ter form is much more frequent and tends to develop rap- 
 idly downward, giving the tumor an elongated form with 
 higher origin than the direct. 
 
 In femoral or crural hernia the intestine passes down 
 through the crural ring under Pouparts' ligament where it 
 causes a protrusion of the anterior wall in a round tumor 
 that lies in the groin just below the fold at the saphenous 
 opening. It is situated farther externally from the median 
 line than the direct inguinal and if large will have its axis 
 in a horizontal rather than a perpendicular direction. 
 
 These three forms of tumor must be readily differentiated 
 from cystic tumors, varices, glandular enlargements, etc. 
 
 Cysts have a well-marked fluctuation. Varices have fixed 
 relations to the venous trunks and subside on the subject 
 assuming a horizontal position and fill again on rising if 
 the inguinal rings are supported. Glandular swellings are 
 due to some attendant local irritation and are painful and 
 unyielding to pressure. 
 
 The antero-posterior curves of the spine (7) are a con- 
 cavity in the cervical and lumbar regions and a convexity 
 in the dorsal and pelvic. These curves may all be exag- 
 gerated by disease or occupation or muscular development. 
 Any increase in the curves must shorten the total height. 
 Any weakness of muscles at the back of the neck will per- 
 mit the head to hang forward, thus increasing the dorsal 
 convexity, producing round shoulders, or kyphosis. An 
 over- development of the lumbar muscles as compared with 
 those of the abdomen will increase the lumbar concavity, 
 causing lordosis. The strong back is the straight back. 
 
'JO Exaininatio?i by Inspection and Palpation. 
 
 The gymnastic treatment of lordosis, or abnormal an- 
 terior curvature, is the only satisfactory one where there is 
 no caries or breaking dowa of bone. The same is true of 
 kyphosis, of which Dr. Stedman writes for The Reference 
 Handbook : " A cure of adolescent kyphosis, when of 
 slight degree, may be obtained by exercise alone, without 
 mechanical support ; but it will be found advantageous to 
 aid the patient in maintaining an erect posture by suitable 
 apparatus. — The treatment by exercises in this form of 
 kyphosis should never be omitted, since the fault lies chiefly 
 in a want of tonicity of the muscular and ligamentous 
 tissues." 
 
 If there is exaggerated curve at any part of the spine, 
 there will be more or less compensatory curve in the oppo- 
 site direction at other parts ; and, in prescribing exercise, 
 great care must be used in deciding which is the primary 
 and which the compensatory curve, for an error would 
 make matters worse from the development of parts already 
 strong, and the neglect of parts that are weak. 
 
 In observing the depth of chest and abdomen, (8) and the 
 movement of each under respiration we have a clue to the 
 activity of the person. If the chest is deep at the sixth rib, 
 but thin at the second, the sternum will usually be found 
 unsupported by the muscles of the neck ; those behind be- 
 ing weak and letting the spine slope forward at the upper 
 part so that the sterno-mastoid and the scaleni muscles can 
 not raise the chest. This throws all the work of respira- 
 tion on the diaphragm, and the person is unfitted for any 
 athletic exercise, and would have a cramp in his side if he 
 were to run an eighth of a mile. It is said that a round 
 chest of equal girth with a flat one will not show as great 
 a lung capacity on the spirometer, but my experience does 
 not corroborate the statement. 
 
 If the abdomen protrudes, or sags, so that the intestines 
 seem to be held just above the pubic arch, especially if 
 there be a history of hernia, or excessive corpulence, or 
 indigestion, the matter is of such import as to call for thor- 
 ough instruction and earnest advice. Much discomfort, 
 
Examination by Inspection and Palpation. Ji 
 
 ill-health, and physical suffering will be saved such cases, 
 if the abdominal muscles be developed by persistent exer- 
 cise — the abdominal cavity contains quite as important or- 
 gans of health as the thorax, and the competent instructor 
 will not spend all his time and talk on the chest. 
 
 In (9), (10), (11), (12), we have some of the points that go 
 to make up the carriage or general appearance of the sub- 
 ject, and they constitute the difference in physique between 
 a West Point cadet and a slouching loafer. 
 
 Our rear view of the subject will disclose any lateral 
 curvatures (13) of the spine, or scoliosis, and we should not 
 only see any deformity of this character but should be able 
 to judge of its nature, and determine its causation. The 
 curve may be simple and confined to one part of the spine, 
 or it may be multiple. In the latter case one of the curves 
 is usually the primary lesion, and the others compensatory. 
 The reason for the compensatory curve is found in the 
 natural effort to maintain an erect carriage. If there be a 
 slight curvature to the left in the lumbar region, it would 
 tend to tip the shoulders to the right but the natural effort 
 to straighten the spine has most success where the muscle 
 is stronger and not at the point of greatest weakness, to- 
 ward which the convexity lies. The result is the bending 
 of the upper part into such a position that the weight is in 
 equilibrium, and the shoulders fairly level. This effort to 
 bend a higher portion of the spine to produce a balance of 
 weight usually is the cause of a slighter curve higher up in 
 the cervical portion, that restores the head to the erect 
 position. This gives a curve to the left, in lumbar region, 
 another higher up to the right, in dorsal region, and an- 
 other still higher to the left in the cervical portion of the 
 spine. If this explanation is correct it is plain that the pre- 
 disposing cause of scoliosis must be due, in a large majority 
 of the cases, to the weakness or uneven development of the 
 muscles and ligaments that support the spine. If the mus- 
 cular strength and activity of one side be greatly in excess 
 of that of the other, the spine must of necessity be drawn to 
 that side which will throw the convexity toward the weak- 
 
^2 Examination by Inspection and Palpation. 
 
 ness. If this principle obtains in all the anatomical relations 
 — and its influence can not be denied — no better argument 
 could be used in favor of training for bilateral symmetry. 
 
 The fact that girls are affected by spinal curvature more 
 often than boys (the proportion being 4 to i) would seem 
 to indicate a need of more robust exercise out of doors or 
 in gymnasiums that shall give a development of the erector- 
 spinae mass and all the muscles above the hips that shall 
 compare favorably with that of boys. The influence of 
 corsets and stays has been repeatedly shown to be the cause 
 of great muscular debility in the parts constricted, and all 
 medical authorities assign a large part of responsibility for 
 curvatures to their use. The lumbar muscles of the female 
 have a comparatively larger field of origin at the pelvis 
 and should be correspondingly strong, but under the dif- 
 ferentiation of civilization and the corset, the female waist 
 has degenerated into a backache. 
 
 Pressure on a muscle tends to drive the blood out, and 
 if it be continuous, the circulation is impaired. This con- 
 dition means bad nutrition of the muscle, and that leads to 
 imperfect development or to actual atrophy. Is it any 
 wonder then that a physician hears from his female clients 
 one long complaint of weak backs, back-aches and general 
 debility ! 
 
 The remedial exercises for curvatures need only be sug- 
 gested here, as the only treatment, is forcible straightening 
 and proper exercises. The care should be exercised on the 
 weakest spot, which, in some way, " must stand the strain." 
 Suspension, as on the rings and bars, and the direct exer- 
 cise, either active or passive, of the degenerate muscle, is 
 the general plan of treatment. 
 
 The prominence of the spinous processes are of diagnos- 
 tic value in locating weak spots. If the interspinous liga- 
 ments have been strained and stretched by lack of muscu- 
 lar support or bad habits of posture, as sitting back on the 
 hips, and letting the weight of the trunk press the lumbar 
 vertebrae back, or a pernicious habit of letting the head 
 hang forward, the saw-toothed appearance of the spine, as 
 
Examination by Inspectio7i and Palpation. yj 
 
 the subject bends well over, will disclose the fact. Notice 
 the alignment of these processes as the subject is bent 
 over, and straightens up. A failure of one or two, here 
 and there, to stand in the line, is not an indication of dis- 
 ease, but is due to a slight bend in the process, as will be 
 seen on examining almost any skeleton. The spinal curva- 
 ture will be indicated by a number of them assuming a 
 general curved outline. 
 
 The mobility of the scapulae (14) varies greatly in differ- 
 ent people. A more beautiful contour exists when the 
 trapezius and rhomboidei are strong and short holding the 
 scapulae down and well back to the spine, but the range 
 of arm movement is not so great. A good development 
 of these muscles is very desirable as they prevent the 
 shoulders from rolling forward and flattening the chest. 
 
 In (15) notice the size of the lumbar muscles, with the 
 subject bent over. 
 
 It should be borne in mind that a shortness of one (16) 
 leg is comparatively frequent, and this deficiency causes 
 the pelvis to tip with resulting spinal curvature. Distocia, 
 or deformity of the pelvis may have the same effect. 
 
 The bone of the legs (17) can not be greatly changed by 
 exercise, but something can be done in early life to relieve 
 one of the burden of bow legs or knock-knees. Therefore, 
 in the examination of children, do not overlook this point ; 
 nor needlessly turn the attention of the subject to it when 
 there is no relief, but occupy his mind with matters that 
 can be improved and modified. In observing the legs, 
 notice any cyanosis about the ankles, and varicose condi- 
 tion of the veins, especially of the lower leg. In some 
 persons the skin is firm and seems to fit the underlying 
 tissues very closely, thus giving support to the venous 
 walls ; while in other cases the skin is relaxed and thin, 
 furnishing poor support to the superficial vessels. If we 
 recall the fact that the hydrostatic pressure alone in a 
 person of ordinary height, while standing, would be a 
 trifle over two lbs. in the vessels of the foot, and that the 
 friction of the current along the vessel wall, the impedi- 
 
7^ Enamination by Inspection and Palpation. 
 
 ment from constriction of clothing and speed of the 
 current, all add to this pressure we can readily see why 
 certain classes of people are specially liable to dilation of 
 the veins, and suffer accordingly. Persons obliged to 
 stand much of the time without great change of position 
 (as clerks, book-keepers, bench mechanics, etc.), and very 
 fat people, who stand a considerable part of the time, are 
 most often affected. The pressure on the external iliac 
 vein in corpulent people is a predisposing cause, as it pre- 
 vents the free return of the blood into the trunk ; and the 
 same may be said of garters, tight clothing on the thighs, 
 or elastic thigh bands, tight belts around the waist, corsets, 
 and any garment or device that prevents normal respira- 
 tion. ■ (See illustrations, Chap. IX.) The proper advice in 
 these cases is clear. Restriction should be placed on all 
 exercises like jumping where the feet strike the ground 
 hard ; running on pavement, floors, etc.; bicycle riding, 
 because of the pressure of the saddle on the femoral and 
 saphenous veins ; violent exercises, like foot ball, etc., etc. 
 Light exercise should be encouraged, for, the better the 
 tone of the tissues, the less giving way will there be to 
 pressure. Exercise of the skin to keep it healthy and firm 
 — such as massage and cold water baths, to stimulate the 
 contraction of the tissues — will be of assistance. In this 
 condition, "forewarned is forearmed." Cyanosis is a 
 varicose condition of capillary veins and indicates poor 
 circulation. In cyanosis about the trunk search carefully 
 for some heart lesion. 
 
 The condition of the skin (19) will signify much to the 
 careful examiner. Not that every subject with acne should 
 be set down as dyspeptic, but in an almost intuitive way 
 the careful observer will learn to diagnose many internal 
 ailments and judge of vices that might otherwise be un- 
 known. There is something that can not be described in 
 the healthy, firm, velvety skin of an athlete. It must not 
 only be seen, but felt, in order to be appreciated. It is 
 better to be rolled in the dust by a hearty, healthy wrestler 
 than to shake the flabby, moist hand that is placed in 
 
Exafnination by Inspection and Palpation. 
 
 75 
 
 yours by some advocate of moral suasion and intellectual 
 top-heaviness. The skin, like the eye, is the mirror of the 
 bodily health, if we only know how to see the image 
 clearly. Its firmness, its elasticity, its smoothness, its 
 moisture, its odor, its color, its warmth, all are full of 
 meaning. Physicians often read the complaint in the 
 countenance of the patient, before his mouth has uttered 
 it. We have in observation not only the facial coun- 
 tenance but the expression of the whole body. How much, 
 then, should we rightly judge of the inner man ! The 
 delicate tint seen on the skin of the woman who has exer- 
 cised in the open air, until every tissue proclaims her the 
 type of health, is as superior to the rusty covering of the 
 dyspeptic house plant, as that is superior to the hide of a 
 pachyderm. Local diseases may deform the skin, but the 
 indications of general health will be found, if it exists. 
 
 The following table will present in compact form some 
 of the more prominent points observed by inspection : 
 
 GENERAL ASPECT. 
 
 Aspect of chest. 
 
 Front View. - 
 
 (i) Form. -{ 
 
 waist. 
 
 legs. 
 
 f Flat. 
 I Round. 
 
 \ Bilateral asymmetry. 
 I Sternum depressed. 
 1^ Pectoral muscles. 
 
 j Breadth. 
 ( Muscles. 
 
 Bow-legs. 
 
 Knock-knees. 
 
 Muscles. 
 
 Side View. 
 
 Rear View. ^ 
 
 " " neck. I y 
 
 Poise of head. 
 " " thorax. 
 " " loins and belly. 
 " " hips. 
 
 f Neck. 
 j Shoulders. 
 Waist. 
 Hips. 
 Height of acromions. 
 Line of spinous processes. 
 Scapulae. 
 Pelvic crests. 
 
 Sterno-mastoid. 
 ateral muscles. 
 
 Breadth. 
 
^6 Examijiation by Inspection and Palpation. 
 
 ' Undulythin. | g^StV'"" \^'^-^^^- 
 
 (2) Nutrition. ^ 
 
 (3) The Skin. - 
 
 i Evenly distributed and firm. 
 Unevenly " and soft. 
 Fatty degeneration. 
 
 Acne, furuncles, etc. 
 
 Eczema. 
 
 Psoriasis. 
 
 T-^,,^^.^ ^ J ( Circinatus. 
 
 ii-ruptions. -< rp. ) TT • 1 
 
 ^ I iinea. •< Versicolor. 
 
 ( Tricophytosis cruris, 
 
 I Ulcerations. 
 
 1^ Erysipelas. 
 
 Cicatrices. < 
 
 { Bruises. 
 
 Traumatisms. \ ^"^"s. 
 I Cuts. 
 [ Lacerations. 
 Carbuncles, variola, etc. 
 Free. 
 Bone. 
 
 Abscesses. 
 
 Tumors. ■{ 
 
 i Comedones. 
 Seborrhoea. 
 Sebaceous cysts. 
 ^ Ichthyosis. 
 Hypertrophy. \ Goitre. 
 
 ( Condylomata, callus, etc. 
 r Chicken breast. 
 Malformation. X Retained testis. 
 
 ( Funnel chest, etc. 
 Varicocele. 
 Cysts. \ Hydrocele. 
 Abscess. 
 
 Lentigo. 
 
 Chloasma. 
 
 Jaundice. 
 
 Discolorations. \ Erythema. 
 
 Purpura. 
 
 C)''anosis. 
 
 Bruises. 
 
CHAPTER VI. 
 
 PALPATION. 
 
 The use of the sense of touch, or palpation, is of great 
 importance in locating tumors and determining chest 
 movements, viz : frequency of respiration, vocal fremitus, 
 ronchi, frictions, etc. By the eye you can only imperfectly 
 judge of size and consistency. An arm may be large, but, 
 if soft and flabby, it does not indicate health or strength ; 
 while if it meets our hand with a proper resistance — not 
 too hard nor too soft — we know that it is capable of good 
 things, be it large or small. Palpation enables us to say 
 how much fatty tissue underlies the skin, and how firm the 
 muscle is under the fat. It is a mistake to set every person 
 with abundant adipose tissue in the list of " muscles unde- 
 veloped." Nor is fat a substance of no worth to the 
 physical economy and to be avoided. In certain quanti- 
 ties it is of the greatest advantage to health, and is an 
 indication of high nutrition. It is so much physiological 
 capital stored up, and is so located as to prevent loss of 
 heat by radiation, especially over the more sensitive organs, 
 and therefore saves the energy that would be lost in heat. 
 This is nature's way of protecting her children from the 
 increased severities of the season ; for, as autumn brings 
 presages of winter by her cooler nights, every animal, in 
 health, grows fat, and those that are exposed to. continued 
 low temperatures, like whales, seals, bears, etc., lay up 
 enormous stores of it underneath the skin, where it will do 
 the most good, and over the abdominal organs and heart. 
 If the supply of food is cut off, the fat is consumed to pro- 
 vide vital force for long periods of time. The same is true 
 of man, but to a less extent. As civilization has relieved 
 
y8 Palpation. 
 
 him of many of the exigencies of nature, it has modified 
 his requirements, restricting them in some directions, and 
 enlarging them in others. The modern civilized man 
 needs less fat than the Esquimaux, because he has a milder 
 climate and better facilities for heating his house, but he 
 needs some fat to prevent the irritation of the nervous 
 tissues from the adjustments of heat production that are 
 so rapid in a well-balanced body, when we pass from a 
 cold to a warm atmosphere, and the reverse. This strain 
 is thrown on the involuntary or sympathetic nervous sys- 
 tem, and this is the part that breaks down in the so-called 
 " nervous prostration," or " neurasthenia," which is so 
 common. Not that lack of fat stands in causative relation 
 to this disease, but that one source of strain is found here. 
 Such persons bear the cold badly and seek warmth ; their 
 treatment is warmth and nutrition. The argument, then, 
 is that a fair amount of fat is conducive to health of the 
 nervous system. The same may be said of all the other 
 organs. The lean man has no extra physiological resource 
 to fall back upon, if irregularities are forced upon him, 
 either in the way of lessened food supply, or sleep, or 
 greater demand on his energy, either physical or mental, 
 and his comfort and health soon suffer. 
 
 By palpation we may also judge of the temperature and 
 moisture of the skin, and thus estimate its activity in ex- 
 cretion. A healthy skin should be firm and velvety, even 
 in texture and activity, slightly moist under ordinary cir- 
 cumstances but not wet, colored a delicate shade of pink, 
 without being flushed or having dilated capillary vessels, 
 as will be found common in the clavicular or scapular 
 region. If the skin is hot and flushed, it indicates the 
 presence of fever, or a local disturbance of circulation, due 
 to deranged nerve activity. If the skin be dry, and tends 
 to form scales, the superficial circulation is insufficient, 
 and bad digestion is a common accompaniment. Free 
 exercise, shower bathing, massage and friction will set 
 things to rights if persistently employed, unless the skin 
 
Palpation. yg 
 
 be affected by ichthyosis, which " is a congenital, chronic, 
 hypertrophic disease," and hence will be but little bene- 
 fitted. Profuse perspiration is found frequently, and 
 seems injurious only in prolonging bronchial inflamma- 
 tions and general catarrhal conditions, by keeping the 
 clothing damp a large part of the time. There is also an 
 increased liability to Bright's disease from high concentra- 
 tion of urine and chilling of the surface on slight exposure. 
 
 Hyperidrosis will be favorably influenced by active 
 exercise, as the circulatory system will at that time be 
 depleted by the free sweating, and will give up less moist- 
 ure in a state of rest. After exercise the damp clothes are 
 removed, the sweat is washed off in the shower bath, and 
 the skin is dried by proper massage, leaving slight liability 
 to "colds." Local hyperidrosis may seriously impair the 
 health by keeping the feet damp and cold and thus induce 
 catarrhal, pneumonic, and rheumatic conditions. Medical 
 advice is to be recommended in such cases, if hygienic 
 precautions — such as cold baths, frequent change of cloth- 
 ing, sensible shoes with cloth tops, proper diet and regular 
 exercise — do not avail. At times the under and inner sur- 
 faces of the toes and the outside margin of the foot from 
 the little toe back to the instep will appear white and 
 swollen in these cases. This condition closely resembles 
 large blisters from scalds, but is only a water-soaked, 
 " parboiled," state of the epidermal layer, like that seen on 
 the hands of washer-women after they have been in hot 
 soap-suds for a half hour. The advantage of a cloth-top 
 shoe in these cases is apparent when we think of the com- 
 parative ease with which moisture passes through woolen 
 fabrics as compared with difficulty of evaporation through 
 leather. 
 
 A condition of anidrosis, or too scanty perspiration is 
 frequent without evident impairment of health. The skin 
 is apt to get very dry and harsh, especially in cold weather, 
 and eczema of the hands result. In many of these cases 
 there is no general sweating, even in extremely hot weather, 
 and perspiration is not copious. 
 
8o Palpation. 
 
 It may be well to explain that " perspiration " is the 
 term applied to the insensible exudation from the sweat 
 glands that is evaporated as fast as secreted, while " sweat- 
 ing " is the appreciable collection of this exudation in 
 drops of greater or less abundance. (See Foster's Physi- 
 ology). 
 
 In addition to what we learn of the integument and 
 muscle by palpation, we detect by it certain movements 
 that characterize health or disease. If we place the hands 
 firmly on the walls of the chest, letting the fingers press 
 the intercostal regions, there will be felt a movement of 
 the chest on each inspiration and expiration, if respiration 
 be normal. Any failure in expansion is noticed if there 
 be interference with the chest action, from muscular or 
 mechanical cause, that is unilateral. There should be 
 bilateral symmetry of movement, but this may be hindered 
 by muscular soreness from rheumatism, neuralgia, traumat- 
 ism, etc.; paresis of a muscle, or group of muscles ; intra- 
 pleural effusions ; new growths ; or by solidification of the 
 lung or any considerable part of it. Malformations may 
 also interfere with bilateral symmetry of movement. 
 
 If the subject be asked to repeat some word such as 
 " ninety-nine," or to count aloud, one, two, three, while 
 the hands are on the chest, as above described, a peculiar 
 vibration will be felt, which is known as the " vocal 
 fremitus." This thrill, or vibration, is much more promi- 
 nent in persons with thin chest walls and low pitched 
 voices, than where the wall is thickly padded with fat, and 
 the voice in high key, on the same principle that the low 
 bass strings of a piano, when struck, impart vibration to 
 solid articles in the room in an appreciable degree ; while 
 the high notes have a less perceptible effect. The " vocal 
 fremitus " is somewhat plainer on the right side, on account 
 of the larger size of the right bronchial tube. A fremitus 
 may be caused by other sources of vibration than the voice, 
 as by a cough, by mucous rales, by pleuritic friction, and 
 the splashing of liquid, when the chest contains liquid and 
 air. 
 
Palpation. 8i 
 
 The " ronchial fremitus," due to mucous in the bronchial 
 tubes, is frequently very marked in bronchitis, and felt by 
 the subject himself ; but the area is circumscribed in most 
 •cases. The friction fremitus of pleuritic inflammation is 
 faint and local in character. In general, those diseases 
 that produce solidification of the air cells of the lungs, 
 without obstruction of the bronchial tubes, increase the 
 vocal fremitus ; while those that interpose more air, like 
 emphysema, decrease it. Liquids diminish or check it 
 altogether. The scapulae interfere with the fremitus as 
 does the liver, the latter not conveying the vibrations, and, 
 if pressing firmly against it, preventing the chest wall from 
 doing so below the margin of the lung. 
 
 Palpation is of great service in the diagnosis of tumors. 
 The fingers are to be placed on one side of the swelling, 
 and gentle but firm pressure made on the opposite side of 
 it with the fingers of the other hand, by a quick movement 
 of the wrist. If the contents of the tumor are liquid a 
 bulging will be felt under the fingers, caused by the dis- 
 placement of the fluid, that passes as a wave through the 
 tumor, distending the sac at one part to accommodate the 
 liquid depressed at another. This peculiar wavelike 
 motion, called fluctuation, can be well studied by exami- 
 nation of a rubber water bag under varied thickness of 
 covering, having the bag distended hard, and again with 
 less water in it, but no air. In cases of ascites the wave 
 impulse is readily felt across the abdominal cavity — a light 
 tap with the end of the finger against the side being suffi- 
 cient to start the wave. A close estimate of the amount of 
 fluid can be formed in this way, as the wave simply con- 
 tinues through the liquid part, and is not propagated by 
 the intestines or general tissues. 
 
 The apex beat of the heart may also be located by palpa- 
 tion in a large majority of cases. In many subjects the 
 chest wall is thin, and the heart action strong, so that 
 inspection can determine the apex impulse with- tolerable 
 precision ; but if it fail to fall in an intercostal space, or 
 
82 Palpation. 
 
 the chest wall be thick, or the heart -beat feeble, palpation 
 must be used. In this connection it may be said, that for 
 this purpose the ear may be the organ of tactile, as well as 
 of auditory impressions. 
 
 The character of acute or chronic inflammatory action 
 can often be determined by palpation, as in swellings 
 about joints. 
 
CHAPTER VII. 
 
 PERCUSSION AND AUSCULTATION. 
 
 The condition of the internal organs is determined in 
 several ways. Among the most frequently employed, be- 
 cause most satisfactory in results, is by listening to the 
 passive and active sounds so far as they can be secured to 
 the ear. The passive sounds are obtained by percussion, 
 or striking the surface over an organ, either with the tips 
 of the fingers or a rubber mallet directly, or by laying a 
 solid substance, or the finger, firmly against the surface, 
 and striking this. The first method is called immediate 
 percussion, and is seldom used, except for hard, bony sur- 
 faces. The- second is called mediate percussion, and is 
 applicable to all parts. 
 
 The sounds obtained by percussion vary in quality, in- 
 tensity and pitch. The quality of the sound obtained over 
 the various organs can only be rudely described, but prac- 
 tice will give skill in distinguishing it. The intensity will 
 vary according to the surrounding medium, and the pitch 
 will vary largely through change in the organs that pro- 
 duce the sound. 
 
 The region of the body most frequently examined by 
 percussion is the thorax. The abdomen, especially in con- 
 ditions of disease, is often examined by this method (in 
 connection with palpation), but without the satisfactory 
 accuracy that is to be secured over the chest, although it 
 enables one to distinguish the outline of solid tumors of 
 hepatic, splenic or intestinal origin and the area covered 
 by cystic enlargements. 
 
 The method of employing percussion is generally with 
 the fingers, although, if many examinations are made daily, 
 
84- Percussion and Auscultation. 
 
 it is well to use a pleximeter and percussor (as shown in cut). 
 It seems to the writer that the appreciation of vibrations 
 by the finger is of considerable importance in assisting the 
 ear, and, therefore, that digital percussion is better than 
 instrumental. The act is easily performed by laying the 
 fingers of one hand firmly, over the part to be examined, 
 and, with the tips of the first two or three fingers of the 
 other hand, or the middle finger alone, striking against one 
 of the fingers imposed on the part with a firm blow, accom- 
 plished by a wrist movement of flexion. The force of the 
 blow may be varied to perceive the difference in resonance, 
 
 Fig. 19. 
 
 Showing the normal outlines and positions of the heart, lungs, liver, 
 and stomach. The light dotted line shows the outline of the lung at 
 inspiration b. d. and at expiration f. h., and also the lobar divisions at 
 i. k. 1. The heavy continuous line shows the outline of the liver. 
 The light line shows the location and divisions of the heart. The heavy- 
 broken line indicates the outline of the stomach. Luschka. 
 
Percussion and Auscultation. 8^ 
 
 quality, and pitch of the sound under the new conditions, 
 as this may have an important bearing on our determina- 
 tion of the case. Forcible percussion sets in vibration 
 deeper tissues, and, if their condition varies greatly from 
 the superficial tissues, there will be a mixed quality to the 
 sound that aids in identifying healthy activity, or disease, 
 or abnormal position. For instance, if we begin at the 
 right clavicle and percuss downward, until we reach the 
 lower edge of the liver, we shall pass over lung tissue at 
 first where the sound elicited under mild or forcible per- 
 cussion is essentially the same ; lower down we reach a 
 part of the lung that contains the large bronchial tubes 
 when the pitch is lower and resonance good, then still 
 lower to a part that is backed by the upper convexity 
 of the liver with only the solid diaphragm and lung 
 between it and the chest wall. Here under mild per- 
 cussion the resonance is unimpaired ; but under a firmer 
 stroke the resonance is found to lose its clearness and 
 become duller, and this dullness increases as we percuss 
 to the very edge of the lung, where the sound is fiat. See 
 Fig 20. The term "flat," as applied to percussion sounds, 
 is such a quality of tone as is produced when an organ con- 
 taining no free gaseous element is set in vibration by an 
 impact. The word " dullness " is comparative only and 
 denotes less resonance than should be expected under 
 normal conditions. 
 
 In using the pleximeter, we press it firmly against the 
 surface, and strike upon it with the rubber percussor. The 
 resonance of the instrument is slightly confusing to the 
 person who has been accustomed only to digital percussion, 
 but practice soon enables us to eliminate this sound, as 
 one does the sounds of mercantile life while listening to a 
 voice in the telephone. Practice alone will give skill in the 
 determination of normal or abnormal sounds. It may be 
 remembered that for any individual the resonance of the 
 chest is fairly constant in health, but that of the abdomen 
 varies continually ; again, the resonance of the abdomen 
 
86 Percussion and Auscultation. 
 
 is always tympanitic or flat, while that of the healthy chest 
 is neither. In making a physical examination, percussion 
 of the abdomen is useless, unless there be a history of ab- 
 dominal disorder, or inspection and palpation indicate 
 something abnormal. 
 
 For convenience in describing any location on the anterior 
 aspect of the trunk there has been a long-continued custom 
 of dividing the body into a right and left half by a median 
 perpendicular line and then designating the portion on 
 either side above the clavicle as the supraclavicular region, 
 right or left. The portion below the clavicle as far down 
 as the third rib is called the infraclavicular region and the 
 part covered by the clavicle is called the subclavian region. 
 The mammary region extends from the third rib to the 
 sixth. Below the sixth rib is the inframammary region, 
 extending to the margins of the ribs. The lower sternal 
 region extends from the ensiform cartilage to the third 
 costal cartilage, and from this point to the sternal notch is 
 called the upper sternal region. From the top of the ster- 
 mine to the cricoid cartilage is the suprasternal region. 
 The limits on the right and left are perpendicular lines 
 drawn from the tips of the acromions. At the side the 
 axillary region extends from the summit of the axilla to 
 the sixth rib, and below this is the infra-axillary space, ex- 
 tending to the bottom of the chest. 
 
 The abdomen is divided into nine regions for purposes 
 of description, as follows : Draw a horizontal line across 
 at the level of the narrowest part of the waist and a second 
 line at the level of the iliac crests. Draw a perpendicular 
 line from the middle of Poupart's ligament, on each side, 
 extending up to the chest. On the outside of these lines 
 will be found, above, the right and left hypochondriac re- 
 gions extending down to the first horizontal line. Between 
 the horizontal lines will be the lumbar regions and below 
 these the iliac regions bounded by Poupart's ligament. The 
 central portion is called the umbilical region. Above this 
 is the epigastric and below the hypogastric regions. 
 
Percussion and Auscultation. 
 
 87 
 
 In examining a subject by percussion it is well to begin 
 on the supra-clavicular region and percuss lightly and then 
 forcibly on each side, and press the fingers well against the 
 intercostal muscle rather than over the ribs, while proceed- 
 ing to the lower edge of the chest ; then purcuss the right 
 axillary region ; then the posterior thoracic, from top to 
 bottom, striking on alternate sides in order to discover any 
 difference in sound that may exist, and then the left axil- 
 lary space. There should be equal resonance of sound on 
 each side behind, unless there be extreme unevenness of 
 muscular development, which will slightly dull the sound 
 on the strong side ; but in front the location of the heart 
 
 Fig. 20. 
 Showing the areas of percussion dullness and flatness over heart, 
 liver, and stomach, i. k. line of beginning dullness around the 
 heart, a. b. d. c. area of flat sound or without pulmonary resonance. 
 p. q. line of dull area over the liver, e. c. m. I. area of flatness over liver. 
 m. n. 0. area of varying resonance over the stomach. Weil. 
 
88 Percussion and A uscultation. 
 
 to the left of the sternum, and the liver to the right of it, 
 and lower down gives a wide variation in sound for sim- 
 ilar locations on the two sides. On the right we usually 
 find the point of liver dullness beginning about 2*=™. be- 
 low the nipple, while the line of flatness is about 6^"". 
 below it — the flat area extending about the breadth of the 
 hand or to the edge of the ribs, and around to the spine. 
 See Fig. 20. On the left the area of heart dullness begins 
 at about the third intercostal space, near the sternum and 
 extends out to a point nearly an inch above the nipple, 
 and down for 3*^™., shading off into the flat heart area — that 
 
 Fig. 21. 
 
 Showing the positions of the kidneys, j. k., and spleen, k ; margin 
 of liver, /. The dotted line, e. f. g., shows the lobar divisions of the 
 lungs. Scheube. 
 
Percussion and Auscultation. 8g 
 
 is circular above about 5°™. in diameter and having its 
 center at a point half way between the nipple and the 
 center of the end of the sternum, and reaching down- 
 ward to the sixth rib, where it is merged in the stomachic 
 resonance. See fig. 20. 
 
 The line of stomach dullness is of variable location and 
 may not be perceptible at all. 
 
 The percussion sound of the abdomen is tympanitic or 
 flat, according to the existence of gas in the intestinal canal. 
 In cases of ascites, a peculiar wave impulse is started by 
 immediate percussion that is readily felt by the other hand 
 held against the abdominal wall opposite the point of im- 
 pact. The same is true of cystic tumors in other locations, 
 where the walls are protected only by soft tissues, as in 
 effusion into the synovial cavity of the knee and other 
 joints, as a result of inflammation or hemorrhage. This 
 wave impulse corresponds to the fluctuation of palpation. 
 See page 81. 
 
 The area of liver dullness should not extend below the 
 lower edge of the ribs, on the right side, while the spleen 
 is found well around to the left side, extending from the line 
 of dullness at ninth rib, downward about eight cm., the 
 breadth being about half this distance. See fig. 21. In 
 ordinary cases the spleen is not to be sought, as its func- 
 tion is not fully known, and its recognized abnormalities 
 are confined to malarial and congestive fevers, with oc- 
 casional malignant growths. The length of the thorax will 
 be found to vary greatly in different people, and, where the 
 ribs come well toward the umbilicus, the liver should hardly 
 reach to the lower edge of the ribs, except in front, while 
 in the cases of short chest it may extend five or more c. m. 
 below the free margin. The left lobe extends across the 
 median line for about six or eight c. m., (fig. 19) where its 
 limits are not readily discovered by percussion, on account 
 of the area of heart dullness. At the right side the liver 
 extends down to the tenth intercostal space, and behind it 
 reaches to the last rib. See fig. 21. 
 7 
 
po Percussion and Auscultation. 
 
 It should be remembered that the lower limits of the 
 liver may vary greatly without its being an indication of 
 enlargement or disease. In examining this organ, there- 
 fore, it is well, if any apparent malformation exists, to 
 determine by percussion, and mark with a flesh pencil the 
 outline of the organ. The exact measurements can then 
 be made and malposition differentiated from hypertrophy. 
 
 Some of the more common causes of malposition are 
 tight lacing, pleuritic effusion, congenital and traumatic 
 malformations, pericarditis with effusion, and certain ab- 
 dominal tumors. For convenience in treating the normal 
 positions of certain organs, the following points should be 
 fixed in mind : 
 
 The sternal notch is on a level with the top of the second 
 dorsal vertebra or tip of seventh cervical spine. 
 
 The spine of the scapula is on a level with the third dor- 
 sal spine. 
 
 The lower angle of the scapula is on a level with the 
 seventh dorsal spine. 
 
 The base of the heart lies at the fourth dorsal spine. 
 
 The apex of the heart lies at the level of the eighth dor- 
 sal spine. 
 
 The apex of the lung lies opposite the seventh cervical 
 spine and vertebra, and from two to four cm. above the top 
 of the sternum. 
 
 The base of the lung is on the level of the tenth dorsal 
 spine. 
 
 The spleen lies on the level of the ninth and eleventh 
 dorsal spines. 
 
 The upper convexity of the liver lies on a level with the 
 eighth dorsal spine or slightly above the lower end of the 
 sternum. 
 
 The nipple usually covers the fourth intercostal space at 
 level of sixth spinous process. 
 
 These locations are all referred to the spinous processes 
 of the vertebra as fixed points that can always be found. 
 If we rub the ball of the thumb firmly down the furrow 
 
Percussion and Auscultation. gi 
 
 between the erector spinae muscles, the tips of the spinous 
 processes will show as pink spots on the skin. This 
 method is recommended by Dr. Holden to determine the 
 existence of lateral curvatures. 
 
 In auscultation we have the method of most precise 
 knowledge in diagnosis. By other methods of examina- 
 tion we may learn that there is something wrong, but the 
 ear is the supreme court to decide the case and tell what 
 that " something " is. For purposes of auscultation sev- 
 eral instruments have been devised, but none better for 
 general use than the binaural stethoscope of Dr. Camman 
 (see Fig. 8), with its improvements for clasping into the 
 ears, without undue pressure. The unassisted ear is able 
 to do all that is required in most cases, as the sounds are 
 equally distinct, but the ear can not be readily applied to 
 all parts of the chest, and to attempt it in some cases would 
 be to affect other parts of the sensorium with more pro- 
 found salutations. 
 
 The stethoscope also enables us to localize sounds closely 
 by making a direct course of travel for sound-waves. Con- 
 sequently, it readily transmits those waves that pass directly 
 into its bell or tube ; while those waves that are not thrown 
 directly in, are either lost or become obscure, so that our 
 attention is centered on the sounds produced directly be- 
 neath. The pressure of the aural tips closes the external 
 meatus of the ear, so that foreign sounds are entirely 
 eliminated. 
 
 The following points in the use of the instrument should 
 be borne in mind : 
 
 1. Apply the instrument to the ears so that the aural tips 
 will point downward and inward, thus following the direc- 
 tion of the meatus of the ears. 
 
 2. Have just sufficient pressure in the ears to hold the 
 instrument steady and make the tips fit perfectly. 
 
 3. Let no foreign material touch against the stethoscope 
 at any part of it during use, as friction-vibrations will be 
 set up. 
 
g2 Percussion and A ttscultation. 
 
 4. Press the bell firmly over the spot to be auscultated, 
 so that it fits the integument perfectly all around. If the 
 surface is uneven, the soft rubber bell should be used. 
 
 5. Do not let the fingers move on the instrument while 
 holding it in place. 
 
 6. Always apply directly to the skin, as nothing satisfac- 
 tory can be heard through even a thin layer of cloth. 
 (See page 30.) 
 
 7. The examiner should keep his own head as nearly 
 erect as possible to avoid cerebral congestion from venous 
 constriction. 
 
 "Where the naked ear is used, a soft cloth can be inter- 
 posed between it and the subject. 
 
 In listening to the sounds of the mitral and tricuspid 
 valves with a stethoscope, it is well, should there be doubt 
 in diagnosis, to place a thin cloth, like a napkin, on the 
 chest, and auscultate through it. The only sound heard 
 through this will be the valvular click — the first sound 
 becoming short and uncomplicated like the second sound. 
 
 In auscultation continued practice must be given to 
 learning normal sounds and their relations. If the exam- 
 iner knows every healthy sound with its variations, he will 
 instantly recognize an abnormal one, even if he is not able 
 to clearly state or even understand the existing lesion. 
 Some sounds are so complicated as to defy experienced 
 surgeons in reading their significance. 
 
 The following points are to be studied : 
 
 {a) Muscle-sounds, by placing the stethoscope over a 
 muscle like the biceps, during its contraction and relaxa- 
 tion. 
 
 {b) Heart-sounds, by studying the sound at each location 
 in the precordial region and along the large arteries. 
 
 {c) Lung-sounds, in every region of the chest. 
 
 [d) Intestinal-sounds, that are caused by the gases of 
 fermentation. • 
 
 ((?) Succussion or splashing sounds of fluid in the stom- 
 ach (or chest), while it contains free gas. 
 
Percussion and A uscidtation. pj 
 
 (/) The " bruit " or hum heard in many cases over the 
 large venous trunks, especially of the neck and upper 
 chest, and over aneurismal sacs. 
 
 A muscle sound is of low pitch and vibratory quality — a 
 rapid throbbing as it were. Its character is represented in 
 exaggerated form by moistening the end of the thumb and 
 then rubbing it along the surface of a wooden table with a 
 fairly rapid movement. The thumb will jump along the 
 surface giving a low vibration to the wood. This muscle 
 sound is the cause of the peculiar, prolonged, " booming" 
 sound of the heart during its contraction, and it modifies 
 the valve sound of closing to some extent ; therefore the 
 directions on page 30 should be followed if there is an 
 apparent systolic murmur. 
 
 The valve sounds are brief in duration, of high pitch and 
 clicking or non-resonant quality. These sounds are con- 
 fused more or less by the muscle sound, by respiration 
 sounds and by the vibrations of blood currents both nor- 
 mal and abnormal. These abnormal sounds are generally 
 of blowing quality and are called murmurs. They will be 
 studied more at length in Chapter VIII. The sounds of 
 the normal heart must be patiently studied with the stetho- 
 scope until its every peculiarity is familiar ; its rythm, its 
 force, its various valve sounds, its points of clearest differ- 
 entiation of complex sounds and its transmission of sounds, 
 the relation of the pulse in various localities to heart im- 
 pact, etc. It is only by a thorough acquaintance with nor- 
 mal conditions that the abnormal can be recognized. 
 
 There will be found frequent cases of arterial and venous 
 murmurs or humming sounds that will be likely to be 
 mistaken for heart murmurs. These have a location over 
 the larger blood vessels and the sound is continuous rather 
 than intermittent, if of venous origin, and if arterial, the 
 sound is usually not heard at the heart, but at some point 
 where a large trunk makes a sharp turn as in the subclavian 
 artery.* The venous murmur may vary from a low hum 
 
 * N. Y. Med. Rec, Nov. 5, 1887. " An undescribed arterial murmur,'' 
 by H. H. Seelye, M.D. 
 
g^ Percussion and A uscultation. 
 
 to a whistling sound. The jugular vein is the spot where 
 the venous hum is most frequently heard, and in many 
 cases a hum can be produced by an uneven pressure of the 
 stethoscope, making a slight constriction in the calibre of 
 the vessel. Turning the face of the subject to one side will 
 sometimes produce a hum on the opposite side. This 
 sound has been called by some writers an anaemic hum, 
 but its cause can hardly be assigned directly to the quality 
 or quantity of the blood. Anaemia might be a factor in 
 the production of the sound by causing a softening of the 
 tissues supporting the vessel, and the watery venous blood 
 may be sonorous to a larger extent than arterial blood, as 
 taught by Walshe, but the direct cause must be the uneven- 
 ness of the calibre of vessels, through which blood must be 
 flowing at a speed bearing some relation to the size of 
 their lumena. 
 
 Arterial murmurs may be due to roughness of the inner 
 coat due to inflammations or vegetations, sacculations, or 
 pressures. These causes would produce systolic murmurs 
 that would be loudest over the site where they are produced. 
 From similar causes murmurs may be produ<:ed in the 
 cavity of the heart itself. Another class of murmurs is 
 found in extremely nervous people, excessive tobacco 
 users and over-trained athletes. It is due to irregular 
 muscular action of the heart, with consequent imperfect 
 closing of the valves, and is therefore systolic and heard 
 more commonly over the base of the heart. These mur- 
 murs are not constant, and do not frequently, if ever, 
 exist with benign hypertrophy. 
 
 Heart murmurs due to dilatation of the cavities from 
 anaemia do occur, and in those cases it is difficult to decide 
 whether there is aortic obstruction or a simple dynamic 
 i;nurmur. In the first case, however, we would find a 
 powerful heart impulse from hypertrophy, while in the 
 second there would be a feeble impulse from the imperfect 
 contractions. At times the respiratory sounds may con- 
 fuse the heart sounds by the air being driven out of a 
 
Percussion and A usciUtatioji. g^ 
 
 portion of the lung by the heart impulse, giving rise to a 
 sound that may be mistaken for a heart murmur. This 
 sound would be systolic and not heard at the apex. 
 
 It is well, then, in examination, to apply the stethoscope 
 to the apex of the heart first and then over the base, listen- 
 ing carefully to the valvular sounds and asking the subject 
 to suspend respiration in expiration for a moment if any 
 abnormal sound is heard. Then listen over the carotid 
 and subclavian arteries on each side. If a humming sound 
 is heard that can not be understood, let the subject take 
 some of the gentler strength tests, and after a slight accel- 
 eration of the pulse listen again, and so proceed until he 
 understands the case. The case may not be one to be 
 determined in a few minutes or days. 
 
 In listening to the sounds of the lungs we must also have 
 a fixed idea of the normal before endeavoring to study 
 abnormal sounds. In perfect health the normal vesicular 
 murmur of the lungs varies within quite wide limits of 
 force, pitch, quality and duration, due to the difference in 
 thickness of the chest wall and the activity of respiration in 
 different individuals, but the general character of the 
 sounds remains the same. 
 
 This sound has been likened to the faint rustling of dry 
 leaves or straw, but the only description that is of help to 
 a student, is the one that he makes to himself by continuous 
 use of the stethoscope and naked ear applied to the chest. 
 
 The following points may be borne in mind as helpful 
 in examination : 
 
 ist. The murmur is shorter in expiration than inspira- 
 tion, and in some cases the murmur is entirely suspended 
 during expiration. 
 
 2d. The murmur is harsher over the region of the larger 
 bronchial tubes, becoming milder as we pass downward to 
 the base. 
 
 3d. The heart sounds will tend to confuse the lung sounds 
 in the front of the left lung, but only in a few cases is it 
 difiicult to hear only the sounds you search for. 
 
g6 Percussion and Ausciiltation. 
 
 4th. The sounds of bronchial breathing are heard in 
 simple, uncomplicated form, over the trachea and upper 
 sternal region. 
 
 5th. the quality of bronchial respiration sound is tubular 
 and harsh ; the pitch is high. 
 
 6th. The expiration sound is longer than inspiration in 
 the region of pure bronchial breathing. 
 
 7th. Vesicular or fine respiratory murmur is heard to 
 the lower margin of the lung tissue. 
 
 8th. If the murmur ends abruptly at any point above the 
 natural border of the lung, and the murmur is normal, 
 suspect an effusion into the chest cavity. 
 
 9th. Normal flatness may begin as high as the sixth rib 
 on the right side, and at the seventh on the left. 
 
 The abnormal respiratory pounds are called rales. They 
 are in general of the bronchial type rather than the vesicu- 
 lar. The sounds may be dry and rasping as when the tubes 
 are contracted by an inflammation at the initial stage or a 
 spasm of the muscular fibres of their walls or by local pres- 
 sure. The sounds are called moist when the tubes are ob- 
 structed by more or less fluid. These rales may be so loud 
 as to obscure the vesicular murmur. 
 
 The crepitant rale is a fine dry, crackling sound, heard 
 in the last part of inspiration in pneumonia and phthisis, 
 and has been compared to " the sound produced by rubbing 
 a small wisp of hair between the thumb and finger near 
 the ear," " pulling postage stamps apart," etc. 
 
 The subcrepitant rale is heard in bronchitis, pneumonia, 
 oedema of the lungs, phthisis, etc. It is a fine, moist, 
 bubbling sound, heard in both inspiration and expiration. 
 
 Coarse bronchial rales are heard in bronchitis, phthisis, 
 etc., and are caused by mucous interrupting the flow of air. 
 These rdles may be so loud as to be heard without applying 
 the ear to the chest and if the mucous is very dry a whist- 
 ling sound will be produced. 
 
 Gurgling rales are sometimes heard, especially if the 
 subject is very weak and can not expel thin mucous from 
 
Percussion and A uscultation. gy 
 
 the larger tubes or if there is a cavity in the lung from 
 tubercular degeneration. 
 
 Aside from the respiratory sounds the vocal resonance 
 is of importance in determining the condition of the lungs. 
 
 I. — The laryngeal voice is heard over the trachea and large 
 bronchial passages, while in the general area of the chest 
 the sound is modified and softened, until the vocal expres- 
 sion is lost except over the right bronchus, and, in thin 
 persons, the left. 
 
 2. — This tone with '' far-away " quality is known as the 
 pulmonary resonance. It corresponds to the vocal fremitus 
 of palpation. 
 
 3. — Increased resonance indicates some consolidation of 
 the lung without closure of the bronchial tubes, cavities, 
 pleuritic adhesions or compressed lung tissues from 
 effusions. 
 
 4. — Diminished resonance is due to obstruction of the 
 bronchi or a layer of fluid between the lung and chest wall. 
 
 5. — Suppressed resonance is caused by large effusions in 
 the pleural sac, with compression of the lung or new 
 growths. 
 
 6. — Broncophony or a development of the bronchial type 
 of resonance in unusual locations indicates a condensation 
 or hardening of lung tissue, or cavities. 
 
 7. — Amphoric resonance indicates very large cavities, or 
 pneumohydrothorax. The quality of the sound is musical 
 and metalic ; the pitch is high and the resonance hollow 
 and without articulation. 
 
 8. — Whispered resonance is found in as many forms as 
 vocal resonance, and its modifications are due to the same 
 causes. It is a more delicate test of slight consolidation- 
 and hence should be thoroughly studied. In normal cases 
 it presents a soft blowing sound at the upper part of the 
 chest only, where consolidation usually begins. 
 
 9. — A cough resonance is helpful at times in securing 
 cumulative evidence of a condition suspected from other 
 sources of information. This is specially true of the diag- 
 nosis of cavities. 
 
CHAPTER VIII. 
 
 THE SIGNIFICANCE OF CERTAIN PHYSICAL SIGNS. 
 
 In considering the sounds of the heart it is well to bear 
 in mind the anatomical features of the heart, and the course 
 of the blood as it passes into the heart and through it to 
 the aorta. The blood from the lower parts of the body is 
 conducted by the inferior vena cava to a point near the 
 heart where it meets the current brought from the upper 
 parts by the superior vena cava, and unites with it to form 
 the innominate vein which empties into the right auricle 
 after a length of 30 to 40'°". There is no valve at the 
 mouth of this vein, but blood can flow backward through 
 it under pressure. The right auricle is a pouch-like sac 
 with only a small amount of muscular fibre in its wall. 
 This auricle acts as a reservoir of a fairly steady current 
 whose contents are discharged at intervals into the ven- 
 tricle or muscular compartment directly below it. This 
 act of discharge is easy during the period of diastole or 
 relaxation of the ventricular muscle, and is accomplished 
 by gravity and the contraction of the auricular walls. 
 When the ventricle is distended with blood the muscular 
 walls begin to contract, and the blood is forced toward the 
 two openings, the pulmonary artery and the auriculo- 
 ventricular passage, but this latter is fringed by the tri- 
 cuspid valve which is quickly closed by the current and 
 »the blood sent on, to the lungs. At the opening of the 
 ventricle into the pulmonary artery there is a valve com- 
 posed of three semilunar flaps of pocket shape, which pre- 
 vents a return current after the contraction or systole has 
 ceased. 
 
 After passing through the pulmonary tissue the blood 
 comes back to the left side of the heart and enters the left 
 
The Significance of Certain Physical Signs. gg 
 
 auricle by the pulmonary veins which are ungarded by 
 valves to prevent a regurgitation. The right auricle is 
 very similar to the left in function and anatomical charac- 
 ter. From it the blood passes down into the left ventricle 
 during its period of diastole, and is prevented from flowing 
 back during the powerful contraction of the ventricle by 
 the mitral or bicuspid valve. This closure of the auricular 
 orifice leaves only the opening of the aorta by which the 
 blood must be driven out, and which then conducts it to 
 the general circulation. At the aortic opening are located 
 semilunar valves to retain the blood that has once passed 
 into the arterial trunk, so that it can not flow back and 
 refill the ventricle during its period of receptivity. 
 
 It is clear, then, that in normal heart action we must 
 have four valvular sounds, and these must all originate at 
 points at no great distance from each other. In fact a 
 circle of 25™™. radius drawn from a center at the sternal 
 end of the fourth costal cartilage on the left will cover the 
 four valves. There are points, however, where each sound 
 is heard more plainly, and these are for the mitral valve at 
 the apex of heart ; for the aortic valves at second inter- 
 costal space just at the right of the sterum, and over the 
 right common carotid artery ; for the tricuspid valve at 
 middle of the sternum at the level of the nipple ; for the 
 pulmonary valve at the left of the sternum in the second 
 intercostal space. The mitral and tricuspid sounds must 
 be at the beginning of the systole, and are called the first 
 sound of the heart while the semilunar closings will be at 
 the end of the systole, and are called the second sound of 
 the heart. The first two sounds are synchronous, and also 
 the last two. 
 
 The first sounds are prolonged by the muscle vibration 
 into a full booming sound, while the second sounds are 
 short and clicking. Foster illustrates the difference by 
 pronouncing the words loob-diib in the same relative time 
 as the heart sounds. Between the second and first sounds 
 is an interval that is essentially two-fifths of the time 
 
700 The Significance of Certain Physical Signs. 
 
 required for a complete cycle of heart action. This is 
 called the period of rest. 
 
 The following table is a summary of normal heart 
 sounds : 
 
 NORMAL HEART-SOUNDS. 
 
 Sounds. 
 I. Muscular. 
 
 2. Mitral 
 
 valve. 
 
 3. Aortic 
 
 valve. 
 
 4. Tricuspid 
 valve. 
 
 5. Pulmonafy 
 valve. 
 
 Location. 
 
 Within boundary limits 
 heart or precordial area. 
 
 of 
 
 Behind the 3rd left intercostal 
 space and 4th costal car- 
 tilage about 20™™. from 
 sternum. 
 
 Behind the left edge of the 
 sternum at the level of the 
 3rd intercostal space. 
 
 Behind the sternum at the 
 level of the 4th costal car- 
 tilages. 
 
 Behind the junction of the 
 3rd costal cartilage with the 
 sternum on the left. About 
 in front of the aortic valve. 
 
 Where Heard. 
 
 Heard best at apex and 
 just above. 
 
 Just above apex beat 
 and at 3rd intercostal 
 space on left of ster- 
 num. 
 
 At 2nd intercostal space 
 on right of sternum, 
 and over the common 
 carotid arteries. 
 
 At lower end of the 
 sternum above the en- 
 siform cartilage. 
 
 At 2nd intercostal space 
 to left of the sternum. 
 
 The boundary limits of the heart as given by Holden are 
 as follows : 
 
 For the base draw a horizontal line over the third costal 
 cartilages extending 12°"°. to the right and 25™"". to the left 
 of the sternum. For the apex draw a perpendicular line 
 50™™. long downward from the left nipple and from its 
 lower extremity draw a horizontal line 25°^™. to the right, 
 which will bring the pencil over the apex to the heart in 
 the fifth intercostal space. The nipple is usually located 
 over the fourth intercostal space. From the apex draw a 
 curve to the end of the sternum, and continue it up more 
 sharply to the right edge of the sternum, and continue it 
 upward to the right end of the base line by a gentle curve. 
 The left side will be marked by a curve of about 200""™. 
 radius extending from the left end of the base line to the 
 apex. See Fig. 19. 
 
 The part of the heart not covered by lung tissue is incon- 
 
The Significance of Certain Physical Signs. loi 
 
 siderable, and is described by Dr. Latham as being outlined 
 roughly by a circle of 25™™. radius drawn from a center 
 half way between the nipple and lower end of the sternum. 
 Fig. 20. 
 
 Abnormal heart sounds are usually called murmurs, and 
 result from four causes : 
 
 1. The failure of valves to perfectly hold the blood from 
 leaking through. 
 
 2. The narrowness of the opening through which the 
 blood is forced into a tube of larger caliber. 
 
 3. Friction of the external surface of the heart against 
 an inflamed pericardium. 
 
 4. Friction on endocardium from vegetations. 
 
 The first cause may be due to active inflammation of the 
 valves from endocarditis, etc., that produces vegetations or 
 uneven thickening of the valves and therefore imperfect 
 closure, or the walls of the heart may become so distended 
 as to prevent perfect coaptation of the valves. Other 
 causes also may produce imperfect closure. 
 
 The second cause usually depends on inflammation that 
 has caused a deposit of fibrous tissue around the orifice 
 affected. 
 
 The third cause is more often the result of an injury or 
 strain, and is found in some cases after violent exercise. 
 
 The fourth is found after fevers, rheumatism, etc. 
 
 The character of these abnormal endocardial sounds is 
 hissing or blowing, and for this reason they are called by 
 some writers "bellows murmurs," while the friction sound 
 is more squeaking or grazing in its quality, and can 
 frequently be diagnosed by the fremitus discovered by 
 palpation. 
 
 The pitch varies in all the sounds from a low, gentle 
 murmur to a high whistling note — the pitch giving us some 
 idea as to the size of the opening ; for if the sound be 
 caused by a stream forced through a small aperture the 
 pitch will be higher — the surfaces set in vibration being 
 much shorter than in the large opening. 
 
 The most common heart lesion is a failure of the mitral 
 
102 The Significance of Certain Physical Signs. 
 
 valve to perfectly close the left auriculo-ventricular pas- 
 sage. This is called mitral insufficiency. It is plain, that 
 any fault in the closing of this valve would permit the 
 blood to flow back into the left auricle during systole, and 
 that this would cause increased pressure in the auricle and 
 pulmonary veins, thus interfering with respiration and 
 distending the auricle. As the heart contraction forces 
 blood into the aortic arch, there is an effort toward straight- 
 ening the aortia from the pressure, and this brings the apex 
 of the heart against the chest wall at about the fifth inter- 
 costal space. This brings a continuous vibratory medium 
 of solid tissue from the point of vibration to the external 
 surface where we may receive it by the ear or stethoscope. 
 We also find that the sound is carried to the left axillary 
 region along the fifth or sixth rib. The sound is heard 
 over the valvular region at the base of the heart but with- 
 out characteristic qualities. The time of the murmur is 
 during the systole, and hence it begins with the valvular 
 click of the first sound and ends with the second valve 
 closing at the aorta which gives the second sound. 
 
 If the heart sounds are so deranged that it is difficult to 
 decide which is the first sound, it may be determined by 
 remembering that it is synchronous with the impact of the 
 apex against the chest wall, and also with the pulse wave 
 in the carotid arteries. 
 
 The following sphygmogram shows the typical disturb- 
 ance of the arterial pressure in mitral regurgitation Fig. 24 : 
 
 The curve is not abrupt in the systole, 
 and the pressure is not sustained to the 
 dicrotic wave. If the systole is very 
 energetic the pulse would be large but 
 soft. The rhythm is irregular. Fig. 25 
 shows mitral regurgitation with slight 
 aortic insufficiency. In order to under- 
 stand the meaning of 
 these curves, let us 
 study briefly the nor- 
 mal pulse tracing. Fig. 24. Fig. 25. 
 
The Significance of Certain Physical Signs. loj 
 
 "All scientific investigators agree that the 
 line A represents the cardiac contraction, 
 the impulse being conveyed to the needle 
 through the arteries in the same manner 
 Fig. 26. that the impulse is given to the last marble 
 
 in a row of marbles by striking the first marble in the row 
 a quick blow, the difference being that the row of marbles 
 does not advance, while the blood current does. This 
 ascent we will call the systolic wave. 
 
 The arteries thus suddenly filled begin immediately by 
 virtue of their elasticity to contract and the needle descends 
 to the point B. Next we have a wave, the cause of which 
 is not definitely settled. It is generally believed that the 
 wave B-C, called the tidal wave, is due to a rebound of the 
 blood from the terminal vessels or capillaries, for the fol- 
 lowing reasons : 
 
 The tidal wave is more perceptible nearer the capillaries. 
 The base of tidal wave approaches the systolic line and 
 systolic apex the farther the tracing is taken from the 
 heart. 
 
 Sweating renders the tidal wave less perceptible and the 
 base nearer the dicrotic notch. 
 
 From C the artery again contracts till the needle reaches 
 point D. The rise at D is generally conceded to be due to 
 the rebound of blood from the closed aortic valves and is 
 usually termed the dicrotic wave. The remainder of the 
 cycle represents the diastole or rest of the heart."* 
 Fig. 27 shows a normal pulse 
 of high tension and Fig. 28 a 
 Fig. 27. normal pulse of low tension. Fig. 28. 
 
 The lesion that stands second in frequency is obstruc- 
 tion at the aortic orifice — any narrowing of this opening 
 that makes its caliber less than that of the aorta will pro- 
 duce a murmur and tend to increase the work of the ven- 
 tricle with resulting hypertrophy. It obviously does not 
 
 * See an article on the Use of the Sphygmograph, by Dr. J, G. Smith, in 
 the Annual Report of the Amer. Assoc, for the Adv. of Phy. Ed., 1888. 
 
10^ The Significance of Certahi Physical Signs. 
 
 menace life and health to the same extent as mitral insuffi- 
 ciency. The sound being produced by the current forced 
 out by the contraction of the ventricle it must be synchro- 
 nous with the systole and end with the second sound of the 
 heart. Its location being at the base of the heart, we 
 would expect to find the sound clearest at the beginning 
 of the aorta. It is in fact heard most distinctly over the 
 sternum at level of the second rib or just to the right of 
 the sternum, and is also heard over all the large arterial 
 trunks of the upper thorax and neck. It is called aortic 
 stenosis. 
 
 Fig. 29 illustrates the typical pulse trac- 
 ing in this lesion. The systolic curve is 
 Fig. 29. not abrupt nor high, but the pressure is 
 
 well sustained past the dicrotic notch. The pulse is small 
 and usually regular. 
 
 The third lesion in frequency is a regurgitation of blood 
 through the semilunar valves from the aorta into the left 
 ventricle. Evidently this can only occur during the dias- 
 tole of the heart. It should be heard in the same locations 
 as the murmur of aortic stenosis, and also down along the 
 sternum. The lesion is termed aortic insufficiency. 
 
 The interference with the pulse is shown by 
 Fig. 30. Its characteristics are marked. The 
 systolic curve is high and abrupt. The fall is 
 
 Fig- 3°- abrupt. The dicrotic wave is small. The pulse 
 is quick and strong ; the " bullet " pulse. 
 
 The fourth lesion producing a characteristic sound is 
 mitral obstruction due to stenosis of the left auriculo-ven- 
 tricular passage. This would interfere with the passage 
 of blood from the auricle to the ventricle in the period of 
 diastole. The murmur being started during the stage of 
 auricular contraction and ending with the beginning of 
 the first sound ; it is called presystolic. It is heard over 
 the mitral valve and at the apex of the heart, but is not 
 transmitted over a large area. This lesion leads to much 
 pulmonary disturbance on account of the increased blood 
 pressure in the lungs. 
 
The Significance of Certain Physical Signs. lo^ 
 
 The fifth lesion is obstruction of the pulmonary orifice 
 from stenosis. This would place extra work on the right 
 ventricle, which hypertrophies by natural accommodation. 
 The murmur must be systolic and heard over the second 
 cartilage to left of the sternum. It is prolonged upward 
 and to left of the sternum for only a short distance as the 
 artery soon divides into small branches to ramify through 
 the lungs. 
 
 The sixth lesion is a regurgitation through the tricuspid 
 valves due to insufficiency of the closure. It is systolic 
 and causes great increase of venous pressure by the current 
 forced back into the auricle and through it into the venous 
 trunks causing a venous pulse. It is heard at junction of 
 ensiform cartilage with the sternum and to the apex. 
 
 The seventh lesion is an obstruction of the right auricuio- 
 ventricular opening by narrowing, and hence the murmur 
 must be presystolic. 
 
 It is heard over the middle of the sternum at level of 
 fourth cartilage, and is not transmitted except to a slight 
 extent downward to the end of sternum. It is called tri- 
 cuspid stenosis. 
 
 The eighth lesion is a regurgitation through the valves 
 (semilunar) at the opening of the pulmonary artery, and is 
 termed pulmonary insufficiency. It tends to enlargement 
 of the right ventricle, and interferes with the pulmonary 
 circulation and aeration of blood. In time it must be dias- 
 tolic, and is heard at the region of the second left costal 
 cartilage. The sound is carried along the sternum faintly. 
 
 A murmur is transmitted, in general, by the blood and 
 hence in the direction of the current. 
 
 If these lesions be tabulated in the order of their fre- 
 quency, it will be observed at once that the left side of the 
 heart is most frequently affected — all possible abnormal- 
 ities having representation before the most frequent mur- 
 mur of the right side. The reason for this is clear when 
 we consider the vastly greater extent of tissues to be 
 supplied by the left side of the heart compared with the 
 pulmonary circulation supplied by the right. 
 
jo6 The Significance of Certain Physical Signs. 
 
 TABLE OF ABNORMAL HEART SOUNDS. 
 
 Condition. 
 
 1. Mitral regurg. 
 
 2. Aortic obstruct. 
 
 regurg. 
 
 Mitral obstruct. 
 
 S- Pulmon. obstruct. 
 
 6. Tricusp. regurg. 
 
 obstruct. 
 
 8. Pulmon. regurg. 
 
 Heart Sound. 
 ist sound. 
 
 After 2d sound. 
 
 ist sound. 
 
 After 2d sound. 
 
 With 2d sound. 
 
 Heart Action. 
 Systolic. 
 
 Diastolic. 
 
 Systolic. 
 
 Diastolic. 
 
 Where Heard. 
 Mitral area and 
 apex. 
 
 2d rt. cost, car- 
 til, at sternum. 
 
 2d rt. cost, car- 
 til, at sternum. 
 
 Mitral area and 
 apex. 
 
 2d left cost, car- 
 tilage. 
 
 Just above ensi- 
 form cart. 
 
 Sternum at head 
 of 4th rib. 
 
 2d left costal 
 cartilage. 
 
 Transmitted. 
 Along 6th rib to 
 axilla. 
 
 To top of ster- 
 num and arterial 
 trunks. 
 
 Down along ster- 
 num. 
 
 Not transmitted. 
 
 Up a short dist., 
 ends abruptly. 
 
 Down a short dis- 
 tance. 
 
 Not transmitted. 
 
 Up a short dis- 
 tance. 
 
 Lesion. 
 Mitral insuf 
 
 Aortic 
 
 stenosii 
 
 Aortic 
 insufficiencj 
 
 Mitral 
 
 stenosis 
 
 Pulmonary 
 stenosii 
 
 Tricuspid 
 insufficiency 
 
 Tricusp. 
 stenosis 
 
 Pulmonary 
 insufficiency 
 
 The exocardial murmur is due to the movement of the 
 heart rubbing two inflamed and roughened surfaces to- 
 gether. The pitch is usually high and quality squeaking. 
 It has no connection with the valve sounds in time or 
 location — is not transmitted in any particular direction, 
 and if loud, may be felt as a fremitus at the apex beat. It 
 has no influence on the pulse curve. 
 
 The Pulse of Mitral regurgitation: 
 
 (a) Compensated, is soft and often large. 
 
 (b) Uncompensated, is soft and short (celer.) 
 
 " " " " stenosis is small and soft (sometimes frequent and 
 
 often irregular). 
 " " " Aortic regurgitation is quick, large, " shotty pulse" (and 
 
 regular). 
 " " " " stenosis is small and long (tardus). 
 " " " Tricuspid regurgitation is venous. 
 
 There is a normal venous pulse. In time it precedes the 
 arterial pulse, and may be said to alternate with it. It is 
 caused by the auricular systole and the consequent stop- 
 ping of the free current toward the heart. 
 
 The abnormal venous pulse is discovered most easily at 
 the lower part of the jugular vein, and is synchronous with 
 the arterial pulse, being due to the same cause, namely, the 
 systole of the ventricles. This indirect current can be 
 forced into the veins only when there is insufficiency of 
 the tricuspid valve. 
 
CHAPTER IX. 
 
 PRESCRIPTION OF EXERCISE. 
 
 The main object of a physical examination is to learn as 
 many facts concerning the physical needs and tendencies 
 of the subject as possible in order to be able to advise him 
 properly regarding his exercise and personal hygiene. 
 Without being able to give exactly the measures of a per- 
 fect man or woman we must have a standard of form and 
 development that is derived from a knowledge of anatomy 
 and experience in observing the individuals that present 
 the highest evidence of perfect health and power. We learn 
 also in a negative way by a study of pathological cases. 
 The persons of impaired health can usually be so classified 
 in groups with common symptoms that certain physical 
 signs will be found common to nearly all in the group. 
 Then by a study of the history of these cases we can judge 
 with some correctness whether the physical sign stands in 
 the relation of cause or effect to the abnormal symptoms. 
 For instance, if we group together all cases of organic lung 
 diseases such as tuberculosis, chronic bronchitis, recurrent 
 attacks of pneumonia, pulmonary congestion, emphysema, 
 etc., and find that a very large per cent, of the cases have 
 in common poorly developed respiratory muscles,flat chests, 
 sagging shoulders, etc., with no other common feature, we 
 may properly conclude that a chest of this type is not an 
 ideal in the sense of being a model toward which we should 
 endeavor to conform the flexible chests of our people. 
 
 But our inference might be very far from truth and un- 
 trustworthy if we did not also approach the subject from 
 a different line of study and reach the opinion in a positive 
 way. We do this by grouping the individuals that have 
 
loS . Prescription of Exercise. 
 
 proved their ability for enduring prolonged mental and 
 physical strain, the superior individuals of society like 
 Bismark, Gladstone, Greeley, Webster, etc. If we find in 
 this group the physical conformity of chest exactly oppo- 
 site to our other group, we have added to our knowledge 
 of what should be avoided, a type that may wisel}^ be fol- 
 lowed. 
 
 It is often a question how far the aesthetic sense may 
 guide us in deciding as to a physical standard. The eye 
 will ordinarily be pleased with the form that has scientific 
 perfection. A well rounded and developed body is more 
 pleasing than a lax, untrained one, but there may be senti- 
 ments and unjust standards of criticism, the result of faulty 
 training in youth, that bias even our judgments of beauty. 
 
 This is seen everywhere in the world of fashion. A head 
 of hair that is considered beautiful and becoming one sea- 
 son must be bleached or dyed to some other color in order 
 to be " perfectly lovely " the next. This depraved taste 
 that approves of a pale face and crooked spine in a student, 
 and a narrow waist with constricted chest and pelvic dis- 
 placements in a woman, must be educated up to the scien- 
 tific and artistic standard. We must show in the gymna- 
 siums that increased health means not only increased 
 ability, but increased beauty, and that health is only a 
 correct balance of functional activities. It cannot exist in 
 perfection if one part is under-developed or over-developed. 
 * This brings us to the first point in prescription. If we 
 discover an abnormality of shape due to extraneous causes 
 we should first prescribe the removal of these causes when 
 possible. To forget this would be to give medicine to 
 counteract a poison while permitting the patient to ingest 
 the deadly substance. In work with both sexes the matter 
 of dress should be inquired into where we find any suspi- 
 cious abnormality of shape. This is especially true of con- 
 strictions of the trunk. Boys will often wear a belt in im- 
 itation of some noted "slugger" or local "tough," or for 
 other reasons known only to themselves. The injurious 
 
Prescription of Exercise. log 
 
 efifects are the same as may be seen in the case of corset- 
 aflEiicted women ; weak lumbar muscles, narrow loins, 
 pendent abdomen, varicose veins, costal respiration, diges- 
 tive ailments, etc. 
 
 The muscular weakness can not be cured while circula- 
 tion is impeded by pressure on the fibres ; the narrow waist 
 can not be brought out into correct outline, to give room 
 for a proper location of the digestive organs, that would 
 relieve the supra pubic distention, while every force is 
 crowding them down into the pelvis. 
 
 The respiratory act should be unimpeded or imperfect 
 oxidation will result and this means virtually an enforced 
 vitiated atmosphere. A reduction of waist-girth by 50™™. 
 is shown by Dr. Sargent to reduce the lung capacity twenty 
 per cent. A number of persons with an average lung ca- 
 pacity of 2.70 litres, and waist girth of 710™™. were found to 
 have a lung capacity of only 2.15 liters when the waist 
 girth was reduced to 660™'". 
 
 A reduction of the oxygen in the air by diluting it with 
 nitrogen or carbon dioxide to the extent of one-fifth (20 
 per cent.) would soon be disastrous to active life. Again, 
 constriction of the waist calls for an entirely artificial 
 method of respiration, as has been conclusively shown by 
 Dr. Kellogg, through whose courtesy the following illus- 
 trations of normal and abnormal respiration are given on 
 pages no, III, 112. 
 
 After looking at these illustrations, that explain them- 
 selves, two questions might be suggested by any person 
 not fully acquainted with Anatomy and Physiology: ist. 
 Does not the amplification of the costal curves during com- 
 pression show that the respiratory act is fairly complete — 
 one set of muscles acting when the other is impeded ? This 
 view has been presented in articles by Dr. Mays, to which 
 reference has already been made, who attempts to show 
 that this method of breathing may tend to prevent tuber- 
 culosis by causing a better action of the apices of the lungs 
 where that disease usually locates. The only support 
 brought to this theory was the fact that more men than 
 
PLATE I. 
 
 Costal. 
 
 Abdoxuinal. 
 
 Fig. 1. Man. 
 
 Costal. Abdominal. 
 
 Fig. 2. Civilized "Woman (Unmarried, age 33 years). 
 
 Costal. 
 
 Abdominal. 
 
 Pig. 3. Chinese Woman. 
 
 Costal. Abdominal. 
 
 Fig. 4. Indian Man (Chickasaw). 
 
 Costal. AbdominaL 
 
 Fig. 0. Indian Woman (Chickasaw). 
 
 Costal. Abdominal. 
 
 Fig. 6. Chippeway Indian Woman. 
 
PLATE II. 
 
 Fis. 
 
 Costal. Abdominal. 
 
 A Scotcli Woman, who has never worn a corset (age 45, nnmamed). 
 
 Costal. Abdoniinal. 
 
 Fig. 8. A Reformed Corset-wearer (ordinary respiration) 
 
 Costal. AoaonuBaL 
 
 Fig. 9. Reformed Coreet-wearer (forced respiration). 
 
 Costal. Abdominal. 
 
 Fig. 10. Young Woman in Corset. 
 
 Costal. 
 
 Fig. 11. 
 
 Abdominal. 
 
 Man in Corset. 
 
 Costal. Abdominal. 
 
 Fig. 18. Male Dog. 
 
 postal. Abdominajl: 
 
 Fig. 18. Female Dog. 
 
PLATE III. 
 
 Costal. Abdominal. 
 
 Fig. 14. Woman at Seventli Month of Pregnancy. 
 
 Costal. Abdominal. 
 
 Pig. 15. Woman, a Week Before Confinement. 
 
 Costal. Abdominal. 
 
 Fig. 16. Man with Enlarged Spleen. 
 
 Ordinary. Forcedi 
 
 Fig. ir. Respiratory Tracing (Vaginal). 
 
 Ordinary. Forced. 
 
 Fig. 18. Vaginal Tracing, with Corset. 
 
 Without Corset. Xishtening With Corset. 
 
 Corset. 
 
 Fig. 19. With and Without Corset. 
 
Prescription of Exercise. iij 
 
 women die of pulmonary tuberculosis ; but when we re- 
 member that this disease is largely due to climatic influences 
 of which wide and sudden variations are the chief feature, 
 and that men are more exposed to these variations than 
 women, the argument seems worthless. 
 
 But even if we concede a possible safeguard against tub- 
 erculosis in tight lacing we must still look upon it as a 
 case where the remedy is worse than the disease, or a dis- 
 guised blessing of the kind described by " Josh Billings," 
 who remarked that " tight boots are a blessing, inasmuch 
 as they cause a man to forget all his other miseries." 
 
 2nd, If costal respiration is prejudicial to health why do 
 we not have a larger death-rate from acute lung diseases 
 and other diseases directly traceable to interference with 
 respiration ? 
 
 The reply is ready that the impaired activity of one organ 
 rarely gives evidence in physical signs of its abnormality. 
 Even as sensitive an organ as the brain may disclose its 
 disordered function, not by pain in the head, but by an ab- 
 normal secretion in some remote organ ; or a disease of the 
 kidney be discovered by its causing an organic change in 
 the heart. The lungs are ordinarily capable of enduring 
 great hardship. Their flexibility enables them to conform 
 to any shape of the thorax or to be compressed for a long 
 time by a pleuritic effusion, or other cause, without per- 
 manent injury, as is frequently seen in cases of extreme 
 kyphosis. According to the statistics of the New York 
 Mutual Life Insurance Co., consumptives average one and 
 a half inches less in chest girth than non-consumptives. 
 But meanwhile how fare the organs that are dependant 
 on good blood ? The brain can not act well from the in- 
 stant unoxidized blood which flows in to supply it. Low- 
 ered vitality is the result with a yielding to acute diseases 
 of every kind. Many a death is recorded as due to typhoid 
 fever, peritonitis, malaria, etc., that is really due to a defi- 
 cient respiration when the system requires the most active 
 oxidation. The respiratory power is recognized as of the 
 highest importance in all acute diseases. 
 
ii/f. Prescription of Exercise. 
 
 We must see to it, then, that no article of clothing inter- 
 fere with the free action of every organ. 
 
 The same care must be exercised in judging whether or 
 not a bad form is due to faulty habits of posture. If the 
 respiration is checked by a position that brings a bend in 
 the trunk with a depression across the upper part of the 
 abdomen, as is the case when one slides forward in his seat 
 until the sacrum instead of the ischia bears the weight of 
 the body, the same ill results will be found that are noticed 
 in tight lacing. 
 
 The horizontal depression due to the above cause will 
 sometimes be found as high as the fifth rib and we can 
 readily understand the interference with circulation that 
 must exist in such cases. In all there will be more or less 
 disturbance of the hepatic function, impaired digestion, 
 constipation and atrophy of the lumbar muscles. 
 
 The muscular condition of the loins and abdominal wall 
 can tell us much about the digestion and nutritive powers. 
 If these muscles are weak we must point out the fact with 
 emphasis and order such exercises as shall tend to give 
 strength and activity to them. The small size of a man's 
 biceps or gastrocnemius often troubles him when his real 
 anxiety should be regarding his erector spinae or rectus 
 abdominalis. 
 
 It is the essentials that we must lay stress upon in our 
 prescriptions, for the other parts will get incidental exer- 
 cise in almost every case. A person's arm will always be 
 large enough for the ordinary demands of life upon it — his 
 heart may not be ; his leg will always be strong enough to 
 fill every requirement — his stomach may fail utterly. A 
 man may have life and fair health with complete loss of 
 some muscles, while others act at the seat of life itself. 
 
 A class of cases will come under the care of the instruct- 
 ors in the gymnasiums of Schools and Colleges that will 
 be rarely met by the Directors of other gymnasiums ; a 
 set of boys and girls who have been overworked mentally 
 and underworked physically, until the nervous side of 
 
Prescription of Exercise. 115 
 
 their lives is far in the ascendant. The whole idea of 
 physical exercise has become repulsive to them because 
 their muscular tissue is so weak that any fair activity 
 begets great weariness, and sometimes even lameness. 
 Brain work is easy for them because it has become the 
 habit of their lives ; they can generally accomplish great 
 feats in the way of bearing severe strains of short duration, 
 both mental and physical. They can sit up all night pre- 
 paring for an examination, and the next day are bright 
 and ready for good work, or, at the time of physical exam- 
 ination they show a surprisingly high record in strength 
 tests, but come in the next day to tell of a strained back or 
 lame shoulder as the result of their lifting. They make 
 good athletes, but are continually getting over-trained. 
 They invariably do too much. 
 
 Is gymnastic work advisable for such persons ? An 
 affirmative answer can only be given when there is to be 
 personal supervision of the work. The boy of high nerv- 
 ous organization needs exercise quite as much as one who 
 has no tendency to abnormal nerve activity, but it must be 
 of a different character, for the results sought are dissimi- 
 lar. The nervous person does not live enough in his 
 muscles. His habit is to make excursions out into his 
 extremities, and after stirring them up and making every 
 tissue tingle he retires, to leave each muscle exhausted 
 and every energy depleted. The exercise prescribed for 
 these cases, and enforced by personal supervision, must be 
 light, and continued over a long period of each day. To 
 satisfy the mental requirement of the case the work must 
 be made attractive, either as a game or a personal contest 
 between individuals. In a few cases such an interest in 
 the physical welfare can be excited in the subject as to 
 take the place of this mental interest that is stimulated by 
 games, and a person will do routine work that is laid out 
 simply from the enjoyment that he gets from visible im- 
 provement. 
 
 Athletic work, on the other hand, is too stimulating to 
 
Ii6 Prescription of Exercise. 
 
 the nerve centers to be advisable for such cases. The ex- 
 citement of contests will leave a person exhausted, for it 
 I will continually lead him to over-exertion.. This objection 
 
 does not apply to those contests where skill rather than 
 great strength is the source of excellence. 
 
 Many of these persons, if uncared for in the gymnasium, 
 would shortly fall into the hands of a physician as typical 
 cases of neurasthenia, and rest must often be prescribed 
 instead of exercise. The Swedish system of passive move- 
 ments, or massage, gives us an opportunity to develop 
 muscular tissue even while the patient is resting, for the 
 passive motion of the muscles tends to stimulate the circu- 
 lation in the same way as active exercise, and consequently 
 the nutrition and growth of the part is actively promoted. 
 
 Comparatively few people understand what is meant by 
 complete rest. The complete relaxation of every tissue 
 is a requisite of rest, and a habit of relaxation by an 
 act of will can soon be secured. There are many noted 
 cases of this ability to even sleep by an act of sheer will 
 power. One of the most useful features of the Delsarte 
 system lies in the attention that is paid to this idea of 
 physiological rest. The effect of sunlight on these Neuras- 
 thenic cases is almost always favorable, and consequently 
 outdoor work should be prescribed in preference to indoor 
 work. 
 
 In marked contrast to the cases mentioned the athlete 
 may be placed. Advice in regard to exercise will be 
 sought, and such exercise must be prescribed as will tend 
 to secure a development of the muscles that are least used 
 in the particular form of exercise in which the athlete en- 
 gages. Again, after a severe course of training for any 
 athletic event, many cases will find discomfort from local 
 congestions on account of an over-activity of the heart 
 during the period when there is no great physiological 
 "wear and tear" to require a very active circulation. To 
 meet these cases a course of training must be laid out that 
 shall be graduated from heavy work down to light, so that 
 
Prescription of Exercise. iiy 
 
 the person may slowly accustom himself to the new con- 
 ditions under which he must live. The heart of an athlete, 
 who has been properly trained, is usually in good condi- 
 tion, and a very small percentage develop any heart lesion 
 during their training, but a large strong heart may be an 
 actual disadvantage to a man leading a sedentary life, as a 
 puny, feeble heart surely is. 
 
 The examiner will find many cases of debility and ner- 
 vous irritability. Among men a large per cent, of these 
 cases will be inordinate users of tobacco. The very first 
 glance will betray to the experienced eye the " something 
 wrong," but we must always remember that some of the 
 most persistent users of tobacco are strong and hearty 
 while a few of those who do not use it are weak and ner- 
 vous. How then shall we say to a person who asks our 
 advice whether he is suffering from nicotine poisoning or 
 not? 
 
 In the first place the heart action under continued in- 
 fluence of nicotine is peculiar and attention is called to 
 
 the sphygmo- 
 gram, Fig.31, 
 of a typical 
 Fig. 31. pulseofa 
 
 " tobacco heart," from the Reference Handbook of the 
 Medical Sciences. It will be noticed that the first two 
 beats are essentially normal with the tidal wave as marked 
 as the dicrotic. The interval between the second and third 
 waves is longer than the first which may be considered the 
 normal for this case. The third interval is short and the 
 dicrotic notch deep while the systolic wave is not high. 
 The fourth interval is normal ; the fifth longer and fol- 
 lowed by a very faint impulse after which the heart again 
 rallies, and so on. 
 
 The character of this pulse as felt at the wrist is irreg- 
 ular and tremulous. A beat or two of high tension fol- 
 lowed by one of low, or there may be no rythm discover- 
 able. 
 
ii8 
 
 Prescription of Exercise. 
 
 These cases should be studied carefully and can readily 
 be distinguished from the frequent pulse of nervous ex- 
 citement or Ihe palpitation and irregularity of chronic 
 indigestion. In perhaps three-fourths of the cases there 
 will be some nervous excitement attendant on the new 
 experiences of a thorough examination but this influence 
 on the pulse may be either quickening or depressing, and 
 these changes come not for single beats but during cycles 
 covering many pulsations. 
 
 An intermittent pulse may not be an indication of serious 
 interference with health or longevity and may not be due 
 to any appreciable cause. The omission is then usually 
 found at stated intervals not very short, but from ten to a 
 hundred beats apart. 
 
 Of course the examiner's duty is clear in each discovered 
 case of smokers' irritable heart, and it is only suggested 
 that other narcotic stimulants, like tea and coffee, will pro- 
 duce effects that are nearly similar. In these cases the 
 exercise recommended must be light, and such as tends to 
 relieve the circulation. 
 
 The following form of blank prepared by Mr. C. M. Williams of the 
 St. Louis Y. M. C. A. Gym. is the best of the many that have come 
 under the author's notice where personal explanations can accompany 
 the directions : 
 
 Apparatus. 
 
 Move- 
 ments. Times. 
 
 Chest Weights . 
 Giant Pull. " ., 
 Low Chest " - 
 Split H'dle Giant 
 Intercost. Mach. - 
 Abd. Giant Pull.. 
 Quarter Circle . 
 Rowing Machine 
 ScullingMachine 
 Paddl'g Mach. . 
 Chest Expander . 
 Leg Developer . 
 Leg Developer _ 
 Neck Machine . 
 Forearm Devel. . 
 Abdominal Stool 
 B'k&LoinPuU. . 
 Finger Machine . 
 Paral. Bar Mach.. 
 Parallel Bars.. . 
 Horizontal Bar _, 
 Vaulting Bar.. _ 
 
 Weight. 
 
 Apparatus. 
 
 23. Vertical Bar .. 
 
 24. Floor Bars 
 
 15. Incl. Chest Bars 
 
 26. Ver. Chest Bars 
 
 27. Susp. Par. Bars 
 
 25. Vaulting Horse 
 
 28. Vaulting Buck 
 
 29. Inclined Ladder 
 
 30. Horizont'I Lad. 
 
 31. Climbing Ropes 
 
 32. Peg Pole 
 
 33. Climbing Pole 
 
 34. Striking Bag.. 
 
 35. Kicking Appar. 
 
 36. Jumping Stand. 
 
 37. Flying Rings. 
 
 38. Traveling Rings 
 40. Spring Table.. 
 
 Bar Bells 
 
 Dumb Bells... 
 Indian Clubs . 
 
 Move- 
 ments. Times. 
 
 Weight. 
 
Prescription of Exercise. iig 
 
 The following directions prepared by Dr. J. G. Smith are more intel- 
 ligible where the person has no direct supervision in his work : 
 
 1. For Grip and Forearm — Opening and shutting fingers with or 
 without resistance, (a) wrist roller : (3) clubs ; (c) bells ; (</) horizontal 
 bar and {e) rings. 
 
 2. Front Arm — Any exercise bending the elbow joint against resist- 
 ance especially while rotating the thumb outwards ; such as {a) curling 
 dumb bells ; {U) the pull up ; (c) the rings ; {d) the horizontal bar ; (e) 
 the high parallels ; (/) the pulley weights ; {g) climbing ropes and 
 ladders. 
 
 3. Back Arm — Any exercise straightening elbow against resistance ; 
 {a) pushing up dumb bells ; (b) dip on parallels ; (c) traveling parallels ; 
 (d) pulley weights ; (e) striking bag ; (/) chest bars, either straight or 
 inclined ; {g) work on horse or buck. 
 
 4. Shoulders — Any exercise carrying the arm from the body against 
 resistance, either front, back or out, with (a) bells ; (b') clubs ; {c) pulley 
 weights ; (d") wands, etc. 
 
 5. Neck — Bending head back, front or sideways against resistance of 
 the hand or neck machine. 
 
 6. Chest Muscles — Any exercise tending to bring the arms across 
 the body, whether front or back, or raising the body when arms are 
 fixed, as (a) pulley weights ; {b) parallels ; {c) horizontal bar ; {d) travel- 
 ing parallels ; {e) high parallels ; (/) ladders ; {g) chest expanders ; {h) 
 giant pulleys ; (j) rings ; (/) quarter circle. 
 
 7. Abdominal Muscles — Any exercise tending to bend the body 
 forward against resistance ; such as («) quarter circle ; (U) abdominal 
 mat and stool ; {c) raising from a reclining to a sitting posture ; {d) pul- 
 ley weights ; (e) giant pulleys ; (/) the " L" on ladders, rings, horizontal 
 and parallels. 
 
 8. Back — Any exercise straightening or bending the body back 
 against resistance, such as (a) rowing ; {b) low pulleys ; (c) dumb bells ; 
 (^) free-hand and setting up drills, {e) wands. 
 
 9. Front Thigh — Any exercise bending the hip or straightening the 
 knee against resistance ; {a) leg work of free-hand and dumb bell drills ; 
 {b) running ; (c) hurdling ; (d) jumping ; (e) leaping ; (/") rowing ; (g) 
 leg machine. 
 
 10. Back Thigh — Any exercise bending knee or straightening hip 
 against resistance, {a) Second motion of West Point Setting Up Drill ; 
 (b) leg work of pulley weight drills ; {c) free-hand and dumb bell drills ; 
 {d) striking bag. 
 
 11. Front of Leg. — Any exercise raising toes, or tending to carry 
 body forward with bent knee against resistance ; («) pulley weights with 
 back towards them ; (b) leg work of dumb-bell and free-hand drills ; 
 (<:) ankle machine. 
 
 12. Back of Leg — Any exercise raising the body on the toes. All 
 exercises for front of thigh ; ankle machine. 
 
120 
 
 Prescription of Exercise. 
 
 For all around development with light apparatus no better work has ever 
 been devised than the dumbbell drill of R. J. Roberts. 
 
 Roberts' Gymnasium Dumbbell Drill No. i, . 
 
 Div. I— Free Work. 
 
 Open and shut fingers. 
 
 Wrist shakes. 
 
 Wrist extensions. 
 
 Small circles. 
 
 Arm quivers. 
 
 Yawn stretch. 
 
 Windmill down in front of face. 
 
 8 Same down through sides horizontals. 
 
 9 Milkman's slap. 
 
 10 Back neck exercise. 
 
 11 Sternum expression. 
 
 12 Out-door breathing work. 
 
 13 In-door breathing extensions. 
 
 14 Massage. 
 
 Raise high on tip-toes. 
 Raise sharp on heels. 
 Combine one and two. 
 Ankle cradle rock. 
 
 Squat half way down. 
 Squat all the way down. 
 Combine one and two. 
 Front hammer. 
 Side hammer, No. 2. 
 
 1 Side push. 
 
 2 Sternum elevator. 
 
 3 Cradle rock. 
 
 4 The chop — vocal. 
 
 5 Shoulder raiser. 
 
 6 The cut — vocal. 
 
 7 The cut — stretch. 
 
 8 Liver squeezer. 
 
 9 The flip. 
 
 10 Yawn stretch. 
 
 Div. 2 — Leg Work. 
 
 5 Spread eagle. 
 
 6 Raise on toes and roll the shoulders 
 
 back and down. 
 
 Div. 3 — Thigh Work. 
 
 6 4 count side pull the string. 
 
 7 Spring board jump. 
 
 8 Jump rope. . 
 
 9 Stationary run with %, % turns and 
 
 arm expressions. 
 
 Div. 4 — Body Work. 
 
 11 Forward push — vocal. 
 
 12 "A" walls. (Jump feet together on 
 
 last count.) 
 
 13 Push to sides horizontals. 
 
 14 Muscular chest. 
 
 15 Vertical push (pull the string.) 
 
 16 Dry land swim (forward hammer.) 
 
 17 Same side hammer, No. 2. 
 
 18 The 32 count, Nos. 1,4,6,9, 11, 13, 15. 
 
 1 Biceps — up hard. 
 
 2 Triceps — down hard. 
 
 3 Combine two and one. 
 
 4 Triceps, vocal — Hello. 
 
 5 " " —Ah. 
 
 Div. 5— Arm Work. 
 
 6 Triceps, vocal — Sh. 
 
 7 Tricep swing (st. exp.) 
 
 8 Wrist twists. 
 
 9 Wrist curls. 
 10 Yawn stretch. 
 
 Div. 6 — Extension Work. 
 
 1 Forward sweeps. 
 
 2 Side sweeps. 
 
 3 Strike, hard, behind heels and under 
 
 chin and over head. 
 
 4 Clavicular exercise. 
 
 5 Trapezius squeeezer. 
 
 6 Strike behind thighs and under chin. 
 
 7 Strike over head and under chin. 
 
 8 Combine six and seven. 
 
 9 2 count side pull the string. 
 
 10 Repeat No. 7 and pull the string. 
 
 11 The scoop, (do slowly.) 
 
 12 The toe yawn stretch. 
 
Prescription of Exercise. 121 
 
 For cards or prescription blanks to be furnished to the 
 individual examined many devices have been originated, 
 the principal ones, containing a list of the measurements 
 of the person, on which is marked the parts that especially 
 need development, while on another, part of the card is a 
 reference either to apparatus or to the form of exercises 
 that will specially tend to develop those parts. The 
 standard that is commonly used on these cards is an 
 average made up from the measurements of a large num- 
 ber of individuals. The question of what is a typical or 
 ideal man is still an open one, however, but perhaps no 
 better idea of such a man can be gained at present than 
 the measurements illustrated in the chart of Dr. E. Hitch- 
 cock, Jr., as shown in Appendix 4. 
 
 We should have a standard of marking physical excel- 
 lence or deficiency in a numerical way that shall in some 
 way correspond with the mark that is given on examination 
 for intellectual accomplishments. Francis Galton, in a pa- 
 per prepared for the American Association, suggests that 
 attention be given to this point, and says : " I would ask to 
 be permitted to suggest a subject, or rather a very interest- 
 ing class of subjects, that fall under this head ; it is to in- 
 vestigate the best method of assigning marks for physical 
 efficacy based on anthropometric tests. The colleges of 
 America would greatly help in a good cause by working 
 on the general lines suggested in this paper. I see no 
 reason why a man's physical efficacy should not be valued 
 in terms simply of the number of marks awarded on a well 
 understood system, nor do I see any reason why an 
 employer, making his selection among many candidates, 
 should not hereafter, at some not distant time, be in- 
 fluenced in favor of that candidate who possessed a certifi- 
 cate of having been awarded high marks. Man is a 
 machine of flesh and bone, and a good machine of any 
 kind is worth more than a bad machine." 
 
CHAPTER X. 
 
 GRAPHIC ANTHROPOMETRY. 
 
 Within the last six years various devices for applying 
 the principles of graphic mathematics to the measures and 
 tests of men have been invented. These have been the 
 outgrowth of the graphic method of Quetelet for showing 
 the mean of any part, as chest girth or height, and the tables 
 of averages and means published from time to time during 
 the last twenty-five years by Dr. Hitchcock of Amherst 
 and the tables of percentages published by Francis Galton 
 and other students of anthropology. 
 
 The oldest record of anthropometrical data in any col- 
 lege in the country is to be found at Amherst, where from 
 1 86 1-2 to this date the students have had the advantage of 
 a physical examination, and advice regarding exercise and 
 a record of their general size has been secured. In 1881 
 Dr. D. A. Sargent proposed a more extensive list of items 
 for measurement after the plan of Dr. W. T. Brigham of 
 Boston and the European studies in anthropometry. In 
 the following year this plan was adopted at Amherst, and 
 in 1883 at Yale. 
 
 The order of items as originally arranged by Dr. Sargent 
 has been rearranged in a better order for graphic represen- 
 tation if not a more logical order by the author in his an- 
 thropometric table and the recent record books of Yale. 
 This list of items with only slight modifications is now in 
 general use in all educational institutions where there is an 
 aim at complete methods and the highest results. 
 
 The items given on Dr. Hitchcock's table page 126 are 
 extended in the record book of Yale by the addition of age, 
 breadth of chest, development, condition, exercise, vision, 
 hearing, color of hair and eyes, pulse rate, and use of to- 
 bacco. The horizontal length is omitted. It may be said 
 in further explanation of these tables of Dr. Hitchcock that 
 
Graphic Anthropometry. i2j 
 
 the record of each student is transcribed for him on a table 
 that is compiled from the measurements of men of the 
 same height as the subject — the table here shown being the 
 one that would be given to the man of average height or 
 1725"". 
 
 In 1878 Dr. D. A. Sargent of Harvard began a system- 
 atic record of measurements of students examined by him- 
 self, and with the enthusiasm which he excited in the edu- 
 cational world by his abundant preparation for the work, 
 his natural ability and his unequaled field for observation, 
 he soon established a school for training teachers in the 
 theory and practice of gymnastics, and sent out many able 
 instructors imbued with his ideas and ready to assist him 
 in the development of a plan for the determination of some 
 physical standard for American college students that should 
 be derived from a tabulation of all the measurements that 
 could be secured. The work was very comprehensive in 
 scope and the main results have not yet been given to the 
 public, but a partial result has been seen in the graphic 
 chart that was prepared in 1886 (see appendix I.) by which 
 Dr. Sargent was able to give a person an idea of how he 
 compared with the whole body of students whose measures 
 had been tabulated. A second result was seen in the July 
 and October numbers of " Scribner's Magazine" for 1887, 
 where, in an article on "The Physical Characteristics of the 
 Athlete," certain well-known men were pictured graphically 
 as well as literally, and thus the application of the method 
 was more clearly impressed by Dr. Sargent on the minds 
 of persons engaged in physical education. 
 
 Meanwhile Dr. Hitchcock of Amherst College, who had 
 published tables of average measurements of Amherst stu- 
 dents of all ages, from fifteen up to twenty-eight years, and 
 tables of averages where height instead of age was the basis 
 of tabulation, issued a table in which the latter averages 
 were arranged on a sheet in order from shortest to tallest, 
 by gradation of one centimeter, and the records of an or- 
 dinary person, could be indicated on this new table in a 
 graphic way. In 1887 an ''adjusted averages" table was 
 
1 2/1. Graphic Anthropometry. 
 
 prepared as a simple acknowledgment that the tables were 
 compiled from so few records in many cases that there was 
 considerable irregularity, and therefore after determining 
 the apparent law of variation, the table was made to con- 
 form more or less closely to this law, and a better sheet 
 for graphic illustration was produced. The numerical com- 
 parison method that has been in use at Amherst for over 
 twenty-five years is still the favorite one there. See page 
 126. The tables compiled by Dr. Hitchcock are the most 
 complete in existence in this country, the records all having 
 been taken by one man. 
 
 In 1888 the measurements of Yale students for five years, 
 that had been taken by the author and that included every 
 man in the undergraduate departments for three years and 
 of two other academical classes, except three men, for four 
 years ; altogether over 2,200 men were compiled and ar- 
 ranged in tabular form according to the method of Mr. 
 Galton. See appendix II. 
 
 This has furnished a table for graphic illustration and 
 personal information that is fairly complete. It combines 
 the comparison of a man's record with the whole mass of 
 students ; a comparison with the mean ; the statement of 
 the actual numerical size of each part of an individual, and 
 its relation to every other part. 
 
 Dr. Fremont Swain of Brooklyn also, in 1888, devised a 
 chart for graphic illustration, using the figures of Dr. Sar- 
 gent as a basis. 
 
 In 1889 Dr. W. L. Savage of Savage's Gymnastic Institute, 
 308 West 59th Street, New York City, devised a chart for 
 use in plotting the measures of boys and youths. See ap- 
 pendix III. The scheme is very ingenious and will be found 
 generally useful when the table on which it is based is placed 
 in the hands of instructors. The chart can be used for any 
 age and gives absolute record of averages rather than com- 
 parative. For boys the method of averages is probably the 
 best, as the method of means can not be scientifically used 
 in compiling data derived from all ages as is being done 
 at present by some prominent teachers and anthropome- 
 trists, the material not being homogeneous. 
 
Graphic Anthropometry. 12^ 
 
 In the present year undoubtedly the most completely 
 graphic method that has yet been devised was completed 
 by Dr. E. Hitchcock, Jr., of Cornell University. See appen- 
 dix IV. It is based on the tabulation of 15,000 sets of 
 measurements — all made by physicians who are experi- 
 enced in the work. The figure is drawn from the average of 
 the various measures, and lines to right and left show in a 
 perfect manner the relation of girths as they are actually 
 found to exist. The relation in size of limb girths to semi- 
 girths of the trunk have never been so clearly demonstrated 
 before, and therefore the chart is an important contribution 
 to artistic anatomy. This chart has been the product of a 
 larger compilation of measurements than has ever before 
 been made of the same class in the community. 
 
 " The Table first following, which is called the Average 
 Anthropometric Table, exhibits, under fifty-five items, the 
 average measurements of bodily proportions and tests of 
 strength which were obtained during the college years 
 1 86 1-2 to 1888-9 from the study of nearly eight thousand 
 Amherst College students seventeen to twenty-six years of 
 age. 
 
 The Table is so arranged that it may be used to record 
 the measurements of any young man, affording him a ready 
 comparison of himself with the normal or average young 
 man as represented by the printed columns of figures. 
 
 To record the results of an examination : if the item is 
 less than the standard as represented in these central col- 
 umns, put it in the left blank space ; if the same or greater, 
 put it in the right. In this way, when the examination is 
 fully recorded, the person can ascertain at a glance, by 
 simple addition or subtraction, how much he varies from the 
 measurements of a young man of 1725 millimetres, or 67.9 
 inches stature, which is regarded as the standard for the 
 students of Amherst College. Should he desire to know 
 the percentage of difference between himself and the stan- 
 dard, a simple division will inform him, and its result, 
 whether less or greater, can be recorded on the outer blank 
 space." 
 
126 
 
 Graphic Anthropometry. 
 
 AVERAGE ANTHROPOMETRIC TABLE. 
 
 7725 millimeters, or 6y.g inches being the standard. 
 
 
 Items. 
 
 Per 
 Cent. 
 
 Below 
 Aver- 
 age. 
 
 Metric English 
 System. System. 
 
 At or 
 
 above 
 
 A verage. 
 
 Per 
 Cent. 
 
 
 
 
 
 
 
 We 
 
 
 
 
 Kilos. Pounds. 
 61.2 134.6 
 
 
 
 
 
 
 
 
 Sta 
 
 
 
 
 M. M. Inches. 
 
 1725 67.9 
 
 
 
 
 
 
 
 
 5 
 
 $- 
 
 [ Sternum, . . 
 
 
 
 1410 S5-£ 
 1030 40.6 
 860 33.9 
 903 35-5 
 475 18.7 
 
 
 
 Navel, 
 
 
 
 
 
 Pubes, 
 
 
 
 
 
 Sitting, 
 
 
 
 
 
 1 Knee, 
 
 
 
 
 
 . . 
 
 
 
 
 
 
 
 Head, 
 
 
 
 572 22.5 
 349 13-8 
 880 34.6 
 927 36.5 
 724 28.4 
 893 35-1 
 517 20.3 
 512 20.2 
 361 14-3 
 359 14-2 
 359 14-2 
 349 13-8 
 245 9-5 
 242 9.4 
 257 lO.O 
 
 253 9-9 
 295 II. 6 
 251 9-8 
 247 9-7 
 267 10.5 
 261 10.2 
 166 6.5 
 16s 6.5 
 
 
 
 
 Neck, 
 
 
 
 
 
 
 Chest, repose, 
 
 
 
 
 
 
 Chest, full, 
 
 
 
 
 
 
 Belly, 
 
 
 
 
 
 
 Hips, 
 
 
 
 
 
 
 Right Thigh, 
 
 
 
 1 .^ 
 
 
 Left Thigh, 
 
 
 
 
 
 
 Right Knee, 
 
 
 
 
 
 
 Left Knee, 
 
 
 
 
 
 1^ 
 
 OS 
 
 Right Calf, 
 
 
 
 
 
 Left Calf, 
 
 
 
 
 
 Right Instep, 
 
 
 
 
 
 Left Instep, 
 
 
 
 
 
 
 R. U. Arm, 
 
 
 
 
 
 
 L. U. Arm, 
 
 
 
 
 
 
 R. U. A., cent., 
 
 
 
 
 
 
 
 Right Elbow, 
 
 
 
 
 
 
 Left Elbow, 
 
 
 
 
 
 
 Right Forearm, 
 
 
 
 
 
 
 Left Forearm, 
 
 
 
 
 
 
 Right Wrist, 
 
 
 
 
 
 
 L Left Wrist, 
 
 
 
 
 
 
 Head, 
 
 
 
 155 6.1 
 108 4.2 
 430 16.9 
 198 7.8 
 250 g.8 
 323 12.7 
 
 
 
 Neck, 
 
 
 
 
 
 Shoulders, 
 
 
 
 
 
 Nipples, 
 
 
 
 
 
 Waist, 
 
 
 
 
 
 I Hips, 
 
 
 
 
 
 n 
 
 Chest, 
 
 
 
 
 
 
 Abdomen, 
 
 
 
 
 
 
 
 
 
 
 
 
 
 f R. Shoulder Elbow,.. 
 
 
 
 373 H-7 
 371 14.6 
 461 18.1 
 459 18.0 
 260 10.2 
 259 10.2 
 1780 70.1 
 1732 68.1 
 
 
 
 . 
 
 Left Shoulder Elbow, 
 Right Elbow Tip, 
 
 
 
 
 
 
 
 
 
 
 Left Elbow Tip, 
 
 
 
 
 
 
 Right Foot, 
 
 
 
 
 
 Left Foot, 
 
 
 
 
 
 i>^ 
 
 Stretch of Arms, 
 
 
 
 
 
 
 . Horizontal Length,... 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Kilos. Pounds. 
 1-5 3-3° 
 137 301 
 166 36s 
 
 41-5 91-3 
 38.1 83.8 
 No. of times. 
 6 
 
 9 
 
 
 
 rS> 
 
 Back 
 
 
 
 
 
 ■» 
 
 Legs, 
 
 
 
 
 
 1 ' 
 
 Right Forearm, 
 
 
 
 
 
 Left Forearm, . . 
 
 
 
 
 
 
 Dip, 
 
 
 
 
 
 00 
 
 
 
 
 l Pull Up, 
 
 
 
 
 
 
 
 
 
 
 Luh 
 
 
 
 
 Litres. Cub. In. 
 3.77 230 
 
 
 
 
 
 
 
 
 PlLOSITV, 
 
 
 
 Tenths of Body. 
 2.25 
 
 
 
 * Depths. 
 
Graphic Anthropometry. 12'j 
 
 The numerical method of comparison has been the one 
 in most general use because the data necessary for making 
 a graphic picture of a person's anatomical proportions has 
 only recently been made public. The advantage of a graphic 
 illustration of physical proportions is as great as the ad- 
 vantage of that method in any department of scientific 
 work. It discloses at a glance what is discovered only 
 after considerable time spent in study of figures. It would 
 seem that the union of the graphic and numerical methods 
 of stating the proportions of an individual must be more 
 comprehensive than either method alone, and more satis- 
 factory to both instructor and student. 
 
 The use of photography is a legitimate application of 
 graphic principles and it will soon be employed in all gym- 
 nasiums where scientific study and accurate work is accom- 
 plished. It gives an idea of the form of a man that cannot 
 be derived from figures or graphic lines, and will therefore 
 show results of exercise that figures can not express. 
 
u 
 
 
 E JtBOVC Z 
 
 i 95 00 80 70 60 50 40 30 20 10 5 | 
 
 
 = BtLow ; 
 
 E 5 10 20 30 40 50 60 70 80 SO 95 s 
 
 
 j.. ... . . _.| — 
 
 
 Age T 
 
 
 WcigM \"V 
 
 
 HsiRht Slandinir. \ ' •■ 
 
 
 7 j- 
 " Sitting.... ^ ^■- , 
 
 
 •• Knee "I" , 
 
 
 " PubitArch "~~~-3^.j.r' 
 
 
 ., sternum.. ■z:r.-'-''"' 
 
 
 Girth Head . ~ "'""^-ii:- 
 
 
 ■• Neck .----' ^'1 , 
 
 
 ■■ Chest _. -' 
 
 
 " Full.. _, _ ,. ! 
 
 
 •' Waist _ _""^--,'i 1 , 1 ' ■ L 
 
 
 " Hips .«:';;''i' 1 r 
 
 
 •• Thigh R... '"'S-'^-L. X. 
 
 
 ... .. t.. t T-ft ^ 
 
 
 •■ Knee R.. , _I II ~" ~E-i ;-- - _ - _L 
 
 
 '' •• t. :.____.? T_ -___ X 
 
 
 •• CalfR .-'-:-'-'■" T ' IL 
 
 
 ..... I _ • ' t\ 1 
 
 
 " rnstep R.. -~~I~~--;s.i. ■_ J X - 
 
 
 •• .. L.. ^^ . IT It I fT_ 
 
 
 ■• Up Arm R.. -■c---ZZ--''~'~"" ^ ' I 
 
 
 ■• •• L.. .„^.._. :!-..___._.. _. _._.. 1. ....._ 
 
 
 .• Elbow R... __»_'' _ Jj 
 
 
 •• •• L..: ....::......:,__„_:..::"':::"""■:":::_:::_._...!._ 
 
 
 " foro Arm R.. ,-''' J'' ' ' 
 
 
 " - " L. , , 
 
 
 •• Wr.stR... ~E~~ri:^~""~ • ■, X -L 
 
 
 ■• •• L,.. r? __:::—- ::::---ti ::_ i.. 
 
 
 OepthChcst \,.-- '' ' ' 
 
 
 " Abdomen.. "'*. ;^ ' j i 
 
 
 Breadth Head.... ^., 4; _ _, J _^. 
 
 
 •■ Neck N_ , --■ ,1 
 
 
 •• Shoulders Ch" 1- 
 
 
 ■• Waist.... '"'"'"'^^--c-- r 
 
 
 H.ps ..'-ZZZZ- ''' -_ -_L __ _ - . 
 
 
 ^ _ .i^_ _ , -_ -_ _._-.- -- .-1- 
 Shoulder-tlbow R'. n, ^.^ , 
 
 
 " " L. .. _ _ ^ T 
 
 
 Elbow.TIp R "'^^---."j I 
 
 
 " •• L 
 
 
 Length Foot R ^^^ ~~~--^ 
 
 
 ' .7 .. . " ;■' / ~ . ----- _p 
 
 
 " HorContal. -.^s^^"''"" 
 
 
 Stretch of Arms .. '"~ -^ 
 
 
 Capacity Lungs... _ i_ .'. ~''"-^..._ . ---.,_„ 
 
 
 Strength Lunps.. ::;--- 
 
 
 * " Eac-« ".'--■ 
 
 
 ■■ Legs.... -_-__5__-_r..,_ "■■-'- ..__ _. r_ 
 
 
 Chest... . _ _£; - _ __ _„=.--m' _ - _ .- 
 
 
 " Upper Arrris. _ , _, 
 
 
 " fore Armj.. "^-^ ,'" 1 
 
 
 Total.... ^--''' ~""---.. 
 
 
 Development , ^ ^ ' ^ " _, 
 
 
 Vision 1 
 
 
 Hcar.rg -j 4- J 4- 1- 
 
 
 - _ - - I .. . _ _ ■_ . . ,. -__r 
 
1 and compiled by 
 
 pounds.) 
 
 Jay 
 
 w. 
 
 Seaver, 
 
 M. 
 
 D. 
 
 
 
 
 
 
 I 
 
 BKEADTH. 
 
 Depth. 
 
 si 
 
 
 
 
 
 a 
 W 
 
 ^4 
 
 i 
 
 6 
 
 1 
 
 1-1 
 
 1 
 
 M 
 
 i 
 
 K 
 
 S 
 
 02 
 
 jj 
 
 1 
 
 a, 
 p. 
 
 
 ft 
 E 
 
 1 
 
 6 
 
 J 
 
 < 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 . 404 
 
 15.9 
 
 403 
 
 15-9 
 
 406 
 
 16. 
 
 407 
 
 16. 
 
 260 
 
 10.3 
 
 260 
 
 10.3 
 
 166 
 
 6.5 
 
 131 
 
 4-8 
 
 457 
 
 iS. 
 
 330 
 
 13- 
 
 332 
 
 9.2 
 
 300 
 
 11. 
 
 363 
 
 14.3 
 
 225 
 
 S.o 
 
 225 
 
 3.0 
 
 5.70 
 
 34S 
 
 239 
 
 373 
 
 600 
 
 83 
 
 ISO 
 
 394 
 
 * 15-5 
 
 394 
 
 15.5 
 
 395 
 
 15.6 
 
 397 
 
 15.6 
 
 256 
 
 10. 1 
 
 256 
 
 10. 1 
 
 164 
 
 6-5 
 
 119 448 
 
 4-7 17-7 
 
 333 
 
 12.7 
 
 225 
 
 8.9 
 
 387 
 II .3 
 
 355 
 
 14. 
 
 215 
 
 8.S 
 
 2141 
 8.4 
 
 5.40 
 
 330 
 
 220 
 
 4S5 
 
 361 
 
 575 
 
 75 
 
 130 
 
 " 385 
 
 "5-2 
 
 385 
 
 15.2 
 
 386 
 
 15.2 
 
 388 
 
 252 
 
 10. 
 
 252 
 
 10. 
 
 162 
 
 6.4 
 
 115 442 
 
 4-5j 17-4 
 
 314 
 
 12.4 
 
 220 
 
 8.7 
 
 281 
 
 II. I 
 
 349 
 
 13.8 
 
 205 
 
 8.1 
 
 204 
 
 8. 
 
 5.16 
 
 315 
 
 211 
 
 465 
 
 247 
 
 545 
 
 70 
 
 120 
 
 " 379 
 
 I14.9 
 
 379 
 
 14.9 
 
 377 
 
 14.8 
 
 377 
 
 14.8 
 
 247 
 
 9-7 
 
 248 
 
 9.7 
 
 161 
 
 6.3 
 
 113 
 
 4-4 
 
 433 
 
 17- 
 
 306 
 
 12. 1 
 
 216 
 
 8.5 
 
 274 
 
 10. S 
 
 344 
 
 13.6 
 
 199 
 
 7.8 
 
 201 
 
 7.9 
 
 4.94 
 
 302 
 
 195 
 
 430 
 
 231 
 
 510 
 
 67 
 
 "5 
 
 - 373 
 
 I14.7 
 
 373 
 
 14-7 
 
 373 373 
 
 14.7 14.7 
 
 243 
 
 9.6 
 
 244 
 9.6 
 
 160 
 
 6-3 
 
 112 
 
 4-4 
 
 428 
 
 16.9 
 
 298 
 
 II. 8 
 
 212 
 
 8.3 
 
 270 
 
 10. 6 
 
 340 
 
 13.4 
 
 197 
 
 7.8 
 
 198 
 
 7.8 
 
 4.76 
 
 290 
 
 186 
 
 410 
 
 226 
 
 49 S 
 
 65 
 
 no 
 
 — 368 
 2i4-5 
 
 370 
 
 14.6 
 
 368 368 
 
 HS 14-5 
 
 241 
 
 9-5 
 
 343 
 
 9-.S 
 
 159 
 
 6.2 
 
 111 
 
 4-4 
 
 434 
 
 16.7 
 
 293 
 
 II. 5 
 
 208 
 
 8.2 
 
 267 337 
 
 10-5 13.3 
 
 195 
 
 7-7 
 
 194 
 
 7-7 
 
 4.63 
 
 282 
 
 179 
 
 395 
 
 317 
 
 478 
 
 63 
 
 106 
 
 — 365 
 
 214.4 
 
 367 
 
 14-5 
 
 364 
 
 143 
 
 364 
 
 14-3 
 
 239 
 
 0.4 
 
 240 
 
 9-5 
 
 158 
 
 6.2 
 
 111 
 
 4-4 
 
 421 
 
 16.6 
 
 288 
 
 II-3 
 
 205 
 
 8.1 
 
 364 334 
 
 I0.4 13.2 
 
 193 
 
 7.6 
 
 191 
 
 7.5 
 
 4.53 
 
 273 
 
 175 
 
 385 
 
 211 
 
 465 
 
 61 
 
 102 
 
 — 363 
 
 3 14-3 
 
 365 
 
 14.4 
 
 361 
 
 14.2 
 
 361 
 
 14.2 
 
 238 
 
 9-4 
 
 239 
 
 9-4 
 
 157 
 
 6.2 
 
 110 
 
 4-3 
 
 418 
 
 16.5 
 
 283 
 
 II. I 
 
 203 
 
 8. 
 
 263 
 
 10.3 
 
 331 
 
 13 I 
 
 191 
 
 7.5 
 
 188 
 
 7.4 
 
 4.45 
 
 270 
 
 171 
 
 376 
 
 206 
 
 454 
 
 60 
 
 100 
 
 - 360 
 
 Jx4.2 
 
 363 
 
 14-3 
 
 358 
 
 14. 1 
 
 358 
 
 14. 1 
 
 236 
 
 9-3 
 
 237 
 
 9-3 
 
 156 
 
 6,1 
 
 109! 415 
 
 4.3 16.4 
 
 279 
 
 II. 
 
 201 
 
 7.9 
 
 359 
 
 10.2 
 
 339 
 
 13. 
 
 190 
 
 7.5 
 
 186 
 
 7-3 
 
 4.37 
 
 264 
 
 167 
 
 367 
 
 201 
 
 442 
 
 59 
 
 98 
 
 — 358 
 <li4.i 
 
 359 
 
 14.2 
 
 355 
 
 14- 
 
 355 
 
 14. 
 
 234 
 
 9.2 
 
 235 
 9.2 
 
 156 
 
 6.1 
 
 108 413 
 
 4-3, 16.3 
 
 276 
 
 10. 9 
 
 199 
 
 7-8 
 
 257 
 
 10. 1 
 
 327 
 
 12.9 
 
 189 
 
 1 7-4 
 
 184 
 
 7.3 
 
 4.30 
 
 261 
 
 162 
 
 356 
 
 195 
 
 430 
 
 58 
 
 96 
 
 ~ a56 
 
 ^14. 
 
 357 
 
 14. 
 
 353 
 
 13-9 
 
 353 
 
 13.8 
 
 233 
 
 9.2 
 
 23tj 
 9.2; 
 
 155 
 
 6.1 
 
 107! ^0 
 
 4.2^ l6.2 
 
 273 196 
 
 lo.s: 7.7 
 
 255 
 
 10. 
 
 325 
 
 12.8 
 
 183 
 
 7.4 
 
 183 
 
 7.2 
 
 4.22 
 
 157 
 
 345 
 
 191 
 
 420 
 
 57 
 
 94 
 
 fi4. 
 
 355 
 
 14- 
 
 ' 350 
 
 13-8 
 
 350 
 
 I3-S 
 
 331 
 
 9.1 
 
 333! 
 
 5■^ 
 
 155 
 
 6.1 
 
 106 407 270 
 
 4.2 16. 10.7 
 
 194 
 
 7.7 
 
 253 
 
 10. 
 
 333 
 
 12.7 
 
 187 
 
 7.4 
 
 181 
 
 7.1 
 
 4.15 
 
 253 
 
 153 
 
 33S 
 
 186 
 
 410 
 
 56 
 
 92 
 
 ~ 353 
 
 -113.9 
 
 353 
 
 13-9 
 
 348 
 
 13-7 
 
 347 
 
 137 
 
 330 
 
 9-1 
 
 331 i 
 
 9.1 
 
 155 
 
 6.1 
 
 f. 
 
 4a5 
 
 16. 
 
 268 
 10.6 
 
 193 
 
 7.6 
 
 251 
 
 9.9 
 
 331 
 
 12.7 
 
 186 
 
 7.3 
 
 179 
 
 7- 
 
 4.07 
 
 250 
 
 1.50 
 
 330 
 
 183 
 
 403 
 
 55 
 
 90 
 
 - 350 
 
 ^13-8 
 
 351 
 
 13-8 
 
 345 
 
 13-6 
 
 344 
 
 13.6 
 
 339 
 
 9- 
 
 330 
 
 9- 
 
 154 
 
 6.1 
 
 105 
 
 4-2 
 
 403 
 
 IS. 8 
 
 265 
 
 10. 5 
 
 190 
 
 7.5 
 
 249 
 
 9.8 
 
 319 
 
 12.6 
 
 184 
 
 7-3 
 
 178 
 
 7- 
 
 4.00 
 
 244 
 
 145 
 
 320 
 
 179 
 
 395 
 
 53 
 
 88 
 
 - 348 
 J ^3.7 
 
 349 
 
 13-7 
 
 343 
 
 13-5 
 
 341 
 
 13-5 
 
 337 
 9- 
 
 328 
 9- 
 
 153 
 
 6. 
 
 104 
 
 41 
 
 400 
 
 15-8 
 
 263 
 
 10.4 
 
 188 
 7-4 
 
 347 
 
 9-7 
 
 317 
 
 12-5 
 
 183 
 
 7.2 
 
 177 
 
 7- 
 
 3.92 
 
 240 
 
 140 
 
 308 
 
 176 
 
 387 
 
 53 
 
 86 
 
 - 346 
 
 J 13.6 
 
 346 
 
 13.6 
 
 339 
 
 13-4 
 
 338 
 
 13-3 
 
 336 
 
 8.9 
 
 337 
 9- 
 
 153 
 
 6. 
 
 103 
 
 4.1 
 
 397 
 
 15-7 
 
 361 
 
 10.3 
 
 186 
 
 7.3 
 
 245 
 
 9.7 
 
 315 
 
 12.4 
 
 180 
 
 7.1 
 
 175 
 
 6.9 
 
 3.83 
 
 232 
 
 135 
 
 298 
 
 171 
 
 376 
 
 51 
 
 84 
 
 - 343 
 
 5 13.5 
 
 343 
 
 13-5 
 
 335 
 
 13.2 
 
 335 
 
 13.2 
 
 335 
 
 8.9 
 
 236 
 
 8.9 
 
 152 
 
 6. 
 
 103 
 
 41 
 
 394 
 
 iS-S 
 
 359 
 
 10.2 
 
 184 
 
 7.2 
 
 243 
 
 9.6 
 
 313 
 
 13.3 
 
 178 
 
 7. 
 
 174 
 
 6.9 
 
 3.73 
 
 22S 
 
 130 
 
 2S7 
 
 166 
 
 365 
 
 50 
 
 82 
 
 - 339 
 
 '13-4 
 
 3t0 
 
 13-4 
 
 331 
 
 13- 
 
 331 
 
 13. 
 
 233 
 
 S 8 
 
 224 
 
 8.8 
 
 151 
 
 5-9 
 
 103 
 
 4- 
 
 391 
 
 15.4 
 
 257 
 
 10. 1 
 
 181 
 
 7.1 
 
 240 
 
 9-5 
 
 310 
 
 12.2 
 
 176 
 
 6.9 
 
 172 1 
 6.8^ 
 
 3.63 
 
 220 
 
 135 
 
 275 
 
 159 
 
 350 
 
 49 
 
 So 
 
 ~ 336 
 
 ^X3.3 
 
 337 
 
 13-3 
 
 337 
 
 12.9 
 
 337 
 
 12.9 
 
 221 
 
 8.7 
 
 233 
 8.7 
 
 150 
 
 5-9 
 
 101 
 
 4- 
 
 387 
 15-3 
 
 354 
 
 10. 
 
 178 
 
 7. 
 
 237 
 
 9.4 
 
 307 
 
 12 I 
 
 173 
 
 6.8 
 
 170| 
 6.7 
 
 3.48 
 
 212 
 
 130 
 
 26s 
 
 151 
 
 332 
 
 47 i 
 
 75 1 
 
 ' 333 
 ■I3-I 
 
 334 
 
 13.2 
 
 333 333 
 
 12.7 12.7 
 
 218 
 
 8.6 
 
 3191 
 
 8.6 
 
 149 
 
 5-9 
 
 98 
 
 3-9 
 
 333 
 
 iS-i 
 
 247 
 
 9.8 
 
 175 
 
 6.0 
 
 234 
 
 9.2 
 
 303 
 
 II. 9 
 
 1 170 
 
 6.7 
 
 167 i 
 
 6.6 
 
 3.35 
 
 205 
 
 113 
 
 24S 
 
 144 
 
 317 
 
 45 
 
 70 
 
 - 336 
 
 12.8 
 
 337 
 
 12.9 
 
 316 
 
 12.5 
 
 316 
 
 12. 5 
 
 216 
 
 8.5 
 
 316 
 
 8.5 
 
 147 
 
 5-8 
 
 93 
 
 3-9 
 
 375 
 
 14.3 
 
 240 
 
 9-5 
 
 170 
 
 6.7 
 
 330 
 
 9.1 
 
 297 
 II. 7 
 
 167 
 
 6.6 
 
 1631 
 
 6.5 
 
 3.13 
 
 192 
 
 104 
 
 230 
 
 136 
 
 300 
 
 43 
 
 6S 
 
 - 330 
 
 '' 12.6 
 
 333 
 
 12.7 
 
 310 
 
 12.2 
 
 310 
 
 12.2 
 
 213 
 
 8.4 
 
 212 
 
 8.4 
 
 145 
 
 5-7 
 
 96 
 
 3-8 
 
 368 
 
 14-5 
 
 233 
 
 9.2 
 
 164 
 
 6.5 
 
 235 
 
 8.9 
 
 292 
 
 "■5 
 
 164 
 
 6.3 
 
 159 
 
 6.3 
 
 3.90 
 
 178 
 
 95 
 
 2TO 
 
 135 
 
 275 
 
 41 
 
 60 
 
 " 313 
 
 12.3 
 
 315 
 
 12.4 
 
 304 
 
 12 
 
 304 
 12. 
 
 208 
 
 8.2 
 
 208 
 
 8.2 
 
 143 
 
 5-6 
 
 94 
 
 3-7 
 
 3S1 
 
 14.2 
 
 338 
 
 9- 
 
 160 
 
 6.3 
 
 220 
 
 8.7 
 
 286 
 
 II -3 
 
 160 
 
 6.3 
 
 152 
 
 6. 
 
 2.65 
 
 162 
 
 84 
 
 185 
 
 114 
 
 250 
 
 as 
 
 55 
 
 ' 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 8 . 1- 
 
 COPYRIGHTED 1 
 
 )V 
 
 389, BY J. W. SEAVER. ■ 
 
 
 
 
 J ' 
 
 
 
 
 
 
 
 
ANTHROPOMHTRIC TABLE. 
 
 Arranged according to the percentages indicated at the left, from measurements taken and compiled by Jay W. Seaver, M. D. 
 
 {The black figures represent millimeters and kilograms ; the red, inches and] pounds.) 
 
 e4 
 
 CM 
 
 
 EH 
 
 2 
 
 HEIGHT. 
 
 LENGTH. 
 
 GIRTH. 
 
 BHEADTH. 
 
 Depth. | 
 
 it 
 
 4 
 
 to 
 
 4 
 
 tl 
 
 
 1 
 
 a 
 
 3 
 
 S 
 
 1 
 
 1 
 
 3 
 
 to 
 
 1 
 
 ■6a 
 SS 
 
 m 
 
 la 
 CO 
 
 ►4 
 
 If 
 
 if 
 
 4 
 
 I 
 t 
 
 
 4 
 
 1 
 
 ii 
 !3 
 
 a 
 1 
 
 6 
 
 a 
 
 1 
 
 
 
 1 
 
 
 
 m" 
 
 1 
 
 i4 
 
 
 H 
 
 
 
 a 
 1 
 
 1 
 4 
 
 1 
 
 i 
 
 .a 
 
 I 
 i-i 
 
 1 
 
 1 
 
 M 
 
 i 
 
 1 
 
 ^ 
 
 "a 
 
 W 
 
 1 
 
 1 
 1 
 
 to 
 
 1 
 
 i 
 
 1 
 
 t 
 K 
 
 1 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1 
 
 Zl. 
 
 86.1 
 
 190 
 
 1876 
 
 73.8 
 
 1546 
 
 60.3 
 
 U46 
 
 45 I 
 
 966 
 
 37.6 
 
 986 
 
 33. S 
 
 494 
 19.5 
 
 4ia 
 16.2 
 
 410 
 
 16. 1 
 
 513 
 
 bi2 
 
 19o0 
 
 76.7 
 
 280 
 
 280 
 
 600 
 
 23.6 
 
 397 
 
 15-7 
 
 1005 
 
 39-5 
 
 1060 
 
 41.8 
 
 857 
 
 3i--7 
 
 1046 
 
 363 
 
 14-3 
 
 315 
 
 310 
 
 272 
 
 10.7 
 
 268 
 10.6 
 
 302 
 
 11. 7 
 
 295 
 
 11.6 
 
 183 
 7-2 
 
 182 
 
 7-2 
 
 616 
 
 24.3 
 
 614 
 
 24,2 
 
 404 
 15.9 
 
 403 
 
 15-9 
 
 406 
 
 16. 
 
 407 
 
 16. 
 
 260 
 
 10.3 
 
 260 
 
 10.3 
 
 166 
 
 6.5 
 
 131 
 
 4-8 
 
 457 
 
 '3. 
 
 330 
 
 13- 
 
 232 
 
 9.2 
 
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 363 
 
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 225 
 
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 225 
 
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 229 
 
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 272 
 
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 82 
 
 
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 263 
 
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 293 
 
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 285 
 
 180 
 
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 394 
 
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 394 
 
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 398 
 
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 396 
 
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 497 
 
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 74.5 
 
 274 
 
 273 
 
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 288 
 
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 175 
 
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 385 
 
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 385 
 
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 386 
 
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 388 
 
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 252 
 
 252 
 
 103 
 
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 115 
 
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 314 
 
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 281 
 
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 393 
 
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 373 
 
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 282 
 
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 173 
 
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 306 
 
 216 
 
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 274 
 
 344 
 
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 199 
 
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 195 
 
 231 
 
 67 
 
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 15 
 
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 72.1 
 
 159 
 
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 388 
 
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 278 
 
 271 
 
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 244 
 
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 160 
 
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 113 
 
 428 
 
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 298 
 
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 212 
 
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 270 
 
 340 
 
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 197 
 
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 198 
 
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 186 
 
 226 
 
 65 
 
 
 20 
 
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 69.4 
 
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 463 
 
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 382 
 
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 479 
 
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 264 
 
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 264 
 
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 273 
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 233 
 
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 275 
 
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 268 
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 169 
 
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 368 
 
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 159 
 
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 111 
 
 424 
 
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 293 
 
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 208 
 
 267 
 
 337 
 
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 195 
 
 194 
 
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 63 
 
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 151 
 
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 381 
 
 378 
 
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 476 
 
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 262 
 
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 239 
 
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 366 
 
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 367 
 
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 364 
 
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 239 
 
 240 
 
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 421 
 
 288 
 
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 206 
 
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 264 
 
 334 
 
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 193 
 
 7.6 
 
 191 
 
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 175 
 
 311 
 
 61 
 
 
 30 
 
 20.7 
 
 67.6 
 
 149 
 
 1754 
 
 69 
 
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 56.7 
 
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 41.6 
 
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 376 
 
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 474 
 
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 473 
 
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 260 
 
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 260 
 
 575 
 
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 360 
 
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 888 
 
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 918 
 
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 308 
 
 265 
 
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 259 
 
 237 
 
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 232 
 
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 270 
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 263 
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 168 
 
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 167 
 
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 537 
 
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 365 
 
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 418 
 
 283 
 
 203 
 
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 262 
 
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 331 
 
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 191 
 
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 206 
 
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 147 
 
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 259 
 
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 363 
 
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 358 
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 358 
 
 236 
 
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 109 
 
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 269 
 
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 367 
 
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 372 
 
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 70.7 
 
 258 
 
 257 
 
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 253 
 
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 238 
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 265 
 
 259 
 
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 359 
 
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 108 
 
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 276 
 
 199 
 
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 257 
 
 337 
 
 189 
 
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 58 
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 464 
 
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 256 
 
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 569 
 
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 356 
 
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 231 
 
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 226 
 
 89 
 
 263 
 
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 164 
 
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 356 
 
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 357 
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 273 
 
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 196 
 
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 335 
 
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 188 
 
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 183 
 
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 345 
 
 191 
 
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 57 
 
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 446 
 
 17.61 
 
 368 
 
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 368 
 
 14.4 
 
 462 
 
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 1778 
 
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 254 
 
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 568 
 
 350 
 
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 254 
 
 248 
 
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 339 
 
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 261 
 
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 163 
 
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 515 
 
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 231 
 
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 333 
 
 155 
 
 106 
 
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 187 
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 181 
 
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 186 
 
 66 
 
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 366 
 
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 364 
 
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 460 
 
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 459 
 
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 253 
 
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 567 
 
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 293 
 
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 251 
 
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 246 
 
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 105 
 
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 268 
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 321 
 
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 288 
 
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 248 
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 257 
 
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 342 
 
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 343 
 
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 335 
 
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 103 
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 394 
 
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 365 
 
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 430 
 
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 444 
 
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 337 
 
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 10.7 
 
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 215 
 
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 475 
 
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 336 
 
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 337 
 
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 327 
 
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 327 
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 6.7 
 
 
 265 
 
 332 
 
 75 
 
 
 10 
 
 17.8 
 
 53.5 
 
 ii3 
 
 1645 
 
 64.7 
 
 1345 
 
 52.9 
 
 974 
 
 38.4 
 
 80S 
 
 868 
 
 433 
 
 16.6 
 
 346 
 
 344 
 
 I, .6 
 
 437 
 
 17.2 
 
 437 
 
 17.2 
 
 1687 
 
 66.3 
 
 240 
 
 9-5 
 
 340 
 
 9.'- 
 
 550 
 
 21.6 
 
 339 
 
 13. 
 
 800 
 
 31-5 
 
 846 
 
 33.3 
 
 677 
 
 26.7 
 
 841 
 
 33-1 
 
 262 
 
 10.3 
 
 227 
 
 222 
 
 3.8 
 
 208 
 
 8.2 
 
 204 
 
 8. 
 
 242 
 
 9-5 
 
 235 
 
 9-3 
 
 155 
 
 154 
 
 6.. 
 
 474 
 
 18.7 
 
 466 
 
 18.3 
 
 333 
 
 13. 1 
 
 334 
 
 13.2 
 
 323 
 
 12.7 
 
 323 
 
 12.7 
 
 218 
 
 8.6 
 
 219 
 
 8.D 
 
 149 
 
 5-9 
 
 98 
 
 382 
 
 247 
 
 98 
 
 176 
 
 6.C 
 
 234 
 
 9.2 
 
 302 
 
 iVO 
 
 6,7 
 
 16V 
 
 3.36 
 
 248 
 
 
 
 
 5 
 
 17.3 
 
 61.3 
 
 1626 
 
 1325 
 
 958 
 
 794 
 
 854 
 
 418 
 
 340 
 
 338 
 
 431 
 
 431 
 
 1658 
 
 fir -> 
 
 236 
 
 235 
 
 545 
 
 aj4 
 
 784 
 
 826 
 
 601 
 
 838 
 
 37 6 
 
 255 
 
 233 
 
 R 8 
 
 217 
 
 R 6 
 
 203 
 
 R 
 
 200 
 
 7.8 
 
 237 
 
 230 
 
 152 
 
 6. 
 
 151 
 
 6. 
 
 463 
 
 iS 2 
 
 455 
 
 336 
 
 12.8 
 
 327 
 
 316 
 
 316 
 
 216 
 
 8.5 
 
 216 
 
 8.5 
 
 147 
 
 5-3 
 
 98 
 
 3-9 
 
 3Vo 
 
 14. 8 
 
 240 
 
 9-5 
 
 170 
 
 6.7 
 
 230 
 
 9.1 
 
 39V 
 11.7 
 
 1 16V 
 
 6.6 
 
 163 
 
 6.5 
 
 3.13 
 
 23" 
 
 
 65 
 
 
 2.5 
 
 17.1 
 
 49.4 
 
 lO'J 
 
 1605 
 
 63,: 
 
 1314 
 
 5". 7 
 
 947 
 
 780 
 
 30.7 
 
 842 
 
 414 
 
 t6,3 
 
 334 
 
 333 
 
 435 
 
 16.7 
 
 435 
 
 16.7 
 
 1630 
 
 64.1 
 
 333 
 
 9.1 
 
 233 
 
 9.1 
 
 540 
 
 21.3 
 
 318 
 
 12-5 
 
 766 
 
 30. J 
 
 812 
 
 3=- 
 
 W4 
 
 25-4 
 
 814 
 
 32. 
 
 "247 
 9.7 
 
 217 
 
 8.6 
 
 213 
 
 8.4 
 
 198 
 
 7-7 
 
 195 
 
 7-7 
 
 232 
 
 225 
 
 8-9 
 
 150 
 
 5-9 
 
 149 
 
 5-9 
 
 450 
 
 '7-7 
 
 444 
 
 17-5 
 
 320 
 
 32:3 
 
 12.7 
 
 310 
 
 310 
 
 213 
 
 8.4 
 
 213 
 
 8.4 
 
 145 
 
 5-7 
 
 96 
 
 3-8 
 
 368 
 
 '4-5 
 
 233 
 
 g.2 
 
 164 
 
 6.5 
 
 225 
 
 8.9 
 
 293 
 
 "■5 
 
 164 
 
 6.5 
 
 159 
 
 6.3 
 
 3.90 
 
 178 
 
 95 
 
 J2o 
 
 a 
 
 60 
 
 
 1 
 
 lli.7 
 
 45.4 
 
 1576 
 
 1290 
 
 50 8 
 
 931 
 
 36.2 
 
 765 
 
 30 I 
 
 820 
 
 403 
 
 328 
 
 327 
 
 12.9 
 
 418 
 
 16.5 
 
 418 
 
 16.5 
 
 1600 
 
 63. 
 
 226 
 
 8.9 
 
 220 
 
 8.Q 
 
 535 
 
 311 
 
 740 
 
 29.1 
 
 787 
 
 3'- 
 
 .595 
 
 24 -5 
 
 794 
 
 31.3 
 
 340 
 
 9-5 
 
 210 
 
 8.3 
 
 205 
 
 8.1 
 
 191 
 
 7.6 
 
 191 
 
 7-5 
 
 236 
 
 8.9 
 
 320 
 
 8.7 
 
 148 
 
 5.8 
 
 147 
 
 5-7 
 
 437 
 
 433 
 
 ■7- 
 
 313 
 
 '2-3 
 
 315 
 
 304 
 
 304 
 
 208 
 
 8.2 
 
 208 
 
 3.2 
 
 143 
 
 5-6 
 
 94 
 
 3-7 
 
 331 
 
 '4.2 
 
 228 
 
 160 
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 220 
 8.7 
 
 286 
 II-3 
 
 160 
 6.3 
 
 162 
 
 6. 
 
 162 
 
 '85 
 
 250 
 
 55 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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