Chapter XIX: Part 19

Herein probably lies a better explanation of American intolerance than in the indictment of Puritanism which furnishes such a favourite invective for our iconoclasts. Puritanism has become a literary catchword and by no means covers the case. For it must be remembered that we are dealing with offshoots of deteriorated religions which spring from a very wide range of individuals. Religion, having been cut off from direct interference with the State, and having gradually lost its primitive anthropomorphism which really was one of its sources of strength, proceeded to project itself more and more outwardly upon social questions. As the personality of God grew dim the figure of the Devil also lost its vividness and the problem between good and evil could not longer be fought out entirely in the individual’s own bosom; he was no longer tempted by the figure of the Devil appearing to him in person. Christian religion in its prime saw very clearly that the soul must put its own salvation to the fore, and constantly used many apt similes, such as the beam in our own eye, to remind us that while our neighbour might also have his hands full in fighting the Devil, he probably was capable of taking care of himself. Our modern reformer has no use for any such simile; he would have to go out of business if he could not keep picking at the mote in his neighbour’s eye. He finds the equivalent of the Devil in our social vices, in alcohol, in tobacco, in tea and coffee, in practically all forms of amusements. He preaches a crusade which no longer has an ideal object, and enlists a vague religious emotion which is inaccessible to reason and mocks intellectual criticism. The device of using religious associations as carriers of propaganda has 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 the exercise you need, if you walk five miles or more a day. Golf, then, is really beneficial, and it costs you about $25.00 a week the year round.

So much for our “five major sports.” We look on at four of them, and if we can support the family, and pay taxes and insurance, on $1250 a year less than we earn, we take part in the fifth.

The minor sports, as the editor will tell you, are tennis, boating, polo, track athletics, trap-shooting, archery, hockey, soccer, and so on. Not to mention games like poker, bridge, bowling, billiards, and pool (now officially known as “pocket billiards” because the Ladies’ Guild thought “pool” must have something to do with betting), which we may dismiss as being of doubtful physical benefit, since they are all played indoors and in a fog of Camel smoke.

Of the outdoor “minors,” tennis is unquestionably the most popular. And it is one whale of a game--if you can stand it. But what percentage of grown-ups play it? I have no statistics at hand, and must guess. The number of adult persons with whom I am acquainted, intimately or casually, is possibly two thousand. I can think of ten who play as many as five sets of tennis a year.

How many of the two thousand play polo or have ever played polo? One. How many are trap-shooters? Two. How many have boats? Six or seven. How many run footraces or jump? None. How many are archers? None. How many play hockey, soccer, la crosse? None.

If I felt like indulging in a game of cricket, which God forbid, whom should I call up and invite to join me?

Now, how many of my two thousand acquaintances are occasional or habitual spectators at baseball games, football games, boxing matches, or horse races? All but three or four. The people I know (I do not include ball-players, boxers, and wrestlers, who make their living from sport) are average people; they are the people you know. And the overwhelming majority of them don’t play.

Why not? If regular participation in a more or less interesting outdoor game is going to lengthen our lives, why don’t we participate? Is it because we haven’t time? It takes just as much time to look on, and we do that. Is it because we can’t afford it? We can play tennis for as little as it costs to go to the bail-game and infinitely less than it costs to go to the races.

We don’t play because (1) we lack imagination, and because (2) we are a nation of hero-worshippers.

When we were kids, the nurse and the minister taught us that, if we weren’t good, our next stop would be hell. But, to us, there was no chance of the train’s starting for seventy years. And we couldn’t visualize an infernal excursion that far off. It was too vague to be scary. We kept right on swiping the old man’s cigars and giggling in the choir. If they had said that misdemeanours such as those would spell death and eternal fire, not when we were old, but to-morrow, most of us would have respected father’s property rights and sat through the service with a sour pan. If the family doctor were to tell us now that unless we got outdoors and exercised every afternoon this week, we should die next Tuesday before lunch, you can bet we should get outdoors and exercise every afternoon this week. But when he tells us that, without healthful outdoor sport, we shall die in 1945 instead of 1949, why, it doesn’t mean anything. It’s a chimera, a myth, like the next war.

But hero-worship is the national disease that does most to keep the grandstands full and the playgrounds empty. To hell with those four extra years of life, if they are going to cut in on our afternoon at the Polo Grounds, where, in blissful asininity, we may feast our eyes on the swarthy Champion of Swat, shouting now and then in an excess of anile idolatry, “Come on, you Babe. Come on, you Baby Doll!” And if an hour of tennis is going to make us late at the Garden, perhaps keep us out of our ringside seats, so close to Dempsey’s corner that (O bounteous God!) a drop of the divine perspiration may splash our undeserving snout--Hang up, liver! You’re on a busy wire!

RING W. LARDNER

HUMOUR

With the aid of a competent bibliographer for about five days I believe I could supply the proof to any unreflecting person in need of it that there is no such thing as an American gift of humorous expression, that the sense of humour does not exist among our upper classes, especially our upper literary class, that in many respects almost every other civilized country in the world has more of it, that quiet New England humour is exceedingly loud and does not belong to New England, that British incomprehension of our jokes is as a rule commendable, the sense of humour generally beginning where our jokes leave off. And while you can prove anything about a race or about all races with the aid of a bibliographer for five days, as contemporary sociologists are now showing, I believe these things are true. Belief in American humour is a superstition that seldom outlasts youth in persons who have been exposed to American practice, and hardly ever if they know anything of the practice elsewhere. Of course I am not speaking of the sad formalism of the usual thing as we see it in newspapers and on movie screens or of the ritual of magazines wholly or in part sanctified to our solemn god of fun. I mean the best of it.

In the books and passages collated by my bibliographer the American gift of humour would be distributed over areas of time so vast and among peoples so numerous, remote, or savage, that no American would have the heart to press his claim. The quaintness, dryness, ultra-solemnity with or without the wink, exaggeration, surprise, contrast, assumption of common misunderstanding, hyperbolical innocence, quiet chuckle, upsetting of dignity, _éclat_ of spontaneity with appeals to the everlasting, dislocation of elegance or familiarity, imperturbability, and twinkle--whatever the qualities may be as enumerated by the bacteriologists who alone have ever written on the subject, the most American of them would be shown in my bibliographer’s report to be to a far greater degree un-American. Patriotic exultation in their ownership is like patriotic exultation in the possession of the parts of speech. Humour is no more altered by local reference than grammar is altered by being spoken through the nose. And if the bibliography is an ideal one it will not only present American humour at all times and places but will produce almost verbatim long passages of American humorous text dated at any time and place, and will show how by a few simple changes in local terms they may be made wholly verbatim and American. It will show that American humorous writing did in fact begin everywhere but only at certain periods was permitted to continue and that these periods were by no means the happiest in history. I have time to mention here only the laborious section that it will probably devote to Mark Twain in the Age of Pericles, though for the more active reader the one on Mr. Cobb, Mr. Butler, and others around the walls of Troy might be of greater contemporary interest.

Mark Twain, according to the citations in this section, would seem actually to have begun all of his longer stories, including “Pudd’nhead Wilson,” and most of the shorter ones, essays, and other papers, at Athens or thereabouts during this period, but not to have finished a single one, not even the briefest of them. He started, gave a clear hint as to how the thing would naturally run, and then he stopped. The reason for this was that owing to the trained imagination of the people for whom he wrote, the beginning and the hint were sufficient, and from that point on they could amuse themselves along the line that Mark Twain indicated better than he would have amused them, had he continued. Mark Twain finally saw this and that is why he stopped, realizing that there was no need of his keeping the ball rolling when to their imaginative intelligence the ball would roll of itself. He did at first try to keep on, and being lively and observant and voluble even for a Greek he held large crowds on street-corners by the sheer repetition of a single gesture of the mind throughout long narratives of varied circumstance. In good society this was not tolerated even after supper, and there was never the slightest chance of publication. But the streets of Athens were full of the suppressed writings of Mark Twain.

Every man of taste in Athens loved Mark Twain for the first push of his fancy but none could endure the unmitigated constancy of his pushing of it, and as Mark Twain went everywhere and was most persistent, the compression of his narrative flow within the limits of the good breeding of the period was an embarrassing problem to hosts, unwilling to be downright rude to him. Finally he was snubbed in public by his friends and a few of the more intimate explained to him afterwards the reason why.