Darwinism, Medical Progress, and Eugenics

Excerpts from Darwinism, Medical Progress and Eugenics: The Cavendish Lecture, 1912, An Address to the Medical Profession. [1] Originally published in the West London Medical Journal, vol. 17, pg. 165--193, 1912. Abridged.

Karl Pearson [2]

Mr. President, Gentlemen, -- I confess to strangely mixed feelings in venturing as a layman to stand up and address you -- a professional audience -- to-night. When I look through the long list of names borne by those who have, during more than a quarter of a century, given the Cavendish Lecture, I find all that is best in English Medical Science represented, and more than one foreign authority of world-wide repute. Your lecturers have been men known not only within the medical profession, but men who have won the confidence of a wide lay public by the extent and efficiency of their labours for general social welfare. It must appear presumption on my part to stand on this platform and break -- if it be only for a single occasion -- that flow of wide medical and surgical experience which has been placed before you annually for more than twenty-five years. It seems to me that I have before me the very serious task of justifying not only my acceptance of this post, but also your Council's invitation to a layman, who is not only a layman -- i.e. a man without medical training -- but is held by more than one distinguished leader in your profession to criticise without knowledge more than one accepted medical truth.

I am quite clear, however, that the suggestion conveyed by your Council's invitation and my own inclinations would lead me on this occasion to give a wide berth to these controversies. I feel sure that it is rather the office I hold than my personal opinions which explain that invitation and my presence here to-night. I ask myself: What is the bond between the Director of the Francis Galton Laboratory for National Eugenics and the medical profession? How far have we common ends, and how far do we follow the same path towards increased social welfare?

The founder of our laboratory, Sir Francis Galton, was descended on one side from a stock which was clinical by instinct, and produced a number of medical men of distinction. Erasmus Darwin and Robert Darwin are still honoured names in medicine. Sir Francis Darwin, being on a pleasure journey in the East, settled down in charge of a plague hospital that he might understand the nature of plague. His nephew and godson, Francis Galton -- then a medical student of the Birmingham General Hospital -- found his chief disappointment in visiting Smyrna that the plague was over, and that he could not study it at first hand. He spent nearly four years in medical studies, partly before and partly after his mathematical work at Cambridge, and when independence came to him on the death of his father, he tells us: "I abandoned all thought of becoming a physician, but felt most grateful for the enlarged insight into Nature that I had acquired through medical experiences" (Memories, p. 82).

Sir Francis Galton was, like his grandfather, by instinct a clinician, and that instinct, together with his four years' medical study, influenced both his lines of research and all he wrote. Within a few months of his death he approved the scheme we had drafted for the University Commissioners, by which the first application of any new funds accruing to the laboratory should be the provision of a permanent medical officer. I mention these matters because, from our founder downwards, we have always sought cooperation with the medical profession, and I venture to think -- as a study of our publications will indicate -- that that cooperation has been as generously given as it was frankly sought.

Examine with me for a moment the definition of my science: "National eugenics is the study of those agencies under social control, which may improve or impair the racial qualities of future generations, either physically or mentally." How can you expect to do anything in a science such as that without the hearty co-operation of the medical profession? Hereditary deformities and diseases, influences of special environments, alcohol, syphilis, tuberculosis, insanity, feeble-mindedness, all racial defects known or asserted to influence future generations, fall at once into the category of medical experience, even if ability, genius, physique, and craftsmanship belong less markedly within its sphere.

Who are the men who, alone in the present state of our development in this country, can provide adequate data as to the influence of occupation, environment, parental history, on the racial qualities of future generations? Why, in the first place they are the local medical officers of health, who, directly and through their district visitors, are recording home environment, parental occupation, and infantile and child health and mortality. And in the second place they are the school medical officers, who are annually examining thousands of children and scheduling their characteristics. And in the third place they will shortly be the medical officers of the National Insurance scheme, who will have material at their disposal of even wider importance and of more interesting scope.

To the outsider, like myself, it appears as if a sharp dividing line were being at present drawn right across the medical profession. I do not suggest that men will not at first pass from one division to the other, but the interests of the two divisions will be largely distinct, the tastes of the men who follow them will be widely different, and ultimately the training will be markedly differentiated. The one class of men will be in public service, they will be studying and recording humanity in the mass -- the normal and the pathological, side by side -- their objects will be to enforce medico-social legislation, and to provide data from which proposals as to further legislation can be judged. The limits to the public health service seem for the time beyond our ken; we are only at the very beginning of the movement, and its possibilities are enormous, and in one sense or another every man in that service is concerned with what makes for the racial efficiency of future generations -- he must nolens volens become a eugenist.

Pray understand me. I am using the term "eugenist" in no narrow sense. I do not signify by it membership of any propagandist body -- such societies often do more harm than good to the cause we have at heart. [3] I do not understand by eugenist one who desires to segregate the mentally defective or prohibit the epileptic from parentage, although I might sympathise with both those attempts to improve the racial qualities of future generations. No, I am thinking of something far wider and broader than this! The public health service brings a man right up against the fundamental biological problems of society. He is forced to consider them; he cannot progress until he has determined whether nature or nurture contributes more to the evils he sees around him. The physician in general practice has one main object -- the welfare of the individual human being who chances to be his patient; the relief of individual suffering and the prolongation of lives which possibly have little or no social value are the primary duties before him. But in the public health service the medical man must see individuals in the mass. For example, within his district he finds a certain intensity of infant mortality. Is it due to employment of mothers, to dearth of breast-feeding, to unhealthiness of parents, to alcohol, to syphilis, to overcrowding? Or again in what proportions is it due to one or more of these causes? He turns to thousands of school-children, and at once recognises among them factors which render them racially inefficient -- congenital cataract, defective teeth, epilepsy, feeble-mindedness, evidences of active or healed tuberculous lesions; he is at once impelled to inquire into the causes of these things, and from that moment he is a eugenist in the true sense of the term. In the words of Sir Francis Galton, he begins to study the agencies under social control which may improve or impair the racial qualities of future generations, either physically or mentally. The whole range of eugenic problems is opened up for him at once. He has an entire city, a county at his disposal, and data in quantity beyond the dreams of the most avaricious statistician, but what can he do with it? What is it possible for him to make of it?

He is given a laboratory on a scale unparalleled in pure science; he has before him a population being born, breeding, and dying, which the most keen experimental disciple of genetics must envy him. He has his thousands, and he is able to record fine differences in parentage and environment which must escape those of us who can only breed our tens of dogs or hundreds of mice or guinea-pigs; we can only discriminate crude differences, such as colour of coat, or length of hair, or shape of nose; or environments which are measured in rough differences of temperature, of light, or of bulk of food. What differentia are there that we can observe in the intelligence of mice? Even with the dog relative intelligence is difficult indeed to estimate, and what man calls intelligence is often obedience to human wants, and not the obstinacy and self-determination which would actually aid these animals in a free struggle for existence. The male of a race of dogs I breed is ever alert, eminently companionable, and can be taught to do all sorts of tricks -- he is at once supposed to be very intelligent; the female is apparently relatively inert, learns few tricks, and shows no special keenness for human comradeship -- she is accordingly described as less intelligent than the male. And yet her whole conduct is planned so that pregnancy and motherhood may be successful. She knows the right amount of exercise at each stage; she knows at the critical time what she herself has to do and what she expects you to do, and, if you go beyond that, the hand will be held firmly in her mouth, to he really punished if the intrusion be persistent. As a mother her conduct is at every point pre-eminently intelligent; the male is only intelligent under circumstances wholly artificial. I have digressed thus to indicate how on the mental side there is no comparison between the value of the data at the disposal of the experimental breeder and of the medical officer of health working in conjunction with the school medical officer. The wages, the habits, the employment of parents, the nature of the home, are all at the service of the medical officer of health; they have been tabled in thousands and thousands of cases; the physique and mentality of thousands of children are studied every day by teacher and school medical officer.

I do not write without knowledge of the splendid work done in following up defective children into their homes by many school medical officers. I am in possession of many pedigrees provided by such energetic investigators in cases of cataract, albinism, Polydactyly and other marked pathological states. But these very men will tell you that this type of inquiry, which should be an essential part of their work, is directly discouraged, and must be done, so to speak, outside hours and sub rosa. "Your business," they are told, "is to provide a remedy, not to investigate causes." Can you conceive a more fatuous position to take up ?

Medical men in public service, whether as officers of health, school officers, or as superintendants of asylums, sanatoria and reformatories, have access to immense masses of data bearing on medico-social problems, and schedule it in increasing quantities. Are these schedules to be wasted, to be stacked and ultimately burned for want of space, or shall they form archives from whence knowledge as to the factors which improve or impair national well-being may be extracted?

To anyone who hopes for human progress -- not by arbitrary guesswork -- but by the gradual unravelling of truth there can be but one answer to that question. Many medical officers of health and school medical officers have answered it already by placing their data unreservedly at the disposal of professional statisticians. The Eugenics Laboratory possesses thousands of schedules bearing on the health of children, the effect of the employment of mothers, the family histories of imbeciles, the action of tuberculin, and many other problems. We have the material to answer -- in numerous cases already have the answers to -- various medico-social problems. Now I would ask you whether it is better that this material should perish, or that it should pass through the hands of laymen who at least have the requisite statistical training to analyse it? [4]

If you suggest that it would be best that we created a new class of medical mathematicians -- I am wholly with you; this is undoubtedly the ideal of the future. It has been to some extent the ideal of the past, for I rejoice to number among those who have worked in my laboratory the Director of the Pasteur Institute of India and the Medical Statistician to the Lister Institute of London. But is its full realisation possible? You know how arduous is the five years' training in medicine, but do you appreciate how equally arduous is the requisite training in mathematics to be followed by at least a two years' training in statistics? Do not fancy for a moment that the medical lectures on vital statistics in a course for the D.P.H. are of the least service in view of the modern statistical calculus. Sir Francis Galton, who is the father of the scientific treatment of medico-social problems and the founder of the modern science of eugenics, spent four years over medicine and four over mathematics, and the result was simply that because he was not a certified specialist in either study the medical world gave no weight to his judgments, and the mathematicians denied he was one of their number! [5]

I am convinced that every officer of the public health service who really appreciates the magnitude and importance of his work both for medical progress and with it for social welfare, is, however unconscious he may be of Sir Francis Galton's definition, a true eugenist. [6] I know from many talks with medical officers of health that at least a moiety of the problems before which they find themselves at a halt are precisely the fundamental problems of eugenics. The alliance between this branch of medicine and eugenics is in the essential nature of things; it is basal; and no amount of surface differences, no intensity of personal prejudices, can avail to screen it permanently.

Is it not after all this fundamental fact, the existence of this alliance, which explains the invitation of your Council and my presence here to-night? So far it seems to me that those who are really working at scientific inquiry in eugenics and those belonging to an important section of the medical profession are wholly at one in their aims. But there is undoubtedly a fly in the amber, and if the alliance between eugenics and medicine, as a whole, is to be a real one, we cannot for a moment overlook a possible source of divergence between them.

I belong to a school which still believes that Darwin taught us the truth. I think it is rather the fashion nowadays to dismiss its views, not by meeting its arguments, but by describing it as "mid- Victorian." When in literature, science, and statemanship this twentieth century has produced minds which out-top the "mid-Victorians," then it will be time enough to reply to a mere nickname. Let me, even at the risk of talking about the familiar, sketch for you the broad outlines of Darwin's theory of evolutionary progress. The individual better fitted to its environment lived longer than its fellows, had more offspring, and these, inheriting its better fitness, raised the type of the race. The environment against which the individual had to struggle here was not only formed by the other members of its species, not only by its physical surroundings, but by the germs of disease of all types. According to Darwin -- and some of us still believe him to be right -- the ascent of man, physical and mental, was brought about by this survival of the fitter. Now, if you are going lo take Darwinism as your theory of life and apply it to human problems, you must not only believe it to be true, but you must set to, and demonstrate that it actually applies. [7]

That task I endeavoured to undertake after the late Lord Salisbury's famous attack on Darwinism at the Oxford meeting of the British Association in 1894. It was not a light task, but it gave for many years the raison d'etre of my statistical work. In the first place it was demonstrated that on the average the longer lived leave sensibly more offspring. In the next place it was proved that both physical and mental characters were definitely inherited. Then, if the third point could be demonstrated -- namely, that there was a selective death-rate in man -- there could be no flaw in the argument that Darwinism applied to man; from a mere plausible belief it would become a law of human life. How was this selective death-rate to be determined? How was general physical fitness to be measured? It occurred to me that taken all round physical fitness was properly measured by length of life. If length of life in the case of human beings was a perfectly arbitrary quantity, then the shafts of death were random shots. Death did not select his victims. In other words the question of the selective death-rate in man was the question of the random character of length of life. Now if length of life depends on physical constitution and power to resist disease, then on the Darwinian theory these characters would be inherited, and length of life would on the average be related in parent and offspring. Briefly, if there be no selective death-rate there will be no relation between lengths of lives of parent and offspring, or generally between members of the same stock; if all deaths be selective, then the relation between durations of life will be the same as that of any physical character in parent and child. As a matter of fact neither one nor other position is true; not all deaths are selective, but we can determine what proportion are. In the case of individuals living under the same environment over 75 per cent. of the deaths were thus shown to be selective.

That demonstration that some 75 per cent. of deaths depend upon hereditary constitution seems to me conclusive, but it has not seemed so to a distinguished member of the Local Government Board, although my conclusions have been verified by a distinguished biologist. Prof Ploetz, [8] working on German, not English material. Dr. Newsholme has recently published a Government report on infantile mortality, and, working in conjunction with Mr. G. U. Yule has discovered that when the infantile death-rate is high in a given locality, then the death-rate of children of a greater age during the same period is also high. This result has apparently been used to demonstrate that a high infantile death-rate does not mean a low child mortality, and indirectly by one of its authors and a whole army of party newspapers to preach that the Darwinian doctrine has no application to man, and that environment, not constitution -- nurture, not nature -- is the sole thing that social reformers need pay attention to. It is astonishing that two statisticians of such repute should not have recognised that practically no result of any importance could be deduced from the fact that in the same neighbourhood and for the same period the death-rates for two classes of the community would both be high or both low! How could the deaths of infants in this year possibly influence the deaths of children of three and more in the same year? Darwin's theory means this, that if individuals are reared under a constant environment, and a larger percentage of them are killed off in the first year of life, then a smaller percentage of those remaining will die in the later years of life, because more of the weaklings have been killed off. Dr. Newsholme's position is, if I grasp it, this: that a high death-rate means a high rate of sickness, and this sickness produces a general weakening in those that do not die, so that they fall an easier prey in later years. In other words he wholly rejects Darwin's position that a hard winter or general scarcity would leave a stronger race of birds behind.

Whether Newsholme or Darwin held the truer view could not possibly be tested upon Newsholme and Yule's data. You must follow each array through its life and see whether increased infantile death-rate means decreased child death-rate for the same group. This method has actually been followed by Dr. Snow, working in my laboratory. He has taken English and Prussian data, and he has endeavoured to follow the same group from birth through childhood. Dr. Snow has attacked the equality of environment from a number of sides, but the general conclusion is substantially the same: When the infantile death-rate is intensified, then the death-rate in childhood of the survivors is lessened, not increased. In other words, a heavy infantile death rate does select the weaker individuals and leave a stronger population physically to the later years of life. It is difficult, indeed, to believe that it could possibly be otherwise, and I have every confidence in my view that Darwinism applies absolutely to the case of man.

But, because I state that the infantile death-rate is selective, and assert that it by no means follows that a low infantile death-rate will compensate racially for a falling birth-rate, why should I be described as a Herod, and those who hold the same views as supporters of the "better-dead" doctrine? I feel sure that many of you who have, by your skill, helped into the world the cripple, or the child of deformed or diseased parents, must have said to yourselves, when you found it viable, better it had not been born. Many of you, I take it, hold with me the "better-not-born" doctrine, [9] but the recognition of the fact that the infantile death-rate is selective cannot of itself justify the charge that we wish the weaklings killed off.

Nevertheless, medical science has to face the fact that the upward progress of man in the past has been largely controlled by a stringent Darwinian selection. We shall gain nothing for racial efficiency by neglecting that central fact of human development.

Now if there be -- and I, for one, think that two independent lines of inquiry demonstrate that there is -- a fairly stringent selection of the weaker individuals by the mortality of infancy and childhood, what will happen, if by increased medical skill and by increased state support and private charity, we enable the weaklings to survive and to propagate their kind? Why, undoubtedly we shall have a weaker race. Remember that "general health" is undoubtedly inherited. Now couple this partial suspension of the stringency of natural selection with a reduced fertility of the fitter stocks and we have the state of affairs -- the very grave state of affairs -- which we of to-day are called upon to meet.

Now you will say, and rightly say, that each stage of this argument needs to be supported by very solid facts. Well, as far as is consistent with the time available let me give you illustrations of what I mean.

In the first place, I hope you will agree with me when I say that the general death-rate is selective. Secondly, the progress of medical and sanitary science has altered the stringency of selec- tion. To deny that, Gentlemen, is after all to deny the progress of medical science. You know in a general way that the death-rate, corrected for age, has fallen enormously in this country. But I should like to place before you its actual history.

You see at once the three great periods in the history of our English death-rate: (1) The period of stability, quite uninfluenced by factory legislation, 1835-1865; (2) the period of sanitary science, 1866-1891, with its continuous fall in the death-rate; (3) the period of modern medicine, 1891-1911, with still further acceleration in the fall. I think we can be quite confident that within sixty years from 1865, namely, in 1925, we shall have reduced the death-rate by nearly 50 per cent, in this country. To this extent modern progress -- chiefly medical progress -- has suspended the action of natural selection.

Does this suspension of natural selection really mean that more of the weaklings survive to propagate their kind? Some light may be thrown on that point by considering the percentages of the population in 1881 and in 1901 in broad age-groups.

[There follows many examples of hereditary and supposedly hereditary conditions, diseases, degeneracies, dysgenic families, etc. --eco]

Well, these are individual illustrations of what is happening, because the intensive selection of the old days has been suspended. That suspension is partly due to medical progress; you are enabling the deformed to live, the blind to see, the weakling to survive -- and it is partly due by the strain of modern life, is fed up and restored, for a time to his family and to paternity. In our institutions we provide for the deaf-mute, the blind, the cripple, and render it relatively easy for the degenerate to mate and leave their like. In the old days, without these medical benefits and without these social provisions the hand of Nature fell heavily on the unfit. Such were numbered, as they are largely numbered now, among the unemployables; but there were no doctors to enable them to limp through life; no charities to take their offspring or provide for their own necessities. A petty theft meant the gallows, unemployment meant starvation, feeble-mindedness meant persecution and social expulsion; insanity meant confinement with no attempt at treatment. To the honour of the medical profession, to the credit of our social instincts, be it said, we have largely stopped all this. We have held out a helping hand to the weak, but at the same time we have to a large extent suspended the automatic action whereby a race progressed mentally and physically.

Surely here is an antinomy -- a fundamental opposition between medical progress and the science of national eugenics, of race efficiency. Gentlemen, I venture to think it is an antinomy, and will remain one until the nation at large recognises as a fundamental doctrine the principle that everyone, being born, has the right to live, but the right to live does not in itself convey the right to everyone to reproduce their kind.

Our social instincts, our common humanity enforce upon us the conception that each person born has the right to live, yet this right essentially connotes a suspension of the full intensity of natural selection. Darwinism and medical progress are opposed forces, and we shall gain nothing by screening that fact, or, in opposition to ample evidence, asserting that Darwinism has no application to civilised man. [10]

It is here, at this opposition of Darwinism and medical progress, that eugenics seem to provide a key to the situation. As eugenists we assert that the right to live does not connote the right of each man to reproduce his kind. Step by step, as we lessen the the suffering denoted by these percentages, not only on the individuals themselves, but on their friends and relatives, and what is more important, on the nation as a whole? I believe, if the general public, but above all the medical profession, once fully realised the very large part which heredity plays, not only in cases of deformity, but in cases of general mental and physical debility, where it leads to many forms of degeneracy, they would be most wholly and heartily with me when I say that only a very thorough eugenic policy can possibly save our race from the evils which must flow from the antagonism between natural selection and medical progress. You will say: "In what way can help be most efficiently given to such a eugenic policy?" There are two ways in which it can be done -- by public action and by personal influence.

By public action: In supporting some measure, whether it be the present Government Bill or a modified form of it, for the segregation of the mentally defective.

But great as is the influence of medical opinion on public action, it is more than equalled by the weight which the individual medical man can exert in his private relationship either as consultant or as family doctor. He is the confidential friend of many men and women, and as such in a quiet and unobtrusive way he can do much to encourage the fit to parentage and discourage the unfit. The public is in a receptive mood at the present time -- I feel sure of this by the number of letters of inquiry, often with elaborate pedigrees, which reach my laboratory -- and a very little directive from medical advisers may have great ultimate national value.

Be this as it may, I am certain there is from the racial standpoint a divergence between the conception of natural selection and the progress of medical science; I see only one way of bringing the two into harmony. [11] If we suspend -- as we all agree we ought to suspend -- the stringent selection of the living, then we can only progress as a race, mentally and physically, by a stringent selection for parenthood; we must resolve that the fit shall not only be parents, but have a fertility which entirely dominates the fertility of the unfit. Unless we have a firm belief that man differs in toto from every other type of life with which we are acquainted -- and there is no basis for such a belief in our experience of the influence of environment on man -- then the acceptance of the eugenic standpoint is, I am convinced, the only way in which we can safely reconcile medical progress with racial progress. [12] We cannot make a fine race of men -- as Mr. John Burns seems to believe -- by simply reducing the infantile death-rate; that death-rate is selective, and if we check Nature's effective but roughshod methods of race betterment, we must take her task into our own hands and see to it that the mentally and physically inferior have not a dominant fertility. In the organised and conscious race-betterment of the future I believe that medicine and eugenics will advance hand in hand, for their missions, if not identical, will, I venture to think, be in complete sympathy.

notes

[1]	download djvu

[2]	Darwin Medalist. Fellow of the Royal Society. Director of the Galton Eugenics Laboratory. Marxist. Raving atheist.

[3]	Pearson did not join the Eugenics Society because it was too bourgeois for his marxist tastes. Also, he had trouble getting along with people.

[4]	Pearson's biostatistical methods -- the methods he is advocating here -- is called biometry. Biometry turned out be complete rubbish.

[5]

This paragraph is typical Pearson. He seems to have had a major insecurity complex. Neither he nor Galton were ever considered peers by biologists or real scientists. Pearson often goes off on tangents justifying himself (and Galton) to biologists and other scientists. Yet history shows that neither Pearson nor Galton ever contributed anything of value to biology.

[6]	Eugenists have a way of making others into eugenists (without them knowing or even against their will), just as evolutionists have a way of portraying others (even anti-evolutionists) as evolutionists.

[7]	Imagine preaching this ridiculous 19th century dog-eat-dog Malthusian-Darwinian-Spencerian dreck to an audience of professionals who actually work for a living: doctors and surgeons.

[8]	Alfred Ploetz. Founder of race-hygiene societies in Germany, and, along with his brother-in-law, one of the architects of Nazi eugenic policies. Founded the Archiv fur Rassen und Gesellschaftsbiologie. The first issue of this journal was dedicated to Weismann and Haeckel.

[9]	Pearson is projecting the eugenist's own moral degeneracies onto the audience. But as has been said, eugenists have a way of making everyone into a eugenist.

[10]

David Stove said that Darwinians have an amazing habit of blaming reality when the reality conflicts with their theory. Pearson, a statistician with little knowledge of medicine or even biology, is in front of an audience of surgeons, informing them that the medical profession is in conflict with Darwinism, of all things, and that they should do something about it. Pearson, consistent with the 'amazingly arrogant habit', lays the blame on the medical profession for "enabling the deformed to live, the blind to see, the weaklings to survive". Can you fathom the arrogance of that? A sensible person would conclude: 'well then, that's just too bad for Darwinism. Off you go!'

[11]	There is another way to achieve harmony: if Darwinism is in conflict with medical progress, then Darwinism, and Pearson along with it, is wrong.

[12]	You see, there are consequences to believing that man is just another animal, he has no soul, a meat by-product, etc.

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