Abstract

It is commonly believed that the Scopes trial was about the propriety of banning the teaching of evolution pushed by ignorant persons for religious reasons. In fact, not just human evolution but racism were the major concerns. This fact is well documented, and a review of the books used to teach evolution in the public schools at the time shows that they were blatantly racist. This fact is critical in understanding the concerns of those supporting the Butler act law, which was the focus of the trial.


Introduction

Almost 90 years ago “the trial of the century,” the now-infamous Scopes evolution trial, occurred in Dayton, Tennessee (Lienesch 2007). The textbook involved, titled A Civic Biology (1914), was mandated by the state of Tennessee and many other states. For nearly a decade Hunter’s book was the most widely used high school science textbook in the nation. It was endorsed by many distinguished professors, including those at both Brown and Columbia Universities (Larson 1997). In 1919 the Tennessee Textbook Commission selected the Hunter book as the biology text for use in every one of its public schools.

The state of Tennessee did not have any issues with the bulk of the text, most of which covered basic information about earth’s plants and animals. Then, in March of 1925, the Tennessee Legislature passed the following law:

Be it enacted by the General Assembly of the State of Tennessee, that it shall be unlawful for any teacher in any of the Universities, Normals and all other public schools of the State which are supported in whole or in part by the public school funds of the State, to teach any theory that denies the story of the Divine Creation of man as taught in the Bible, and to teach instead that man has descended from a lower order of animals (Ginger 1974, p. 3).

The statute was aimed at teaching the evolutionary origins of human beings (“the Divine Creation of man”), not the origin of the rest of life or even the origin of life. The law was intended to allow parents the right to instruct their children in matters of the origin of humans, human nature, and the destiny of humans. Because the law did not openly conflict with any section in A Civic Biology, which did not openly teach human evolution, the text remained in use throughout the state. Harvard law professor Alan Dershowitz correctly noted that those actively advocating evolution in 1925 included “racists, militarists, and nationalists,” who used evolution “to push some pretty horrible programs,” including forced sterilization (1990, p. 2). Those who wanted to prevent the immigration into America of persons judged by eugenists then as “unfit” and “inferior,” or of “inferior racial stock,” worked to pass the so-called “Jim Crow” laws. They rationalized their agenda on the grounds that blacks, Jews and others were racially inferior and would interbreed with the superior races, causing deterioration of the superior white race (Dershowitz 1990, p. 2). Dershowitz added that the eugenics movement “took its impetus from Darwin’s theory of natural selection,” explaining that German militarism

drew inspiration from Darwin’s survival of the fittest [law]. The anti-immigration movement, which had succeeded in closing American ports of entry to “inferior racial stock,” was grounded in a mistaken belief that certain ethnic groups had evolved more fully than others. The very book—Hunter’s Civic Biology—from which John T. Scopes taught Darwin’s theory of evolution to high school students in Dayton, Tennessee, contained dangerous misapplications of that theory. It explicitly accepted the naturalistic fallacy and repeatedly drew moral instruction from nature. Indeed, its very title, Civic Biology, made it clear that biology had direct political implications for civic society (Dershowitz 1990, p. 2).

Darwin explained in detail the process of how selection functioned and the importance of death and war in advancing evolution. He stressed “how all-important, in the never-ceasing wars of savages, fidelity and courage” were to evolution, adding that a nation with superior qualities, those selected by natural selection, would have an evolutionary advantage that would enable them to destroy the weaker races (Darwin 1871, p. 162). This process of conflict was critical for evolution, and when natural selection that resulted from conflict—such as from war—ceases, evolution also ceases. Hitler and other dictators repeatedly stressed this point—Hitler in his “bible” Mein Kampf, and Marx, Engles, Lennin, Mao, and Stalin in their voluminous writings (Bergman 2012).

Bryan’s Fight against the Degradation of Humans and Racism

The law was supported by the famous Christian attorney, William J. Bryan, and opposed by the well-known agnostic attorney, University of Michigan trained Clarence Darrow. At issue in the 1925 trial were certain chapters on evolution and eugenics in a biology text by George W. Hunter. A major concern of attorney William J. Bryan was the degradation of humans by evolution and the influence of evolution on war and national conflicts. He wrote that the Darwinian theory teaches mankind reached “his present perfection by the operation of the law of hate—the merciless law by which the strong crowd out and kill off the weak” (quoted in Larson 2003, p. 252).

One book that influenced Bryan to draw this conclusion about the doctrine of evolution was written by American biologist Vernon Kellogg, who documented the importance of Darwinism in causing War World I (Kellogg 1917). The Hunter text perfectly illustrated Bryan’s concern because it was “laced with the racism of the day” (Larson 1997, p. 23). Its discussion of eugenics included such scarlet passages as the following openly racist claim:

At the present time there exist upon the earth five races or varieties of man, each very different from the other in instincts, social customs, and, to an extent, in structure. These are the Ethiopian or negro type, originating in Africa; the Malay or brown race, from the islands of the Pacific; the American Indian; the Mongolian or yellow race, including the natives of China, Japan, and the Eskimos; and finally, the highest type of all, the Caucasians, represented by the civilized white inhabitants of Europe and America (Hunter 1914, p. 196).

Hunter also wrote that, if we can improve domesticated animals by breeding then “future generations of men and women on the earth” can also “be improved by applying to them the laws of selection” taught by Darwin. Hunter stressed that this is no small concern because nothing less than the “improvement of the future race” is at stake (1914, p. 261). Hunter then, under the subheading “Eugenics,” which made it clear what type of “improvement” programs he was referring to, applied the animal breeding research to humans:

When people marry there are certain things that the individual as well as the race should demand. The most important of these is freedom from germ diseases which might be handed down to the offspring. Tuberculosis, that dreaded white plague which is still responsible for almost one seventh of all deaths, epilepsy, and feeble-mindedness are handicaps which it is not only unfair but criminal to hand down to posterity. The science of being well born is called eugenics (1914, p. 261).

When defending his eugenics program, Hunter incorrectly concluded that Tuberculosis (TB) is a genetic disease—TB is actually caused by bacteria pathogens. Furthermore, the main causes of both epilepsy and feeble-mindedness are pathogens, trauma, and genetic damage occurring in the womb due to such conditions as genetic non-disjunction, not heredity as Hunter claimed. Hunter then wrote that research had been completed on many different families in America,

in which mental and moral defects were present in one or both of the original parents. The “Jukes” family is a notorious example. . .. In seventy-five years the progeny of the original generation has cost the state of New York over a million and a quarter of dollars, besides giving over to the care of prisons and asylums considerably over a hundred feeble-minded, alcoholic, immoral or criminal persons (1914, pp. 261–262).

One now infamous case that Hunter cited was the “Kallikak” family that

has been traced to the union of Martin Kallikak, a young soldier of the War of the Revolution, with a feeble-minded girl. She had a feeble-minded son from whom there have been to the present time 480 descendants. Of these 33 were sexually immoral, 24 confirmed drunkards, 3 epileptics, and 143 feeble-minded. The man who started this terrible line of immorality and feeble-mindedness later married a normal Quaker girl. From this couple a line of 496 descendants have come, with no cases of feeble-mindedness. The evidence and the moral speak for themselves (1914, pp. 261–263, emphasis in original)!

Both of the Jukes and Kallikak family studies have now been thoroughly debunked by a reevaluation of the data and cases used to support the studies’ original conclusions (Smith 1985). The study is fatally flawed because it implied that the source of both the so-called bad as well as the good genes was from the female: the man bore all good progeny from the Quaker girl, and all bad progeny from the putative feeble-minded girl.

These irresponsible studies were the “product of a powerful idea”—Darwinism—and they created “a social myth” that Hunter did much to spread throughout the Western world (Smith 1985, p. 193). The Kallikak family study was even translated into German in 1914, and the full text appeared in the German academic journal Friedrich Mann’s Pedagogishes Magazin. As a result, the Kallikak study also had a significant impact on Nazi Germany’s racist policies that ended in the Holocaust.

One example was the infamous July 14 1933, sterilization law that began the murder of millions of “inferior” persons (Smith 1985, pp. 161–162). Hitler used the same reasoning that Hunter used to justify his eugenic programs. For example, under the subheading “Parasitism and its Cost to Society” Hunter wrote that hundreds of families, such as the Kallikak family,

exist to-day, spreading disease, immorality, and crime to all parts of this country. The cost to society of such families is very severe. Just as certain animals or plants become parasitic on other plants or animals, these families have become parasitic on society. They not only do harm to others by corrupting, stealing, or spreading disease, but they are actually protected and cared for by the state out of public money. Largely for them the poorhouse and the asylum exist. They take from society, but they give nothing in return. They are true parasites (1914, p. 263).

Hunter then quotes the now-notorious American eugenicist Charles Davenport (using the expression that Hitler later made famous: “blood tells”), writing eugenics has documented the belief that families which produce brilliant men and women did so because they received good genes from their ancestors. The text then used an example lifted from Davenport’s Heredity in Relation to Eugenics to illustrate the claim that greatness is due largely to genes (1914, p. 263). The story is about Elizabeth Tuttle, a women “of strong will, and of extreme intellectual vigor” who married Richard Edwards, a man of high repute and great erudition.” This union produced Jonathan Edwards

a noted divine, and president of Princeton College. Of the descendants of Jonathan Edwards . . . a brief catalogue must suffice: Jonathan Edwards, Jr., president of Union College; Timothy Dwight, president of Yale; Sereno Edwards Dwight, president of Hamilton College; Theodore Dwight Woolsey . . . president of Yale College; Sarah, wife of Tapping Reeve founder of Litchfield Law School, herself no mean lawyer; . . . Timothy Dwight, second, president of Yale University . . . Theodore William Dwight, founder and for thirty-three years warden of Columbia Law School . . . Merrill Edwards Gates, president of Amherst College. . . . Of the daughters of Elizabeth Tuttle distinguished descendants also came. Robert Treat Paine, signer of the Declaration of Independence; Chief Justice of the United States Morrison R. Waite; Ulysses S. Grant and Grover Cleveland, presidents of the United States. These and many other prominent men and women can trace the characters which enabled them to occupy the positions of culture and learning they held back to Elizabeth Tuttle (Hunter 1914, pp. 263–264).

No mention was made of the critical factor that social influence and privilege had in the success of this family. Genetics was the only factor given (Smith 1985). Olasky and Perry wrote that “Hunter’s view of eugenics, widely accepted early in the twentieth century, was a common deduction drawn from and associated with Darwinian theory” (2005, p. 70). They added that Hunter explained Darwinian evolution in only five pages, then moved on to the meat of the book, namely the section on

“heredity and variation” that included eugenics. This popular connection between natural selection and social engineering would soon fan the flames of opposition to teaching Darwinism, particularly in light of the “remedies” that had “been tried successfully in Europe” on the eve of World War I, including sterilizing mental patients, criminals, and other genetic “contaminants” (Olasky and Perry 2005, p. 70).

Hunter openly advocated the infamous solution, negative genetics, to what he saw as the mental illness and crime problem, genetically inferior persons. The reasoning was if these

people were lower animals; we would probably kill them off to prevent them from spreading. Humanity will not allow this, but we do have the remedy of separating the sexes in asylums or other places and in various ways preventing intermarriage and the possibilities of perpetuating such a low and degenerate race (Hunter 1914, pp. 261–263).

Many Tennessee taxpayers, especially those of African American background, objected to the implications of the whole evolution doctrine that were made explicit in the very science text required by their state. Even prior to the 1925 Tennessee law, so great was the outcry against these passages in many other states that the publisher, American Book Company, had them rewritten (Tennessee used the original 1914 edition until 1926). Even the title of the book, Civic Biology, implied eugenics because the text taught that it is our civic duty to apply eugenics to achieve racial improvement.

The ACLU Becomes Involved

Soon after the Tennessee “anti-evolution law” was passed, the American Civil Liberties Union began advertising for volunteers to challenge the law in court. The city of Dayton saw this as an opportunity to attract both attention and tourism. The local politicians then urged a new young football coach and math teacher, John Scopes, who once substituted for a biology teacher for a few days, to claim that he had violated the law during his short substitute teaching stint.

Prominent scientists from major universities soon flocked to Dayton to challenge the right of the state to regulate the teaching of human evolution and eugenics in public schools. A critical point is that these expert witnesses never once distanced themselves from the many inflammatory racist passages in A Civic Biology. Some of them were active supporters of the eugenics movement, as was Hunter’s text. Even after the abuses of Darwinian eugenics by the Nazis in the 1930s became common knowledge, some academics still approved the eugenic passages in this once-required public high school biology textbook.

Among the first persons to awaken to the racism lurking quite undisguised in these passages had been the left-leaning Democratic presidential candidate, William Jennings Bryan. Mr. Bryan “stood at the forefront of the most progressive victories in his time: Women’s suffrage, the direct election of senators, the graduated income tax,” among others (Gould 1991, p. 417). His nickname since his first presidential candidacy (1896) was “The Great Commoner,” and Bryan believed his battle against evolution was an extension of both his populist support and his life work (Gould 1991, p. 419).

Historian Michael Kazin expatiates on Bryan’s attachments both to Thomas Jefferson and to the type of rural yeomen on whom Jefferson had pinned his moral hopes for the American Republic (2006). Although Bryan harbored “doubts on the subject of evolution,” his objections to teaching human evolution went far beyond his concerns about a scientific theory (Gilbert 1997 p. 25). A major concern of Bryan was that Darwinism had been used to justify the German war machine and that the survival-of-the-fittest philosophy had been translated into the might-makes-right ethos that had engulfed Germany and threatened to spread to other countries (Gilbert 1997 p. 31).

Bryan, a life-long opponent of solving national problems by war, was fearful that other nations would soon emulate Germany by using “the martial view of Darwinism [that] had been invoked by most German intellectuals and military leaders as a justification for war and future domination” (Gould 1991, pp. 421–422). Bryan even resigned as Secretary of State in President Wilson’s cabinet in protest of America’s entry into World War I.

Bryan Takes on the Scopes Case

Even though his health was flagging, Bryan took on the arduous Scopes case on the basis of several issues, including his opposition to the Darwinian philosophy of survival of the fittest, might makes right, and his support of the solid Jeffersonian principle: “To compel a man to furnish contributions of money for the propagation of opinions which he disbelieves, is sinful and tyrannical” (Virginia Act for Establishing Religious Freedom, 1786). In other words, Bryan believed that the people in a democracy had the “right to determine what was taught in their schools” (Gilbert 1997, p. 31).

Bryan pointed out several implications that many professors of his day were drawing from Darwin’s theory, included not only eugenics, but also the nihilistic morals of Nietzsche as elucidated in Darrow’s brief about the University of Chicago in the Leopold-Loeb murder case, and the “moral obligation” of “superior” races, such as the Germans in World War I, to overpower the weak races (e.g., the Belgians) for the advantage of the superior races future welfare. Bryan had been awakened to this last concern by reading a book by the well-known Stanford University biologist Vernon L. Kellogg (1917) that related his conversations with the German General Staff in Belgium in 1914.

Opposition to Evolution by African Americans

African Americans were especially active in opposing evolution because Darwinism was a major force that supported racism against “Negroes.” The African American responses to Darwinism

were not merely darker reflections of the white world. On the contrary, in an era of tremendous religious and cultural ferment within African America, many leaders employed the controversy over evolution in ways that were strikingly different from white approaches. In the religious world, the trial prompted numerous black ministers to proclaim themselves fundamentalists and to declare that the [black] race’s only hope for the future lay in a conservative, literal interpretation of Genesis and the Bible (Moran 2012, p. 73).

Professor Moran added that African Americans living in both the Southern and Northern states openly expressed

opposition to the theory of evolution. Ministers delivered sermons with titles such as “Darwin’s Monkey Theory Versus God’s Man Theory” and “Bible Versus Evolution.” The text: “Obey God.” The National Baptist Convention, with five thousand delegates at its annual meeting in Baltimore in September 1925, passed resolutions against both the Ku Klux Klan and evolution (Moran 2012, p. 73).

Furthermore,

[j]ust as the anti-evolution movement provoked many white Protestants to declare publicly that they were fundamentalists, so the Scopes trial inspired many African Americans . . .. Whether they were part of the growing diaspora of black southerners in the North or lifetime residents of the South, a great many members of the race in the summer of 1925 identified themselves as fundamentalists and anti-evolutionists. While rehearsing the standard scientific and theological critiques of evolution, however, African Americans suggested that maintaining a conservative Christian faith was uniquely important for the advancement of the race (Moran 2012, p. 73).

He added that

many black anti-evolutionists introduced distinctive race notes into their discussions of Darwinism. Some African American ministers found a concrete message for the race in the anti-evolution controversy. Dr. E. W. White, pastor of Houston’s powerful Tulane Avenue Baptist Church, preached a sermon titled “Plenty Monkey, but More Hog in Man” to one of that church’s largest crowds ever (Moran 2012, p. 74).

The Blunder Revealed Today

Using Darwinism to defend the coercive eugenics that was then being taught in American schools from Hunter’s book—and promoted by academia—is now seen as repulsive by both most scholars and most Americans. Bryan turned out to be right on this point, while the promoters of eugenics as a corollary of human evolution were embarrassingly wrong. Bryan was right to object to Hunter’s text because its interpretation of science was wrong, and evolutionists were wrong to coercively impose their Darwinian eugenics philosophy and racism on public school students. The fact is, Bryan had identified “something deeply troubling” in the Scopes case—and that the “fault does lie partly with scientists and their acolytes” (Gould 1991, p. 423).

Bryan was also very concerned about the effects of Darwin’s racism teachings, such as the following passage from The Descent of Man: “With savages, the weak in body or mind are soon eliminated” (Darwin 1871, p. 168). Bryan made his concerns about the dignity of humankind very clear in the presentation that he gave to the court at the Scopes trial:

Darwin reveals the barbarous sentiment that runs through evolution and dwarfs the moral nature of those who become obsessed with it. . . . Darwin speaks with approval of the savage custom of eliminating the weak so that only the strong will survive, and complains that “we civilized men do our utmost to check the process of elimination.” How inhuman such a doctrine as this! He [Darwin] thinks it injurious to “build asylums for the imbecile, the maimed and the sick” or to care for the poor. Even the medical men come in for criticism because they “exert their utmost skill to save the life of everyone to the last moment” (Bryan 1975, pp. 24–25).

Bryan also noted that Darwin’s hostility to the use of vaccinations existed

because it has “preserved thousands who, from a weak constitution would, but for vaccination, have succumbed to smallpox!” All of the sympathetic activities of civilized society are condemned because they enable “the weak members to propagate their kind.” Then he drags mankind down to the level of the brute and compares the freedom given to man unfavorably with the restraint that we put on barnyard beasts. . . . Let no one think that this acceptance of barbarism as the basic principle of evolution died with Darwin. Within three years a book has appeared whose author is even more frankly brutal than Darwin. The book . . . “The New Decalogue of Science” . . . has attracted wide attention (Bryan 1975, pp. 24–25).

Bryan then quoted Wiggam, a best-selling author in 1925, who wrote that

Evolution is a bloody business, but civilization tries to make it a pink tea. Barbarism is the only process by which man has ever organically progressed, and civilization is the only process by which he has ever organically declined. Civilization is the most dangerous enterprise upon which man ever set out. For when you take man out of the bloody brutal but beneficent hand of natural selection you place him at once in the soft, perfumed, daintily gloved but far more dangerous hand of artificial selection. And unless you call science to your aid and make this artificial selection as efficient as the rude methods of nature you bungle the whole task (quoted in Bryan 1975, p. 25).

Darrow Supports Bryan’s Arguments

In his defense of accused murderers Loeb and Leopold, Darrow acknowledged the influence of Darwin on his clients. In his appeal to the court, Darrow wrote that Loeb “became enamored of the philosophy of Nietzsche,” a writer

who probably has made a deeper imprint on philosophy than any other man within a hundred years, whether right or wrong. More books have been written about him than probably all the rest of the philosophers in a hundred years. More college professors have talked about him. In a way he has reached more people, and still he has been a philosopher of what we might call the intellectual cult. Nietzsche believed that [at] some time [in the future] the superman would be born, [and] that evolution was working toward the superman (quoted in McKernan 1924, pp. 270–271, emphasis added).

Women’s Leading the Opposition to Darwinism

In a chapter titled “Monkeys and Mothers,” Moran discusses “gender and the anti-evolution impulse,” concluding that, during the debate over the Butler anti-evolution act, the Tennessee State Senate Speaker

Lew D. Hill, proclaimed he had been petitioned to support the bill by “the women of the state and the teachers association.” The bill was, he continued, a last stand for Christianity, civilization, and motherhood. Another senator poignantly gestured toward a mother in the gallery “whose son had been made a confirmed infidel by having been taught evolution in a high school” (Moran 2012, p. 28).

In addition, letters to

newspapers in favor of the Butler bill were almost always sent by women, while letters against the law tended to come from men. As Mrs. E. P. Blair of Nashville proclaimed in a poem supporting the Butler bill, the fight against evolution was being waged “for country, God and mother’s song” (Moran 2012, p. 28).

Moran concluded that the

This “mother’s song” was hard to ignore. In 1925 and afterward, women played important roles in the anti-evolution controversy, both as symbols and as flesh-and-blood activists, and they were not divided on the issue . . . one editorialist estimated in 1925 that 70 percent of the anti-evolutionists were women. Further . . . the new world of gender relations in the early twentieth century were surprisingly significant forces in bringing about the Scopes trial (Moran 2012 p. 28).

One reason postulated by Moran for the opposition to Darwinism by women was because American women

have always attended church more often than men, and usually with deeper commitment. From the creation of the Puritan colonies to the recent rise of megachurches, women have consistently made up 60 to 70 percent of the churchgoing population (Moran 2012, p. 32).

Another reason he gave for women’s support of anti-evolution was they were already secure

in their church work, female activists increasingly wielded their moral authority to carve out a larger place for themselves in politics. But they did not simply throw themselves into the hurly-burly of masculine party politics. Rather, beyond fighting for suffrage itself, these Victorian reformers directed their political energy toward goals that were consistent with their traditional roles as conservators of the home and family. The struggle against prostitution, campaigns to secure child protection laws, and, above all, the crusade against the saloon embodied this feminine politics of home protection (Moran 2012, p. 29).

This concern of women was also over the harm that they felt Darwinism caused to their family.

Darrow added that one book Nietzsche wrote, titled Beyond Good and Evil, contained a criticism of all moral codes, and actually argued that the

intelligent man is beyond good and evil; that the laws for good and the laws for evil do not apply to those who approach the superman. . . . the things that [the convicted murderer] Nathan [Leopold] read and which no doubt influenced him. . . . [W]hile healthy boys were playing baseball or working on the farm, or doing odd jobs, he was reading Nietzsche, a boy who never should have seen it, at that early age. Babe was obsessed of it, and here are some of the things which Nietzsche taught: “Why so soft . . . For all creators are hard, and it must seem blessedness unto you to press your hand upon millenniums . . . Become hard. To be obsessed by moral consideration presupposes a very low grade of intellect. We should substitute for morality the will to our own end, and consequently to the means to accomplish that (quoted in McKernan 1924, pp. 270–271).

These were exactly Bryan’s concerns as he documented in his booklet titled the Last Message (1975). Bryan was very concerned about the fact that an increasing number of students were attending high school and, Bryan believed, that “Darwinism made man too much the product of essentially a material Godless process that invited his degradation through eugenics, too much a competitor in a struggle for survival that justified rapacious business relations and war between nations” (Kevles 2007, p. x).

Conclusions

Bryan’s objections to evolution were openly related to Darwin’s writings about eugenics and its implications for human rights, human dignity, and humanity as a whole. In short, he focused “public attention on the social implications of Darwinism” (Larson 2003, p. 250). Bryan was especially concerned about defending the weak against the assaults of the strong and powerful, a fact that resulted in his being labeled “The Great Commoner.” Bryan, as a “political progressive,” was very concerned about the

Darwinism survival-of-the-fittest thinking (known as social Darwinism when applied to human society) [that was] behind World War 1 militarism and postwar materialism. Of course Bryan also held religious objections to Darwinism and he invoked [Harvard Biology Professor Louis] Agassiz’s scientific arguments against it as well—but his fervor on this issue arose from his social concerns (Larson 2007, p. 68).

As a result, due to “his progressive political instinct of seeking legislative solutions to social problems, Bryan campaigned for restrictions against teaching the Darwinian theory of human evolution in public schools” (Larson 2007, p. 68). These many well-documented facts of history are often forgotten or ignored when Bryan’s role in the Scopes trial is reviewed (Gould 1981, p. 1987).

The most common claim is Darrow “scored a triumph for academic freedom after John Scopes was accused of violating a Tennessee law that prohibited the teaching of evolution” (Farrell 2011, p. 111). This background is imperative to understand why the trial occurred and the implications of evolution both then and today. Last, this review shows how totally erroneous the common claims are about the Scopes Trial, such as those presented in the film Inherit the Wind.

Acknowledgments

I wish to thank John UpChurch, Jody Allen, RN, Clifford Lillo, M.S., and Mary-Ann Stewart, M.S., for their comments on an earlier draft of this paper.

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