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 Contributing Authors

MAJED H. ALGHAMDI, MBBS SCOTT MOORE, DO

King Abdulaziz University College of Medicine Assistant Professor of Medical Laboratory Sciences
Weber State University
VIJAY BALAKRISHNAN
Emory University School of Medicine JUN YEN NG, MBBS
Class of 2018 Princess Alexandra Hospital

BRIAN BALLARD CONNIE QIU

Michigan State University School of Osteopathic Medicine Lewis Katz School of Medicine at Temple University
Class of 2018 MD/PhD Candidate, Class of 2021

HUMOOD BOQAMBAR KALLI A. SARIGIANNIS

Royal College of Surgeons in Ireland Oakland University William Beaumont School of Medicine
Class of 2018 Class of 2018

TARUNPREET DHALIWAL SARAH SCHIMANSKY, MB BCh BAO

St. George’s University School of Medicine Resident, Department of Ophthalmology
Class of 2018 Gloucestershire Hospitals NHS Foundation Trust

RACHEL L. KUSHNER, MSc JESSE D. SENGILLO

Mercer University School of Medicine SUNY Downstate College of Medicine
Class of 2018 Class of 2018

LAUREN N. LESSOR ISABELLA T. WU

St. George’s University School of Medicine Tulane University School of Medicine
MD/PhD Candidate, Class of 2018 Class of 2019

JONATHAN LI VAISHNAVI VAIDYANATHAN

University of Michigan Medical School University of Missouri-Kansas City School of Medicine
Class of 2018 Class of 2018

Image and Illustration Team

ARTEMISA GOGOLLARI, MD AIDA K. SARCON

PhD Candidate St. George’s University School of Medicine
University for Health Sciences, Medical Informatics, and Technology, Class of 2018
Austria
RENATA VELAPATIÑO, MD
MATTHEW HO ZHI GUANG San Martin de Porres University School of Medicine
University College Dublin (MD), Dana Farber Cancer Institute (PhD) Hospitalist, Clinica Internacional
MD/PhD Candidate

VICTOR JOSE MARTINEZ LEON, MD

Central University of Venezuela

vii

FAS1_2018_00_Frontmatter_i-xxii.indd 7 10/12/17 10:39 AM

 Associate Authors

ANUP CHALISE, MBBS ALEX MULLEN

Nepal Medical College and Teaching Hospital University of Mississippi School of Medicine
Class of 2017 Class of 2019

CATHY CHEN VASILY OVECHKO

University of Mississippi School of Medicine Pirogov Russian National Research Medical University
Class of 2019 Class of 2019

MATTHEW S. DELFINER ERIKA J. PARISI

Resident, Internal Medicine Frank H. Netter MD School of Medicine at Quinnipiac University
Temple University Hospital Class of 2018

RICHARD A. GIOVANE, MD JOHN POWER

University of Alabama Icahn School of Medicine at Mount Sinai
Department of Family Medicine Class of 2018

JOSEPH G. MONIR MIGUEL ROVIRA

University of Florida College of Medicine University of Michigan Medical School
Class of 2018 Class of 2018

Image and Illustration Team

BENJAMIN F. COMORA ANTONIO N. YAGHY, MD

Alabama College of Osteopathic Medicine University of Balamand School of Medicine
DO/MBA Candidate

NAKEYA KHOZEMA DEWASWALA, MBBS

Lokmanya Tilak Muncipal Medical College
Class of 2016

viii

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 Faculty Advisors

MEESHA AHUJA, MD PETER V. CHIN-HONG, MD

Psychiatrist Professor, Department of Medicine
Rhode Island Hospital University of California, San Francisco School of Medicine

DIANA ALBA, MD BRADLEY COLE, MD

Clinical Instructor Assistant Professor
University of California, San Francisco Loma Linda University School of Medicine

MARK A.W. ANDREWS, PhD LINDA S. COSTANZO, PhD

Lake Erie College of Osteopathic Medicine at Seton Hill Professor, Physiology & Biophysics
Greensburg, Pennsylvania Virginia Commonwealth University School of Medicine

MARIA ANTONELLI, MD ANTHONY L. DeFRANCO, PhD

Assistant Professor, Division of Rheumatology Professor, Department of Microbiology and Immunology
MetroHealth Medical Center, Case Western Reserve University University of California, San Francisco School of Medicine

HERMAN SINGH BAGGA, MD CHARLES S. DELA CRUZ, MD, PhD

Urologist, Allegheny Health Network Associate Professor, Department of Pulmonary and Critical Care Medicine
University of Pittsburgh Medical Center, Passavant Yale School of Medicine

SHIN C. BEH, MD CONRAD FISCHER, MD

Assistant Professor, Department of Neurology & Neurotherapeutics Associate Professor, Medicine, Physiology, and Pharmacology
UT Southwestern Medical Center at Dallas Touro College of Medicine

PAULETTE BERND, PhD JEFFREY J. GOLD, MD

Professor, Department of Pathology and Cell Biology Associate Professor, Department of Neurology
Columbia University College of Physicians and Surgeons Assistant Professor, University of California, San Diego School of Medicine

ANISH BHATT, MD RAYUDU GOPALAKRISHNA, PhD

Clinical Fellow Associate Professor, Department of Integrative Anatomical Sciences
University of California, San Francisco Keck School of Medicine of University of Southern California

SHELDON CAMPBELL, MD, PhD RYAN C.W. HALL, MD

Professor of Laboratory Medicine Assistant Professor, Department of Psychiatry
Yale School of Medicine University of South Florida

BROOKS D. CASH, MD LOUISE HAWLEY, PhD

Professor of Medicine, Division of Gastroenterology Immediate Past Professor and Chair, Department of Microbiology
University of South Alabama School of Medicine Ross University School of Medicine

SHIVANI VERMA CHMURA, MD JEFFREY W. HOFMANN, MD, PhD

Adjunct Clinical Faculty, Department of Psychiatry Resident, Department of Pathology
Stanford University School of Medicine University of California, San Francisco School of Medicine

JAIMINI CHAUHAN-JAMES, MD BRIAN C. JENSEN, MD

Psychiatrist Assistant Professor of Medicine and Pharmacology
NYC Health + Hospitals University of North Carolina Health Care

ix

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 CLARK KEBODEAUX, PharmD NATHAN W. SKELLEY, MD
Clinical Assistant Professor, Pharmacy Practice and Science Assistant Professor, Department of Orthopaedic Surgery
University of Kentucky College of Pharmacy University of Missouri, The Missouri Orthopaedic Institute

MICHAEL R. KING, MD SHEENA STANARD, MD, MHS

Instructor, Department of Pediatric Anesthesiology Assistant Professor, Department of Obstetrics and Gynecology
Northwestern University Feinberg School of Medicine University of Rochester School of Medicine and Dentistry
THOMAS KOSZTOWSKI, MD
HOWARD M. STEINMAN, PhD
Spine Instructor
The Warren Alpert Medical School of Brown University Assistant Dean, Biomedical Science Education
Albert Einstein College of Medicine
KRISTINE KRAFTS, MD
Assistant Professor, Department of Basic Sciences MARY STEINMANN, MD
University of Minnesota School of Medicine Assistant Professor, Department of Psychiatry
University of Utah School of Medicine
GERALD LEE, MD
Assistant Professor, Departments of Pediatrics and Medicine RICHARD P. USATINE, MD
Emory University School of Medicine
Professor, Dermatology and Cutaneous Surgery
University of Texas Health Science Center San Antonio
KACHIU C. LEE, MD, MPH
Assistant Clinical Professor, Department of Dermatology
Brown University, Providence, Rhode Island
PRASHANT VAISHNAVA, MD
Assistant Professor, Department of Medicine
WARREN LEVINSON, MD, PhD Mount Sinai Hospital and Icahn School of Medicine
Professor, Department of Microbiology and Immunology
University of California, San Francisco School of Medicine J. MATTHEW VELKEY, PhD
Assistant Dean, Basic Science Education
PETER MARKS, MD, PhD Duke University School of Medicine
Center for Biologics Evaluation and Research
US Food and Drug Administration BRIAN WALCOTT, MD
Clinical Instructor, Department of Neurological Surgery
J. RYAN MARTIN, MD University of California, San Francisco
Assistant Professor of Obstetrics, Gynecology, and Reproductive Sciences
Yale School of Medicine
TISHA WANG, MD
DOUGLAS A. MATA, MD, MPH Associate Clinical Professor, Department of Medicine
Brigham Education Institute and Brigham and Women’s Hospital David Geffen School of Medicine at UCLA
Harvard Medical School
SYLVIA WASSERTHEIL-SMOLLER, PhD
SOROUSH RAIS-BAHRAMI, MD Professor Emerita, Department of Epidemiology and Population Health
Assistant Professor, Departments of Urology and Radiology Albert Einstein College of Medicine
University of Alabama at Birmingham School of Medicine
ADAM WEINSTEIN, MD
SASAN SAKIANI, MD
Assistant Professor, Pediatric Nephrology and Medical Education
Fellow, Transplant Hepatology Geisel School of Medicine at Dartmouth
Cleveland Clinic

ROBERT A. SASSO, MD ABHISHEK YADAV, MBBS, MSc

Professor of Clinical Medicine Associate Professor of Anatomy
Ross University School of Medicine Geisinger Commonwealth School of Medicine

MELANIE SCHORR, MD KRISTAL YOUNG, MD

Assistant in Medicine Clinical Instructor, Department of Cardiology
Massachusetts General Hospital Huntington Hospital, Pasadena, California

FAS1_2018_00_Frontmatter_i-xxii.indd 10 10/12/17 10:39 AM

 Preface
With the 28th edition of First Aid for the USMLE Step 1, we continue our commitment to providing students with
the most useful and up-to-date preparation guide for the USMLE Step 1. This edition represents an outstanding
revision in many ways, including:
ƒƒ 35 entirely new high-yield topics reflecting evolving trends in the USMLE Step 1.
ƒƒ Extensive text revisions, new mnemonics, clarifications, and corrections curated by a team of more than 40
medical student and resident physician authors who excelled on their Step 1 examinations and verified by a team
of expert faculty advisors and nationally recognized USMLE instructors.
ƒƒ A new section on learning and memory science in Section I, Guide to Efficient Exam Preparation.
ƒƒ Updated with 35+ new full-color photos to help visualize various disorders, descriptive findings, and basic
science concepts. Additionally, revised imaging photos have been labeled and optimized to show both normal
anatomy and pathologic findings.
ƒƒ Updated study tips on the opening page of each chapter.
ƒƒ Improved integration of clinical images and illustrations to better reinforce and learn key anatomic concepts.
ƒƒ Improved organization of text, figures, and tables throughout for quick review of high-yield topics.
ƒƒ Updated with 50+ new and revised diagrams and illustrations as part of our ongoing collaboration with
USMLE-Rx (MedIQ Learning, LLC).
ƒƒ Reorganized Rapid Review section to present high-yield concepts by topic and with page numbers to the
corresponding text.
ƒƒ Revitalized coverage of current, high-yield print and digital resources in Section IV with clearer explanations of
their relevance to USMLE Step 1 review.
ƒƒ Real-time Step 1 updates and corrections can be found exclusively on our blog, www.firstaidteam.com.
We invite students and faculty to share their thoughts and ideas to help us continually improve First Aid for the
USMLE Step 1 through our blog and collaborative editorial platform. (See How to Contribute, p. xvii.)
Louisville Tao Le
Boracay Vikas Bhushan
St. Louis Matthew Sochat
New York City Yash Chavda
Ann Arbor Andrew Zureick
Pittsburgh Mehboob Kalani
San Francisco Kimberly Kallianos

xi

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 Special Acknowledgments
This has been a collaborative project from the start. We gratefully acknowledge the thousands of thoughtful
comments, corrections, and advice of the many medical students, international medical graduates, and faculty who
have supported the authors in our continuing development of First Aid for the USMLE Step 1.
We provide special acknowledgment and thanks to the following individuals who made exemplary contributions
to this edition through our voting, proofreading, and crowdsourcing platform: Huzaifa Ahmad, Ram Baboo, Kashif
Badar, Nwamaka Bob-Ume, Paige Estave, Nathaniel Fitch, Panagiotis Kaparaliotis, Elaine Luther, Sarah Hamid
Mian, Prashank Shree Neupane, Keyhan Piranviseh, Cindy Tsui, and Ankeet Vakharia.
For support and encouragement throughout the process, we are grateful to Thao Pham, Jinky Flang, and Jonathan
Kirsch, Esq. Thanks to Louise Petersen for organizing and supporting the project. Thanks to our publisher, McGraw-
Hill, for the valuable assistance of its staff, including Bob Boehringer, Christina Thomas, Jim Shanahan, Laura
Libretti, and Jeffrey Herzich.
We are also very grateful to Dr. Fred Howell and Dr. Robert Cannon of Textensor Ltd for providing us extensive
customization and support for their powerful Annotate.co collaborative editing platform (www.annotate.co), which
allows us to efficiently manage thousands of contributions. Thanks to Dr. Richard Usatine and Dr. Kristine Krafts
for their outstanding image contributions. Thanks also to Jean-Christophe Fournet (www.humpath.com), Dr. Ed
Uthman, and Dr. Frank Gaillard (www.radiopaedia.org) for generously allowing us to access some of their striking
photographs. Thank you to Dr. Brenda Zureick for her ophthalmology review. For faculty contributions, we thank
Dr. Aditya Bardia, Dr. Christina Ciaccio, Dr. Stuart Flynn, Dr. Vicki Park, Dr. Jeannine Rahimian, Dr. Joseph
Schindler, and Dr. Stephen Thung.
For exceptional editorial leadership, enormous thanks to Christine Diedrich, Emma Underdown, and Catherine
Johnson. Thank you to our USMLE-Rx/ScholarRx team of editors, Linda Davoli, Jacqueline Mahon, Janene
Matragrano, Erika Nein, Isabel Nogueira, Sally Rineker, Rebecca Stigall, Ashley Vaughn, and Hannah Warnshuis.
Many thanks to Tara Price for page design and all-around InDesign expertise. Thank you to Ruthie Whittaker for
assistance in reorganizing the Rapid Review section. Special thanks to our indexer Dr. Anne Fifer. We are also
grateful to our medical illustrator, Hans Neuhart, for his creative work on the new and updated illustrations. Lastly,
tremendous thanks to Rainbow Graphics, especially David Hommel and Donna Campbell, for remarkable ongoing
editorial and production support under time pressure.
Louisville Tao Le
Boracay Vikas Bhushan
St. Louis Matthew Sochat
New York City Yash Chavda
Ann Arbor Andrew Zureick
Pittsburgh Mehboob Kalani
San Francisco Kimberly Kallianos

xii

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 General Acknowledgments

Each year we are fortunate to receive the input of thousands of medical students and graduates who provide new material, clarifications,
and potential corrections through our website and our collaborative editing platform. This has been a tremendous help in clarifying
difficult concepts, correcting errata from the previous edition, and minimizing new errata during the revision of the current edition. This
reflects our long-standing vision of a true, student-to-student publication. We have done our best to thank each person individually
below, but we recognize that errors and omissions are likely. Therefore, we will post an updated list of acknowledgments at our website,
www.firstaidteam.com/bonus/. We will gladly make corrections if they are brought to our attention.

For submitting contributions and corrections, many thanks to Mohammad Abbasi, Ibrahim Abdelfattah, Mostafa Ahmed Abdellah,
Omar Abdelrahim Alawadi, Sufyan Abdul Mujeeb, Omar Abu Slieh, Khalil Abu Zaina, Muhamed Abubacker, Ayman Abunimer, Terumbur
Abwa, Jesus Mauricio Acero, Raghav Acharya, Rojan Adhikari, Anisha Adhikari, Shivani Adhyaru, Kristopher Aghemo, Cassandra Ahmed,
Adiel Aizenberg, Dolani Ajanaku, Mythri AK, Ahmad Akhtar, Murad Al Masri, Mejbel Alazemi, Isam Albaba, Camilo José Albert
Fernández, Khalil Ali, Muhammed Alikhan, Mohamed Ali, Murad Almasri, Luai Alsakkaf, Vivian V Altiery De Jesus, Fazilhan Altintas,
Alvaro Alvarez, Farah Amer, Christopher Anderson, Gilberto Aquino, Jay Argue, Khashayar Arianpour, Fernando Daniel Arias, Lama Assi,
Rizwan Attiq, Scarlett Austin, Carlos Andres Avila, Zaki Azam, Sara Azeem, Parag Badami, Nadia Badar, Louis Baeseman, Karsyn Bailey,
Bryce Baird, Devin Baith, Matthew Balatbat, Vyshnavy Balendra, Ugur Berkay Balkanci, Josiah Ballantine, Muhammad Yasir Baloch,
Melissa Banez, Hari Prasad Baral, Saira Bari, Elan Baskir, Jacqueline Bekhit, Leah Beland, Jackson Bell, Elizabeth Benge, Lauren
Benning, Hussein Berjaoui, Maresa Dorothee Berns, Kulsajan Bhatia, Saravjit S. Bhatti, Navpreet Bhurji, M. Yaasen Bhutta, Jacques
Bijon, Safal Bijukshe, Jeffrey Black, Christer Blindheim, Luigi Bonini, Peter Boucas, Mary Boulanger, Alexandre Boulos, Chantal Brand,
Zachary Britstone, Aaron Brown, Conor Buckley, Natassia Buckridge, Omar Bukhari, Welland Burnside, Pavel Burskii, Avi Bursky-
Tammam, David Buziashvili, Michael Byers, Adam Cadesky, Elizabeth Cai, Alexandra Calingo, Andrei Callejas, Francisco Caraballo, Jorge
Carrasco, Esteban Casasola, Gabriel Castano, Yoly Angelina Castellanos, Marco A Castillo, Gabriel Castro Gueits, Rorigo Cavalcante,
Natalie Cazeau, Harold Viviano Cedeño, Jesse Chait, Ingita Chand, Eric Chang, Fong-Wan Chau Zhou, Jaimini Chauhan, Mit Chauhan,
Maureen Chavez, Mehmood Cheema, Christopher Chhoun, Youna Choi, Rebecca D. Chou, Erika Chow, Mahbub Chowdhury, Elizabeth
Ann Chu, Jessica Chung, Katherine Chung, Benjamin Ciccarelli, Joseph Cioffi, John Coda, Zack Cohen, Lee Colaianni, Nahimarys Colón
Hernández, Julijana Conic, Jeffrey Cooney, Erica Corredera, Cody Couperus, Eric Cox, Caitlin Crosier, Matthew Culbert, John Cummins,
Abdul Dada, Christopher Dallo, Parnaz Daneshpajouhnejad, Jason Darr, Camille Davis, Solomon Dawson, James Dee, Matthew
Derakhshesh, Rajat Dhand, Shreena Dhawan, Vijay Dhillon, Angel Joel Diaz Martinez, Luboslav Dimitrov, Lennox Din, Soraya Djadjo,
Mustafa Rıdvan Dönmez, Hima Doppalapudi, Landry Dorsett, Morgan Drucker, Elena Duca, Wesley Durand, Aaron Dwan, Marc
Egerman, Christopher El Mouhayyar, David Ellenbogen, Mahmoud Elmahdy, Ashley Ermann, Yashar Eshman, Mikael Fadoul, Joseph

xiii

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 Fahmy, Giselle Falconi, Matthew Farajzadeh, Behnam Faridian, Amelia Fatsi, Rachel Fayne, Anthony Febres, Jin Feng, Brittany Fera,
Leila Ferreira, Anthony Findley, Eitan Fleischman, Thomas Flynn, Allison Forrest, Adisson Fortunel, Brandon Fram, Daniel Franco,
Gabriel Franta, Jacob Fried, Yaakov Fried, Luis Alberto Ribeiro Froes Jr., Virginia Fuenmayor, Sudha Gade, Emily Gall, Max Galvan, Nick
Gamboa, Dan Ganz, Fabian Garcia, Melanie Garcia, Okubit Gebreyonas, Nicholas Geiger, David Gelbart, Bill Gentry, Dylan Gerlach,
Brielle Gerry, Nina Gertsvolf, Sara Ghoneim, Jake Gibbons, Gobind Gill, Victoria Gonzales, Alberto Gonzalez, Mounica Gooty, Barbara
Gordon, Sophie Gottesman, Manjeet Goyal, Kylie Grady, Zacharia Grami, Mark Greenhill, Jora Singh Grewal, Harry Griffin, Maria Grig,
Vincent Grzywacz, Jinglin Gu, Leidy Laura Guerrero Hernández, James Guirguis, Nikhil Gupta, Deepak Gupta, Zarar Hafeez, Ramez
Maher Halaseh, Erik Haley, Mohanad Hamandi, Saffa Hamde, Mohammad Hamidi, Nicola Hampel, Alexandra Handy, Christine Hanish,
Mary Hanna, Laura Harding, Maxwell Harley, Glenn R. Harris, Hasanain Hasan, Danial Hayek, Corrie Hays, Luke He, Jackson Hearn, Leif
Helland, Ariana Hess, Joyce Ho, Walter Hodges, Tara Hogan, Brian Huang, Naureen Huda, Daniel Huff, Robert Huis in ‘t Veld, Frank Hurd,
Zaid Hussain, Jordan Huxall, Elizabeth Hwang, Taylin Im, Mimoza Isufi, Frank Jackson, Banafsheh Jalalian, Abbas Jama, Nader
Jamaleddine, David Janese, Jesse Jaremek, Ranjit Jasraj, Parth Javia, Kyu-Jin Jeon, Benjamin Hans Jeuk, Eric Jiang, Alfredo Joffre, Hollis
Johanson, Ryan Johnson, Sarah Johnson, Gavin Jones, Gregory Jordan, Josefina Fernandez, Michael Joseph, Pavel Kacnov, Preethi
Kamath, Irina Kanzafarova, Komal Kapoor, Egishe Karapetyan, Nikoloz Karazanashvili, Shalemar Ann Kasan, Matt Kasson, Orest Kayder,
Chelsae Keeney, Kristen Kelly, Danielle Keyes, Fahad Khan, Tamer Khashab, Susie Kim, Ann Kim, Rachel Kim, Nikhar Kinger, Mark
Kirane, Tamara Kliot, Walter Klyce, Sammy Knefati, Christopher Kocharians, Sam Kociola, Karthikram Komanduri, Nicholas Kondoleon,
David Kowal, Robert Kowtoniuk, Leonardo Kozian, Oleksandr Kozlov, Alec Krosser, Judah Kupferman, Stephanie Kuschel, Stephanie
Kwan, Nikola Kyuchukov, Ton La, Michael Landolfi, Wells LaRiviere, Matthew Lee, Sean Lee, Sun Yong Lee, Michael Lee, Daniel Leisman,
Jacob Leroux, Solomon Levin, David Li, Yedda Li, Jonathan Lieberman, Viktor Limanskiy, Meng-Chen Vanessa Lin, David Liu, Serena Liu,
Jason Livingstone, Mavis Lobo, José López, Zhuo Luan, Marcela Marie Luna, Nicolas Luzino, Miles Maassen, Emily MacDuffie, Robertson
Mackenzie, Jonathan Macleod, Evan Madill, Sergio Magaña, Marielle Mahan, Hossen Mahmud, Nodari Maisuradze, Abdallah Malas,
Genesis Maldonado, Madiha A. Malik, Margaret Maloney, Hassan Mandil, Taylor Maney, Navyata Mangu, Kori Mansfield, Lina Marenco,
John Marinelli, Laurel Mast, Micah Mathai, Anita Mathew, Candler Mathews, Fasil Mathews, John Mayfield, Guillermo Maza, Lina
Mazin, Benjamin McCormick, Luis Medina, Romy Megahed, Laura I Mendez Morente, Felipe Alonso Mercado, Haley Mertens, Raman
Michael, Amanda Miller, Joseph Mininni, Andria Marcela Miranda Chada, Thomas Mitchell, Sarah Mizrachi, Ghady Moafa, Pezhman
Mobasher, Mahmoud Mohamed, Syed Mohammad, Denelle Mohammed, Sarah Mohtadi, Agnes Mokrzycki, Guarina Molina, Austin
Momii, Eric Mong, Edgar Moradel, Andreina Moreno, Zachary Mortensen, Rachel Moss, Zachary Mostel, Turna Mukherjee, Greg Muller,
Nirav Mungalpara, John Myers, Louai Naddaf, Merna Naji, Rohit Nallani, Aram Namavar, Alex Nantsios, Anthony Naquin, Abeeha Naqvi,
Haider Naqvi, Samir Narula, Suraj Narvekar, Iraj Nasrabadi, Steven Nevers, Norman Ng, Samuel Ng, Raye Ng, Brandon Nguyen, Brian
Nguyen, Chi-Tam Nguyen, Doris Nguyen, Michael Nguyen, Vanessa Nguyen, Timothy Nguyen, Hosea Njoku, Jason Nosrati, Yoav Nudell,
Agnes Nyeck, Onyeka Olisemeka, Foluwakemi Olufehinti, Oluyinka Olutoye II, Abdillahi Omar, Nuhah Omar, Michael O’Shea, Zonghao
Pan, Abdullah Panchbhaya, Niranjan Pandey, Saurabh Pandit, Khang Wen Pang, Rajbir Singh Pannu, Brian Park, Anishinder Parkash,
Om Parkash, Jordan Parker, Matt Partan, Aaron Parzuchowski, Arpan Patel, Dharti Patel, Harshkumar Patel, Neel Patel, Tejas Patel,
Vanisha Patel, Yesha Patel, Vrutant Patel, Dwani Patel, Jayesh Patel, Savan Patel, Dipesh Patel, Shiv U. Patel, Jay Patel, Thomas Paterniti,
Priya Pathak, Saikrishna Patibandla, Iqra Patoli, Fernando Pellerano, Luke Perry, Romela Petrosyan, Jimmy Tam Huy Pham, Suzanne
Piccione, Saran Pillai, Vivek Podder, Dmitry Pokhvashchev, Marc Polanik, Chelsea Powell, Andrew Puckett, Abdulhameed Qashqary,
Carlos Quinonez, Joshua Radparvar, Shahrose Rahman, Alia Raja, Vinaya Rajan, Shayan Rakhit, Ferza Raks, Devan Ramachandran,
Bashar Ramadan, Gokul Ramani, Shandilya Ramdas, Jose Ramos, Rakin Rashid, Mikhail Rassokhin, Mohsin Raza, Yunus Raza,

xiv

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 Dheevena Reddy, Lenisse Miguelina Reyes Reyes, Peter Rezkalla, Beatriz Rivera, Dalianne Rivera, Chelsea Roberts, Moshe Roberts,
Lydia Robles, Alexander Rodriguez, Daniel Rodriguez Benzo, Daniel Enrique Rodríguez Benzo, Evgeny Romanov, Lukas Ronner, Geoffrey
Rosen, Max Rosenthal, Yuan Ross, Lindsay Rothfield, Cody Russell, Anas Saad, Rorita Sadhu, Anna Sadovnikova, Dev Sahni, Kamal Sahu,
Hemamalini Sakthivel, Abid Saleem, Ololade Saliu, Julienne Sanchez, Mason Sanders, Roshun Sangani, Michael Santarelli, Theodore
Schoenfeldt, Kyle Scott, Arshiya Sehgal, Anand Sewak, Congzhou Sha, Nazila Shafagati, Anna Shah, Nauman Shah, Shaili Shah, Ahmed
Shah, Abdulla Shaheen, Milton Shapiro, Kanika Sharma, Elizabeth Shay, Derek Sheen, Daniel Sherwood, David Shieh, Scott Shuldiner,
Sunober Siddiqi, Gabriel Silva, Matthew Simhon, Bhart Singal, Amadeldin Singer, Amitoj Singh, Chandandeep Singh, Shivreet Singh,
Steven Siragusa, Ramzi Y. Skaik, Christina Small, Conor Smith, Destini Smith, Will Smith, Austen Smith, Benjamin Smood, Hannah
Snyder, Anubhav Sood, Benjamin Rojas Soosiah, Wilfredo Soto-Fuentes, Matthew Spano, Phalguni Srivastava, Tina Stanco, Josiah
Strawser, Thomas Strobel, Annie Suarez, Zoilo Karim Suarez Yeb, Akhil Sureen, Gorica Svalina, Kayley Swope, Laura Szczesniak, Aboud
Tahanis, Jayul Tailor, Austin Tam, Ming Yao Jonavan Tan, Olive Tang, Asna Tasleem, Sara Tavarez, Claudia Tejera, Anand Tekriwal, Priyesh
Thakurathi, Vaishakh Tharavath, Chris Thomas, Lanice Thomas, Karima Thompson, John Tiang-Leung, Alvin Trieu, Michelle Trieu, Birva
Trivedi, Katie Truong, Akshit Tuli, Marcia E. Uddoh, Nneamaka Ukatu, Johnson Ukken, Claire Unruh, Adelynn Vadrar, Andrew Valliyil,
Vivek Vallurupalli, Blanca Vargas, Vandana Vekariya, Erick Candido Velasquez Centellas, Michael Venincasa, Michael Villalba, Marcos
Villarreal, Phuong Vo, Steven Vuu, William Waddell, Holden Wagstaff, Nicholas Walther, Tony Wang, Jason L. Wang, Jonathan Warczak,
Jacob Warner, Eric Wei, Paul Wei, Ronald Weir, Garrett Welle, Matthew Wells, Allison Williams, Michael Winter, Adriana Wong, Donald
Wright, Brian Wu, Lawrence Wu, Michael Wydeko, Catherine Xie, Tamar Yacoel, Dong-han Yao, Alexander Yevtukh, Jaemin Yim, Raquel
Yokoda, Sadaf Younis, Christopher Yun, Nicholas Yurko, Mubarak Hassan Yusuf, Pavel Zagadailov, Alireza Zandifar, Batool Zehra, Xue
Zhang, Eric Zhang, Angie Zhang, Jasmine Zhao, Mohammad Zmaili, Spyridon Zouridis, Andrew Zovath, and Kathleen Zuniga.

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 How to Contribute

This version of First Aid for the USMLE Step 1 incorporates thousands of contributions and improvements suggested
by student and faculty advisors. We invite you to participate in this process. Please send us your suggestions for:

ƒƒ Study and test-taking strategies for the USMLE Step 1

ƒƒ New facts, mnemonics, diagrams, and clinical images

ƒƒ High-yield topics that may appear on future Step 1 exams

ƒƒ Personal ratings and comments on review books, question banks, apps, videos, and courses

For each new entry incorporated into the next edition, you will receive up to a $20 Amazon.com gift card as well as
personal acknowledgment in the next edition. Significant contributions will be compensated at the discretion of the
authors. Also, let us know about material in this edition that you feel is low yield and should be deleted.

All submissions including potential errata should ideally be supported with hyperlinks to a dynamically updated Web
resource such as UpToDate, AccessMedicine, and ClinicalKey.

We welcome potential errata on grammar and style if the change improves readability. Please note that First Aid style
is somewhat unique; for example, we have fully adopted the AMA Manual of Style recommendations on eponyms
(“We recommend that the possessive form be omitted in eponymous terms”) and on abbreviations (no periods with
eg, ie, etc).

The preferred way to submit new entries, clarifications, mnemonics, or potential corrections with a valid,
authoritative reference is via our website: www.firstaidteam.com.

This website will be continuously updated with validated errata, new high-yield content, and a new online platform
to contribute suggestions, mnemonics, diagrams, clinical images, and potential errata.

Alternatively, you can email us at: [email protected].

Contributions submitted by May 15, 2018, receive priority consideration for the 2019 edition of First Aid for the
USMLE Step 1. We thank you for taking the time to share your experience and apologize in advance that we cannot
individually respond to all contributors as we receive thousands of contributions each year.

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 NOTE TO CONTRIBUTORS
``

All contributions become property of the authors and are subject to editing and reviewing. Please verify all data and
spellings carefully. Contributions should be supported by at least two high-quality references.

Check our website first to avoid duplicate submissions. In the event that similar or duplicate entries are received,
only the first complete entry received with valid, authoritative references will be credited. Please follow the style,
punctuation, and format of this edition as much as possible.

JOIN THE FIRST AID TEAM

``

The First Aid author team is pleased to offer part-time and full-time paid internships in medical education and
publishing to motivated medical students and physicians. Internships range from a few months (eg, a summer) up
to a full year. Participants will have an opportunity to author, edit, and earn academic credit on a wide variety of
projects, including the popular First Aid series.

For 2018, we are actively seeking passionate medical students and graduates with a specific interest in improving our
medical illustrations, expanding our database of medical photographs, and developing the software that supports our
crowdsourcing platform. We welcome people with prior experience and talent in these areas. Relevant skills include
clinical imaging, digital photography, digital asset management, information design, medical illustration, graphic
design, and software development.

Please email us at [email protected] with a CV and summary of your interest or sample work.

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 How to Use This Book
CONGRATULATIONS: You now possess the book that has guided nearly two million students to USMLE success
for over 25 years. With appropriate care, the binding should last the useful life of the book. Keep in mind that putting
excessive flattening pressure on any binding will accelerate its failure. If you purchased a book that you believe
is defective, please immediately return it to the place of purchase. If you encounter ongoing issues, you can also
contact Customer Service at our publisher, McGraw-Hill Education, at https://www.mheducation.com/contact.html.

START EARLY: Use this book as early as possible while learning the basic medical sciences. The first semester of
your first year is not too early! Devise a study plan by reading Section I: Guide to Efficient Exam Preparation, and
make an early decision on resources to use by checking Section IV: Top-Rated Review Resources. Note that First Aid
is neither a textbook nor a comprehensive review book, and it is not a panacea for inadequate preparation.

CONSIDER FIRST AID YOUR ANNOTATION HUB: Annotate material from other resources, such as class
notes or comprehensive textbooks, into your book. This will keep all the high-yield information you need in one
place. Other tips on keeping yourself organized:

ƒƒ For best results, use fine-tipped ballpoint pens (eg, BIC Pro+, Uni-Ball Jetstream Sports, Pilot Drawing Pen,
Zebra F-301). If you like gel pens, try Pentel Slicci, and for markers that dry almost immediately, consider
Staedtler Triplus Fineliner, Pilot Drawing Pen, and Sharpies.

ƒƒ Consider using pens with different colors of ink to indicate different sources of information (eg, blue for
USMLE-Rx Step 1 Qmax, green for UWorld Step 1 Qbank).

ƒƒ Choose highlighters that are bright and dry quickly to minimize smudging and bleeding through the page
(eg, Tombow Kei Coat, Sharpie Gel).

ƒƒ Many students de-spine their book and get it 3-hole-punched. This will allow you to insert materials from other
sources, including curricular materials.

INTEGRATE STUDY WITH CASES, FLASH CARDS, AND QUESTIONS: To broaden your learning strategy,
consider integrating your First Aid study with case-based reviews (eg, First Aid Cases for the USMLE Step 1), flash
cards (eg, First Aid Flash Facts), and practice questions (eg, the USMLE-Rx Step 1 Qmax). Read the chapter in the
book, then test your comprehension by using cases, flash cards, and questions that cover the same topics. Maintain
access to more comprehensive resources (eg, First Aid for the Basic Sciences: General Principles and Organ Systems
and First Aid Express videos) for deeper review as needed.

PRIME YOUR MEMORY: Return to your annotated Sections II and III several days before taking the USMLE
Step 1. The book can serve as a useful way of retaining key associations and keeping high-yield facts fresh in your
memory just prior to the exam. The Rapid Review section includes high-yield topics to help guide your studying.

CONTRIBUTE TO FIRST AID: Reviewing the book immediately after your exam can help us improve the next
edition. Decide what was truly high and low yield and send us your comments. Feel free to send us scanned images
from your annotated First Aid book as additional support. Of course, always remember that all examinees are under
agreement with the NBME to not disclose the specific details of copyrighted test material.

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 Selected USMLE Laboratory Values

* = Included in the Biochemical Profile (SMA-12)

Blood, Plasma, Serum Reference Range SI Reference Intervals

*Alanine aminotransferase (ALT, GPT at 30°C) 8–20 U/L 8­–20 U/L

Amylase, serum 25–125 U/L 25–125 U/L
*Aspartate aminotransferase (AST, GOT at 30°C) 8–20 U/L 8–20 U/L
Bilirubin, serum (adult)
Total // Direct 0.1–1.0 mg/dL // 0.0–0.3 mg/dL 2–17 µmol/L // 0–5 µmol/L
*Calcium, serum (Total) 8.4–10.2 mg/dL 2.1–2.8 mmol/L
*Cholesterol, serum (Total) Rec: < 200 mg/dL < 5.2 mmol/L
*Creatinine, serum (Total) 0.6–1.2 mg/dL 53–106 µmol/L
Electrolytes, serum
Sodium (Na+) 136–145 mEq/L 136–145 mmol/L
Chloride (Cl–) 95–105 mEq/L 95–105 mmol/L
* Potassium (K+) 3.5–5.0 mEq/L 3.5–5.0 mmol/L
Bicarbonate (HCO3–) 22–28 mEq/L 22–28 mmol/L
Magnesium (Mg2+) 1.5–2 mEq/L 0.75–1.0 mmol/L
Gases, arterial blood (room air)
PO 2 75–105 mm Hg 10.0–14.0 kPa
PCO2 33–45 mm Hg 4.4–5.9 kPa
pH 7.35–7.45 [H+] 36–44 nmol/L
*Glucose, serum Fasting: 70–110 mg/dL 3.8–6.1 mmol/L
2-h postprandial: < 120 mg/dL < 6.6 mmol/L
Growth hormone − arginine stimulation Fasting: < 5 ng/mL < 5 µg/L
provocative stimuli: > 7 ng/mL > 7 µg/L
Osmolality, serum 275–295 mOsm/kg 275–295 mOsm/kg
*Phosphatase (alkaline), serum (p-NPP at 30°C) 20–70 U/L 20–70 U/L
*Phosphorus (inorganic), serum 3.0–4.5 mg/dL 1.0–1.5 mmol/L
Prolactin, serum (hPRL) < 20 ng/mL < 20 µg/L
*Proteins, serum
Total (recumbent) 6.0–7.8 g/dL 60–78 g/L
Albumin 3.5–5.5 g/dL 35–55 g/L
Globulins 2.3–3.5 g/dL 23–35 g/L
*Urea nitrogen, serum (BUN) 7–18 mg/dL 1.2–3.0 mmol/L
*Uric acid, serum 3.0–8.2 mg/dL 0.18–0.48 mmol/L
(continues)

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 Cerebrospinal Fluid Reference Range SI Reference Intervals

Glucose 40–70 mg/dL 2.2–3.9 mmol/L

Hematologic

Erythrocyte count Male: 4.3–5.9 million/mm3 4.3–5.9 × 1012/L

Female: 3.5–5.5 million/mm3 3.5–5.5 × 1012/L
Erythrocyte sedimentation rate (Westergen) Male: 0–15 mm/h 0–15 mm/h
Female: 0–20 mm/h 0–20 mm/h
Hematocrit Male: 41–53% 0.41–0.53
Female: 36–46% 0.36–0.46
Hemoglobin, blood Male: 13.5–17.5 g/dL 2.09–2.71 mmol/L
Female: 12.0–16.0 g/dL 1.86–2.48 mmol/L
Hemoglobin, plasma 1–4 mg/dL 0.16–0.62 µmol/L
Leukocyte count and differential
  Leukocyte count 4,500–11,000/mm3 4.5–11.0 × 109/L
    Segmented neutrophils 54–62% 0.54–0.62
    Band forms 3–5% 0.03–0.05
    Eosinophils 1–3% 0.01–0.03
    Basophils 0–0.75% 0–0.0075
    Lymphocytes 25–33% 0.25–0.33
    Monocytes 3–7% 0.03–0.07
Mean corpuscular hemoglobin 25.4–34.6 pg/cell 0.39–0.54 fmol/cell
Mean corpuscular volume 80–100 μm3 80–100 fL
Partial thromboplastin time (activated) 25–40 seconds 25–40 seconds
Platelet count 150,000–400,000/mm3 150–400 × 109/L
Prothrombin time 11–15 seconds 11–15 seconds
Reticulocyte count 0.5–1.5% of red cells 0.005–0.015
Sweat

Chloride 0–35 mmol/L 0–35 mmol/L

Urine

Creatine clearance Male: 97–137 mL/min

Female: 88–128 mL/min
Osmolality 50–1,400 mOsmol/kg H2O
Proteins, total < 150 mg/24 h < 0.15 g/24 h

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 First Aid Checklist for the USMLE Step 1

This is an example of how you might use the information in Section I to prepare for the USMLE Step 1. Refer
to corresponding topics in Section I for more details.

Years Prior
□□ Select top-rated review resources as study guides for first-year medical school courses.
□□ Ask for advice from those who have recently taken the USMLE Step 1.

Months Prior
□□ Review computer test format and registration information.
□□ Register six months in advance. Carefully verify name and address printed on scheduling permit. Call
Prometric or go online for test date ASAP.
□□ Define goals for the USMLE Step 1 (eg, comfortably pass, beat the mean, ace the test).
□□ Set up a realistic timeline for study. Cover less crammable subjects first. Review subject-by-subject
emphasis and clinical vignette format.
□□ Simulate the USMLE Step 1 to pinpoint strengths and weaknesses in knowledge and test-taking skills.
□□ Evaluate and choose study methods and materials (eg, review books, question banks).

Weeks Prior
□□ Simulate the USMLE Step 1 again. Assess how close you are to your goal.
□□ Pinpoint remaining weaknesses. Stay healthy (exercise, sleep).
□□ Verify information on admission ticket (eg, location, date).

One Week Prior

□□ Remember comfort measures (loose clothing, earplugs, etc).
□□ Work out test site logistics such as location, transportation, parking, and lunch.
□□ Call Prometric and confirm your exam appointment.

One Day Prior

□□ Relax.
□□ Lightly review short-term material if necessary. Skim high-yield facts.
□□ Get a good night’s sleep.
□□ Make sure the name printed on your photo ID appears EXACTLY the same as the name printed on your
scheduling permit.

Day of Exam
□□ Relax. Eat breakfast. Minimize bathroom breaks during the exam by avoiding excessive morning caffeine.
□□ Analyze and make adjustments in test-taking technique.

After the Exam

□□ Celebrate, regardless.
□□ Send feedback to us on our website at www.firstaidteam.com.

xxii

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Another Random Scribd Document
with Unrelated Content
 THE STORY OF UTOPIAS haps one of the stigmata of a
civilized community. Nevertheless, unless one*s skill can be
definitely brought home it remains a personal achievement ; and the
community as a whole is not a pound of meat the better for it. If
science is to play the significant part that Bacon and Andreae and
Plato and the other great humanists desired it to, it must be
definitely brought home and realized in our here and now. The need
for this humanization of science has already been perceived in Great
Britain. During the last decade a movement has gathered headway
in the schools and extended itself to associations outside the
schools. The title of this movement is "Regional Survey,*' and its
point of origin is, I believe, the Outlook Tower in Edinburgh which
was well described more than two decades ago as the **world*s
first sociological laboratory." The aim of the Regional Survey is to
take a geographic region and explore it in every aspect. It differs
from the social survey with which we are acquainted in America in
that it is not chiefly a survey of evils ; it is, rather, a survey of the
existing conditions in all their aspects ; and it emphasizes to a much
greater extent than the social survey the natural characteristics of
the environment, as they are discovered by the geologist, the
zoologist, the ecologist — in addition to the development of natural
and human conditions in the historic past, as presented by the
anthropologist, the archiEologist, and the historian. In short, the
regional survey attempts a local synthesis of all the specialist
"knowledges." Such a survey has been conducted in the
Southeastern counties of England under the auspices of various local
[279] >y Google
 THE STORY OF UTOPIAS scientific societies; and the result
of it is a complete description of the community's foundations, its
past, its manner of working and living, its institutions, its regional
peculiarities, and its utilization of physical, vital, and social
resources. Each of the sciences draws upon its general body of
knowledge to illuminate the points under observation ; and when
problems arise which point definitely to the lack of scientific or
scholarly data, new trails are opened and new territory defined. In
looking at the community through the Regional Survey, the
investigator is dealing with a real thing and not with an arbitrary
idolum. In so far as the local community has certain elements in
common with similar regions in other countries, or has absorbed
elements from other civilizations, these things will be given their full
value, instead of being disregarded because they weaken the
identity of the local community with that precious myth, the National
State. The greater part of the data that is thus brought to light may
be plotted on a map, graphically presented in a chart, or
photographed. In Saffron Walden, England, there is an admirable
little museum devoted to such an exhibition of its region; and in the
Outlook Tower, at Edingburgh, there used to be a library and an
apparatus of exhibition by which one could begin at the point where
one was standing and work outwards, in thought, to embrace the
whole wide world. Knowledge that is presented in this fashion is
available so that whoever runs may read ; it has every feature,
therefore, of popular science as it is purveyed in the cheap
newspaper and magazine, whilst it remains real science and is not
presented as something that verges from a miracle to a superstition.
[280] ,, Google
 THE STORY OF UTOPIAS The knowledge embodied in the
Regional Survey has a coherence and pithiness which no isolated
study of science can possibly possess. It is presented in such a form
that it can be assimilated by every member of the community who
has the rudiments of an education, and it thus differs from the
isolated discipline which necessarily remains the heritage of the
specialist. Above all, this knowledge is not that of "subjects," taken
as so many water tight and unrelated compartments: it is a
knowledge of a whole region, seen in all its aspects ; so that the
relations between the work aspect and the soil aspect, between the
play aspect and the work aspect, become fairly simple and
intelligible. This common tissue of definite, verifiable, localized
knowledge is what all our partisan Utopias and reconstruction
programs have lacked; and lacking it, have been one-sided and
ignorant and abstract — devising paper programs for the
reconstruction of a paper world. Regional survey, then, is the bridge
by which the specialist whose face is turned towards the library and
the laboratory, and the active worker in the field, whose face is
turned towards the city and region in which he lives, may come into
contact; and out of this contact our plans and our eutopias may be
founded on such a permanent foundation of facts as the scientist
can build for us, while the sciences themselves will be cultivated with
some regard for the human values and standards, as embodied in
the needs and the ideals of the local community. This is the first step
out of the present impasse: we must return to the real world, and
face it, and survey it in its complicated totality. Our castlesin-air must
have their foundations in solid ground. [281] ,, Google
 THE STORY OF UTOPIAS The needed reorientation of
science is important ; but by itself it is not enough. Knowledge is a
tool rather than a motor ; and if we know the world without being
able to x*eact upon it, we are guilty of that aimless pragmatism
which consists of devising all sorts of ingenious machines and being
quite incapable of subordinating them to any coherent and attractive
pattern. Now, men are moved by their instinctive impulses and by
such emotionally colored pattern-ideas or idola as the dreamer is
capable of projecting. When we create these pattern-ideas, we
enlarge the environment, so that our behavior is guided by the
conditions which we seek to establish and enjoy in an imaginary
world. However crude the Marxian analysis of society may have
been, it at least had the merit of presenting a great dream — the
dream of a titanic struggle between the possessors and the
dispossessed in which every worker had a definite part to play.
Without these dreams, the advances in social science will be just as
disorderly and fusty as the applications of physical science have
been in our material affairs, where in the absence of any genuine
scale of values, a patent collar button is regarded as equally
important as a tungsten filament if the button happens to bring the
inventor as great a financial reward. 6 Up to about the middle of the
seventeenth century, before modern physical science had rigorously
defined its field, the breach between literature and science, which
Aristotle had made, was not altogether complete ; [282] >y Google
 THE STORY OF UTOPIAS and while the humanist ideal was
intact both literature and science were regarded as coeval phases of
man's intellectual activity. The two dominating figures of the
Renascence, Leonardo da Vinci and Michael Angelo, were artists,
technicians, and men of science; and in a comparison between a
translation of Michael Angelo*s sonnets and a photograph of St.
Peter's th« sonnets come off rather well. The great contribution of
the Renascence was the ideal of fully energized human beings, able
to span Iif« in all its manifestations, as artists, scientists, technicians,
philosophers, and what not. This ideal exercised a powerful influence
on lesser figures, like the Admirable Crichton and Sir Walter Raleigh,
and even down to the time of Descartes it contributed to that
exuberance of the intellectual life which was the Renascence at its
best. When John Amos Comenius wrote his remarkable little book
called The Labyrinth of the World and the Paradise of the Heart in
1623, he combined the outlooks of science and art in a remarkable
synthesis ; for the first part of this work is a picturesque survey of
the actual world as Comenius found it, and the second a picture of
the transition to the heavenly world promised in the Christian
religion. The idea behind Comenius' Labyrinth was the same that
inspired Andrea; and were it not for the complete otherworldliness of
this theological utopia, the Paradise of the Heart, Comenius*
discourse would take a high place in the history of utopian thought.
There is no genuine logical basis, as far as I can see, in the
dissociation of science and art, of knowing and dreaming, of
intellectual activities and emotional activi[283] >y Google
 THE STORY OF UTOPIAS ties. The division between the two
is simply one of convenience; for both these activities are simply
different modes in which human beings create order out of the
chaos in which they find themselves. Such is the humanist view. As
an instance of this, when the Royal Society was projected in England
in the middle of the seventeenth century, Johann Andreae advised
his friend Samuel Hartlib, then in Lo;idon, not to neglect the
humanities while furthering the pursuit of the physical sciences.
Unfortunately, the men who gathered together to form the Royal
Society were specialists in physical science ; and in the lapse of the
humanist tradition through the religious acerbities of the time, they
had lost some of their desire for a complete life. As a result, the
original charter of the society confined its work to the physical
sciences. Insignificant as it now appears in the annals of. science,
this decision seems to me to mark a definite turning point in human
thought. Henceforth the scientist was to be one sort of person and
the artist another ; henceforth the idolum of science and the idolum
of art were not to be cemented together in a single personality;
henceforth, in fact, the dehumanization of art and science begins. It
is interesting to note that with the divorce of the humanities from
science, art and science entered upon separate careers which, for all
their diversities, are curiously similar. Both art and science, for
example, ceased to be the common property of the community; and
each of them split up into a multiplying host of specialisms. In this
process, art and science made many notable advances ; so that this
period is usually spoken of as a period of enlightenment or progress
; but the result on the community was [284] >y Google
 THE STORY OF UTOPIAS what we discovered in our
examination of Coketown and the Country House. We must now
consider the development of the arts in the modern community. At
the height of the Middle Age, as in fifth century Athens, the arts
formed together a living unity. A citizen did not go into a concert hall
to hear music, to a church to say his prayers, to a theatre to see a
play, to a picture gallery to view pictures : it was a mean town,
indeed, that could not boast a cathedral and a couple of churches;
and in these buildings, drama and music and architecture and
painting and sculpture were united for the purpose of ringing
changes on the emotional nature of men and converting them to
accept the theological vision of otherworldly Utopia. The splitting up
of these arts into a number of separate boxes was part of that
movement towards individualism and protestantism whose effects
most people are familiar with in the field of religion alone.
Henceforward, music, drama, painting, and the other arts developed
largely in isolation ; and each of them was forced to build up a
separate world. The greater part of the gains that were made in
these worlds was not carried over into the community at large, but
remained the possession of the artists themselves or their private
patrons and critics in the Country House. With such exceptions as
the Italian and Japanese woodcuts of the eighteenth century, and
the few survivals of ballad and drama that slipt over from the Middle
Age, popular art became another name for all that was coarse and
stunted and depressed. The popular architecture [285] >y Google
 THE STORY OF UTOPIAS of the nineteenth century is the
sordid little redbrick rabbit hutch: popular religion is embodied in the
stunted sheet-iron or brick chapel (as it is called in England) of the
Baptists and Methodists: popular music is the latest barrel organ lilt:
popular painting is the calendar lithograph: and popular literature is
the dime novel. The divorce of the art of the cultivated classes from
that of the whole community tended to deprive it of any other
standards than the artist himself was content to erect. Here again
the comparison with science is curiously pertinent. The world of art
is in a sense a separate world, and it can be cultivated for a time
without reference to the desires and emotions of the community out
of which it has sprung. But the motto "Art for art's sake" turns out in
practice to be something quite different — namely, art for the artist's
sake ; and art which is produced in this manner, without any
external standard of performance, is frequently just an instrument
for overcoming a neurosis or enabling the artist to restore his
personal equilibrium. Divorced from his community, the artist was
driven back upon himself: instead of seeking to create a beauty
which all men might share, he devoted himself to projecting a
poignant angle of his personal vision — an angle which I shall call
the picturesque. The cause of this divorce I have already pointed out
in the chapter on the Country House; it is with the effects of this
divorce, for which the artist was not greatly to blame, that we are
here concerned. This conflict between "beauty" and the
"picturesque" is perhaps common to all the arts, and with sufficient
[286] ,, Google
 THE STORY OF UTOPIAS factual detail I might be able to
trace its effects on literature and music. For the sake of clearness
and simplicity I shall confine myself to painting and sculpture, with
the proviso that our conclusions will apply, by and large^ to the
whole field. Let me emphasize, before going any further, that I am
using the terms "beauty" and the "picturesque" in quite different
senses from the vague ones that are usually attached to them ; and
that I use them without any preliminary judgment as to their place
and value in the good life. The picturesque, in the quite arbitrary
sense in which the word is used here, is an abstract quality of vision,
sound, or meaning which creates what we might call pure esthetic
experience. In painting, the picturesque probably arose with the
discovery, on the part of the leisured classes in the Country House,
that it was possible to achieve rapture, a sort of esthetic trance, a
complete state of beatitude, by the more or less prolonged
contemplation of a pictorial subject. Up to the time of this discovery,
painting was simply a branch of interior decoration; the great
paintings of the Christian World served, for the public, as illustrations
to that outline of history which medieval theology provided: they had
a habitat, a social destination. With the splitting off of the
picturesque from the main body of ecclesiastical art, painting came
into its own as an end in itself, apart from any place that it might
have in the scheme of the community's affairs. The symptom of this
change is the rise of landscape painting: in the search for pure
esthetic experience the painter began to look for themes which were
divorced from any human interest but that of pure [287] >y Google
 THE STORY OF UTOPIAS contemplation. During the last
century this split between painting as a form of social art and
painting as a means of achieving contemplative ecstasy has become
deeper: even those academic painters who followed the methods of
the older artists no longer have the same field to work in, whilst the
revolutionist — the impressionists of one period, the cubists of
another, and the post-impressionists or expressionists of a third —
are forced by the general irrelevance of art in Coketown to produce
work which only the more or less initiate will appreciate. Now, I
would not for worlds underrate the gains which have been achieved
by the divorce of art from the whole life of the community. In their
isolation from the social group that produced them the modern
artists have been able to pursue their solitary way to limits which the
common man is probably incapable of reaching: they have widened
the field of esthetic delight and have introduced new values into the
world of painting, values which wUl remain even though the disease
which created them disappears, just as one can salvage a pearl from
an oyster whose sickness is healed. The view from the mountain top
is none the worse because many people are afflicted with dizziness
and nausea before they have reached the summit; and, like the
pursuit of truth, the pursuit of esthetic values is a good in itself apart
from any values which may be realized in the community. On these
terms, Cezanne and Van Gogh and Ryder, to mention a few of the
dead, will hold their own, and keep the boundaries of art from ever
shrinking again, I trust, to its academic limits. Nevertheless, the
effects of focussing on the pictur[288] >y Google
 THE STORY OF UTOPIAS esque can no more be overlooked
in art than the dangers of specialization in science. It is almost a
banality to point out how, historically, as the picturesque developed
in art, beauty has tended to disappear from life. Whilst the cultivated
few have become gloriously alive to more exquisite sensations than
their ancestors had probably ever experienced, the "mutilated many"
have been forced to live in great cities and in abject country towns
of a blackness and ugliness such as the world, if we are to judge by
the records that exist, has never seen before. In other words, we
have become more sensitive to experiences — to the contents of our
inner worlds — only to become more callous to things, to the brash
surfaces of the world without. In our preoccupation with the inner
worlds we have to a large extent lost our hold upon beauty, which,
in the limiting sense in which the word is used here, is the quality by
which anything, from a torso to a building, shows its adaptation to
an end and its sensitiveness to esthetic values — values which are
abstracted and intensified in the pure picturesque — that are
involved in such an adaptation. In this sense, the beautiful, as
Emerson said, rests on the foundations of the necessary : it is the
outward token of an inward grace ; its appearance is the
manifestation of a humanized life; and its existence and
development constitute, in fact, a sort of index to a community's
vitality. The divorce of the artist from the community, and the
turning away of his energies from beauty, in which the picturesque
might be fulfilled, to the picturesque itself, separate from any
practical needs, has scarcely been compensated by the advances
that have been made in the separate world of art. The result has
been that [289] >y Google
 THE STORY OF UTOPIAS work which should have been
done by artists of great capacity has been done by people of minor
or degraded ability. Anonymous jerrybuilders have erected the
greater number of our houses, absurd engineers have laid out our
towns with no thought for anything but sewers and paving contracts
; rapacious and illiterate men who have achieved success in business
discourse to the multitude on what constitutes the good life — and
so on. There is really no end to the number of things which we do
badly in the modern community, for want of the artist to do them at
all. This generalization applies to the whole range of the arts. The
greater part of the creative dreaming and planning which constitutes
literature and art has had very little bearing upon the community in
which we live, and has done little to equip us with patterns, with
images and ideals, by means of which we might react creatively
upon our environment. Yet it should be obvious that if the inspiration
for the good life is to come from anywhere, it must come from no
other people than the great artists. An intense social life, as Gabriel
Tarde pointed out in his fine Utopian fantasy. Underground Man, has
"for its indispensable condition the esthetic life and the universal
propagation of the religion of truth and beauty." The common man,
when he is in love, has a little glimpse of the way in which the
drudgery of the daily world may be transmuted through emotional
stimulus ; it is the business of the artist to make the transmutation
permanent, for the only difference between the artist and the
common man is that the artist is, so to say, in love all the while. It is
out of the vivid patterns of the artist's ecstasy that he draws men
together and gives them the vision to [290] >y Google
 THE STORY OF UTOPIAS shape their lives and the destiny
of their community anew. 8 ' No matter how the modern artist may
use or fritter away his abiHties, it is plain that he has an enormous
reservoir of power at his disposal. What, for instance, has made
America so wholly devoted to the conquest of material things? Why
are we so given over to collecting those vast miscellanies of goods
which are temptingly displayed in the advertising sections of our
illustrated weeklies and monthly magazines? The necessity for
ameliorating the hard, crude life of the pioneer has indeed been an
important influence; but the traditions of this life in turn produced all
the minor "artists" or "artlings" who write and draw for the popular
papers, who create the plots of plays and motion picture scenarios ;
and since most of these poor wretches have never been educated In
the humanist sense to any degree — since they know no other
environment than New York or Los Angeles or Gopher Prairie, since
they are acquainted with the achievements of no other age than
their own, they have devoted themselves wholeheartedly to
idealizing a great many of the things that are crude or ugly or stupid
in their beloved community. So the idola of business have been
perpetuated by "artlings" who themselves know only the standards
of the business man. Because of the limited horizons of the
American artist, therefore, the rising generation aspires after the
things that Messrs. Jack London, Rupert Hughes, Scott Fitzgerald,
and heaven knows who else have thought good and fine; the
younger generation talks [291] ,, Google
 THE STORY OF UTOPIAS like the heroes and heroines of a
melodrama by Mr. Samuel Shipman, when they do not attain the
higher level of comic cuts ; the younger generation thrills to the type
of beauty which Mr. Penryhn Stanlaws sets before its gaze. The
notion that the common man despises art is absurd. The common
man worships art and lives by it ; and when good art is not available
he takes the second best or the tenth best or the hundredth best.
The success of Mr, Eugene O'Neil, one of the few playwrights of any
girth who has contributed to the American stage, proves that the
only way that people can be kept away from good art is by not
providing it. The younger generation might just as well have had its
idea-patterns shaped by Sophocles, Praxiteles, and Plato, if our
genuine artists were not so aloof to their responsibilities, and if they
were intellectually mature enough to accept the full burden of their
vocation. It is a sign of a terrific neurosis — and no mark at all of
esthetic aptitude — that our genuine art is so completely disoriented
and so thoroughly out of touch with the community. We must turn to
a man of such uneven parts as Mr. Nicholas Vachel Lindsay before
we have anything like a recognition of the classic rfile of the artist.
Art for the artist's sake is largely a symptom of that neurotic
individualism which drives the artist out of a public world which
baffles him into a private world where he may reign in solitude as an
unruly demiurge. Art for the public's sake, on the other hand,
substitutes the vices of the extrovert for the vices of the introvert.
When I say that art must have some vital contact with the
community I do not mean, let me emphasize, that the artist must
cater to public whim [292] >y Google
 THE STORY OF UTOPIAS or demand. Art in its social setting
is neither a personal cathartic for the artist, nor a salve to quiet the
itching vanity of the community : it is essentially a means by which
people who have had a strange diversity of experiences have their
activities emotionally canalized into patterns and molds which they
are able to share pretty completely with each other. Pure art is
inevitably propaganda. I mean by this that it is meant to be
propagated, and that in so far as it fails to impregnate the
community in which it exists with its ideas and images, in so far as
the community is not changed for better or worse by its existence,
its claims are spurious. Propagandist art, on the other hand, is
inevitably impure since instead of bringing people together on a
common emotional plane, as men, it tends to accentuate their
diflFerences, and to void emotions which are proper to art into a
realm where the emotions of the missionary's tent or the
soapboxer's platform hold exclusive sway. It is just because the
"artist" in America has been impure in motive — a propagandist for
Pollyanna in the face of Euripides, a propagandist for "just folks" in
the face of Swift, a propagandist for niceness in the face of Rabelais
— that he has failed miserably as an artist, and has left our
communities to stew so completely in their own savorless juice. 9
For examples of what the artist might be, and what his proper
relation to the community might be when he was mature enough to
recognize it and discipline himself to it, let us look at Mr. William
Butler Yeats or A.E. There are doubtless a good many other
exam[293] >y Google
 THE STORY OF UTOPIAS pies that might be offered in
Europe; but these are particularly good; for the reason that with A.E.
one can see in his The National Being how the conceptions of art
enter into the tissues of all his plans for renovating life in the Irish
Countryside. In the work of these artists and their fellows we have a
clue to one of the most promising attempts to establish a concrete
eutopia which shall rise out of the real facts of the everyday
environment and, at the same time, turn upon them and mold them
creatively a little nearer the heart's desire. In the account of Four
Years which Mr. Yeats published in The Dial he explains his attitude
towards the literature and social life of Ireland; and I recommend
that account to all the forlorn revolutionaries and reformers who
wonder why the dry bones of their doctrines remain dry bones,
instead of knitting themselves together and becoming alive. This
passage in particular, defines the relation of the artist both to the
tradition of his art and to the community in which he must find a
root: "The Huxley, Tyndall, Carolus Duran, BastienLepage coven,
asserted that an artist or a poet must paint or write in the style of
his own day, and this with the Fairy Queen and the Lyrical Ballads
and Blake's early poems in its ears, and plain to the eyes, in book
and gallery, those great masterpieces of later Egypt, founded upon
that work of the ancient kingdom already further in time from Later
Egypt than Later Egypt is from us." He dismisses this claim with the
just assertion that the artist is free to choose any style that suits his
mood and subject; for in the world of art time and space are
irrelevant ; and he goes on to say, "We had in [294] >y Google
 THE STORY OF UTOPIAS Ireland imaginative stories, which
the uneducated classes knew and even sang, and might we not
make those stories current among the educated classes,
rediscovering, for the work's sake, what I have called 'the applied
arts of literature,* the association of literature, that is, with music,
speech, and dance ; and at last, it might be, so deepen the political
passion of the nation that all, artist and poet, craftsman and day
laborer, would accept a common design. Perhaps even these images,
once created and associated with river and mountain, might move of
themselves and with some powerful, even turbulent life, like those
painted horses that trample the rice-fields of Japan." By citing Mr.
Yeats' conceptions I do not mean to limit the artist to a single
function — that of patterning the good life. It is quite plain that pure
esthetic experience is a good in itself ; and when the artist has
rendered this experience in a picture, a poem, a novel, a philosophy,
he has performed a unique and indispensable piece of work. Could
italics keep this passage from being ignored I should employ them.
What I have called the picturesque is in reality just as self-sustaining
and delightful as the radiant good health which Sir Thomas More
rated so highly in his Utopia. If the community went to the dogs, it
would still be exuberantly self-sustaining, whilst anyone had the time
or the capacity to enjoy it. What I protest against is the way in
which the field of the genuine artist, during these last three hundred
years, has been whittled away, so that it has become more and more
a mark of the artist to concern himself solely with the narrow
province of pure esthetic experience, and to protest his complete
aloofness from anything that lies [295] ,, Google
 THE STORY OP UTOPUS outside this realm. Such an
attitude would have struck Euripides or Milton or Goethe or Wagner
as undignified and stupid, I am sure, because art is as large as life,
and it does not gain in vigor or intensity bj reducing its scope to that
of the puppet stage. The point is that there is an artistic function to
be performed in the community, for the community, as well as in the
world of art, for those who are lifted up to art. **Nations, races, and
individual men,'* as Mr. Yeats says again, "are unified by an image,
or a bundle of related images, symbolical and provocative of the
stat^ of mind that is of all states of mind not impossible, the most
difficult to that man, race, or nation because only the greatest
obstacle that can be contemplated without despair rouses the will to
full intensity." Whether these images shall be provided by
patrioteers, hack editors, politicians, advertising men and
commercialized "artists" or whether they shall be created by genuine
playwrights and poets and philosophers is an important question.
The function of creating these images is a^ artistic one, and the
artist who evades his responsibility is making life for himself and his
kind more difficult, since in the long run a community whose sacred
literature is written by Colonel Diver and Scadder and Jefferson Brick
— the great heroes of Civilization as the star of empire westward
makes its way — will make even the most solitary cultivation of the
arts a thorny and difficult task. • In the good life, the purely esthetic
element has a prominent place; but unless the artist is capable of
moving men to the good life, the esthetic element is bound to be
driven farther and farther away from the common realities, until the
world of the artist will [296] >y Google
 THE STORY OF UTOPIAS scarcely be distinguishable from
the phantasia of dementia praecox. Already, the symptoms of this
corrosive futility have appeared in literature and painting in Western
Europe and America; and such light as comes forth from this art is
but the phosphorescence of decay. If the arts are not to disintegrate
utterly, must they not focus more and more upon eutopia? 10 It
comes to this then: our plans for a new social order have been as
dull as mud because, in the first place, they have been abstract and
cockney, and have not taken into account the immense diversity and
complexity of man's environment ; and in the second place, they
have not created any vivid patterns that would move men to great
things. They have not been "informed by science and ennobled by
the arts.** Through the paralysis of the arts and sciences our
contemporary programs for revolution and reform have done very
little to lift our heads over the disorderly and bedraggled
environments in which we conduct our daily business. This failure to
create a common pattern for the good life in each region has made
such excellent efforts as the garden city movement seem weak and
ineffectual when we place them alongside the towns that mediieval
civilization, which had such a common pattern, created. Without the
common background of eutopian idola, all our efforts at
rehabilitation — the new architecture, the garden city movement,
the electrification of industry, the organization of great industrial
guilds such as the Building Trades have achieved in England and the
garment workers seem on the point of effecting [297J ,, Google
 THE STORY OF UTOPIAS in America — without these
common idola, I say, all our practical eflForts are spotty and
inconsecutive and incomplete. It was not, let us remember, by any
legislative device that the cities of the industrial age were
monotonously patterned in the image of Coketown. It was rather
because everyone within these horrid centers accepted the same
values and pursued the same ends — as they were projected by
economists like Ricardo, industrialists like Stephenson, and lyric
poets like Samuel Smiles — that the plans of the jerrybuilder and the
engineer expressed to perfection the brutality and social disharmony
of the community. The same process that gave us Coketown can,
when our world of ideas is transformed, give us something better
than Coketown. The chief use of the classic Utopias that we have
surveyed is to suggest that the same methods which are used by the
Utopian thinkers to project an ideal community on paper may be
employed, in a practical way, to develop a better community on
earth. The weakness of the Utopian thinkers consisted in the
assumption that the dreams and projects of any single man might be
realized in society at large. From the bitter frustration of Fourier,
Cabet, Hertzka, and even John Ruskin those who are in search of
the beloved community may well take a warning. Where the critics
of the Utopian method were, I believe, wrong was in holding that
the business of projecting prouder worlds was a futile and footling
pastime. These anti-utopian critics overlooked the fact that one of
the main factors that condition any future are the attitudes and
beliefs which people have in relation to that future — that, as Mr.
John Dewey would say, in any judgment of prac[298] ,, Google
 THE STORY OF UTOPIAS tise one's belief in a hypothesis is
one of the things that affect its realization. When we have projected
the pattern of an ideal community and tend to warp our conduct in
conformity with that pattern, we overcome the momentum of actual
institutions. In feeling free to project new patterns, in holding that
human beings can will a change in their institutions and habits of
life, the Utopians were, I believe, on solid ground; and the Utopian
philosophies were a great improvement over the more nebulous
religious and ethical systems of the past in that they saw the
necessity for giving their ideals form and life. In fact, it has been in
the pictures of ideal commonwealths such as Plato's that the "ideal"
and the "actual" have met. It is true that the pure Utopians have
overlooked the fact that every institution has a momentum of its
own : its speed may be quickened or reduced, it may be switched on
another track, as the Roman Church during the Reformation was
switched from the main line of civilization to a subsidiary route; and
at times, in the catastrophe of war or revolution, an institution may
jump the track altogether and be wrecked. The critical problem for
the eutopian, the problem of the transition from one set of
institutions to another, from one way of life to another, was
overlooked. Plato's Republic, for example, was a fairly attractive
place; but one wonders in what Greek city in the Fourth Century B.C.
the transition could have taken place. A transition implies not merely
a goal but a starting point: if we are to move the world, as
Archimedes threatened to with his lever, we must have some ground
to stand on. It is only by paying attention to the [299] ,, Google
 THE STORY OF UTOPIAS limitations of each region, and by
allowing for the driving force of history, that we can make the earth
come to terms with man's idola. This is perhaps the most difficult
lesson that the eutopian must learn. 11 What, then, is the first step
out of the present disorder? The first step, it seems to me, is to
ignore all the fake Utopias and social myths that have proved either
so sterile or so disastrous during the last few centuries. There is
perhaps no logical reason why the myth of the national state should
not be preserved; but it is a myth which has done very little, on the
whole, to promote the good life, and has on the contrary done a
great deal to make the good life impossible; and to continue to cling
to it in the face of perpetual wars, pestilences, and spiritual
devastations is the sort of fanaticism which will probably seem as
blind and cruel to future generations as persecutions for Christian
heresy do to the present one. On the same grounds, there are a
number of other social myths, like the proletarian myth, which run
so badly against the grain of reality that they cannot be preserved
without ignoring a great many values which are essential to a
humane existence; and on pragmatic grounds it would be fine and
beneficial to drop them quickly into limbo. There is no reason to
think that there will be a quick conversion from these myths: the
holocaust of war has only intensified the myth of the National State;
and our experience with religious myths suggests on the contrary
that the forms at any rate will be preserved long after the last shred
of reality has disappeared. But the sooner those who are capable of
intellectual criti[300] >y Google
The text on this page is estimated to be only 29.37%
accurate

THE STORY OF UTOPIAS cism abandon these particular

myths, the sooner will these idola fall into the state which has been
happily described as "innocuous desuetude." If our knowledge of
human behavior counts for anything, however, wc cannot put aside
old myths without creating new ones. The eighteenth century
agnostics very wisely realized that if they wished to maintain the
values which had been created by Deism, they could not abandon
God without inventing him all over again. In. turning away from
obsolete and disastrous social myths I do not suggest that we give
up the habit of making myths ; for that habit, for good or bad,
seems to be ingrained in the human psyche. The nearest we can get
to rationality is not to efface our myths but to attempt to infuse
them with right reason, and to alter them or exchange them for
other myths when they appear to work badly. Here is whore we reap
the full benefit of the great Utopian tradition. In turning away from
the social myths that hamper us, we do not jump blindly into a
blankness; we rather ally ourselves with a different order of social
myth which has always been vivified and enriched hy the arts and
sciences. The idolum of cutopia which we may seek to project in this
or that region is not a carte blanche which any one may fill in at his
will and caprice; certain lines have already been fixed ; certain
spaces have already been filled. There is a consensus among all
Utopian writers, to begin with, thut the land and natural resources
belong undividedly to the community; and even when it is worked by
separate people or associations, as in Utopia and Frceland the
increment of the land — the economic rent — belongs to the
community as a whole. [301] ,, Google
 THE STORY OF UTOPIAS There is also a pretty common
notion among the Utopians that, as land is a common possession, so
is work a common function ; and no one is let off from some sort of
labor of body or mind because of any inherited privileges or dignities
that he can point to. Finally, there is the almost equally common
notion, among the Utopians, that the perpetuation of the species
leaves plenty of room for improvement, and that, as far as human
knowledge and foresight are worth anything, it should be applied to
propagation ; so that the most reckless and ill-bred shall not burden
the community with the support of their offspring while those of
finer capacity are neglected or overwhelmed in numbers. Besides
these general conditions for the good life which the Utopians unite
to emphasize, there are certain other points in the utopian tradition
of which one writer or another has given the classic statement. With
Plato we see the enormous importance of birth and education; we
recognize the part good breeding, in every sense of the word, must
play in the good community. Sir Thomas More makes us aware of
the fact that a community becomes a community to the extent that
it has shared possessions, and he suggests that the local group
might develop such a common life as the old colleges of Oxford have
enjoyed. When we turn to Christianopolis, we are reminded that the
daily life and work of the community must be infused with the spirit
of science, and that an acute practical intelligence such as we find
today among the engineers need not be divorced from the practice
of the humanities. Even the nineteenth century Utopias have a
contribution to make. They remind us by their overemphasis that all
the proud and mighty idealisms in the world are so many shadows
[302] >y Google
 THE STORY OF UTOPIAS unless they are supported by the
whole economic fabric — so that "eutopia" is not merely a matter of
spiritual conversion, as the ancient religions taught, but of economic
and geotechnic reconstruction. Finally, from James Buckingham and
Ebenezer Howard we can learn the importance of converting the
idolum of eutopia into plans and layouts and detailed projections,
such as a townplanner might utilize; and we may suspect that a
eutopia which cannot be converted into such specific plans will
continue, as the saying is, to remain up in the air. Taken together,
there is a powerful impulse towards creating a good environment for
the good life in the classic Utopias we have examined : from one or
another Utopia we may draw elements which will enrich every part
of the community's life. By following the Utopian tradition we shall
not merely escape from the fake Utopias that have dominated us :
we shall return to reality. More than that, we shall return upon
reality and perhaps — who can tell ? — we shall re-create it ! 12 In
discussing the foundations of Eutopia I am conscious of a certain
abstractness in my method of argument; conscious that I have not
been a good Utopian in dealing with these proud idola that we may
project in every region. Let us come down to earth now and realize
what all this amounts to when we turn away from the library and
mingle again on the highways that lead past our door. First of all, I
conceive that we shall not attempt to envisage a single utopia for a
single unit called humanity ; that is the sort of thin and tepid
abstraction [303] >y Google
 THE STORY OF UTOPIAS which the discipline of the
Regional Survey will tend to kill off even in people who are now
inured by education to dealing only in verbal things. All the human
beings on the planet are a unity only for the sake of talking about
them; and as far as that goes, there is very little profitable
conversation that can apply to a Greenlander, a Parisian, and a
Chinaman, except the mere observation that they are all on the
same little boat of a planet and would probably be much happier if
they minded their own business and were not too insistent about
inflicting their institutions and their idola upon their neighbors. We
shall have to dismiss, as equally futile, the notion of a single
stratification of mankind, such as the working class, serving as the
foundation for our Eutopia: the notion that the working class
consists simply of urban workers is a cockney imbecility, and as soon
as one rectifies it and includes the agricultural population, we have
"humanity" pretty much all over again. Finally, if we are to give
eutopia a local habitation it will not be founded upon the National
State, for the National State is a myth which sane people will no
more sacrifice their lives to than they would hand their children into
the furnace of some tribal Moloch; and a good idolum cannot be
founded on the basis of a bad one. As far as extent or character of
territory goes, we will remember that the planet is not as smooth as
a billiard ball, and that the limits of any genuine community rest
within fairly ascertainable geographic regions in which a certain
complex of soil, climate, industry, institutional life and historic
heritage has prevailed. We shall not attempt to legislate for all these
[304] >y Google
 THE STORY OF UTOPIAS communities at one stroke ; for
we shall respect William Blake's dictum that one law for the lion and
the ox is tyranny. There are some 15,000,000 local communities in
the world, the Postal Directory tells us; and our eutopia will
necessarily take root in one of these real communities, and include
within its co-operations as many other communities, as have similar
interests and identities. It may be that our eutopia will embrace a
population as great as that in the Metropolis of London or New York
; but it is needless to say that the land which lies beyond the limits
of the metropolis will no longer be regarded as a sort of
subterranean factory for the production of agricultural goods. In
sum, as Patrick Geddes has finely said, in the Kingdom of Eutopia —
the world Eutopia — there will be many mansions. The inhabitants
of our eutopias will have a familiarity with their local environment
and its resources, and a sense of historic continuity, which those
who dwell within the paper world of Megalopolis and who touch their
environment mainly through the newspaper and the printed book,
have completely lost. The people of Newcastle will no longer go to
London for coals, as the people in the provinces have in a sense
been doing this last century and more : there will be a more direct
utilization of local resources than would have seemed profitable or
seemly to the metropolitan world which now has command of the
market. In these varied eutopias, it is safe to say, there will be a new
realization of the fact that a cultivated life is essentially a settled life:
their citizens will have discovered that the great privilege of
travelling from Brooklyn to Bermondsey, and from Bermondsey to
Bombay is scarcely [305] >y Google
 THE STORY OF UTOPIAS worth the trouble when the
institutions of Brooklyn, Berraondsey, and Bombay, and every other
purely industrial center, are identical — sanitary drinking devices and
canned goods and moving pictures being the same wherever
mechanical duplication of goods for a world market has taken the
place of direct adaptation to local needs. It should not surprise us
therefore if the foundations of eutopia were established in ruined
countries ; that is, in countries where metropolitan civilization has
collapsed and where all its paper prestige is no longer accepted at
its paper value. There was the beginning of a genuine eutopian
movement in Denmark after the war with Germany in the 'sixties :
under the leadership of Bishop Gruntwig came a revival of folk
traditions in literature and a renascence of education which has
renewed the life of the Danish countryside and made an intelligent
farmer and an educated man out of the boor. It would not be
altogether without precedent if such a eutopian renascence took
place in Germany, in Austria, in Russia ; and perhaps on another
scale in India and China and Palestine ; for all these regions are now
face to face with realities which the "prosperous" paperism of our
metropolitan civilization has largely neglected. If the inhabitants of
our Eutopias will conduct their daily affairs in a possibly more limited
environment than that of the great metropolitan centers, their
mental environment will not be localized or nationalized. For the first
time perhaps in the history of the planet our advance in science and
invention has made it possible for every age and every community to
contribute to the spiritual heritage of the local group; and the citizen
[306] >y Google
 THE STORY OF UTOPIAS of eutopia will not stultify himself
by being, let us say, a hundred per cent Frenchman when Greece,
China, England, Scandinavia and Russia can give sustenance to his
spiritual life. Our eutopians will necessarily draw from this wider
environment whatever can be assimilated by the local community ;
and they will thus add any elements that may be lacking in the
natural situation. The chief business of eutopians was summed up
by Voltaire in the final injunction of Candide: Let us cultivate our
garden. The aim of the real eutopian is the culture of his
environment, most distinctly not the culture, and above all not the
exploitation, of some other person's environment. Hence the size of
our Eutopia may be big or little; it may begin in a single village; it
may embrace a whole region. A little leaven will leaven the whole
loaf ; and if a genuine pattern for the eutopian life plants itself in
any particular locality it may ramify over a whole continent as easily
as Coketown duplicated itself throughout the Western World. The
notion that no effective change can be brought about in society until
millions of people have deliberated upon it and willed it is one of the
rationalizations which are dear to the lazy and the ineffectual. Since
the first step towards eutopia is the reconstruction of our idola, the
foundations for eutopia can be laid, wherever we are, without
further ado. Our most important task at the present moment is to
build castles in the air. We need not fear, as Thoreau reminds us,
that the work will be lost. If our eutopias spring out of the realities
of our environment, it will be easy enough to place foundations
under them. Without a common design, without a grand design, all
[307] ,, Google
The text on this page is estimated to be only 24.77%
accurate

THE STORY OF UTOPIAS our little bricks of reconstruction

might just as well remain in the brickyard; for a disharmony between
men's minds betokens, in the end, the speedy dilapidation of
whatever they may build. Our final word is a counsel of perfection.
When that which is perfect has comcj that which is imperfect will
pass away. [308] >y Google
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