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Charles Darwin, in his “Descent of Man,” published in 1871, writes thus of the appendix: “It is occasionally quite absent, or again is largely developed. The passage is sometimes completely closed for half or two-thirds of its length, with the terminal part consisting of a flattened solid expansion. In the orang this appendage is long and convoluted: in man it arises from the end of the short cecum, and is commonly from four to five inches in length, being only about the third of an inch in diameter. Not only is it useless, but it is sometimes the cause of death, of which fact I have lately heard two instances: this is due to small, hard bodies, such as seeds, entering the passage, and causing inflammation.”

But Darwin was not the first to recognize the uselessness and danger of the appendix, since M. C. Martins, in “Revue des Deux Mondes,” which was published in 1862, mentioned the fact that this rudiment sometimes caused death. Indeed it is said the ancient Egyptians knew the appendix became inflamed and caused death, but for this we can not vouch.

In spite of these hints of Martin and Darwin, physicians called the symptom syndrome of what is now known to be appendicitis, typhlitis or perityphlitis for years, although the cecum itself is seldom inflamed without some pathological change in the appendix. The latter structure, however, is often very badly diseased while the cecum is perfectly normal.

The first methodical operation for appendicitis was performed in 1886 by Reginald Fitz, and even today it is sometimes hard to persuade a patient to have this structure removed simply because recovery often occurs without operation.

EUGENICS.

The same author, Charles Darwin, in the same book, writes as follows: “Man scans with scrupulous care the character and pedigree of his horses, cattle, and dogs before he matches them; but when he comes to his own marriage he rarely, or never takes any such care. He is impelled by nearly the same motives as the lower animals, when they are left to their own free choice, though he is in so far superior to them that he highly values mental charms and virtues. On the other hand he is strongly attracted by mere wealth or rank. Yet he might, by selection, do something not only for the bodily constitution and frame of his offspring, but for their intellectual and moral qualities. Both sexes ought to refrain from marriage if they are in any marked degree inferior in body or mind; but such hopes are Utopian and will never be even partially realized until the laws of inheritance are thoroughly known. Everyone does good service who aids toward this end. When the principles of breeding and inheritance are better understood, we shall not hear ignorant members of our legislature rejecting with scorn a plan for ascertaining whether or not consanguineous marriages are injurious to man.”

Though the above was written thirty-five years ago, little real progress has been made in eugenics. It is true we have laws against miscegenation and against certain consanguineous marriages; some States have passed and other States have attempted to pass, laws making certificates of health necessary before marriage licenses can be issued; if we mistake not, in some States the habitual criminal is unsexed, and in many States this question has been discussed, but ignorance in regard to the laws of heredity is still the rule and not the exception.

Wealth and social position, rather than health and intellectuality, determine as many marriages today as when Darwin wrote, and America’s highest legislative body has not yet repealed the law against the dissemination of knowledge of means to prevent conception. Yet too many children in poor families not only means dire poverty and unhappiness instead of comfort and happiness, but oftentimes desertion, divorce, forced immorality or crime. It is just as necessary to be able to limit the number of children so that each will at least get a good start in life as it is to bring healthy children into the world, since healthy children can not remain healthy and develop as well under unfavorable as under favorable conditions.

Did the law affect rich and poor alike it would not be so pernicious, but such is not the case, since the largest families in this country are found among the poor and ignorant, the very ones who can least afford to have many dependents. Without being so intended, it is class legislation. The healthy, well nourished and well educated class escapes, the poor, ill-nourished, and ignorant class bears the burden until this burden is shifted on society in the form of beggar, defective, imbecile or criminal.

If all the members of Congress made a tour of the tenement districts of New York or other large cities, saw the overworked fathers and overbred mothers, the ragged, ill-nourished and oftentimes diseased children, inquired into the total earnings of the family and the necessary expenses, ate of their bread and breathed their air, if our congressmen did this, then the fate of the law as it now stands would be sealed. But our congressmen are not going to make any such tour, they are not even going to inform themselves by study of the actual conditions, but will do something far easier by voting an appropriation for the study of hog cholera, the foot and mouth disease of cattle, the Texas cattle tick or some other measure of more apparent benefit to the people—and the congressman. To vote on appropriations like the above can not weaken the legislator, to vote to repeal the present law might lose him a large following in some communities. Yet the repeal of the present law in regard to preventives is the first step in eugenics, and without the repeal the best efforts of the best men and women will accomplish but little.—W. T. B.

The establishing of small trachoma hospitals in localities where this contagious disease of the eyes is prevalent presents the best solution of the trachoma problem, according to the statement contained in the annual report of the Surgeon General of the United States Public Health Service. The Service now has five trachoma hospitals in the three States of Kentucky, Virginia, and West Virginia, and so great has been the number of applicants for treatment that a waiting list has been established. In the past fiscal year 12,000 cases of trachoma have been treated, the larger proportion of which were cured, while those in which a cure was not effected have been greatly improved and rendered harmless to their associates. The great majority of these trachoma patients were people who lived in remote sections far removed from medical assistance, and who, but for the hospital care and treatment provided would have remained victims of the disease practically the remainder of their lives.

“When it is considered,” the report of the Service states, “that thousands of persons suffering with trachoma, a dangerous contagious disease, would otherwise remain untreated, it is realized how farreaching results have been obtained through these trachoma hospitals and the other public health work done in this connection. It would be impossible to estimate with any degree of accuracy the number of people who have been saved from contracting this communicable disease by thus removing these thousands of foci of infection.”

In addition to treating persons with the disease the hospitals have been used for educational work. Doctors and nurses have visited the homes of the patients and have explained how to prevent the development and recurrence of the disease. One thousand three hundred and eight such visits were made during the year in Kentucky alone. “It has taken some time,” the report continues, “to educate the people afflicted with this disease to the importance of cleanliness and the use of simple hygienic measures in their daily life.” That results have been obtained is evidenced by the noticeably better observance of hygienic precautions by those among whom the work has been done.

In addition to the hospital work, surveys were made in sixteen counties in Kentucky, especially among school children. Eighteen thousand and sixteen people were examined, 7 per cent being found to have trachoma. Similar inspections in certain localities of Arizona, Alabama, and Florida resulted in finding the disease present in from three to six children out of every hundred. Periodic examination of school children for the disease and the exclusion of the afflicted from the public schools, are two of the recommendations the Public Health Service lays emphasis upon.

One of the special features of the trachoma work was the giving of lectures and clinics before medical societies in various counties where trachoma hospitals could not be established. Patients were operated upon in the presence of physicians and the most modern methods of treatment demonstrated. Throughout, the purpose has been to stimulate local interest in taking up the campaign to eradicate trachoma.

Four per cent of the inhabitants of certain sections of the South have malaria. This estimate, based on the reporting of 204,881 cases during 1914, has led the United States Public Health Service to give increased attention to the malaria problem, according to the annual report of the Surgeon General. Of 13,526 blood specimens examined by Government officers during the year, 1,797 showed malarial infection. The infection rate among white persons was above 8 per cent, and among colored persons 20 per cent. In two counties in the Yazoo Valley, forty out of every one hundred inhabitants presented evidence of the disease.

Striking as the above figures are they are not more remarkable than those relating to the reduction in the incidence of the disease following surveys of the Public Health Service at thirty-four places in nearly every State of the South. In some instances from an incidence of fifteen per cent, in 1914, a reduction has been accomplished to less than 4 or 5 per cent in 1915.

One of the important scientific discoveries made during the year was in regard to the continuance of the disease from season to season. Over 2,000 Anopheline mosquitoes in malarious districts were dissected, during the early spring months, without finding a single infected insect, and not until May 15, 1915, was the first parasite in the body of a mosquito discovered. The Public Health Service, therefore, concludes that mosquitoes in the latitude of the southern states ordinarily do not carry the infection through the winter. This discovery indicates that protection from malaria may be secured by treating human carriers with quinine previous to the middle of May, thus preventing any infection from chronic sufferers reaching the mosquitoes and being transmitted by them to other persons.

Although quinine remains the best means of treating malaria, and is also of marked benefit in preventing infection, the eradication of the disease as a whole rests upon the destruction of the breeding places of Anopheline mosquitoes. The Public Health Service, therefore, is urging a definite campaign of draining standing water, the filling of low places, and the regrading and training of streams where malarial mosquitoes breed. The oiling of breeding places, and the stocking of streams with top-feeding minnows, are further recommended. The Service also gives advice regarding screening, and other preventive measures as a part of the educational campaigns conducted in sections of infected territory.

This study is typical of the scientific investigations which are being carried out by the Public Health Service, all of which have a direct bearing on eradicating the disease. The malaria work now includes the collection of morbidity data, malaria surveys, demonstration work, scientific field and laboratory studies, educational campaigns, and special studies of impounded water and drainage projects.