"The next great task of preventive medicine is the inauguration of
universal periodic medical examinations as an indispensable means for the
control of all diseases, whether arising from injurious personal habits,
from congenital or constitutional weakness, or from social and vocational
conditions." That this declaration by the Commissioner of Health of the
city of New York is not the mere expression of an individual opinion,
there is abundant evidence. And no one who has watched the growth of other
movements towards such regulation of life as only a few years ago would
have seemed wholly outside the domain of practical probability can doubt
that the "Life Extension" movement, as thus outlined, will rapidly grow
into prominence. Nor is there much room for doubt that, whether explicitly
contemplated at present or not, compulsion as well as universality is
tacitly implied in the movement.
I say that the movement is sure to grow into prominence, that it is a
thing which must be seriously reckoned with; I do not say that it will
march straight on to victory, or even that it is sure to prevail in the
end. It is instructive, in this regard, to hark back to a recent
experience in a more special, but yet an extremely important, domain.
Several years ago a report on university efficiency was issued under the
auspices--though, it should be added, without the official endorsement--of
the Carnegie Foundation. The central feature of this report lay in its
advocacy of the application to universities of those principles of system
and of standardization which have been successfully applied on a large
scale to the promotion of industrial efficiency, and are generally
referred to by the catch-word, "scientific management." In spite of the
merits of the report in certain matters of detail, and of the high
standing of the expert who wrote it in his own department of industrial
engineering, the report evoked an almost universal chorus of contemptuous
rejection not only in university circles, but also from those organs of
public opinion which have any claim to be regarded as enlightened judges
in questions of education and culture. The thing seemed to have been
laughed out of court. And yet it turned out that a year or two afterwards
a full-fledged scheme for carrying out some of the crudest and most
objectionable features of this "efficiency" program was presented to the
professors of Harvard University, apparently with the expectation that
they would fall in with its requirements without hesitation or protest.
For some days there seemed to be real danger that this would actually
happen. It turned out to be a false alarm; the faculty of the foremost of
American universities were guilty of no such supineness. The project was
ignominiously shelved, with some sort of explanation that the springing of
it on the professors was due to an error or misunderstanding. But that the
attempt should have been made, and in a manner that argued so total a lack
of any sense of its grossness and crudity, is a significant warning of the
extent to which the notions underlying it have fastened upon the general
mind.
The story of the eugenics movement in this country affords a striking
illustration at once of the almost startling rapidity with which
innovating ideas as to the regulation of life gain acceptance, and of the
fact that this rapidity is by no means conclusive proof that their
progress will be continuous. The one thing clear is that there is a large,
active, and influential element in the population that is extremely
hospitable to such ideas, and manifests a naïve, an almost childish,
readiness to put them into immediate execution. Since, in the nature of
things, this element is lively and active--since, too, what is novel and
in motion is more interesting than what is old and at rest--at first there
is almost sure to be produced a deceptive appearance that the new thing is
sweeping everything before it. Just now there is evidently a lull in the
onward march of legislative eugenics. This is sufficient proof of the
conservatism of the people as a whole; we may be quite sure that anything
beyond a very restricted application of eugenical notions will take a long
time to get itself established in our laws or even in our customs.
Nevertheless, it would be a great mistake to suppose that even the more
extreme forms of eugenical doctrine are not forces to be reckoned with as
affecting practical possibilities of a not distant future. Though no
results may appear on the surface, the leaven is working. It is consonant
with tendencies which in so many directions are becoming more and more
dominant. So long as those tendencies continue in anything like their
present strength, there can be little doubt that the idea of control in
the direction of eugenics, like that of the regulation of human life in
other fundamental respects, will continue to make headway, and may at any
time become one of the central issues of the day.
To adduce prohibition as an illustration of this same character in the
thought and the tendencies of our immediate time may seem like forcing the
point. It is true, it may be said, that there has been within the past few
years a rapid spread of prohibition in almost every part of the country;
but the thing itself is sixty years old, has had its periods of advance
and recession, and is now, in the fullness of time, reaping the fruits of
two generations of agitation, investigation, and education. But to say
this is to overlook the distinctive feature of the present situation
regarding prohibition in the United States. A Constitutional amendment
providing for the complete prohibition of the sale of liquor throughout
the Union is pending in Congress. A year ago--probably six months
ago--there was hardly a human being in the United States, other than those
in the councils of the Anti-saloon League, who had so much as thought of
national prohibition as a question of present-day practical politics.
Suddenly it is announced that there is a distinct possibility of a
prohibition amendment being passed by Congress in the near future; and one
of the foremost representatives of the Anti-saloon League states, and with
good show of reason, that if the amendment be passed by Congress, its
ratification by the Legislatures of three fourths of the States can be
only a matter of time. What the probabilities actually are, I do not
undertake to say; neither am I concerned at this moment with the merits of
the issue itself. What I _am_ concerned with is the simple fact that in
this situation, brought upon the country with dramatic suddenness, nobody
seems to have been in the least startled, or so much as disturbed in his
equanimity. There will of course be a great struggle over the question,
sooner or later. But neither in Congress nor in the press has there as yet
been any sign of such an assertion of the claims of personal liberty as,
at any time previous to the past ten years, would have been sure to be
made in such a situation. This collective silence, on an issue affecting
so intimately the lives, the habits, the traditions of millions of people,
is, in my judgment, by far the most impressive proof of the degree in
which the public mind has grown accustomed to the inroads of regulation
upon the domain of individuality.
* * * * *
A number of years ago, when the mathematical concept of space of more than
three dimensions was attracting great popular interest, an ingenious
writer undertook to make the idea intelligible to "the general" by
picturing the state of mind in regard to three dimensions of a race of
beings whose life and whose sensual experience was limited to space of two
dimensions. He gave his little book the title "Flatland," and it gained
wide attention. In his Commencement address at Columbia last year,
President Butler had the happy thought of applying the term in the
characterization of certain aspects of the intellectual and political life
of our time. He was speaking particularly of that absorption in the
immediate problems of the day which makes almost impossible a true study
and contemplation of the lasting concerns of mankind as embodied in
history and literature. "Every ruling tendency," he said, "is to make life
a Flatland, an affair of two dimensions, with no depth, no background, no
permanent root." That this is a literal truth probably neither Dr. Butler
nor anyone else would contend; but it hits off with great force and with
substantial accuracy the prevailing character of thought in the circles
most active and most influential in almost every department of human
activity at the present time. And the tendency which President Butler
describes as arising out of our absorption in current problems is still
more manifest in the spirit of our actual dealings with those problems
themselves. On every hand we find a surprising readiness to accept views
which explicitly tend to take out of life that which gives it depth and
significance and richness. Each one of the four movements we have
mentioned affords an illustration of this: in following any one of them we
travel straight toward Flatland. They differ very much, one from another;
they have very different degrees and kinds of justification; it may be
difficult in the case of some of them to strike a balance between the gain
and the loss. The remarkable thing--the ominous thing, if we are to
suppose that the present tone of thought will long persist--is that the
loss involved in the flattening of life, as such, apparently almost wholly
fails to get consideration. I say apparently, because there is, no doubt,
a deep and strong undercurrent of opposition which, sooner or later, will
manifest itself; in speaking of "ruling tendencies" we are apt to mean
merely the tendencies that are most in evidence. But after all, it is to
these that criticism of contemporary life and thought must, of necessity,
be chiefly directed.
As I have already indicated, the attack on individuality and personal
dignity in the universities was met in a spirit that is highly gratifying,
and which is quite out of keeping with the tendency that I am discussing
and deploring. Yet it is doubtful whether, outside the circle of the
universities themselves, and of those individuals who are thoroughly
imbued with the university spirit, there is any true realization of what
it is that constituted the head and front of that offending. If some
bureau of research were to present a formidable array of figures showing
that the "output" of professorial work could be increased by so and so
many per cent. through the adoption of some definitely formulated system
of "scientific management," it is by no means certain that the scheme
would not receive powerful support in the highest quarters of efficiency
propaganda. We should be told just how many millions of dollars a year we
are spending on university education, and just how many of these millions
go needlessly to waste. Even the opponents of the "reform" would probably
find themselves compelled to use as their most powerful argument this and
that example of great practical results which have flowed from letting men
of genius go their own way. It would be pointed out that many an
investigation which, to the authorities of the time, appeared wholly
unpromising, turned out to be of cardinal value. We should be warned that
what we gain in a thousand cases through time-clock and card-catalogue
methods, might be lost ten times over through the shackling of the
initiative of a single man of unrecognized genius. And all this would be
very much to the purpose; but it is not upon any such special pleading
that the case ought to be made to rest. The loss that would be suffered
transcends all these concrete and definable instances of it. It would be
pervasive, fundamental, immeasurable. Grievous as might be the injury
caused by the prevention of specific achievements of exceptional
importance, this would be as nothing in comparison with the intellectual
and spiritual loss entailed by the lowering of the human level, the
devitalizing of the intellectual atmosphere, which must inevitably follow
upon the application of factory methods to university life.
* * * * *
The case of the eugenics propaganda is far more complex. In its origin,
and doubtless in some of its present manifestations, it may lay claim to
being directed toward aims which are particularly concerned with the
higher interests of life. The author of "Hereditary Genius" certainly
could not be accused of indifference to the part played in the past, or to
be played in the future, by exceptional minds and characters; nor is it
necessary to charge any of the present promoters of the propaganda with
explicit failure to appreciate the importance of such minds and
characters. The criticism is often made, from this standpoint, that the
hard-and-fast rules which the eugenists propose would, in point of fact,
have put under the ban some of the most illustrious names in the annals of
mankind--men whose genius was accompanied with some of the very traits
which they hold should most positively be prevented from appearing. But,
however weighty this objection to the methods of eugenics may be, it is to
be looked upon rather as an item on the debit side of the reckoning than
as marking an ingrained defect, a fault at the very heart of the matter.
The eugenists may well challenge those who urge merely this kind of
objection to show that the losses thus pointed out are great enough to
offset the gains, in the very same direction, which they regard their
program as promising. Whatever the truth of the matter may be, they can at
least set up the contention that, as a mere affair of quantity, genius
will do better under their system than without it.
What brings the eugenics movement into the Flatland category is not its
attitude toward the question of genius, or perhaps even of singularity,
but its attitude toward the life of mankind as a whole--if indeed it can
be said to have any attitude toward the life of mankind as a whole. The
profound elements of that life seem not to come at all within the range of
its contemplation. Of course this does not apply to everything that comes
from the eugenics camp, nor to every person that calls himself a eugenist.
But on the other hand it is by no means only of the crude projects of
half-educated reformers, or the outgivings of the prophets of our popular
magazines, that it _is_ true. The agitation has derived much of its
impetus, directly or indirectly, from the teachings of men of high
scientific eminence who have attacked the question without any apparent
realization of its deeper bearings on the whole character of human life.
This influence often comes in the shape of exhortations, or suggestions,
addressed to the public at a time when attention is centered upon some
conspicuous crime or some particular phase of evil in the community;
sweeping and radical regulation of the right of parenthood being urged as
necessary for the prevention of all such distressing phenomena. Thus,
after the attempted assassination of Mayor Gaynor, there was much talk of
a "national campaign for mental hygiene," which should have the effect of
"preventing Czolgoszes and Schranks." Its program was thus indicated by
one of the foremost professors of medicine in the United States:
Provision must be made for the birth of children whose brains
shall, so far as possible, be innately of good quality; this means
the denial of the privilege of parenthood to those likely to
transmit bad nervous systems to their offsprings.
What the carrying out of such a programme would mean to mankind at large,
how profoundly it would modify those ideas about life, those standards of
human dignity and human rights, which are so fundamental and so pervasive
that they are taken for granted without express thought in every act and
every feeling of all normal men and women--this does not seem ever to
trouble the mind of the devotee of universal regulation. He sees the
possibility of effecting a certain definite and measurable improvement;
that the means by which this is accomplished must fatally impair those
elemental conceptions of human life whose value transcends all
measurement, he has not the insight or the imagination to recognize. The
distinctions of social class, of wealth, of public honor, leave untouched
the equality of men in the fundamentals of human dignity. They do not go
to the vitals of self-respect; they do not interfere with a man's sense of
what is due to him, and what is due from him, in the primary relations of
life. If nature has been unkind to him in his physical or mental
endowments, he does not therefore feel in the least disqualified, as
regards his family, his friends, his neighbors, the stranger with whom he
chances to come into contact, from receiving the same kind of
consideration, in the essentials of human intercourse, that is accorded to
those who are more fortunate; nor does he feel in any respect absolved
from the duty of playing the full part of a man. Under the régime of
medical classification--and the "mental hygiene" programme can mean
nothing less than that--all this would disappear. Some men would be men,
others would be something less. It is true that, so far as regards the
imbecile, the insane, and the criminal, such a state of things obtains as
it is; but this stands wholly apart from the general life of the race, and
has no influence whatever on the habitual feelings and experiences of
human beings. The normal life of mankind is shot through and through with
the idea that a man's a man; all that is highest in feeling and conduct is
closely bound up with it. Lessen its sway over our feelings and thoughts
and instincts, and how much benefit in the shape of "preventing Czolgoszes
and Schranks" would be required to compensate for the loss in nobleness,
in depth, which human life would suffer?
* * * * *
The prohibition movement belongs, in the main, to a wholly different order
of things. The fight against the evils of drink, as it has been carried on
for a century or more, has been animated by a moral fervor which classes
it rather with the fight against slavery, or with the great revivals of
religion, than with those movements which owe their origin to a
calculating and cold-blooded perfectionism. Its leaders have been fired
with the ardor of a war directed against a devastating monster, to whose
ravages was to be ascribed a large part of the misery and wickedness that
afflict mankind. It is true that the economic and physiological aspects of
the drink question were not ignored; the total-abstinence men were glad
enough to have this second string to their bow. But the real fight was not
against alcohol as one of many things concerning which the habits of men
are more or less unwise; it was a fight against the Demon Rum, the ally of
all the powers of darkness. The plea of the moderate drinker was rejected
with scorn, not because there was any objection to moderate drinking in
itself, but because total abstinence was the only true preventive of
drunkenness, and drunkenness must be stamped out if mankind was to be
saved. The moderate drinker was censured not because he was wasting his
money, or failing to "conserve his efficiency," but because for the sake
of a trivial self-indulgence he was giving countenance to a practice which
was consigning millions of his fellow men to wretchedness in this world
and to everlasting damnation in the next.
Now this remarkable thing about the present extraordinary manifestation of
growth and strength in the prohibition movement is that it is not in the
least due to a strengthening of this sentiment. On the contrary, it is
safe to say that feeling about drunkenness, about the drink evil in the
sense in which it was understood a generation ago, is far less intense
than it was then. The prohibition movement in its present stage is not the
old prohibition movement advancing to triumph through the onward march of
its proselyting zeal; of true prohibitionist zealots the number is
probably less, in proportion to the population, than it was forty years
ago. Its great accession of strength has come from the growth of that
order of ideas which is common to all the "efficiency" movements of the
time. And that growth helps it in two ways. On the one hand, to the little
army of crusaders against the Demon Rum there has come the accession of a
host of men who are not thinking about demons at all, but who calmly hold
that the world would be better off without drinking, and that this is an
all-sufficient reason for prohibiting it. And on the other hand, millions
of persons who, in former days would have cried out against this way of
improving the world--against the impairment of personal liberty and the
sacrifice of social enjoyment and social variety--have no longer the
courage of their convictions. The temper of the time is unfavorable to the
assertion of the value of things so incapable of numerical measurement.
Against the heavy battalions led by the statisticians, and the
experimental psychologists, and the efficiency experts, what chance is
there for successful resistance? On the opposing side can be rallied only
such mere irregulars as are willing to fight for airy nothings--for the
zest and colorfulness of life, for sociability and good fellowship, for
preserving to each man access to those resources of relaxation and
refreshment which, without injury to others, he finds conducive to his own
happiness.
* * * * *
It is hardly necessary to say that, in taking up these various movements,
no attempt has been made at anything like comprehensive discussion of
their merits. Whatever may be the balance between good and ill in any of
them, they all have in common one tendency that bodes danger to the
highest and most permanent interests of mankind; and it is with this alone
that I am concerned. What that tendency is has, I trust, been made
sufficiently clear; but it will perhaps be brought out more distinctly by
a consideration of the "Life Extension" propaganda more detailed and
specific than that given to the other three.
Conspicuous in the literature of this propaganda is the appeal to standard
modern practice in regard to machinery. "Those to whom the care of
delicate mechanical apparatus is entrusted," says the New York
Commissioner of Health, "do not wait until a breakdown occurs, but inspect
and examine the apparatus minutely, at regular intervals, and thus detect
the first signs of damage." "This principle of periodic inspection," says
the prospectus of the Life Extension Institute, "has for many years been
applied to almost every kind of machinery, except the most marvelous and
complex of all,--the human body." To find fault with the drawing of this
comparison, with the utilization of this analogy, would be foolish. That
many persons would be greatly benefited by submitting to these inspections
is certain; it is not impossible that they are desirable for most persons.
And the analogy of the inspection of machinery serves excellently the
purpose of suggesting such desirability. What is objectionable about its
use by the Life Extension propagandists is their evident complacent
satisfaction with the analogy as complete and conclusive. Yet nothing is
more certain than that, even from the strictly medical standpoint, it
ignores an essential distinction between the case of the man and the case
of the machine. The machine is affected only by the measures that may be
taken in consequence of the knowledge arising from the inspection; the man
is affected by that knowledge itself. Whether the possible physical harm
that may come to a man from having his mind disturbed by solicitude about
his health is important or unimportant in comparison with the good that is
likely to be done him by the following of the precautions or remedies
prescribed, is a question of fact to which the answer varies in every
individual case. It may be that in the great majority of cases the harm is
insignificant in comparison with the good. However that may be, the
question is there, and it is of itself fatal to the conclusiveness of the
_argumentum ex machina_. That this is not a captious criticism, that it is
based on substantial facts of life, ordinary experience sufficiently
attests; but it may not be amiss to point to a conspicuous contemporary
phenomenon which throws an interesting light on the matter. The Christian
Scientists regard the _ignoring_ of disease as the primary requisite for
health and longevity. That the Christian Science doctrine is a sheer
absurdity, no one can hold more emphatically than the present writer; but
it cannot be denied that in thousands of cases its acceptance has been of
physical benefit through its subjective effect upon the believer.
Personally, I would not purchase any benefit to my physical life at such
sacrifice of my intellectual integrity; I mention the point only by way of
accentuating the undisputed fact that the presence or absence of concern
about health may have a potent influence on one's bodily welfare.
Although it is a still further digression from the main purpose of this
paper, I must permit myself a few words on another point relating to the
strictly medical claims of the plan of "universal periodic medical
examination." It is natural that its advocates say nothing about the
danger of errors in diagnosis; everybody knows that this danger exists,
but sensible men do not allow it to deter them from consulting a
physician; in this, as in other affairs of life, they do not cry for the
moon, but do the best they can. But it seems to be wholly overlooked by
the advocates of the propaganda of "universal periodic examination" that
the extent of this danger under present conditions affords no indication
at all of what it would be under the system they contemplate. Its cardinal
virtue, they constantly proclaim, would be the detection of the very
slightest indication of impairment: "The task before us is to discover the
first sign of departure from the normal physiological path, and promptly
and effectually to apply the brake." The consequence must necessarily be
that for one case of false alarm that occurs today there will be a score,
or a hundred, under the new régime. For, in the first place, the
individuals seeking advice will not be, as they now are in the main,
selected cases in which there is some antecedent presumption that there is
something wrong; and secondly, the examiner, bent upon the one great
object of overlooking nothing, however slight, will give warnings which,
whether technically justifiable or not, will in great numbers of cases
have a wholly unjustifiable significance to the mind of the subject. Who
shall say how many persons will thus be made to carry through life a
burden of solicitude about their health from which, if left to their own
devices, they would have been wholly free?
But it is not my design to find fault with this scheme as a matter of
medical benefit; if I have ventured to point out some drawbacks, it is
only by way of showing that, even from the strictly medical standpoint the
cult of uniformity, of standardization, of mechanical perfection, is not
free from fault. But the great objection against that attitude of mind
which is typified in the appeal to the analogy of machinery is far more
vital. Our only interest in a machine is that we shall get out of it as
much, and as exact, work as possible. Our interest in our bodies is not so
limited. We may deliberately choose to forego the maximum of mechanical
perfection for the sake of living our lives in a way more satisfactory to
us than a constant care for that perfection would permit. Even the most
ardent of health enthusiasts--unless he be an insane fanatic--draws the
line somewhere. What he forgets is that other people prefer to draw the
line somewhere else. They choose to run a certain amount of risk rather
than have their health on their minds. To compel--whether by legal means
or by social pressure--every man to take precautions concerning his own
body which he deliberately prefers not to take; to make impossible, in
this most intimate and personal of all human concerns, the various ways of
acting which the infinite varieties of temperament and desire may
dictate--this would be such an invasion of personal liberty, such a
suppression of individuality, as would strike us all as appalling, had we
not grown so habituated to the mechanical, the statistical, measurement of
human values--to the Flatland view of life.
* * * * *
What gives to these movements that I have been discussing the character
which I have been ascribing to them is not so much the specific things
which they severally aim to accomplish, but the spirit in which they are
carried on, and perhaps still more the spirit, or want of spirit, with
which they are met. It is not that a balance is falsely struck between the
benefit of the concrete, circumscribed, measurable improvement aimed at
and the injury done to some deeper, more pervading, and quite immeasurable
element or principle of life; it is that the balance is not struck at all.
The subtler, the less tangible, element is simply ignored. It was not
always so. It was not so in the last generation, or the generation before
that. The phenomenon is one that is closely bound up with the ruling
tendency of thought and action in all directions; it is not an accident of
this or that particular agitation. Perhaps in no direction is it more
convincingly manifested than in the prevailing tone of opinion, or at
least of publicly expressed opinion, in regard to the objects and ideals
of universities. That in the present state of the world's economic and
social development on the one hand, and of the various sciences on the
other, "service"--that is, service directly conducive to the general
good--should be regarded as one of the great objects of universities, is
altogether right; that it should be spoken of as their _only_ object,
which is the ruling fashion, is most deplorable. The object of a
university, said Mill, is to keep philosophy alive; yet it would go hard
with the present generation to point to any one more truly and profoundly
devoted to the service, the uplifting, of the masses of mankind than was
John Stuart Mill. Were he living he would recognize, as thoroughly as the
best efficiency man of them all, that the universities of today have
opportunities and duties which were undreamed of half a century ago. But
he would know, too, that in those activities which are directed to the
promotion of practical efficiency, the university is but one of many
agencies, and that if it were not doing the work some other means would be
found for supplying the demand. Its paramount value he would find now, as
he did then, in the service it renders not to the ordinary needs of the
community but to the higher intellectual interests and strivings of
mankind. That so few of us have the courage clearly to assert a position
even distantly approaching this--such a position as was mere matter of
course among university men in the last generation--is perhaps the most
significant of all the indications of our drift toward Flatland.