thing about these cases, particularly the causes of death. Of course, they were not put down in the mortality table as syphilis. Perhaps Dr. Rowley has run across the very interesting figures published a number of years ago by the Gotha Insurance Co., a company which accepted syphilitics as risks provided they had been under treatment a certain length of time and provided they had been free from symptoms a certain length of time. They published the figures after forty years' experience and while I don't recall the figures, yet in the main they substantiated what Dr. Rowley showed. That is, the actual mortality was much higher than the expected mortality. Some of the reasons and explanations were very interesting. A great many of them died of carcinoma and neoplasm. Many of them died from diseases of the heart and blood vessels, and so on; and a very much larger percentage of them committed suicide than ordinary risks. I would just like to hear if Dr. Rowley can elaborate on their experience.

DR. OSBORNE (New Haven): I would like to ask questions of both Dr. Rowley and Dr. Root in regard to blood pressure. It seems to me for insurance purposes that it is only fair to take the systolic with the finger and the disastolic with the stethoscope. If the systolic is taken alone with the stethoscope, it is likely to be too high. The diastolic (with the stethoscope of course) shows pretty well what the condition of the applicant is. With the systolic by the finger and the diastolic by the stethoscope the most accurate decision can be made of the actual blood pressure.

DR. ROOT (Hartford): In answering Dr. Osborne's suggestion, of course, we have to consider, as Dr. Rowley says, the ability of some remote sections of the United States to provide scientific information. I recall one case in which an examination was made in a rather remote hamlet in Georgia and the examiner recorded in regard to the blood pressure "Perfectly normal, 1020 the same as urine."

DR. ROWLEY (Hartford): Dr. Root's comment reminds me of a report we received a few days ago from a town in Indiana. The examiner reported the systolic pressure as 124 and the diastolic 126.

I thought I had put in the causes of death in the cases of syphilis, but I see I left it out of my paper. As I remember it, there was a remarkably high percentage of deaths due to pneumonia, suicide and heart disease. Experience of the Gotha Insurance Co. that Dr. Blumer referred to, I don't recall just what the figures were, but I remember different classes ranging from about 137 per cent of expected up to about 160 or 170 per cent of expected mortality, different classes showing a mortality ranging all the way between those two figures.

I think Dr. Osborne's comment in regard to blood pressure is opportune. The Companies more and more are appreciating the importance of diastolic pressure and are asking for report of it in the larger centres of population where there is likelihood of being able to get results that are dependable. So far as I know, no Company has as yet made it a universal requirement, because so many of the physicians in the smaller places where they don't seem to use the blood pressure instrument so often as the men do in the larger centres, appear to get a little confused about its use, and it has been our experience, and I know it is the experience of other offices, that results are so obviously wide of the mark that they are not of great value. That happens not always, by any means, but often enough to make Companies hesitate at present about making it a universal requirement to have the diastolic pressure reported. The auscultatory method is obviously the more accurate and more to be depended upon than the method of palpation.

I want to thank Dr. Root and the others for their valuable contributions to the discussion.

The Physician's Part in the War.*

Major F. F. SIMPSON, M. R. C.

(Chief of Medical Section Council of National Defense.)

Mr. President, ladies and gentlemen: I esteem greatly the privilege of speaking to an audience of this kind, an audience composed of persons of such sterling worth, such mental force and such judicial temperament. Conservative by tradition and training, your people are not easily carried away by impulse and enthusiasm. It takes sterner stuff to move such men. Just as you are slow to anger but mighty in your wrath, so are you deliberate about entering upon a new and great enterprise, but you are determined to be in at the victorious finish.

Rated on a basis of percentage, Connecticut stands twentyeighth among the states in respect of the contributions the medical profession has made to the reserve corps of the army. We are mindful of the fact, however, that you have sent men of high quality. We are mindful of the imperishable deeds that are being enacted in France to-day by the brave men of this state. We know of the great war industries in your midst which are vital to the striking force of the nation, to the force which will determine victory. We know the needs of that industry; we know that it must not suffer from physical needs. Yet the call from the nation requires that there must be some pinching. We must feel the fact that we are in war. The time has come for a little more effective sifting and the picking out of men from communities that may not think they can spare them. Of course, the larger communities are the ones which must yield a higher percentage of their doctors because the men in the larger communities with shorter distances can care for a much larger number of patients than those in the rural districts. Because of the new need I am here to present to you a very

* Not all the figures given in this paper are accepted by the Connecticut State Medical Society as correct.—EDITOR.

brief message, a message from the Federal Government. Of the 1,678 doctors in your state, 260 have been recommended for commissions in the Medical Reserve Corps. If this state does its full part, and we are confident that it will, you will contribute approximately 100 more men to the Medical Reserve Corps of the army before the first day of July. You will contribute approximately 25 men to the navy by that time. Then we must all remember that that is only a start.

With added increment of fighting men still other doctors must come. Keep this in mind hourly. We are just entering upon a death struggle with a resourceful nation which is relentless in the use of all the fiendish methods which can be devised by science and by Satan. A word in review: you have followed current events with keen interest, you know of the shameless intrigue and deception which caused the Russian Empire to crumble and fall and threatened the morale of the Italians. You know of the repeated rumors of peace designed to check the transformation of this nation, and especially in its industries, from a peace to a war footing. That is the meaning of the rumor that comes from the central nations by every cable every day. You know of the rumors of intrigue in the German and Austrian Army, of mutiny in their Navy, of riot and starvation among their people—all designed for the purpose of leading us to underestimate the strength of the enemy. You have seen the masterful stand of our war-weary allies on the western front. You have heard and have not doubted the words of Premier Lloyd George who stated recently that it is impossible to overestimate the importance of getting reinforcements across the Atlantic in the shortest possible space of time. Such men in such times as these do not use words lightly or idly.

Your hearts were gladdened when you saw the statement that the President, himself, had given peremptory orders that all things should be focused upon getting American soldiers to France speedily. With bated breath you are to-day watching the wavering lines on the western front. Your hearts are filled with admiration and with gratitude for the men who for four years have fought your battles and have checked the mad onrush

of the Huns. (Applause.) But you did not realize the full significance of your personal obligation in this matter until the terrific force of the present drive forced from the lips of Sir Douglas Haig these terrible words, this tragic appeal: "Words fail me to express the admiration which I feel for the splendid resistance offered by all ranks of our army under the most trying circumstances. Many amongst us now are tired." Think of it, after four years; that mild expression. "To those I would say that victory will belong to the side which holds out the longest. The French Army is moving rapidly and in great force to our support." And he says "With our backs to the wall and believing in the justice of our cause each one of us must fight to the end. The safety of our homes and the freedom of mankind depend alike upon the conduct of each one of us in this critical moment." What does that mean to this nation? It means that we, too, are in the fight to the finish. It means, as the President has set forth, force without limit until autocracy and intrigue are crushed. It means that in order to win we must be prepared to strike a harder blow than the enemy, to strike it first, but above all things to strike it last.

You know that some months ago the Secretary of War made a statement before the Senate Committee that by the coming year we will have a million and a half men in France. Since that time the drive has come. Since that time the movement of troops has been speeded up. We are informed that the Secretary recently appealed to Congress to give troops without limit save for the need of the hour. You know that prudence of the most primitive type dictates that for every man that goes to France at least one, and possibly more, must enter training to take his place. Even that meagre caution would mean three million men under arms by the close of this year. And who among us believe for a moment that this great nation at the beginning of this great struggle will think for a moment of providing for so small a number? But what does that mean in terms of medical officers? You know that the peace needs of the army are for 7,000 medical officers per million men. You know that the war need sanctioned by the Secretary are 10,000 medical officers per million men.