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often been used for political purposes with consummate skill. Bryan’s
famous Cross of Gold speech and Roosevelt’s Armageddon appeal
are excellent examples of it.
The question has often arisen why the fanatical reformer is so
omnipotent in America. Why does he succeed so well in imposing
his compulsions upon others? Why are we so defenceless against
his blackmail? Why, in plain language, do we stand for him? Foreign
observers have frequently commented upon the enormous docility of
the American public. And it is all the more curious because ordinarily
the average American prides himself upon his assertiveness and his
quickness in detecting false pretensions. Yet it is a common
occurrence to meet people with valid claims to hard-headedness
who nevertheless submit to every form of compulsion. They do not
believe in prohibition but vote for it, they smoke but think smoking
ought to be stopped, they admit the fanatical nature of reform
movements and yet continue their subscriptions.
In giving what can at best be only a partial answer to this
national enigma, we may briefly consider two types which profoundly
contribute to our atmosphere of compulsion: our immigrant and our
native aristocrat. The first, from the very nature of the case, becomes
the victim of compulsion, while the second imposes the compulsion
and then in turn, however unwillingly, succumbs to it himself. Our
society, with its kaleidoscopic changes of fortune and its
unchannelled social distinctions, presents a problem of adjustment
with which even those who are at home in America find it difficult to
cope. People on the make, people who are not sure of themselves
on a new social ladder, are likely to conform: we find an astonishing
amount of social imitation, in its milder and more ludicrous form, in
all our pioneer communities. The immigrant faces the same problem
to an intensified degree. He comes to us in an uprooted state of
mind, with many of his emotional allegiances still lingering in his
native country, and often with an entirely alien tradition. His mind is
set to conform, to obey at first without much asking. He is like a
traveller arriving in a strange town who follows the new traffic
directions even though he does not understand their purpose. But
even with the best of will he cannot entirely conform. He finds
himself in a new world where what formerly seemed right to him is
now considered wrong, his household gods have lost their power, his
conscience is no longer an infallible guide. It is a sign of character in
him to resist, to refuse to sink his individuality entirely, to struggle
somewhat against the democratic degradation which threatens to
engulf him too suddenly. But his struggle leads to a neurotic conflict
which is often not resolved until the third generation. It is thus quite
permissible to talk of an immigrant’s neurosis, which has
considerable sociological importance even though it does not
present an integral clinical picture. It leads either to the formation of
large segments of undigested foreigners in American society who
sullenly accept the forms we impose upon them while remaining
comparatively inarticulate in our cultural and political life, or else it
produces a type of whom our melting-pot romanticists are foolishly
proud, the pseudo-American who has sunk from individualism to the
level of the mob, where he conforms to excess in order to cover his
antecedents and becomes intolerant in order that he may be
tolerated.
Ordinarily, the mob tyranny which has become such an alarming
feature of our public life would be checked by the aristocratic
element in society. It is part of the aristocratic function to foster
cultural tolerance and to resist herd suggestion: the aristocratic or
dominant type, in enjoying the most privileges, is normally least
subject to compulsions and taboos. With us that is not the case. The
Southerner, for instance, our most traditional aristocrat, finds himself
paralyzed by the consciousness of a black shadow behind him who
constantly threatens both his political and his sexual superiority. He
moves in an atmosphere of taboos from which he himself cannot
escape, for it is an established fact that interdiction in one line of
thought has a crippling effect upon a man’s intellectual activity as a
whole. Elsewhere our native aristocrat frequently finds himself in the
position of a lonely outpost of a thin Anglo-Saxon tradition which he
must defend against the constant onslaughts of alien civilizations, in
the desperate attempt to uphold the fiction that spiritually, at least,
we are still an English colony. He is in a state of tension where he
himself cannot move with any of the freedom which he vaunts as
one of the outstanding characteristics of the country of his fathers. In
his hands his own latest hope, our war-born Americanization
programme, which should really be an initiation into freedom, has
quickly become little more than a forced observance of sterile rites
with which to impress the alien. He already sees its failure, and, like
a general who is afraid of his own army, he does not sleep very well.
Alfred B. Kuttner
 MEDICINE
FROM time immemorial the doctor has been the object of
respect and awe by the generality of mankind. It is true that he has
occasionally been made the butt of the satirical humour of such
dramatists as Molière and Shaw, but the majority of people have
regarded these jests as amiable buffooneries, and not as penetrating
criticisms. In ancient days the veneration of the medico was based
upon his supposed association with gods and devils, and upon the
belief that he could cure disease by wheedling propitiation of deus,
or by the exorcism of diabolus. In modern times he holds sway by his
supposed possession of the secrets of science.
In spite of his pretension to scientific attainment, many vestiges
of his former priesthood remain, and this mélange of scientist and
priest has produced curious contradictions and absurdities. But
these absurdities must by an inexorable law remain concealed from
all save a few, and the general failure to recognize them has led to a
great increase in the importance and prosperity of the medical cult.
In America, of all civilized nations, medical magnificence has
reached its most formidable proportions. This exaggeration,
characteristic of all social phenomena in the new world, makes the
real importance of the doctor to society easy to inspect and to
analyze.
A friend not long ago asked me to explain the co-existence, in
the same city, of the elaborate installation of the Harvard Medical
School and the magnificent temple of the religion of Mrs. Eddy.
“What is it in our culture,” said he, “that permits the symbol of such
obvious quackery as that of Mrs. Eddy to flourish within a stone’s
throw of such an embodiment of scientific enlightenment as the
medical college?”
 I replied that the reason for this must be sought in the gullibility
of our citizens, who are capable of entertaining most incompatible
and contradictory credos. Thus, the average American can believe
firmly and simultaneously in the therapeutic excellence of yeast, the
salubrious cathartic effects of a famous mineral oil, the healing
powers of chiropractors, and in the merits of the regimen of the
Corrective Eating Society. His catholicity of belief permits him to
consider such palpable frauds seriously, and at the same time to
admire and respect authentic medical education and even the
scientific study of disease. But the teachers, students, and alumni of
medical colleges are drawn from our excessively credulous
populace. So it is dangerous to consider the votaries of the
profession of medicine as sceptical and open-minded savants, in
contrast to the promulgators of the afore-mentioned imbecilities and
to Homo sapiens americanus, who is the unconscious victim of such
charlatanry. In reality the great majority of the medical profession is
credulous and must always remain so, even in matters of health and
disease.
The tendency to consider physicians in general as men of
science is fostered by the doctors themselves. Even the most
eminent among them are guilty in this respect. Thus the Director of
the Hospital of the Rockefeller Institute maintains that medicine must
be considered not as an applied science but as an independent
science (R. Cole, Science, N. S., Vol. LI, p. 329). And an eminent ex-
President of the American Medical Association holds a similar view,
at the same time preposterously asserting that “medicine has done
more for the growth of science than any other profession, and that its
best representatives have been among the leaders in the
advancement of knowledge....” (V. C. Vaughan, Journal, A. M. A.,
1914, Vol. LXII, p. 2003.)
Such pronunciamentoes rest upon the almost universal
confusion of the art of the practice of medicine with the science of
the study of disease. Science, in its modern definition, is concerned
with the quantitative relationship of the factors governing natural
phenomena. No favourites are to be played among these factors.
They are to be weighed and measured meticulously and coldly,
without enthusiasm for one, or disdain and enmity toward another.
Now, in the case of relationship of doctor to patient, it is clear that
such emotions must enter. The physician must entertain enthusiasm
for the defensive powers of his patient, John Smith, and at the same
time hate virulently the pneumococcus that attacks him. This
emotional state of the soldier of health prevents the employment of
what is known in the language of the laboratory as the “control.” For
example, a doctor wishes to test the efficacy of a serum against
pneumonia. In America it is practically unknown for him to divide his
cases of pneumonia into two groups of equal size, to administer his
serum to group A and to leave group B untreated. He almost
invariably has a parti-pris that the serum will work, and he reflects
with horror that if he holds his remedy from group B, some members
of this group will die, who might otherwise have been saved. So he
injects his serum into all of his patients (A and B), and if the mortality
in the entire group appears to him to be lower by statistics than that
observed in previous series of cases, he concludes that the value of
his nostrum is proved. This is an illustration of the fallacy of the
notion that medicine is a science in the modern sense.
Modern study of disease, conducted in the laboratory upon
experimental animals, has furnished medical practitioners with a few
therapeutic and prophylactic weapons. In the use of these the
American medico has not lagged behind his European colleague.
But the great majority of the malaises that plague us are not
amenable to cure, and it is with these that the doctor has since the
beginning of time played his most important rôle, i.e., that of a
“professional sympathizer.” The encouraging conversation with the
family of the sufferer; the mumbling of recondite Latin phrases; the
reassuring hopeful hand on the patient’s shoulder; the grave use of
complicated gimcracks; the prescription of ineffective but also
innocuous drugs or of water tinted to pleasing hues; all these are of
incalculable value to the ménage stricken by disease. It is my
lamentable duty to point out the danger of the decline of this
essential rôle among the doctors of America. The general
practitioner of the ancien régime was sincere in his performance of
his quasi-religious function. He was unsparing of his energies, stern
in his devotion to duty, deeply altruistic in sentiment, and charmingly
negligent in economic matters.
But at the present time this adorable figure is disappearing from
the land, to be replaced by another, more sinister type, actually less
learned in the important folklore of the bedside, pseudo-scientific,
given to rigidly defined office hours, and painfully exact in the
extortion of his emolument. What are the factors that give rise to the
appearance of this new figure on the American scene? The most
important of these is to be found in the high development of the craft
of surgery in the United States. Of all the dread afflictions that plague
us, a few may be cured or ameliorated by the administration of
remedies, and an equally small number improved or abolished by
surgical interference. But in spite of the relatively few diseases to
which surgery is beneficial, the number of surgeons that flourish in
the land is enormous. The fundamental discoveries of Pasteur and
their brilliant application by Lister were quickly seized upon in
America. The names of Bull, Halstead, Murphy, the brothers Mayo,
Cushing, and Finney are to be ranked with those of the best
surgeons of any nation. In fact, we may be said to lead the world—to
use an apt Americanism—in the production of surgeons, just as we
do in that of automobiles, baby carriages, and antique furniture.
The success of these protagonists in the higher carpentry at
once attracted a horde of smaller fry, imitators, men of inferior ability.
The rapid advances made by the leaders resulted in the
development of a diversified and complicated technic, which the
ordinary surgeon was able to master in sections but not in toto. From
this, specialization in surgery has developed rapidly and naturally, so
that now certain men devote their lives exclusively to the enthusiastic
and indiscriminate removal of tonsils, others are death on gall
bladders, some the foes of the vermiform appendix, and yet others
practise exclusively the radical cure of phimosis. It is obvious that
such narrow specialization, practised in isolation, would lead to most
amusing results, which may best be left to the imagination. But these
absurdities were finally apparent even to the surgeons themselves,
with the resulting development of what is now known as “group
medicine.”
 In brief, surgeons with special penchants for the removal of
various organs, form partnerships, calling to their aid the internist for
the diagnosis of their prospective victims. The internist gathers about
him, in turn, a group of less important fry, known as radiographers,
bacteriologists, pathologists, and serologists. Frequently a dentist is
added to the coterie. The entire organization is welded into a
business partnership of typically American efficiency. These groups
are forming over the entire nation, are appearing even in the tank-
towns of the hinterland. They occupy elegant suites in important
office buildings, their members are generally considered the arbiters
of the medical opinion of the community. Their more or less
intelligent use of the paraphernalia of pathology, bacteriology, et
cetera, gives them an enormous advantage over their more humble
brother, the general practitioner. This last, indeed, is being rapidly
routed in his battle with such associations of “best minds,” equipped
with the armamentarium of modern science.
The remuneration required by the “super-docs” of group
medicine is naturally far in excess of that demanded by the general
practitioner. It is right that this should be so, if not for the results
obtained, then by reason of the elaborate organization and
expensive equipment that the group system demands. This increase
in reward has made the profession of medicine in America what it
never was before, a paying proposition—again to use an apt
Americanism. The result of this entry of crass materialism into a
previously free-and-easy, altruistic, anything but business-like
profession is, once more, better left to the imagination than
described. The brigandage of many of these medical banditti is too
painful even to think about. It will be apparent that relatively few of
our citizens are able to pay for group medicine. So, it is interesting to
observe that the best in medical treatment and advice is accessible
only to the highest and lowest castes of our plutocracy. The rich
receive this at the elegant offices and private hospitals of the groups,
the miserably poor at the teaching hospitals of medical colleges.
The service of the “super-doc” to such of our citizens as can
afford him cannot at this time be properly estimated. It is true that he
is progressive, that he leans heavily upon the subsidiary sciences of
pathology, et cetera, that he publishes papers in medical periodicals,
that he visits medical libraries, frequents medical congresses. It has
just been insisted that the doctor has benefitted himself to a great
extent economically by forming the group; it is for the future to
divulge whether his ministrations have resulted in a perceptible
reduction of human suffering or in a prolongation of human life.
Certainly he has perpetrated some astounding hoaxes, the kind-
hearted will say unwittingly. Probably the most interesting of these is
to be observed in the focal infection mania just now subsiding.
Focal infection came into prominence as the theory, so called, of
a group of eminent physicians in Chicago. It is, in brief, the doctrine
that many of our aches and pains whose direct etiology it is
impossible to demonstrate are due to the presence in the body of
foci of harmful microbes, at the roots of the teeth, in the tonsils,
accessory sinuses, or the appendix. Discover the focus, remove it,
and presto!—the ache disappears like the card up the sleeve of the
expert American poker player. The advantages of this theory to the
various specialists of a group will be obvious. To illustrate. Henry
Doolittle is plagued by a persistent and annoying pain over his left
shoulder-blade. He goes to the office of a group of “super-docs,” is
referred to the diagnostician, who makes a careful record of his
status præsens, then orders his satellites to perform the
Wassermann reaction, make the luetin test, do differential blood
counts, perform the determination of his blood urea, and carry out a
thorough chemical study of his basal metabolism. If the results of
these tests show no departure from the normal, or if they seriously
contradict each other, the cause of the pain is probably focal
infection. The patient is then subjected to examination by X-ray, his
teeth are pulled by the dentist, his tonsils excised by the
otolaryngolist, who also takes a swipe, in passing, at his accessory
sinuses, and should these mutilations fail to relieve him, his
appendix is removed by the abdominal surgeon. If relief still fails to
occur, the theory is not given up, but the focus is presumed to exist
elsewhere. If Mr. Doolittle’s patience is equal to the test, and if his
purse is not by this time completely empty, additional operations are
advised. These continue until all organs and appendages not
actually necessary to mere existence have been removed. Henry
then returns to his former mode of life, depleted and deformed, it is
true, but occasionally minus his original pain. It is not the intention to
deny that infected teeth and tonsils have no significance in
pathology. But it is certain that their importance has been greatly
exaggerated by many physicians. The question needs more
investigation, with fewer preconceived ideas. The “science”
underlying this astounding practice is admirably outlined in the book
of Billings called “Focal Infection.” It is the most striking example of
medical Ga-Ga-ism that has appeared in our country. It is, as its
author himself admits, a triumph of the new idea of team-work and
co-operative research in medicine. The factors giving rise to this
lamentable Ga-Ga are the gullibility of patient and doctor, the
emotional element entering into the interpretation of all of the
phenomena observed by the physician, commercialism, and, finally,
the self-limiting nature of most disease.
So much for the Art of Healing as practised by the physicians of
America. What of our activities in the second aim of medicine, that is,
the prevention of disease? While superficial examination is enough
to lay bare the many hollow pretensions of the practice of medicine,
it would appear a priori that the work of disease prevention might at
least approach the category of the applied sciences. This would
seem to be so, since the greater part of this field must of necessity
concern itself with infectious disease. Now the etiologic agents of the
majority of infectious diseases are known. It is easy to see that the
labour of their prevention rests upon an exact knowledge of the
nature of the disease-producing microbes, the analysis of the
delicate balance between the virulence of the microbic invader and
the resistance of the human host, and, most important of all, upon
the exact path by which the germ in question travels from one
individual to another.
In the early days of preventive medicine, following shortly upon
the fundamental researches of Pasteur, several important
contributions were made by Americans. These include the brilliant
investigations of Theobald Smith on the etiology and mode of
transmission of the Texas fever of cattle, and, later on, the
differentiation of bovine and human tuberculosis. America had again
reason to be proud when, in 1901, Reed, Carroll, Agramonte, and
Lazear demonstrated that yellow fever was spread exclusively by the
mosquito, Ædes calopus. These investigators showed a beautiful
spirit of self-sacrifice and devotion to their science. The construction
of the Panama Canal was made possible by the application of these
researches by Gorgas. Again, the American Russell was the first to
show that vaccination against typhoid and allied infections is
feasible. In the New York Board of Health, Park, Krumwiede, and
their associates have made careful and valuable studies on the
prevention of diphtheria. These constitute the high lights of American
achievement in preventive medicine. It must be admitted that the
majority of these examples are to be placed in the category of the
science of the study of disease, rather than in that of its application—
preventive medicine.
It is noticeable even by cursory survey of recent American work
that such striking achievements have become distinctly fewer in
recent years, despite an enormous increase in personnel,
equipment, and money devoted to the prevention of disease. Along
with this decrease in solid contributions there has been an
augmentation of fatuous propaganda and windy theory. All of the
judicious must view this tendency with alarm and sadness, since it
seemed for a time that science was really about to remove the
vestigia of witchcraft and high-priesthood from this branch of
medicine at least.
What is the cause of this retrogression? It must be laid at the
door of Religio Sanitatis, the Crusade of Health. This is one of the
most striking examples of the delusion of most Americans that they
are the Heaven-appointed uplifters of the human race. Just as all
Baptists, Presbyterians, and Methodists deprecate the heathen
happiness of the benighted Oriental, so the International Health
Board seeks to mitigate his contented squalour and to eradicate his
fatalistically born disease. Just as Billy Sunday rages against John
Barleycorn and the Dionysians who worship him, so the Great
Hygienists seek to point out the multiform malaises arising from such
worship. Just as the now extinct Wilson strove to show the world that
it was horrid and wrong to fight, so the Public Health Service seeks
to propagate the notion that chastity and adherence to marital vows
are the sole alternatives to a universal syphilization.
Thus we observe with horror the gradual replacement of those
Nestors of preventive medicine who had the dispassionate view of
science, and who applied its methods of cold analysis, by a group of
dubious Messiahs who combine the zealous fanaticism of the
missionary with the Jesuitical cynicism of the politician. For most of
the organizations for the promotion of health are closely dependent
upon state and municipal politics, and must become contaminated
with the obscenity of political practice. Finally, it is apparent that the
great privately endowed foundations are animated by the spirit of
proselytism common to the majority of religions, but especially to
Baptists. It will be objected that such charges are vague
generalizations. It is necessary, therefore, to bring forward one or
two specific instances in support of these contentions.
The soldiers of the recent successful campaign for national
prohibition were supported by battalions of noted hygienists who
made excellent practice with a heavy artillery of so-called scientific
evidence upon the confused ranks of brewers, distillers, and their
customers, the American bibuli. What is the value of their “scientific
evidence”? Two charges are made against the use of alcohol as a
beverage. Primo, that its moderate or excessive use is the direct
cause of various maladies. Secondo, that the children of alcoholic
parents are often deformed, degenerates, or imbeciles, and that
such lamentable stigmata are the direct results of the imbibitions of
their parents.
Now it is vain to argue that alcohol, taken in great excess, is not
injurious. Mania a potu (Korsakow’s disease) is without doubt its
direct result, at least in some instances. On the other hand,
excessive indulgence in water is also not without its harmful effects,
and I, for one, would predict evil days for our Great Commoner,
should he so far lose control of himself as to imbibe a gallon of grape
juice per diem. Many enthusiastic hygienists advance the opinion
that alcohol is filling our insane asylums! This generalization is a
gorgeous example of post hoc propter hoc reasoning, and is based
upon the idiotic statistical research which forms so large a part of the
activity of the minions of public health. The recent careful work of
Clouston and others tends more and more to indicate that chronic
alcoholics do not go crazy because they drink, but become
alcoholics because they already were crazy, or had the inherited
tendency toward insanity. This embarrassing fact is carefully
suppressed by the medico-hygienic heavy artillerists of the
prohibition army. What is more, diseases with definite pathologic
pictures, such as cirrhosis of the liver, have by no means been
definitely proved to be caused by alcohol. Indeed, the researches of
Friedenwald, who endeavoured to produce such effects by direct
experiment, have led to negative results.
The second indictment, i.e., that alcoholism in parents causes
degenerate offspring, rests upon still more dubious scientific
foundations. The most important animal experimentation in this field
is that of Stockard, who used guinea-pigs as his subjects, and of
Pearl, who had recourse to chickens. Both of these researches are
sound in scientific method. Unfortunately for hygienists, they lead to
completely contradictory conclusions. Stockard and his collaborators
found the offspring of alcoholic guinea-pigs to be fewer in number
than those of his normal controls. What is more, the children of the
alcoholics were frequently smaller, had a higher post-natal mortality,
and were prone to suffer from epileptiform convulsions. These
results brought forth banzais from the hygienists and were
extensively quoted, though their application by analogy to the
problems of human heredity is not to be made too hastily.
Pearl, on the other hand, discovered that while the number of
offspring from his inebriated chickens was distinctly fewer, yet these
were unquestionably superior to normal chickens in eight of the
twelve hereditary characters amenable to quantitative measurement.
Now if one can generalize Stockard’s results to human beings, then
it is equally permissible to do the same with Pearl’s. Of the two, the
latter generalization would be preferable, and of greater benefit to
the human race, were the analogy valid. For who will not whoop for
“fewer children, but better ones”? Do the votaries of preventive
medicine place the results of Pearl along side of those of Stockard?
Indeed, who even mentions Pearl’s results at all? If satisfactory
evidence is adduced that this has been done, I hereby promise to
contribute one hundred dollars in cash toward the foundation of a
home for inebriated prohibition agents. Again, while much is heard of
the results of Bezzola in regard to the Rauschkinder resulting from
the Swiss bacchanalia, the negative findings of Ireland in similar
investigations of the seasonal debauches of Scotland are carefully
avoided. Once more, Elderton and Karl Pearson have failed utterly to
find increase in the stigmata of degeneracy among the children of
alcoholic parents as compared with those of non-alcoholics. This
research, published in a monograph of the Francis Galton
Laboratory of London, is the one really careful one that has been
made in the case of human beings. It was directed by Pearson,
admittedly a master of biometrical science. Yet, turning to Rosenau’s
“Preventive Medicine and Hygiene,” the bible of this branch, I find
the Elderton-Pearson report relegated to a footnote in the edition of
1913, and omitted completely from the 1920 edition.
A discussion of the fatuity to which American preventive
medicine descends cannot be terminated without touching upon the
current propaganda of the syphilophobes. For just as practitioners of
medicine exploit human credulity, so the preventers of disease play
upon the equally universal instinct of fear. There is no intention of
minimizing the seriousness of syphilis. Along with cancer,
pneumonia, and tuberculosis, it is one of the major afflictions of
humanity. It causes thousands of deaths yearly; it leads to great
misery. Paresis, one of the important psychoses, is definitely known
to be one of its manifestations. It is obvious, therefore, that its
eradication is one of the major tasks of social hygiene.
But by what means? Let one of the most noted of our American
syphilophobes give the answer! This gentleman, a professor of
pathology in one of the most important medical schools of the Middle
West, yearly lectures over the length and breadth of the land on the
venereal peril. He begins his expostulation with reduction of his
audiences to a state of terror by a lantern-slide display of the more
loathsome manifestations of the disease. He does not state that
modern treatment makes these more and more rare. He insists upon
the utter impossibility of its cure, a fact by no means established. He
advocates early marriage to a non-syphilitic maiden as the best
means of prevention, and failing that, advises that chastity is both
possible and salubrious. Then follows a master stroke of advice by
innuendo—the current belief that masturbation causes insanity is
probably untrue. Finally he denies the value of venereal prophylaxis,
which was first experimentally demonstrated by Metchnikoff and
Roux, and which the medical department of the Army and Navy
know to be of almost perfect efficacy when applied early and
thoroughly.
Lack of space prevents the display of further examples of the
new phenomenon of the entrance of religion and morals into
medicine. It is not my intention for a moment to adopt a nihilistic
attitude toward the achievement of preventive medicine. But it is
necessary to point out that its contamination by moralism,
Puritanism, proselytism, in brief, by religion, threatens to reduce it to
absurdity, and to shake its authority in instances where its functions
are of unmistakable value to our republic. At present the medical
profession plays a minor rôle in the more important functions of this
branch. These are performed in the first place by bacteriologists who
need not be doctors at all, and in the second by sanitary engineers,
whose splendid achievements in water supply and sewage disposal
lead those of all other nations.
It has been remarked above that one of the chief causes of the
unscientific nature of medicine and the anti-scientific character of
doctors lies in their innate credulity and inability to think
independently. This contention is supported by the report on the
intelligence of physicians recently published by the National
Research Council. They are found by more or less trustworthy
psychologic tests to be the lowest in intelligence of all of the
professional men excepting only dentists and horse doctors. Dentists
and horse doctors are ten per cent. less intelligent. But since the
quantitative methods employed certainly carry an experimental error
of ten per cent. or even higher, it is not certain that the members of
the two more humble professions have not equal or even greater
intellectual ability. It is significant that engineers head the list in
intelligence.
 In fact, they are rated sixty per cent. higher than doctors. This
wide disparity leads to a temptation to interesting psychological
probings. Is not the lamentable lack of intelligence of the doctor due
to lack of necessity for rigid intellectual discipline? Many conditions
conspire to make him an intellectual cheat. Fortunately for us, most
diseases are self-limiting. But it is natural for the physician to turn
this dispensation of nature to his advantage and to intimate that he
has cured John Smith, when actually nature has done the trick. On
the contrary, should Smith die, the good doctor can assume a pious
expression and suggest that, despite his own incredible skill and
tremendous effort, it was God’s (or Nature’s) will that John should
pass beyond. Now the engineer is open to no such temptation. He
builds a bridge or erects a building, and disaster is sure to follow any
mis-step in calculation or fault in construction. Should such a
calamity occur, he is presently discredited and disappears from view.
Thus he is held up to a high mark of intellectual rigour and discipline
that is utterly unknown in the world the doctor inhabits.
A survey of the present condition of American medical education
offers little hope for a higher intellectual status of the medical
profession or of any fundamental tendency to turn medicine as a
whole from a mélange of religious ritual, more or less accurate folk-
lore, and commercial cunning, toward the rarer heights of the applied
sciences.
Such a reform depends absolutely upon the recognition that the
bodies of all the fauna of the earth (including Homo sapiens) are
essentially physico-chemical mechanisms; that disease is a
derangement of one sort or another of this mechanism; and that real
progress in knowledge of disease can only come from quantitatively
exact investigation of such derangements.
Up to the present, the number of professors in any branch of
medicine who are aware of this fact is pitifully few. The men, who,
being aware of it, have the training in physics and chemistry to put
their convictions into practice are less in number. So, it is vain to
hope that medical students are being educated from this point of
view.
 This casual glance at American medicine may be thought to be
an unduly pessimistic one. It has not been my intention to be
pessimistic or to be impertinently critical. Indeed, turning from the art
of the practice of medicine, and the religion and folk-lore of
sanitation, to the science of the study of disease, we have much of
which to be proud. American biochemists of the type of Van Slyke
and Folin are actually in the lead of their European brothers. Their
precise quantitative methods furnish invaluable tools in the exact
study of the ills that afflict us.
Finally, the greatest figure of all, Jacques Loeb, working in an
institution that declares its purpose to be the dubious one of medical
research, has in the last three years published investigations which
throw a flood of light upon the dark problems of the chemistry of
proteins. His work is of most fundamental significance, will have far-
reaching results, and is measurably in advance of that of any
European in the same field. Loeb, like all men of the first rank, has
no spirit of propaganda or proselytism. His exact quantitative
experiments rob biology of much of its confused romantic glamour.
The comprehension of his researches demands thorough knowledge
of physical chemistry. However, it is encouraging to note that among
a few younger investigators his point of view is being accepted with
fervour and enthusiasm. But it is time to stop. We are straying from
our subject which was, if I remember, American medicine.
Anonymous
 SPORT AND PLAY
BARTLETT does not tell us who pulled the one about all work
and no play, but it probably was the man who said that the longest
way round was the shortest way home. There is as much sense in
one remark as in the other.
Give me an even start with George M. Cohan, who lives in Great
Neck, where I also live, without his suspecting it—give us an even
start in the Pennsylvania Station and route me on a Long Island train
through Flushing and Bayside while he travels via San Francisco
and Yokohama, and I shall undertake to beat him home, even in a
blizzard. So much for “the longest way round.” Now for the other. If it
were your ambition to spend an evening with a dull boy, whom would
you choose, H. G. Wells, whose output indicates that he doesn’t
even take time off to sleep, or the man that closes his desk at two
o’clock every afternoon and goes to the ball-game?
You may argue that watching ball-games is not play. It is the
American idea of play, which amounts to the same thing, and
seventy-five per cent, of the three hundred thousand citizens who do
it daily, in season, will tell you seriously that it is all the recreation
they get; moreover, that deprived of it, their brain would crack under
the strain of “business,” that, on account of it, they are able to do
more work in the forenoon, and do it better, than would be possible
in two or three full days of close sticking on the job. If you believe
them, inveterate baseball fans can, in a single morning, dictate as
many as four or five twenty-word letters to customers or salesmen,
and finish as fresh as a daisy; whereas the non-fan, the grind, is logy
and torpid by the time he reaches the second “In reply to same.”
But if you won’t concede, in the face of the fans’ own statement,
that it is recreation to look on at baseball or any other sport, then let
me ask you to invite to your home some evening, not a mere
spectator, but an active participant in any of our popular games—say
a champion or near-champion golfer, or a first string pitcher on a big
league baseball club. The golfer, let us say, sells insurance half the
year and golfs the rest. The pitcher plays eight months of the year
and loafs the other four. Bar conversation about their specialty, and
you won’t find two duller boys than those outside the motion-picture
studios.
No, brothers, the bright minds of this or any other country are
owned by the men who leave off work only to eat or go to bed. The
doodles are the boys who divide their time fifty-fifty between work
and play, or who play all the time and don’t even pretend to work.
Proper exercise undoubtedly promotes good health, but the theory
that good health and an active brain are inseparable can be shot full
of holes by the mention of two names—Stanislaus Zbyzsk and
Robert Louis Stevenson.
It is silly, then, to propound that sport is of mental benefit. Its
true, basic function is the cultivation of bodily vigour, with a view to
longevity. And longevity, despite the fact that we profess belief in a
post-mortem existence that makes this one look sick, is a thing we
poignantly desire. Bonehead and wise guy, believer and sceptic—all
of us want to postpone as long as possible the promised joy-ride to
the Great Beyond. If to participate in sport helps us to do that, then
there is good reason to participate in sport.
Well, how many “grown-ups” (normal human beings of twenty-
two and under need not be considered; they get all the exercise they
require, and then some) in this country, a country that boasts
champions in nearly every branch of athletics, derive from play the
physical benefit there is in it? What percentage take an active part in
what the sporting editors call “the five major sports”—baseball,
football, boxing, horse racing, and golf? Let us take them one by one
and figure it out, beginning with “the national pastime.”
Baseball. Twenty or twenty-one play. Three hundred to forty
thousand look on. The latter are, for two hours, “out in the open air,”
and this, when the air is not so open as to give them pneumonia and
when they don’t catch something as bad or worse in the street-car or
subway train that takes them and brings them back, is a physical
benefit. Moreover, the habitual attendant at ball-games is not likely to
die of brain fever. But otherwise, the only ones whose health is
appreciably promoted are the twenty or twenty-one who play. And
they are not doing it for their health.
Football. Thirty play. Thirty thousand look on. One or two of the
thirty may be killed or suffer a broken bone, but the general health of
the other twenty-nine or twenty-eight is improved by the exercise. As
for the thirty thousand, all they get is the open air—usually a little too
much of it—and, unless they are hardened to the present-day cheer-
leader, a slight feeling of nausea.
Boxing. Eight to ten play. Five thousand to sixty thousand look
on. Those of the participants who are masters of defence may profit
physically by the training, though the rigorous methods sometimes
employed to make an unnatural weight are certainly inimical to
health. The ones not expert in defensive boxing, the ones who
succeed in the game through their ability to “take punishment” (a trait
that usually goes with a low mentality) die, as a rule, before reaching
old age, as a result of the “gameness” that made them “successful.”
There is a limit to the number of punches one can “take” and retain
one’s health. The five or sixty thousand cannot boast that they even
get the air. All but a few of the shows are given indoors, in an
atmosphere as fresh and clean as that of the Gopher Prairie day-
coach.
Horse Racing. Fifty horses and twenty-five jockeys play. Ten
thousand people look on. I can’t speak for the horses, but if a jockey
wants to remain a jockey, he must, as a rule, eat a great deal less
than his little stomach craves, and I don’t know of any doctor who
prescribes constant underfeeding as conducive to good health in a
growing boy.
Racing fans, of course, are out for financial, not physical, gain.
They, like the jockeys, are likely to starve to death while still young.
Golf. Here is a pastime in which the players far outnumber the
lookers-on. It is a game, if it is a game, that not only takes you out in
the open air, but makes you walk, and walking, the doctors say, is all