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12.6 Pancreas (Islets of Langerhans)
12.7 The Gonads
12.8 Mammary Glands
12.9 Metabolic Bone Disease

Chapter 13
The Skin
13.1 Structure and Functions
13.2 Methods of Evaluating Impairment
13.3 Pruritus
13.4 Disfigurement
13.5 Scars and Skin Grafts
13.6 Patch Testing—Performance, Interpretation, and Relevance
13.7 Criteria for Evaluating Permanent Impairment of the Skin

Chapter 14
Mental and Behavioral Disorders
14.1 Diagnosis of Impairment
14.2 Evidence of Mental Impairment
14.3 Assessing Impairment Severity
14.4 Additional Considerations
14.5 Special Impairment Categories
14.6 Format of the Report
14.7 A Method of Evaluating Psychiatric Impairment

Chapter 15
Pain
15.1 Basic Assumptions
15.2 Definitions
15.3 Pain, Impairment, and Disability
15.4 Classification and Models
15.5 Dynamic Interrelationships of Models
15.6 Clinical Assessment
15.7 Treatment
15.8 Estimating Impairment
15.9 Headache
Examples of Pain Evaluation

Glossary

8
 Terms Used in Assessments According to Guides
Aggravation, Recurrence, Causation, Disability, Workers’ Compensation, and Employability
Social Security Disability Determinations
The Americans with Disabilities Act

Combined Values Chart

Index

9
Foreword

T
he Fourth Edition of the Guides to the Evaluation of Permanent Impairment (Guides) continues an
activity begun by the American Medical Association (AMA) almost four decades ago, the purpose of
which was to bring greater objectivity to estimating the degree of long-standing or “permanent”
impairments. The rationale for this new edition is that the pace of progress and advance in medicine
continues to be rapid, and that a new look at the impairment criteria for all organ systems is advisable. This
edition has been prepared under the auspices of the AMA’s Council on Scientific Affairs.
In preparing the Fourth Edition, the Guides’ editors, AMA staff members, and the Council’s liaison
members first selected well-qualified individuals who, as chairs, would be responsible for preparing the
chapters on organ system impairments and other subjects. Then the AMA staff requested nominations of
knowledgeable, interested physicians from all the state medical societies and the medical specialty societies
that make up the AMA federation. Thereafter, the chairs and committee members selected by them and the
AMA staff prepared the text.
All of the chapters of this edition have undergone peer review, either by the committees who prepared
them or by other knowledgeable persons. In March 1992, representatives of 11 medical specialty societies, the
Social Security Administration, the US Department of Veterans Affairs, the American Bar Association, and
the Oklahoma State Workers’ Compensation Agency, a representative agency that mandates the Guides’ use,
met to consider a draft of the Fourth Edition and provide further peer review. After this meeting, the chairs
made appropriate changes. A multidisciplinary ad hoc committee provided special assistance with the
musculoskeletal system.
The Fourth Edition has some new features. Case reports or examples are included in most of the parts
dealing with the different organ systems. A chapter on pain is included. Organ transplantation and the
adverse effects of pharmaceuticals are considered. The Glossary contains informative material on the
Americans with Disability Act (ADA) of 1992. New data are cited in Chapter 1 on the widespread use of the
Guides by state workers’ compensation agencies.
The Fourth Edition continues to convey several basic principles. A key tenet is that the book applies only
to permanent impairments, which are defined as adverse conditions that are stable and unlikely to change.
Evaluating the magnitude of these impairments is in the purview of the physician, while determining
disability is usually not the physician’s responsibility. This edition emphasizes that impairment percentages
derived by using Guides criteria represent estimates rather than precise determinations. Permanent impairments
are evaluated in terms of how they affect the patient’s daily activities, and this edition recognizes that one’s
occupation constitutes part of his or her daily activities.
Many persons helped with the Fourth Edition. The authors of and the contributors to the Guides,
reviewers, and responsible AMA staff members are listed after the Foreword. The editors acknowledge

10
especially the research and assistance of Alfred B. Swanson, MD, and Genevieve de Groot Swanson, MD,
whose work was essential in preparing the hand and upper extremity section in the chapter on the
musculoskeletal system.
The editors also wish to acknowledge the hundreds of Guides users who have written the AMA in past
years and offered their suggestions. While the editors’ goal has been to prepare the best Guides yet, we realize
there still is room for improvement. The Guides readers and users can contribute to this process. Therefore, we
invite all to continue offering their comments and advice.

Theodore C. Doege, MD, MS, Editor

Thomas P. Houston, MD, Associate Editor

11
Chairs, Contributors, Reviewers, and Participants

Chairs

C. Eugene Carlton, MD, Baylor College of Medicine, Houston, Texas

—The Urinary and Reproductive Systems

Francis I. Catlin, MD, ScD, Houston, Texas

—Ear, Nose, Throat, and Related Structures

Paul E. Epstein, MD, The Graduate Hospital, Philadelphia, Pennsylvania

—The Respiratory System

Don E. Flinn, MD, US Department of Veterans Affairs Medical Center West Los Angeles, Los Angeles,
California
—Mental and Behavioral Disorders

Robert H. Haralson III, MD, Maryville Orthopedic Clinic, Maryville, Tennessee

—The Musculoskeletal System, The Spine

William S. Haubrich, MD, La Jolla, California

—The Digestive System

David L. Horwitz, MD, PhD, SciClone Pharmaceuticals, San Mateo, California

—The Endocrine System

Philipp M. Lippe, MD, San Jose, California

—Pain

James V. Luck, Jr., MD, Orthopaedic Hospital, Los Angeles, California

—The Lower Extremity (In: The Musculoskeletal System)

Nelson G. Richards, MD, Associated Neurologists and US Department of Veterans Affairs McQuire
Hospital, Richmond, Virginia
—The Nervous System

Joseph Sataloff, MD, DSc, Jefferson Medical College, Philadelphia, Pennsylvania

—Impairment Evaluation and Records and Reports

George M. Smith, MD, MPH, GM Smith Associates, Bethesda, Maryland

—Glossary

12
John A. Spittell, Jr., MD, Mayo Clinic, Rochester, Minnesota
—The Cardiovascular System

Alfred B. Swanson, MD, Michigan State University, Grand Rapids, Michigan

—The Hand and Upper Extremity (In: The Musculoskeletal System)

James S. Taylor, MD, Cleveland Clinic Foundation, Cleveland, Ohio

—The Skin

Ralph O. Wallerstein, Sr., MD, University of California, San Francisco, California

—The Hematopoietic System

Nancy Webb, MD, Kelsey-Seybold Clinic, Houston, Texas

—The Visual System

Contributors

Roy D. Altman, MD, University of Miami School of Medicine, Miami, Florida

Douglas R. Anderson, MD, Bascom-Palmer Eye Institute, Miami, Florida

Thomas P. Ball, Jr., MD, University of Texas Health Sciences Center, San Antonio, Texas

Stanley J. Bigos, MD, University of Washington School of Medicine, Seattle, Washington

E. Richard Blonsky, MD, Rehabilitation Institute of Chicago, Chicago, Illinois

Lewis E. Braverman, MD, University of Massachusetts Medical School, Worcester, Massachusetts

James E. Culver, MD, Cleveland Clinic Foundation, Cleveland, Ohio

William E. Davis, MD, University of Missouri School of Medicine, Columbia, Missouri

Theodore C. Doege, MD, MS, American Medical Association, Chicago, Illinois

John A. Dowdle, Jr., MD, St. Paul, Minnesota

Loren H. Engrav, MD, University of Washington, Harborview Medical Center, Seattle, Washington

Gary R. Epler, MD, New England Baptist Hospital, Boston, Massachusetts

E. Harvey Estes, Jr., MD, Raleigh, North Carolina

Blair C. Filler, MD, Los Angeles, California

Gregory Firman, MD, JD, US Department of Veterans Affairs Medical Center West Los Angeles, Los
Angeles, California

John J. Gerhardt, MD, Milwaukie, Oregon

Sherwin Goldman, MD, Mayo Clinic, Rochester, Minnesota

13
William Jason Groves, JD, Rapid City, South Dakota

Donald Hammersley, MD, Bethesda, Maryland

Stephen C. Hammill, MD, Mayo Clinic, Rochester, Minnesota

Jeanne E. Hicks, MD, National Institutes of Health, Bethesda, Maryland

Thomas P. Houston, MD, American Medical Association, Chicago, Illinois

Paul E. Kaplan, MD, Ohio State University, Columbus, Ohio

Arthur H. Keeney, MD, University of Louisville, Louisville, Kentucky

David G. Kline, MD, Louisiana State University, New Orleans, Louisiana

Joseph E. Kutz, MD, Louisville Hand Surgery, Louisville, Kentucky

Paul R. Lambert, MD, University of Virginia School of Medicine, Charlottesville, Virginia

Philip Levy, MD, Phoenix Endocrinology Clinic, Phoenix, Arizona

Donlin M. Long, MD, PhD, Johns Hopkins University School of Medicine, Baltimore, Maryland

L. Russell Malinak, MD, Baylor University College of Medicine, Houston, Texas

John H. Mather, MD, Social Security Administration, Baltimore, Maryland

C. G. Toby Mathias, MD, Group Health Associates, Cincinnati, Ohio

Tom G. Mayer, MD, PRIDE Research Foundation, Dallas, Texas

J. Michael McWhorter, MD, Bowman Gray School of Medicine, Winston-Salem, North Carolina

William Melnick, PhD, University Hospital Clinic, Ohio State University, Columbus, Ohio

Arthur T. Meyerson, MD, Hahnemann University, Philadelphia, Pennsylvania

Ernest H. Neighbor, MD, JD, Bisko, Fee, and Parkins, Kansas City, Missouri

James R. Nethercott, MD, Johns Hopkins University School of Hygiene and Public Health, Baltimore,
Maryland

Rick A. Nishimura, MD, Mayo Clinic, Rochester, Minnesota

George E. Omer, Jr., MD, University of New Mexico, Albuquerque, New Mexico

John T. Purvis, MD, Knoxville, Tennessee

Herbert E. Rosenbaum, MD, Washington University, St. Louis, Missouri

Karen S. Rucker, MD, Medical College of Virginia, Richmond, Virginia

14
Joel R. Saper, MD, Michigan Headache and Neurological Institute, Ann Arbor, Michigan

Robert T. Sataloff, MD, DMA, Jefferson Medical College, Philadelphia, Pennsylvania

Labe C. Scheinberg, MD, Albert Einstein College of Medicine, New York, New York

William S. Shaw, MD, Billings Clinic, Billings, Montana

Elizabeth F. Sherertz, MD, Bowman Gray School of Medicine, Winston-Salem, North Carolina

William Douglas Skelton, MD, Mercer University School of Medicine, Macon, Georgia

Thomas R. Sprenger, MD, Bradenton, Florida

Genevieve de Groot Swanson, MD, Michigan State University, Grand Rapids, Michigan

Sridhar V. Vasudevan, MD, Elmbrook Memorial Hospital, Brookfield, Wisconsin

Kenneth M. Viste, Jr., MD, Oshkosh, Wisconsin

Paul Volberding, MD, San Francisco General Hospital, San Francisco, California

Robert A. Wise, MD, Francis Scott Key Medical Center, Baltimore, Maryland

Edwin T. Wyman, Jr., MD, Massachusetts General Hospital, Boston, Massachusetts

Reviewers

Russell F. Allen, MD, Oklahoma Workers’ Compensation Court, Oklahoma City, Oklahoma

Fern E. Asma, MD, Chicago, Illinois

Philip L. Barney, MD, Community Medical Center, Missoula, Montana

Mark E. Battista, MD, Unum Life Insurance Company, Portland, Maine

E. Richard Blonsky, MD, Rehabilitation Institute of Chicago, Chicago, Illinois

Marcus B. Bond, MD, Golden, Colorado

Bernard B. Bradley, MD, The University of Texas Medical School, Pasadena, Texas

Sergio Delgado, MD, Topeka, Kansas

Joseph L. Demer, MD, PhD, University of California at Los Angeles, Los Angeles, California

John W. Ellis, MD, Oklahoma City, Oklahoma

Alan L. Engelberg, MD, Monsanto Company, St. Louis, Missouri (Editor of the Second and Third Editions,
Guides to the Evaluation of Permanent Impairment)

Kenneth G. Gould, Jr., MD, Exxon USA Company, Houston, Texas

15
Elwood J. Headley, MD, Department of Veterans Affairs, Washington, DC

Alfred Healy, MD, University Hospital, Iowa City, Iowa

Keith S. Henley, MD, University Hospitals, Ann Arbor, Michigan

Ronald Klein, MD, University of Wisconsin Hospital, Madison, Wisconsin

Myron Lewis, MD, Memphis Gastroenterology Group, Memphis, Tennessee

John A. Linfoot, MD, Oakland, California

John H. Mather, MD, Social Security Administration, Baltimore, Maryland

Siza Mekky, MD, Mekky Associates, Bethesda, Maryland

William T. Rumage, Jr., MD, Louisville, Kentucky

William S. Shaw, MD, Billings Clinic, Billings, Montana

Ralph E. Yodaiken, MD, US Department of Labor, Washington, D.C.

Don J. Young, MD, Sandusky, Ohio

Council on Scientific Affairs

Yank D. Coble, Jr., MD, Jacksonville, Florida (Vice Chair)

E. Harvey Estes, Jr., MD, Raleigh, North Carolina (Chairman)*

C. Alvin Head, MD, Tucker, Georgia

Mitchell S. Karlan, MD, Beverly Hills, California

William R. Kennedy, MD, University of Minnesota Hospitals, Minneapolis, Minnesota

Patricia J. Numann, MD, State University of New York Health Science Center, Syracuse, New York

William C. Scott, MD, University Medical Center, Tucson, Arizona

W. Douglas Skelton, MD, Mercer University School of Medicine, Macon, Georgia*

Richard M. Steinhilber, MD, Cleveland Clinic Foundation, Cleveland, Ohio

Jack P. Strong, MD, Louisiana State University Medical Center, New Orleans, Louisiana

Christine C. Toevs, Medical Student Representative, Greenville, North Carolina

Henry N. Wagner, Jr., MD, Johns Hopkins University School of Hygiene and Public Health, Baltimore,
Maryland

American Medical Association Staff

16
Department of Preventive Medicine and Public Health

Theodore C. Doege, MD, MS, Senior Scientist, Editor, Guides to the Evaluation of Permanent Impairment,
Fourth Edition

Thomas P. Houston, MD, Director, Associate Editor, Guides to the Evaluation of Permanent Impairment,
Fourth Edition

Mary D. Haynes, Senior Secretary

Sharon E. Major, Secretary

Michiko Sidney, Senior Secretary

Division of Health Science

Robert C. Rinaldi, PhD, Director

Eileen Keane, Administrative Assistant

Group on Science, Technology, and Public Health

James R. Allen, MD, MPH, Vice President

Jerod M. Loeb, PhD, Assistant Vice President

Leatha A. Tiggelaar, Assistant to the Vice President

Medical Education and Science

M. Roy Schwarz, MD, Senior Vice President

Marketing Services

Walter J. Kaban, Jr.

Denise M. McGill

Louis G. Schaaf

Boon Ai Tan

Marketing Management

R. Todd Bake

Sharna Fetman

Lewis W. Jenkins

17
Barry S. Litwin

Jane E. Piro

Scientific Indexing

Norman Frankel

George Kruto

Office of the General Counsel

Betty Jane Anderson, JD

Veda L. Britt, JD

Executive Vice President

James S. Todd, MD

Participants

Copy Editor

Nicole Netter, Lake Bluff, Illinois

*Liaison Council members for Guides

18
List of Tables and Figures

Chapter 1
Impairment Evaluation

Table Status of Guides to the Evaluation of Permanent Impairment (Guides) According to 53

Workers’ Compensation Agencies

Chapter 2
Records and Reports

Report of Medical Evaluation (Permanent Medical Impairment)

Chapter 3
The Musculoskeletal System

The Hand and Upper Extremity

Table 1 Relationship of Impairment of the Digits to Impairment of the Hand

Table 2 Relationship of Impairment of the Hand to Impairment of the Upper Extremity

Table 3 Relationship of Impairment of the Upper Extremity to Impairment of the Whole Person

Table 4 Longitudinal Sensory Loss Impairment for the Thumb and Little Finger Based on Percent
of Digit Length Involved

Table 5 Thumb Impairment Values Due to Lack of Adduction and to Ankylosis

Table 6 Thumb Impairments Due to Lack of Radial Abduction and to Ankylosis

Table 7 Thumb Impairments Due to Lack of Opposition and to Ankylosis

Table 8 Longitudinal Sensory Loss Impairment for the Thumb and Little Finger Based on Percent
of Digit Length Involved

Table 9 Longitudinal Sensory Loss Impairment of Index, Middle, and Ring Fingers Based on the
Percent of Digit Length Involved

Table 10 Origins and Functions of the Peripheral Nerves of the Upper Extremity Emanating from the
Brachial Plexus

Table 11 Determining Impairment of the Upper Extremity Due to Pain or Sensory Deficit Resulting
from Peripheral Nerve Disorders

19
 Resulting from Peripheral Nerve Disorders Based on Individual Muscle Rating

Table 13 Maximum Upper Extremity Impairment Due to Unilateral Sensory or Motor Deficits of
Individual Spinal Nerves or to Combined Deficits

Table 14 Maximum Upper Extremity Impairments Due to Unilateral Sensory or Motor Deficits of
Brachial Plexus, or to Combined Deficits

Table 15 Maximum Upper Extremity Impairments Due to Unilateral Sensory or Motor Deficits or
Combined Deficits of the Major Peripheral Nerves

Table 16 Upper Extremity Impairment Due to Entrapment Neuropathy

Table 17 Impairment of Upper Extremity Due to Peripheral Vascular Disease

Table 18 Impairment Values for Digits, Hand, Upper Extremity, and the Whole Person for Disorders
of Specific Joints

Table 19 Impairment from Joint Crepitation

Table 20 Impairment from Synovial Hypertrophy

Table 21 Impairment from Digit Ulnar or Radial Deviation

Table 22 Impairment from Digit Rotational Deformity

Table 23 Impairment from Persistent Joint Subluxation or Dislocation

Table 24 Impairment from Joint Mediolateral Instability

Table 25 Impairment from Wrist and Elbow Joint Radial and Ulnar Deviations

Table 26 Upper Extremity Impairment Due to Carpal Instability Patterns

Table 27 Impairment of the Upper Extremity After Arthroplasty of Specific Bones or Joints

Table 28 Impairment from Intrinsic Tightness

Table 29 Impairment Due to Constrictive Tenosynovitis

Table 30 Impairment Due to Extensor Tendon Subluxation

Table 31 Average Strength of Unsupported Grip by Occupation in 100 Subjects

Table 32 Average Strength of Grip by Age in 100 Subjects

Table 33 Average Strength of Lateral Pinch by Occupation in 100 Subjects

Table 34 Upper Extremity Impairment for Loss of Strength

Figure 1 Upper Extremity Impairment Evaluation Record—Part 1 (Hand) and Part 2 (Wrist, Elbow,
and Shoulder)

Figure 2 Impairments of Upper Extremity from Amputation at Various Levels

Figure 3 Impairments of the Digits and of Hand for Amputations at Various Levels

20
Figure 5 Impairment of Hand Due to Total Transverse Sensory Loss of Digits and Longitudinal
Sensory Loss of Radial and Ulnar Sides of the Digits

Figure 6 Illustration of MP Joint Positions in Flexion, Extension, Extension Lag, and Hyperextension

Figure 7 Impairment of Thumb Due to Amputation at Various Levels or Total Transverse Sensory
Loss

Figure 8 Neutral Position and Flexion of Thumb IP Joint

Figure 9 Impairment Curves for Ankylosis (IA%), Loss of Flexion (IF%), and Loss of Extension (IE%)
of IP Joint of Thumb

Figure 10 Thumb Impairments Due to Abnormal Motion at the IP Joint

Figure 11 Neutral Position and Flexion of Thumb MP Joint

Figure 12 Impairment Curves for Ankylosis (IA%), Loss of Flexion (IF%), and Loss of Extension (IE%)
of Thumb MP Joint

Figure 13 Thumb Impairments Due to Abnormal Motion at the MP Joint

Figure 14 Linear Measurements of Thumb Adduction in Centimeters at Various Positions and

Impairment Curve for Lack of Adduction

Figure 15 Radial Abduction of Thumb, Measured in Degrees

Figure 16 Linear Measurements of Thumb Opposition (cm) at Various Positions and Impairment
Curve for Lack of Opposition

Figure 17 Finger Impairment Due to Amputation at Various Lengths and Total Transverse Sensory
Loss

Figure 18 Neutral Position and Flexion of Finger DIP Joint

Figure 19 Finger Impairments Due to Abnormal Motion at the DIP Joint

Figure 20 Neutral Position and Flexion of Finger PIP Joint

Figure 21 Finger Impairments Due to Abnormal Motion at PIP Joint

Figure 22 Neutral Position and Flexion of Finger MP Joint

Figure 23 Finger Impairments Due to Abnormal Motion at the MP Joint

Figure 24 Wrist Flexion and Extension

Figure 25 Impairment Curves for Ankylosis (IA%), Loss of Flexion (IF%), and Loss of Extension (IE%)
of Wrist Joint

Figure 26 Upper Extremity Impairments Due to Lack of Flexion and Extension of Wrist joint

Figure 27 Radial Deviation and Ulnar Deviation of Right Wrist

Figure 28

21
 Ulnar Deviation (IUD%) of Wrist joint

Figure 29 Upper Extremity Impairments Due to Abnormal Radial and Ulnar Deviations of Wrist joint

Figure 30 Flexion and Extension of Elbow

Figure 31 Impairment Curves for Ankylosis (IA%), Loss of Flexion (IF%), and Loss of Extension (IE%)
of Elbow Joint

Figure 32 Upper Extremity Impairments Due to Lack of Flexion and Extension of the Elbow Joint

Figure 33 Pronation and Supination of Forearm

Figure 34 Impairment Curves for Ankylosis (IA%), Loss of Supination (Is%), and Loss of Pronation
(Ip%) of Elbow joint

Figure 35 Upper Extremity Impairments Due to Lack of Pronation and Supination

Figure 36 Shoulder Extension and Flexion

Figure 37 Impairment Curves for Ankylosis (IA%), Loss of Flexion (IF%), and Loss of Extension (IE%)
of Shoulder

Figure 38 Upper Extremity Impairments Due to Lack of Flexion and Extension of Shoulder

Figure 39 Shoulder Abduction and Adduction

Figure 40 Impairment Curves for Ankylosis (IA%), Loss of Abduction (IABD%), and Loss of
Adduction (IADD%) of Shoulder

Figure 41 Upper Extremity Impairments Due to Lack of Abduction and Adduction of Shoulder

Figure 42 Shoulder External Rotation and Internal Rotation

Figure 43 Impairment Curves for Ankylosis (IA%), Loss of Internal Rotation (IIR%), and Loss of
External Rotation (IE%) of the Shoulder

Figure 44 Upper Extremity Impairments Due to Lack of Internal and External Rotation of Shoulder

Figure 45 Cutaneous Innervation of Upper Extremity and Related Peripheral Nerves and Roots

Figure 46 Dermatomes of the Upper Limb

Figure 47 The Brachial Plexus

Figure 48 Motor Innervation of the Upper Extremity

Figure 49 Example 2: Crushed Hand—Upper Extremity Impairment Evaluation Record

Figure 50 Example 5: Upper Extremity Severe Burn Contractures—Upper Extremity Impairment

Evaluation Record

Figure 51 Example 6: Multiple Finger Amputations—Upper Extremity Impairment Evaluation Record

The Lower Extremity

22
Table 36 Lower Limb Impairment from Gait Derangement

Table 37 Impairments from Leg Muscle Atrophy

Table 38 Criteria for Grades of Muscle Function of the Lower Extremity

Table 39 Impairments from Lower Extremity Muscle Weakness

Table 40 Hip Motion Impairments

Table 41 Knee Impairment

Table 42 Ankle Motion Impairment Estimates

Table 43 Hindfoot Impairment Estimates

Table 44 Ankle or Hindfoot Deformity Impairments

Table 45 Toe Impairments

Table 46 Impairment from Ankylosis in Hip Flexion

Table 47 Impairment from Ankylosis in Hip Internal Rotation

Table 48 Impairment from Ankylosis in Hip External Rotation

Table 49 Impairment from Ankylosis in Hip Abduction

Table 50 Impairment from Ankylosis in Hip Adduction

Table 51 Impairment from Knee Ankylosis in Varus

Table 52 Impairment from Knee Ankylosis in Valgus

Table 53 Impairment from Knee Ankylosis in Flexion

Table 54 Knee Ankylosis Impairment in Internal or External Malrotation

Table 55 Ankle Impairment from Ankylosis in Plantar Flexion or Dorsiflexion

Table 56 Ankle Impairment from Ankylosis in Varus Position

Table 57 Ankle Impairment from Ankylosis in Valgus Position

Table 58 Ankle Impairment from Ankylosis in Internal Malrotation

Table 59 Ankle Impairment from Ankylosis in External Malrotation

Table 60 Impairments for Loss of Boehler’s Angle

Table 61 Impairment of the Foot Due to Impairments of Toes

Table 62 Arthritis Impairments Based on Roentgenographically Determined Cartilage Intervals

Table 63 Impairment Estimates for Amputations

Table 64 Impairment Estimates for Certain Lower Extremity Impairments

Table 65 Rating Hip Replacement Results

23
Table 66 Rating Knee Replacement Results

Table 67 Impairments for Skin Loss

Table 68 Impairments from Nerve Deficits

Table 69 Lower Extremity Impairment Due to Peripheral Vascular Disease

Figure 52 Using a Goniometer to Measure Flexion of the Right Hip

Figure 53 Neutral Position (a), Abduction (b), and Adduction (c) of Right Hip

Figure 54 Measuring Internal and External Hip Rotation

Figure 55 Measuring Knee Flexion

Figure 56 Measuring Foot Dorsiflexion and Plantar Flexion

Figure 57 Boehler’s Angle

Figure 58 Evaluating the Range of Motion of a Toe, the Metatarsophalangeal (MTP) Joint of the
Great Toe

Figure 59 Sensory Nerves of the Lower Extremity and Their Roots of Origin

Figure 60 Motor Innervation of the Lower Extremity

The Spine

Table 70 Spine Impairment Categories

Table 71 DRE Impairment Category Differentiators

Table 72 DRE Lumbosacral Spine Impairment Categories

Table 73 DRE Cervicothoracic Spine Impairment Categories

Table 74 DRE Thoracolumbar Spine Impairments

Table 75 Whole-person Impairment Percents Due to Specific Spine Disorders

Table 76 Cervical Region Impairment from Abnormal Flexion or Extension or Ankylosis

Table 77 Impairment Due to Abnormal Motion and Ankylosis of the Cervical Region: Lateral Flexion

Table 78 Impairment Due to Abnormal Motion and Ankylosis of the Cervical Region: Rotation

Table 79 Impairment Due to Abnormal Motion (Flexion) and Ankylosis of the Thoracic Region

Table 80 Impairment Due to Abnormal Motion and Ankylosis of the Thoracic Region: Rotation

Table 81 Impairment Due to Abnormal Motion of the Lumbosacral Region: Flexion and Extension

Table 82 Impairment Due to Abnormal Motion and Ankylosis of the Lumbosacral Region: Lateral
Flexion

Table 83 Unilateral Spinal Nerve Root Impairment Affecting the Lower Extremity

Figure 61 History of Spine Complaint

24
Figure 62 Loss of Motion Segment Integrity: Translation

Figure 63 Loss of Motion Segment Integrity: Angular Motion

Figure 64 The Whole Spine Divided Into Regions Indicating the Maximum Whole-person
Impairment Represented by Total Impairment of One Region (Range of Motion Model)

Figure 65 A Mechanical Inclinometer

Figure 66 Body Planes for Measuring Motion

Figure 67 Two-inclinometer Measurement Technique for Cervical Flexion and Extension

Figure 68 Single-inclinometer Measurement Technique for Cervical Flexion

Figure 69 Two-inclinometer Measurement Technique for Cervical Lateral Flexion

Figure 70 Single-inclinometer Technique for Cervical Lateral Flexion

Figure 71 Measurement of Cervical Rotation

Figure 72 Two-inclinometer Measurement Technique for Obtaining Angles of Minimum Kyphosis

and Measuring Thoracic Flexion

Figure 73 Two-inclinometer Measurement Technique for Thoracic Rotation

Figure 74 Alternative Single-inclinometer Technique for Thoracic Spine Rotation

Figure 75 Two-inclinometer Measurement Technique for Lumbosacral Flexion and Extension

Figure 76 Two-inclinometer Measurement Technique for Lumbosacral Lateral Bend

Figure 77 Cervical Range of Motion

Figure 78 Thoracic Range of Motion

Figure 79 Lumbar Range of Motion

Figure 80 Spine Impairment Summary

Chapter 4
The Nervous System

Table 1 Impairments Related to Aphasia or Dysphasia

Table 2 Mental Status Impairments

Table 3 Emotional or Behavioral Impairments

Table 4 Impairment of Consciousness and Awareness

Table 5 Impairments Related to Epilepsy, Seizures, and Convulsive Disorders

Table 6 Impairment Criteria for Sleep and Arousal Disorders

Table 7 Selected Optic Nerve Impairment Criteria

Table 8 Visual Field Impairment

25
Table 9 Cranial Nerve V (Trigeminal) Impairment Criteria

Table 10 Impairment Criteria for Cranial Nerve VII (Facial) and Adjoining Region

Table 11 Impairment Criteria for Cranial Nerve VIII (Auditory Nerve)

Table 12 Impairment Criteria for Cranial Nerves IX and XII

Table 13 Station and Gait Impairment Criteria

Table 14 Criteria for One Impaired Upper Extremity

Table 15 Criteria for Two Impaired Upper Extremities

Table 16 Neurologic Impairment of Respiration

Table 17 Criteria for Neurologic Impairment of Bladder

Table 18 Criteria for Neurologic Anorectal Impairment

Table 19 Sexual Impairment Criteria

Table 20 Determining Impairment Due to Pain or Sensory Deficit Resulting from Peripheral Nerve
Disorders

Table 21 Determining Nervous System Impairment Due to Loss of Muscle Power and Motor
Function Resulting from Peripheral Nerve Disorders

Table 22 Impairments Related to Syncope or Transient Loss of Awareness

Table 23 Impairments of Spinal Nerves in the Head and Neck Region

Table 24 Impairments of Spinal Nerves Affecting the Inguinal and Perineal Regions

Chapter 5
The Respiratory System

Table 1 Classification of Dyspnea

Table 2 Predicted Normal FVC Values (Liters) for Men (BTPS)

Table 3 Predicted Normal FVC Values for Women (BTPS)

Table 4 Predicted Normal FEV1 Values for Men

Table 5 Predicted Normal FEV1 Values for Women

Table 6 Predicted Normal Single-Breath Dco Values for Men (STPD)

Table 7 Predicted Normal Single-Breath Dco Values for Women (STPD)

Table 8 Classes of Respiratory Impairment

Table 9 Classification of Prolonged Physical Work Intensity by Oxygen Consumption

Table 10 Impairments Not Directly Related to Lung Functions

26
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Propontis, 179.
Proto-Alpines, 135;
language of, 235;
physical characters of, 135.
Proto-Aryan language, 67, 233, 242;
and Alpines, 237;
Nordic origin of, 61.
Proto-Mediterranean Race, 132;
descended from the Neolithic, 149–150.
Proto-Nordics, 224, 233;
in Russia, 64, 170.
Proto-Slavic language, Aryan character of, 143.
Proto-Teutonic race, 169.
Provençal, 244;
Provençal language, 244.
Provençals, 156.
Provence, 23;
Mediterraneans in, 156.
Prussia, Spartan culture of, 161.
Prussian, Old (Borussian), language, 212, 242.
Prussians, ethnic origin of, 72.
Punic Wars, 217.
Punjab, the, 257;
entrance of Aryans into, 258;
decline of Nordics in, 261.
Puritans, 55.
Pyrenees, caverns of, 115.

Quebec Frenchmen, 81.

Race, 3, 4;
Aryan, 3;
Caucasian, 3;
Celtic, 3;
Indo-Germanic, 3;
Latin, 3;
adjustment to habitat of, 93;
characters, 13 et seq.;
consciousness, 4, 57, 60, 90;
in Germany, 57;
in Sweden, 57;
in the United States, 86;
degeneration, 39–43, 109;
determination, 15, 19, 24, 28;
disharmonic combinations of, 14, 28, 35, 110;
distinguished from language and nationality, 34;
effect of democracy on, 5;
feeling, 222;
importance of, 98–100;
physical basis of, 13–16;
positions of the three main races in Roman times, 131;
resistance to foreign invasion, 71;
selection, 46, 50, 54, 55, 215;
versus species and subspecies, 22.
Race mixture, 18, 34, 60, 77, 85, 116, 262;
among the Gauls, 145;
among the Normans, 208;
among the Turks, 237;
among the Umbrians, 145;
and civilization, 214–216;
in North Africa, 151;
in South Africa, 80;
in the Argentine, 78;
in Brazil, 78;
in Britain, 248;
in Canada, 81;
in Europe, 261–262;
in Germany, 135;
 in Greece, 161;
in Jamaica, 76;
in large cities, 92;
in Macedon, 161;
in Mexico, 76;
in the Roman Empire, 71;
in Rome, 154, 220;
in Russia, 174;
in Spain, 192;
in Switzerland, 135;
in the United States, 77, 82–94;
in Venezuela, 76;
in Tunis, 158;
of Alpines and Celts, 177;
of Alpines and Nordics, 151;
of Alpines and Mediterraneans, 151;
of Ainus and Mongols, 225;
of Belgæ and Teutonic tribes, 248;
of Celts and Mediterraneans, 177;
of Goidels and Mediterraneans, 248;
of Mediterraneans and Dravidians and Negroids, 150;
of Nordics and Negroes, 82;
of late Nordics and Paleoliths, 149;
of Slavs and Illyrians, 153, 190.
Race supplanting, 77, 46–48, 110.
Races, European distribution of during the Neolithic, 123;
in Europe, 131;
laws of distribution of, 37;
evolution of through selection, 37 et seq.
Racial, aptitudes, 226–232;
of Alpines, 138–139, 146;
of Negroes, 77, 109;
of Normans, 207–208;
elements of the Great War, 187;
resistance of acclimated populations, 71;
types, intellectual and moral differences of, 206.
Raphael, 215.
Ravenna, surrender of, 189.
Recapitulation of development in infants, 30.
Reformation, the, 191, 210, 228;
in England, 10.
Regiments, German, composition of, 142.
Religion, 64;
nationalities founded on, 57, 58.
Renaissance, 215, 231.
Republic, a true, 7, 8.
Resurgence of types, 15;
of Alpines in Europe, 146–147, 184, 190–191, 196, 210;
of Iberians in Scotland, 249;
of Mediterraneans, 190, 196;
in England, 83, 208.
Revolution, 6;
French, 6, 16, 191, 196, 197;
German, 87.
Revolutionary Wars, 197.
Riss glaciation, 105, 133.
Riss-Würm, 105;
interglacial, 133.
Robenhausian culture, 132;
Period, 121;
Upper, 122, 265.
Rollo, 263.
Romaic language, origin of, 243.
Roman, abandonment of Britain, 200;
aristocracy, 217;
busts, 154;
church, 53, 85;
Empire, 10, 71–72, 142, 176, 179–182, 187, 217–222;
component states of, 183;
 fall of, 221;
Eastern Empire, 165–166;
population of, 216, 220;
slaves in, 216;
Western Empire, re-established, 182;
ideals, 153;
occupation of Britain, effect of, ethnically, 200;
provinces, Teutonized, 191;
Republic, 71, 154, 217, 219;
State, ancient civilization of, 153, 216;
stature, 154;
stock, extinction of, 51.
Romance tongues, 61, 238, 244.
Romans, 68, 156, 174–176, 193, 194, 216–221, 246;
decline of, 217–222;
features of, 154;
in Britain, 200, 250;
in France, 63;
in Spain, 156;
a modified race in Gaul, 69;
stature of, 154.
Romansch language, 244.
Rome, 11, 52, 61, 70, 92, 130, 154, 157, 158, 165, 179, 180, 191, 195,
215–221, 245, 251;
Alpines, Nordics and Mediterraneans in, 130, 153, 154;
change of race in, 218–220;
change of religion in, 219;
early struggles in, 154;
in Dacia, 245;
language of, 61, 70;
Northern qualities of, 153–154;
race mixture in, 154, 220;
slaves in, 71, 100, 216, 218–220;
stormed by Brennus, 157.
Rough Stone Age, see Paleolithic.
Round Barrows, 137–138, 163, 247, 267;
 brachycephalic survivals of, 163–164.
Round skulls, absence of in Britain, 249.
See also physical characters of the Alpines, Armenoids, etc.
Rumania, 59, 245;
Alpines in, 65;
Mediterraneans in, 153.
Rumanian language, 244–246;
origin of, 244–245;
distribution of, 245.
Rumanians, 21, 145;
and Christianity, 65;
descent of, 244–246;
Latin language of, 244–246.
Russia, 38, 143, 253;
Alans and Goths in, 66;
Alpines in, 44, 131, 136, 142–144, 147;
Anaryan survivals in, 235, 243;
Asiatic types in, 144;
Baltic provinces of, Nordic, 212;
blondness in, 190;
Bulgars from, 145;
burial mounds or kurgans in, 172;
changes in racial predominance in, 142–144, 147;
dolichocephaly in, 190;
early Nordics in, 124, 131, 142;
Esthonians in, 236;
Finns in, 236;
Gauls in, 174;
grasslands and steppes of, 240, 253–254, 257;
language in, 235–236, 243;
Livs in, 236;
Mongols in, 65, 142;
Muscovite expansion in, 65;
Nordic substratum in, 64, 142;
Nordics in, 170, 188, 213–214, 231;
organized by Sweden, 180;
race mixture in, 174;
 races in, 142;
Saxons in, 201;
Slavs or Alpines in, 64, 131, 142;
Slavic dialects in, 143;
Slavic future of, 147;
stature in, 190;
Swedes in, 211;
Varangians in, 177;
water connections across, 170.
Russian brachycephaly, 136–137;
settlements of Siberia, 78.
Russians and Christianity, 65.
Ruthenia, 245;
Slavs in, 143.

Sacæ, 173, 214, 216, 254 (see Massagetæ);

date of separation from Persia, 258;
evidence of conquests of, 261;
identified with the Wu-Suns, 260;
in India, 257–258;
language of, 259;
physical characters of, 259, 261.
Sahara, the, 33, 44;
Mediterraneans in, 151–152.
St. Bartholomew, Massacre of, 196.
Sakai, 149.
Sangre Azul, derivation of the term, 192.
Sanskrit, 148, 243, 255, 257–258, 261;
introduction of into India, 173, 216.
See Old Sanskrit.
Santa Fé Trail, 40.
Sardinia, 29;
Mediterraneans in, 152;
 Mycenæan culture of, 164.
Sardinian, the, 28;
stature of, 28.
Sarmatians, 143, 245, 269, 272.
Satem group of Aryan languages, 256.
Saviour, the, blondness of, 230.
Savoy, Alpines in, 146.
Savoyard, 21, 23.
Saxon blood of American settlers, 83;
in Normandy and Scotland, 208;
Saxon type, 40.
Saxons, 69, 73, 141–142, 145, 177, 180, 195, 206;
in Britain, 248–249;
in Brittany, 251–252;
in England, 200–201;
in France, 201;
in Hungary, 201;
in Italy, 201;
in Russia, 201;
invaders, 201;
invasions of, 200–201, 252, 270;
origin of, 200;
ravage Normandy, 251–252.
Saxony, 73, 200–201.
Scandinavia, brunets in, 151;
centre of radiation of the Teutons, 168;
character of the population of, 169;
first Nordics in, 117, 124, 169;
first occupation of by human beings, 169;
introduction of bronze into, 128;
megaliths in, 155;
Mediterraneans never in, 150–151;
Neolithic culture in, 117, 122;
Nordics in, 117, 124, 188, 210.
Scandinavian blood in Normandy and Scotland, 208;
place names in Scotland, 249;
states, 4, 20, 60.
Scandinavians, 61, 68;
hairiness of, 224.
Schleswig, 58, 73.
Sclaveni, 141.
Scotch, 29;
brunet type of, 150;
red hair of, 175;
stature of, 28, 29.
Scotch borders, 40;
Highlanders, 62.
Scotch-Irish in America, 84.
Scotland, 40, 69;
Angles in, 203;
blond elements in, 63;
blonds mixed with brunets in, 202;
brunetness in, 153, 204;
Brythonic elements in, 203;
Gaelic area in, 249;
Goidelic element in, 201, 203;
Goidelic speech in, 200;
Goidels invade from Ireland, 250;
Iberian substratum in, 201;
language in, 204, 249–250;
Mediterraneans in, 153, 203;
Neanderthal type in, 107;
Nordic type in, 249;
Nordics in, 188;
Norse pirates in, 200, 203;
racial elements in, 203–204, 208;
resurgence of types in, especially the Iberian, 249;
Scandinavian place names in, 249.
Scots, 28.
Scottish Highlands, language of, 247.
Scythians, 66, 214, 257.
Selection, 37, 46–55, 215, 225;
by elimination of the unfit, 50–54;
in Colonial times, 92;
in colonies, 93;
in tenements and factories, 92;
practical measures in, 46–55;
through alcoholism, 55;
through disease, 54–55;
through social environment, 46.
Seljukian Turks, 237.
Semitic language, 239;
race, 147.
Senegambian regions, Mediterraneans in, 151.
Senlac Hill, 120.
Serbian national revival, 58.
Serbs, 53, 143;
and Christianity, 65;
in Bulgaria, 145.
Serfs and serfdom, 10.
Servile wars in Rome, 217.
Ship-building, 165, 199.
Siberia, Russian settlements of, 78.
Siberian tundras, 65.
Sicily, Alpines in, 128, 140;
Mediterraneans in, 158;
Normans in, 207.
Sidon, 126, 165.
Sikhs, 261.
Silesia, 72, 260.
Sinai Peninsula, mines of, 125.
Singalese, 258.
Siwalik Hills, fossil deposits of, 101.
Skin color and quality, 27–28.
Skull shape, 13, 15, 17, 19, 139, 226;
among immigrants, 17;
antiquity of distinction between long and round, 23, 24;
as a race character, 151;
of the Ainus, 224;
African, 23;
American Indian, 23;
Asiatic, 22;
Cro-Magnon, 110;
European, 19–21;
Neanderthal, 107;
best method of determining race, 19–24;
see also Brachycephaly, Dolichocephaly, Mesaticephaly, and the
physical characters of the various races.
Slave trade, 79.
Slavery, 8–11, 42, 86.
Slaves, 9–11, 16;
in Italy, 218;
in Rome, 71, 100, 216, 218, 220;
source of, 82, 200.
Slavic Alpines in Germany, 72;
homeland, 245;
languages, 141–145, 238–237, 244–245;
Proto-Slavic, 143;
race, 64, 72;
as an Alpine race, 64, 131.
Slavs, 63, 64, 124, 172, 190;
of Alpine race, 64, 131;
area of distribution of, 143;
expansion of, 272;
in Austria, 141;
 in the Balkans, 153;
eastern Europe, 65;
eastern Germany, 141–142;
Greece, 65;
Middle Ages, 65;
Poland, 142;
Russia, 214;
mixed with Illyrians, 153, 190;
northern and southern, 143.
Slovaks, 91, 143.
Social environment, 46.
Social wars in Rome, 217.
Socialism, 12, 79.
Socrates, 227.
Sogdiana, 254.
Solutrean Period, 105, 111–113;
culture of and the Brünn-Předmost race, 114, 132;
and the Cro-Magnon race, 132.
Sorb, 142.
South Africa, 79, 80;
Dutch and English in, 80.
South America, 61, 73, 75, 76, 78.
Southern States of America, 71, 99;
brunets in, 84;
Mediterranean element in, 44, 45;
Nordic type in, 83, 84;
“poor whites” of, 39, 40;
race consciousness in, 86.
Southerners, effect of climate on, 39–43.
Spain, 115, 149, 176, 202;
Alpines in, 140;
Arabic spoken in, 156;
Arabs in, 156;
 aristocracy of, 192;
Basques in, 140;
blondness in, 192;
bow and arrow of the Azilians in, 115;
cause of the collapse of, 193;
caverns in, 112;
Celtic language in, 155, 234;
decline of the Nordic element in, 193;
elimination of genius producing classes in, 53;
Gauls in, 174, 192;
Gothic language in, 156;
Goths in, 192;
Latin language in, 156;
Mediterraneans in, 123, 149, 152, 155–156;
megaliths in, 155;
Moorish conquest of, 181;
Moors in, 156;
Nordics in, 155–156, 174, 192–193, 269;
Phœnician language in, 156;
Phœnicians in, 126, 156;
racial change in, 192;
Romans in, 156;
Teutons in, 180;
tin mines in, 126;
types in, 156;
Vandals in, 192;
Visigoths in, 180, 192.
Spaniards or Spanish (modern), 53, 68;
(ancient), 68;
in Mexico, 17;
and Nordics, 73;
in the Philippines, 78;
related to the Berbers, 152.
Spanish conquistadores, 76, 193;
infantry, 193;
Inquisition in selection, 53;
Spanish Main, 44;
islands and coasts of, 76;
 Spanish-American War, 74.
Sparta, 160, 162.
Spartans, 160, 164;
and Dinaric race, 164;
physical character of, 164.
Specializations, racial, recent, 27, 18, 24.
Species, significance of the term, 21, 22.
Stature, 13, 28–30, 35;
affected by war, 197–198;
of the Romans, 154;
in Albania, 190;
in France, 198;
in Illyria and the Tyrol, 190;
in the Scottish Highlands, 28–29, 203;
in Sardinia, 28–29.
Sterilization of the unfit, 51, 52.
Stoicism, 221.
Stone weapons in England, 120–121.
For Stone Ages see Neolithic and Paleolithic.
Styria, 183;
Alpines in, 210;
Nordics in, 210.
Suevi, 156, 177, 181, 270;
in Portugal, 180, 192.
Sumer, 119, 147;
language of, 239.
Susa, 147;
language of, 239.
Swabians, 141.
Sweden, 52, 59, 176, 194, 211;
centre of Nordic purity, 168, 170;
colonizes Finland, 211;
 colonizes Russia, 211;
cradle of Teutonic branch of the Nordics, 124, 177;
bronze introduced into, 137;
first Nordics in, 117;
intellectual anæmia of, 210;
Kitchen Middens in, 123;
Nordic race in, 117, 124, 135–136, 168–170, 210–211;
race consciousness in, 57;
saves Protestantism, 210;
unity of race in, 169.
Swedes, 23;
organization of Russia by, 180;
Russification of, 58.
Swiss, 135;
blondness of, 136;
Swiss Lake Dwellers, 121, 127.
Switzerland, 121, 127, 183;
Alpines in, 44, 135, 141;
Lake Dwellings in, 139;
mercenaries in, 135;
Nordics in, 135;
race mixture in, 135.
Sylla, 217.
Synthetic languages, 165, 216, 233, 237, 239–240, 243.
Syr Darya, 119.
Syria, hellenized, 220;
round skull invasion of, 140.
Syrians, 16, 91.

Taal dialect, 80.

Tamahu, blondness of, 223.
Tardenoisian Period, 115, 117, 132.
Tatars, 139, 144.
Tchouds, language of, 236.
Tennessee, 39, 40.
Terramara Period, 122, 127, 266.
Terramara settlements, bronze in, 127;
copper in, 122;
human remains in, 122.
Teutoburgiana forest, 154.
Teutonic, as a term, 231–232;
branch of the Nordic race, 20, 61, 62, 72, 124, 131, 139, 146, 168–
170, 210, 211, 231, 232, 248;
expansion of, 270, 271;
invaders of Gaul, 69;
invasions, 63, 69, 179–184, 189, 194–196;
languages of, 61, 139, 249–251;
duration of Teutonic language in Gaul, 182;
Teutonic tribes mixed with the Belgæ, 248;
speech in the British Isles, 249–250;
Proto-Teutonics, 169.
Teutons, 72, 141–142, 144, 173–174, 176–177, 189, 194–196;
division of in the Great War, 184;
physical characters of, 175;
route of expansion of, 174.
Thebes, 162.
Thessaly, 245.
Thibet, 22, 134.
Thirty Years’ War, 184–187, 198.
Thrace, Nordics in, 214;
early inhabitants of, 246;
Gauls in, 225.
Thracian language, 130, 256;
origin of, 243.
Tin, 126–127.
Tin Isles of Ultima Thule, 127.
Titian, 215.
Tokharian language, 260–261.
Tools, 102–104, 112, 120–121, 123, 126, 129, 155.
Tours, battle of, 181.
Trade routes, 119, 123–125.
Trajan, 244.
Transylvania, Rumanian language in, 245;
Vlachs in, 246.
Trapping, 122.
Trinitarian faith of the Franks, 181.
Tripoli, round skull invasion of, 140.
Trojans, 159.
Troy, siege of, 159.
Tunis, Alpines in, 128, 140, 158;
bronze in, 128;
race mixture in, 158.
Turcomans, 238;
or Turkomans, 21.
Turkestan, 254, 257;
Nomads of, 259;
Tokharian language in, 261.
Turki or Turks, 100, 144–145, 166, 237, 238, 254;
language of, 237–238;
race mixture among, 237.
Tuscan language, 244.
Tyre, 126, 165.
Tyrol, the, 30, 36, 129;
Alpines in, 141, 210;
Dinaric race in, 138;
 Nordics in, 200;
stature in, 190.
Tyrolese, 135;
physical character of, 190.
Tyrrhenians, 157.

Ugrian language, 243.

Ukraine, 213.
Ultima Thule, 126.
Umbrian language, 130, 234, 244.
Umbrians, 145, 157, 160, 173, 244, 269.
Unit characters, 13, 14, 30, 31;
intermixture of, 14;
unchanging, 15–18, 139.
Unitarian faith of the barbarians, 181.
United States of America, affected by immigration, 89 et seq.;
as a European colony, racially, 83, 84;
German and Irish immigrants in, 84, 86;
Indian element in, 87;
Negroes of, 16, 40, 65, 76, 82, 85, 87, 99;
Nordic blood in the colonies, 83–85;
race consciousness in, 86;
Nordics in, 81;
in the world war, 187;
see also America.
Upper Neolithic, 121.
Upper Paleolithic, 100, 105, 108, 113, 132;
close of, 115.
Upper Robenhausian, 122.
Ural mountains, 65, 213.
Ural-Altaic speech, 236.
Urmia, Lake, 253.
Ussher, Archbishop, 4.

Vagrancy, 10.
Valais, 178.
Vandal kingdom, destruction of, 181;
conquests, 223.
Vandals, 73, 142, 145, 156, 176–177, 181, 195, 223, 270;
in Africa, 180;
in Spain, 176–177, 192.
Varangians, 177, 189.
Varus, 154.
Vassalage, 9.
Vedas, 257–259.
Veddahs, 149.
Venethi, 141, 143, 245.
Veneto, 183.
Venezuela, population of, 76.
Venice, Nordic aristocracy of, 189.
Vikings, 129, 177, 206–207, 210, 211, 249, 271;
in America, 211, 249;
see also Norse pirates.
Villein, 10.
Virginia, 84.
Visigoths, 156, 176, 195, 270;
in Gaul, 180;
in Spain, 180, 192;
kingdom of destroyed, 181.
Vlachs, 178, 245–246.
Volga river, 145.
Voluntary childlessness, 217.
Volunteer armies, 198.

Wahlstatt, battle of, 260.

Wales, Celtic language in, 63;
Cymric language in, 205, 248;
derivation of the name, 178;
Goidelic language in, 205;
Mediterraneans in, 63, 153, 203;
Nordics in, 203;
racial elements and survivals in, 204–205.
Wallachia, Little and Great, 246.
Wallachian, 178.
Walloons, 57, 140, 178, 195;
language of, 244.
War and racial elements, 91;
effect of on populations, 183–187, 191–193, 196–198, 216, 231;
Great World War, 73, 74, 168, 186, 187, 191, 230–232.
Wars, European, 56, 191, 198, 230–232;
losses from, 185, 196–198;
Nordic element in, 73, 74, 231;
of the Roses, 191;
Punic, 217;
Servile, 217;
Social, 217.
Wealth, privilege of, 6.
Weapons, 103, 113–115, 120–121, 126–130, 155, 159, 200.
Welsh, 62, 63, 177–178;
in Britain, 248;
Round Barrow survivals among, 164.
Wends, 72, 141–143, 236, 269, 272;
increase of in east Germany, 184.