to recover. After about four hours' journey down the coast, we entered a bay surrounded by cliffs, at the head of which was Wadi Lau, our destination. Here we sighted a large military camp crowded with troops representing every arm of the service, including the first and fifth banderas of the Foreign Legion. There were native soldiers as well as Spaniards, and artillery, infantry, and engineering units of the regular army. The bay is about two miles wide, and is hemmed in on both sides by high plateaus and mountains, which were occupied by the enemy. houses, which it would be our business Our objective was Koba-dossa, a Spanish fort which the Riffi had been besieging for eight days, and from which distress signals were flying. We advanced at first by detours under the cover of mountains and cliffs. Then we had to charge across a little plain and up a narrow brook valley to the summit of the hill about twelve hundred feet high, where the fort was situated. Already we could hear the whistling of the enemy bullets. We were ordered to fix bayonets. Our thoughts involuntarily flew back to our parents and friends in our distant homeland. Bearers brought back a corpse with the head blown partly open. What a warning glittered from its glassy eyes! I saw many a blanched countenance. Another command and we rushed forward. The pak-kuns rose to a crescendo. Man after man fell, but we kept on up the little valley, tortured by thirst but unable to stop even an instant to slake it at the trickling stream winding at our feet. Early next morning our long column of troops wound up the valley like an endless serpent. The ground was either heavy sand or else encumbered with boulders, so that marching was difficult. Thickets of thorns and thistles also hindered our advance. We soon reached a few native huts that had been bombarded by the guns from the ships. Festering corpses of men and mules were scattered about, infecting the air with their intolerable stench. No enemy was in sight, but we could hear in the distance a steady pak-kun, the double report of the Arab rifles. The sun burned unmercifully, and we were tortured by thirst. Our footgear consisted of light canvas shoes with rope soles called alpargatas, and at every step the sharp stones and thorns pierced them. Finally we halted in a little grove by a ruined native village, and a small roll and a tiny piece of salty sausage were issued to each man. But we forgot our hunger and thirst in the excitement of the coming combat. Suddenly orders were shouted and we were formed for attack. We could hear close at hand the sharp tak-tak of the machine-guns and the thunder of artillery, punctuated by the monotonous pak-kun of the enemy riflemen. We reached the foot of the hill, where we were ordered to halt and wait. Three airplanes appeared to bomb the enemy and dampen his fire. Many motionless bodies dotted the little level across which we had just charged. The groans and shrieks of the wounded reached our ears, but we could not stop to help them. Suddenly the first bomb fell, tossing a great column of smoke and dust in the air. The enemy's rifle fire gradually weakened, and at last was silenced. Thereupon we made a new rush forward, pushing on through thickets higher than our waists. Dizzy in the broiling sun, tortured by indescribable thirst, we worked our way upward. Suddenly rifles began to crack from every direction, and our men dropped rapidly. The shrieks of the wounded rose higher. With a last effort we made the summit and reached the post. The enemy retired, firing scattered shots at our advancing men. The liberated post presented a horrible spectacle. The members of the garrison, with their long, unkempt hair and unshaven, dirty, hollow-eyed faces, crawled toward us begging with lifted hands for water. Two had died of thirst. One lay with his hands and feet bound a raving maniac. A mule that had served for carrying water to the garrison had been slaughtered and eaten raw. The partially destroyed walls and ramparts were rebuilt, after the Legion had advanced sufficiently to protect the laborers from snipers. The garrison was relieved, and that night we returned to our previous bivouac. When we reached the brook we threw ourselves flat on the ground and swallowed the water in great greedy gulps. Our numerous wounded were given emergency treatment and hurried back to the hospital. Beyond our camp the pilleton was busy digging graves. There was a general roll call and the names of the casualties were stricken from the lists. There the incident of each man's short life was ended. He simply vanished, without further trace, from the records. Our evening rations consisted of a small portion of half-cooked rice, a piece of pork almost raw, and a tiny roll. Many of the men cast sidelong glances at the officers' mess, from which the enticing odors of what seemed by comparison a sumptuous banquet reached our nostrils. Then men were told off for guard duty, sentries were placed, and we rolled up in our blankets on the sand for a brief respite of oblivion. MAN'S STRUCTURAL IMPERFECTIONS1 BY SIR ARTHUR KEITH, F. R. S. [WE print below the Lloyd Roberts Lecture given to the Royal Society of Medicine on November 16 by the Hunterian Professor of the Royal College of Surgeons.] BETWEEN the activities of Archdeacon Paley and those of Élie Metchnikoff lies the greater part of the nineteenth century. At the beginning of that century we find the Archdeacon extolling the perfections of the human body, just as Celsus had done sixteen centuries before him. By the close of the nineteenth century the alert and 1 From the Lancet (London medical weekly), November 21 fearless brain of Élie Metchnikoff had discovered, or believed it had discovered, that the human body was blemished by many imperfections. The evangelist of this new and startling doctrine approached the study of man's body by an untrodden pathway, one made possible by the advancing science of his day. On his arrival at the Institut Pasteur in 1888, being then forty-three years of age, he set himself to investigate the means by which the human body combats and keeps at bay the swarming hosts of microorganisms that find a natural habitat in its internal passages and recesses. He saw man's body as a battlefield, the scene of a perpetual man. There was in the third place warfare, and as his investigation proceeded the conviction grew on him that the chances of the body's success were imperiled by a heritage of structures that had become out of date and useless. In the Wild lecture, given before the Literary and Philosophical Society of Manchester on April 22, 1901, he declared that man was being killed by his intestinal flora,' and that his great bowel had not only become useless, but was a positive and continual menace to the rest of his body. He believed that the stomach itself, and also part of the small intestine, could be dispensed with. Early in 1903 appeared Etudes sur la Nature Humaine, in which Metchnikoff greatly extended the list of man's structural imperfections. Between the times of Paley and of Metchnikoff lie three great discoveries, and we must take note of them if we are to understand how it was possible for the one to praise the perfection of man's structure at the beginning of the nineteenth century and the other to condemn its imperfections at the end. There was first the discovery that man's body was an aggregate or society of living microscopical units. It was Metchnikoff's fortune to approach the study of man's highly complex body through the simpler societies represented by the bodies of the lower invertebrates. It was thus he came by his discovery that certain units of such societies retain their freedom, thus permitting them to serve as scavengers or phagocytes. In the second place there was Darwin's discovery. Metchnikoff was a convinced evolutionist. He therefore presumed that the alimentary outfit which served in an anthropoid phase of human evolution must be ill-adapted to deal with the dietary of civilized Pasteur's discovery, and so far as Metchnikoff's outlook was concerned this was the most potent of the three. It was under the influence of Pasteur's discoveries that Metchnikoff came to think that the destiny of man lay in the issue of the everlasting contest that went on between the living tissues of his body and the invading hosts of microorganisms that threatened them. It is noteworthy that of the three men -Darwin, Pasteur, and Metchnikoff - who revolutionized in the nineteenth century our conception of man's body, and of the struggles to which it is subjected, not one of them was a professed anatomist; the anatomist stood too near to the subject of his study to see it in its true perspective. Twenty-two years have come and gone since Metchnikoff's studies on La Nature Humaine first appeared, and I propose in this lecture to ascertain how far his doctrine of man's structural imperfections and functional disharmonies has stood the test of time. His thesis presumed that Darwin's theory of man's origin was true. That presumption has been supported by every discovery of the present century, and such evidence as we now have justifies us in believing that the rate of man's evolution has been more rapid than has hitherto been supposed. We realize to-day, more precisely than was possible when Metchnikoff wrote, that the most critical chapter in man's long history opened with the discovery of agriculture, a discovery of but yesterday if we reckon time on a geological scale. Agriculture revolutionized the conditions of human life; it made modern civilization possible. We have reason to believe that this revolution in the condition of man's life was initiated either in Mesopotamia, Egypt, or adjacent lands, not more than eight thousand years ago, It is certainly not more than five thousand years ago since agriculture began to be practised in Western Europe. The vast majority of the people of these islands, probably ninety per cent of them, are the descendants of men and women who, two hundred generations ago, were dependent on the natural but precarious harvest that is provided by shore, river, forest, and moorland. City life is a new experiment for Europeans; most of us who live in London, if we could go back twenty generations, would find an ancestry that was living on the soil and of the soil. And now the poorest of us can add to our dietary produce brought from the ends of the earth. The alimentary system that was evolved to meet the needs of our primitive ancestors has now to accommodate itself to a modern dietary. Beyond a doubt civilization is submitting the human body to a vast and critical experiment. It is not only the alimentary system that is being subjected to new conditions; the bony and muscular framework of our bodies is being subjected to novel stresses. Of the present manhood of Britain, half earns its bread by muscular labor; the other half lives sedentary lives. Our forefathers when they arrived in Western Europe were hunters; their bodies were unaccustomed to either manual labor or an indoor life. Under the stress of civilization the hunter's body has to serve modern needs. It says much for the adaptability of the human body that it stands these stresses as well as it does. Dr. J. D. Comrie, on examining ten thousand recruits for the army, found that three hundred and sixtythree of them suffered from hernia and one hundred and thirteen from flatfoot. Such breakdowns in the supporting system of the body do not occur with this frequency among hunting peoples. Civilization has laid bare some of the weak points in the human body, but the conditions that have provoked them are not of Nature's ordaining, but of man's choosing. If modern civilization is making new demands on our bones, muscles, and nerve-controls, it is otherwise with another important system of our bodies. As our manner of living increases in comfort the calls on our heat-regulating mechanism become fewer in number and less urgent in character. Our primitive forefathers lived in the open; their bodies, unhoused and scantily clad, were exposed to sun, rain, wind, and storm. Such a mode of life throws an increasing burden on the machinery that regulates body temperature body temperature-on skin, on respiratory mucous membrane, and on that elaborate system of reflexes that control the rate of internal combustion. Modern civilization, so far as temperature is concerned, tends to make the human body a hothouse plant. Metchnikoff perceived that civilization had plunged man's body into a new environment, and that the rate of its progress had far outstripped the power of adaptional response that had carried man so far beyond the anthropoid stage. A belief grew within him almost a grudge that Nature was letting man down. He brought against the evolutionary powers that preside over the destiny of man both sins of omission and sins of commission. When Metchnikoff applied his analytical genius to the problems of man's alimentary system he carried us into the realms where thought becomes the guide to action. 'It would be no longer rash to say,' he wrote in 1903, 'that not only the rudimentary appendix and the cæcum, but the whole of the human large intestine, is superfluous, and that their removal would be attended with happy results.' Since Metchnikoff penned this sentence the operation of complete colectomy has been performed on many thousands of men and women, but I do not think that even the surgeons who have performed this operation most frequently and most successfully would maintain that a man or woman who has been rendered colonless enjoys that moderate share of health that falls to the average intact individual. If a finger becomes permanently fixed in an awkward position the hand is improved by the amputation of the offending digit, but the relief thus gained does not restore the hand to its original capacity. The relief afforded by colectomy is of the same kind; the results of that operation in no wise bear out Metchnikoff's doctrine that the colon has become a superfluous organ in man's body. On the other hand, we have only to consult the pages of the medical press, to listen to tales which reach our ears daily, to note the ever-growing demand for patent purgatives, to be convinced that there is, as Metchnikoff maintained, a grave disharmony between the functional capacities of our great intestine and the dietary which modern civilization has compelled us to adopt. The way out of our difficulties is not to call the colon a useless organ, a 'sewage pipe,' a 'cesspool,' but to discover its original purpose and ascertain how far we can modify our mode of living to suit its inherited capacity. What that capacity is we have yet to discover, for we have no complete or exact knowledge of the uses of the great intestine in any animal whatsoever. So far as the human organ is concerned, surgery has stepped far in advance of physiology. Since Metchnikoff first promulgated his belief that the appendix, cæcum, and colon had become superfluous organs in man's body our knowledge. concerning the evolution of these structures and of certain conditions that regulate their action has increased. That increase of knowledge rehabilitates the ancient belief that Nature in her evolutionary mood exercises not only a surprising ingenuity but also the strictest economy. The ferments and catalysts elaborated by plants for their own use were made to serve in the animal body as vitamins. It was for the purposes of economy that the great bowel came into existence. In fishes, the earliest vertebrate forms known to us in the living state, potent digestive juices have to be produced at the expense of body tissues; with the evolution of land-living, air-breathing forms much of this expenditure was saved by the utilization of bacterial digestion. The great bowel was added to the original intestine for this purpose. Nor must we forget how closely the great intestine is linked to the central nervous system - both by afferent and efferent pathways. When we take all these considerations into account, we must conclude that the great bowel of man is not a useless or superfluous organ, but one which we, in our ignorance, are maltreating. Darwin regarded the appendix as one of man's vestigial structures, and Metchnikoff accepted this verdict without demur, although there were then anatomists who refused to regard the appendix as a useless structure. An organ which, as numerous anatomical investigations show, increases in length until the twentieth year, or even until the fiftieth, does not merit the name vestigial. The size of the appendix at birth in the various forms of anthropoid apes we do not know, but in adult gorillas, chimpanzees, and orangs the appendix usually attains a length of one hundred and fifty or one hundred and sixty millimetres and sixty millimetres nearly double the length of the human appendix. In the most primitive form of anthropoid |