When we survey the movement of social reform which has been carried on during the past one hundred years, we thus see that it is proceeding in four stages. 1—The effort to clear away the gross filth of our cities, to improve the dwellings, to introduce sanitation, and to combat disease. 2—The attempt to attack the problem more thoroughly by regulating conditions of work, and introducing the elaborate system of factory legislation. 3—The still more fundamental step of taking in hand the children who have not yet reached the age of work, nationalizing education, and ultimately pushing back the care and over-sight of infants to the moment of birth. 4—Finally, most fundamental step of all, the effort, which is still only beginning to provide the conditions of healthy life even before birth. It must be remembered that this movement in all its four stages is still in active progress among us. It is not mere ancient history. On the contrary, it is a movement that is constantly spreading and at every point becoming more thorough, more harmoniously organized. Before long it will involve a national medical service, which will impose on doctors as their primary duty, not the care of disease, but the preservation of health. We have to realize at the same time that this movement has been exclusively concerned, not with the improvement of the quality of human life, but exclusively with the betterment of the conditions under which life is lived. It tacitly assumed that we have no control over human life and no responsibility for its production. It accepted human life—however numerous it might be in quantity, however defective in quality—as a God given fact, which it would be impious to question. It heroically set itself to the endless task of cleansing the channels down which this muddy torrent swept. It never went to the source. Only take care of the soil, these workers at social reform said in effect, and the seed is no matter. That, as we can now see, was a silly enough position to take up. P. 26. Here we have been spending enormous enthusiasm, labor and money in improving the conditions of life, with the notion in our heads that we should thereby be improving life itself, and after 70 years we find no convincing proof that the quality of our people is one whit better than it was when for a large part they lived in filth, were ravaged by disease, bred at random, soaked themselves in alcohol, and took no thought for the morrow. Our boasted social reform has been a matter of bricks and mortar—a piling up of hospitals, asylums, prisons and workhouses—while our comparatively sober habits may be merely a sign of the quietly valetudinarian way of life imposed on a race no longer possessing the stamina to withstand excess.