Being Well Born Part 11

Studies carried on by Pearson, Elderton and Barrington of the Eugenic Laboratory in London lead these investigators to the conclusion that extreme alcoholism is a _result_ not a _cause_ of degeneracy. That is, the degeneracy is due to the defective stock, not to alcohol. They cite in evidence their records of four thousand school children of alcoholic and of sober parents, which fail to show any unfavorable effect of alcohol on offspring. Some of their critics, however, maintain that they did not choose subjects who were sufficiently alcoholic to give the injurious results that might legitimately be expected among the offspring of excessive drinkers or habitual drunkards.

Where children show a hereditary inclination toward drink, unquestionably one of the strongest factors is the inheritance of the same disposition, the same unstable nervous const.i.tution and its accompanying lack of self-control which led the parent to drink, rather than the inheritance of the effects of the drink on the parent. For in many cases a parent may not become a drunkard until after the children who also become drunkards are born. That the tendency to drink immoderately is frequently due to a strain of feeble-mindedness or epilepsy becomes more evident every day.

In many of the so-called "periodical" drunkards, the accompanying features of their periodic attacks of drink-craving, such as clouding of memory, restlessness and depression, are those commonly a.s.sociated with ordinary epileptic attacks.

=Probably Over Fifty Per Cent. of Inebriety in Man Due to Defective Nervous Const.i.tution.--=Branthwaite, an English authority on drunkenness, finds that about sixty-three per cent. of the inebriates who come to his notice are mentally defective. In alcoholic insanities heredity is a potent factor. It is coming to be realized more and more that p.r.o.nounced alcoholism is due in a large percentage of cases, perhaps over half, to a defective nervous make-up. While it is true that many drunkards would not develop without free access to alcohol, on the other hand many would never develop without a bad heredity back of them, which gives them a peculiar nervous const.i.tution that renders alcohol an undue stimulus. In a recent report of the New York State Hospital Commission it is stated that in fifty-four per cent. of the cases of alcoholic insanity, a family history of insanity, epilepsy or nervous disease exists. Thus in the presence of alcohol most of these unfortunates are helpless p.a.w.ns of a hereditary weakness.

So when the question of alcoholism is viewed from all angles, the children of the human drunkard would seem to run a double menace of misfortune, since they may be subject both to the direct poisoning effects of alcohol and the results of an inheritable degeneracy.

=Factors to Be Reckoned With in the Study of Alcoholism.--=In any thoroughgoing study of alcoholism in man many factors will have to be reckoned with. First of all there is the question of inherent lack of control. This is probably the princ.i.p.al thing inherited where heredity truly enters as a factor. That example and social environment are important factors in addition to or in place of heredity is clear, too, when we observe that often it is the boys only who take after a drunken father, for there is no evidence that the inherited tendency when it really exists is at all s.e.x-linked. Again, in certain occupations carried on under unwholesome influences relief is frequently sought in alcoholic stimulants, and such custom may easily crystallize into habit.

Furthermore, the accustoming young children to doses of alcohol, or the unborn young to alcohol through the body of a drunken mother, may be strongly contributory toward establishing inebriety in certain cases. As we have seen from an abundance of experimental data on animals, moreover, the nurture effects on germ-cells may result in the production of weakened offspring. Such offspring in the case of man are probably less able to withstand temptations of all kinds and hence readily succ.u.mb to the habit-forming effects of alcohol if once its use is begun. Lastly, it must not be forgotten that alcoholism in the father usually means poverty and the subsequent accompaniment of malnutrition and neglect of the children, and this in itself may not only account for poor development of the latter, but may also be strongly contributory toward establishing the habit of alcoholism in them.

An inherent bias plus most of the other conditions just enumerated is the not unusual lot of the offspring of drunkards.

=Venereal Diseases.--=There is yet another very considerable cla.s.s of maritally unfit who in any conscientious discussion of unfitness for marriage or of racial improvement must be considered. I refer to those who are afflicted with the diseases which are inseparably a.s.sociated with the so-called "social evil." To _gonorrhea_, one of the most prevalent of these diseases, more than one-fourth of our total one hundred and ten thousand blind in the United States are said to owe their affliction.

Milder types of eye disease may also result from such infections. As much as eighty per cent., or some say practically all blindness in children born blind is caused by it, the infection occurring at the time of birth or within a few days thereafter. The terrible consequences of this disease to the innocent wife would alone make its discussion imperative.

=The Seriousness of the Situation.--=Unfortunately the insidious nature of gonorrheal infections is unknown to most persons. A cure is apparently effected, yet as a matter of fact the germs may live for years and, if in the male, later be transmitted to the wife, subjecting her to a future of invalidism and misery. Reliable statistics from various medical authorities reveal the appalling fact that seventy-five per cent. or more of the surgical operations for inflammatory pelvic disorders peculiar to women, such as pus tubes and peritonitis, are attributable to this disease, as is also the involuntary sterility of forty-five per cent. of childless women. Unwelcome as the fact is there is an abundance of evidence to show that a large percentage of men in particular have at some period of their life been infected with venereal disease. Of our fourteen million males in the United States under the age of thirty we find estimates by some specialists in venereal diseases to the effect that five million of them, that is, one out of three, suffer from some one of the social diseases or their consequences. Doctor Hugh Cabot, one of the chief surgeons of the Ma.s.sachusetts General Hospital at Boston, a member of the faculty of the Harvard Medical School and president of the American a.s.sociation of Genito-Urinary Surgeons, has this to say about the situation: "We have of late years heard much about the frequency and serious consequences of tuberculosis; it has been dubbed the 'white plague,' and so active has been the campaign that a wide-spread understanding of this serious disease has resulted. It may safely be averred that in the urban population at least there are two, and perhaps three, individuals with syphilis to every one with tuberculosis. The frequency of gonococcus infection is much higher." He believes that over half the male population acquire a gonococcus infection at some period of their career. While as a layman, one can not but feel that a specialist's estimate may run unduly high because of the fact that he is encountering an inordinate proportion of such maladies every day, still such specialists are in position to get at the truth as no other person can and their calculations are probably not grossly in error. In any event any one who has progressed in worldly knowledge beyond the navete of a child must recognize the appalling prevalence of these maladies.

=Infantile Blindness.--=So serious has the matter of infantile blindness become that some state boards of health and some city health departments supply all physicians and midwives with specially prepared packages containing cotton and nitrate of silver solution for preventive or curative treatment of the eyes of all new-born children. At the time of the first bath each eye is carefully washed with a separate pledget of cotton saturated with boric acid solution. Each then receives a drop of the silver solution, which is made just strong enough to kill any gonococci that might be present without itself inflaming the eye. Water used in bathing the baby's body of course is not allowed to come in contact with its eyes. Such treatment should be given every child no matter how unsuspicious the circ.u.mstances may be. German authorities who have been following this method now for some years a.s.sure us that nineteen-twentieths of the blindness of infancy can thus be prevented.

=Syphilis.--=As to _syphilis_, another and even more terrible of these diseases, we have before us the absurd fact that while thousands upon thousands of dollars are being spent to establish a rigid inspection and preventive measures against the spread of a very similar disease in the horse, this malady in man is allowed to pa.s.s unchallenged and we are confronted by the gruesome certainty that there are hundreds of these diseased persons about us to-day who, on their mere affirmation that they are unmarried and of age, will be given the right to marry and thus produce families of infected children irrevocably doomed to early death or to lifelong misery.

While syphilis is most commonly spread through relations between the s.e.xes, it may be acquired in various other ways, as for example, through a cut in shaving with the same razor an infected individual has used. It is commonly transmitted from parent to child. Practically every prost.i.tute is a center of dissemination. Katherine Bement Davis has shown in her studies made at the New York State Reformatory for Women that while ordinary clinical tests show that apparently only twenty-one per cent. of these women are infected with venereal disease, more careful laboratory tests showed at least ninety per cent. to be infected.

Syphilis is caused by _Treponema pallidum_, a small unicellular animal parasite. Given access to the blood by any means whatever, possibly even through an abrasion in the lip by means of a kiss, it multiplies rapidly and any part or organ of the body may be attacked. Usually a small sore occurs at the point of entrance to the body, but often it heals up readily with little indication of the seriousness of the infection.

The development of the malady is insidious and long continued. As a matter of clinical convenience physicians divide its progress into successive stages although in reality the transitions are frequently variable and ill marked. The symptoms that arise within the first few months or even years are readily controlled by appropriate treatment, but to insure a cure prolonged and most thoroughgoing treatment is imperative. The symptoms disappear so completely after a short period of treatment that it is very difficult to persuade the average patient that he is not yet cured. Two years at least are none too short a period of treatment, yet the majority of patients, fully convinced that they are merely being exploited by the physician as a source of revenue, drift away at the end of a few months.

As a matter of fact, however, the germs usually persist long after the obvious symptoms of the disease have disappeared, and in consequence many of the most serious results of syphilis may not manifest themselves for a period of perhaps ten, twenty or thirty years.

=Some of the Effects.--=It is now known that _paresis_, also termed general paralysis or softening of the brain, is probably invariably due to syphilis. The work of Flexner and Noguchi on _paresis_ and _tabes dorsalis_ show that always in such afflictions the tissues of the central nervous system have been invaded by the parasite. The original infection, however, may have occurred so long before as to have been almost forgotten by the patient. Thus many an apparently robust man is stricken down in the prime of life. Earlier and prolonged treatment would in all probability have eradicated the germs and thus prevented the mental breakdown, which can not be cured by any known treatment. Postmortem examination always shows that the _Treponema_ has wrought wide-spread damage in the brain.

The frequency of paresis may be realized when one learns that in some regions it is responsible for about one-fifth of all cases of insanity sent to hospitals for the insane. It ranks next to the highest as a cause of insanity. Statistics show that in the state of New York more deaths result annually from paresis than from smallpox, teta.n.u.s, malaria, dysentery and rabies all combined.

In some cases the disease attacks the membranes of the brain and the small blood vessels giving rise to a still different type of mental disorder.

Practically all patients with _locomotor ataxia_ owe their condition to an antecedent syphilis. Moreover it is one of the important causes of _arterio-sclerosis_, or hardening of the blood vessels, and is also a prominent factor in certain forms of heart-disease, as well as by no means an unimportant cause of blindness in children.

As to specific cases of the effects of this disease on descendants the literature of the subject is crowded full. While it is needless to conduct the reader through a chamber of horrors by reviewing clinical cases, it is desirable to point out in a general way some of the effects. Doctor George H. Kirby, director of Clinical Psychiatry, Manhattan State Hospital, says:

"We find that when either the father or the mother suffers from paresis that many other members of the family may be infected with syphilis, and furthermore, we find that a large number of children in these families are feeble-minded, nervous, or in other ways abnormal.

Doctor Plant examined a group of 100 children, the offspring of cases of paresis, and found that 45 per cent. were plainly damaged mentally or physically, or in both fields; the blood test showed that one-third of these 100 children had the syphilitic poison in their systems.

"Another investigator found in a group of 139 children, the descendants of parents who had syphilitic nervous disease, that over 25 per cent. were definitely feeble-minded or affected with some serious nervous disorders.

"Other studies indicate that there exists a close relation between syphilis and many of the hitherto unexplained cases of feeble-mindedness, including idiocy, imbecility, infantile paralysis, and some forms of epilepsy. While the question is not yet settled, it appears that syphilis is the real cause of many of these cases of mental defect in children."

Still other investigators give details of physical afflictions and distortions, of suppressed development, of inordinate percentages of stillbirths--perhaps the most merciful lot for the little victims--but sufficient has been said to indicate the full horror of the situation.

G.o.ddard,[7] although not minimizing the terrible nature of the disease, finds little evidence in his studies that syphilis in parents is a specific cause of feeble-mindedness.

=A Blood Test.--=Fortunately a delicate blood test known as the Wa.s.serman test has been discovered by means of which, through an examination of a few drops of blood, any trace of syphilitic poison which exists in the body may usually be detected. This is true even though the individual may at the time show no visible symptoms of syphilis. The test is therefore of great value in detecting the latent germs of syphilis in individuals who have apparently been cured, and also often in making an early diagnosis of paresis. The Wa.s.serman test, however, is reliable only in the hands of a skilled operator. It may occasionally give a positive reaction when syphilis does not exist and on the contrary a negative when it is present.

The _luetin_ test is also now applied by some specialists, but is too new a test to have come into general use. It works on the same principle as the tuberculin test for tuberculosis. Some army physicians now also give what is termed a provocative Wa.s.serman. That is, in a suspicious case which gives only negative results by an ordinary Wa.s.serman, they can get, if syphilis really exists, a positive reaction after giving small doses of pota.s.sium iodide or salvarsan.

It should be well understood by every one that syphilis is usually curable provided the patient is given modern scientific treatment by a _competent_ physician. I emphasize competent because there are so many quacks in this field that one undergoing treatment can not be too careful in a.s.suring himself of the competency of the physician. In even a case of long standing, where the symptoms have been in abeyance for a number of years, the disease can be cured provided it has not developed into an active cerebro-spinal type, and even the latter can be much benefited by proper treatment. The great danger of the cerebro-spinal type is that it will result in paresis or locomotor ataxia.

As long as the blood of a patient shows a _positive_ Wa.s.serman reaction, marriage should certainly not be consummated. If after a proper course of treatment by a well-informed physician, the patient shows a _negative_ Wa.s.serman when tested by a competent examiner, he probably would not infect his wife or offspring, although prudence would require that he wait at least six months or a year before marriage, and marrying then only if later tests remain negative.

The only way for a patient to be sure that he is not harboring the cerebro-spinal form would be to have a spinal puncture made and the cerebro-spinal fluid examined. While the cerebro-spinal phase often does not occur until long after the primary infection, cases are known in which it has appeared within a few weeks. Evidence that the central nervous system is frequently invaded early in the course of the disease is increasing. Marriage of an individual suffering from the cerebro-spinal form should not take place, since such a one is almost sure to become a burden on the family or the state.

=Many Syphilitics Are Married.--=It may seem to some that in a treatise on being well-born the subject of syphilis might be ignored as not being especially pertinent, but the supposition that no considerable percentage of syphilitics marry is not borne out by the facts. Seventy-five per cent.

of men with insanity due to syphilis who are admitted to hospitals are married. The insanity in such cases is mainly the result of infections in earlier years, often long before marriage. While syphilis, strictly speaking, is not inherited, that is, does not become part and parcel of the germ-plasm, still the frequency of its direct transmission to offspring is so appalling that the outcome, as far as the immediate child is concerned, is quite as disastrous as the most thoroughgoing real inheritance could be.

=Why Permit Conditions to Continue as They Are?--=When one faces the easily ascertained facts regarding venereal disease, it seems incredible that we, an intelligent people, can go on complacently handing our daughters and sisters over to the surgeon's knife and a life of personal misery, and even in not a few instances to become mothers of incurably defective children, yet the dire fact confronts us that we do. We can no longer excuse ourselves on the plea of ignorance, for the grisly record may now be read in many medical and not a few popular treatises, and we find the theme entering even into the modern drama, as witness Brieux's _Damaged Goods_. Further indifference to these conditions can only be attributed to culpable apathy or prudery.

The extreme dangers to which parents are subjecting their daughters if they do not demand a clean bill of health on the part of their prospective husbands are obvious. Fathers and mothers perfectly willing to inquire into their future son-in-law's social connections, his income, securities, or business chances become strangely "modest" when it comes to determining whether he is physically fit for marriage.

One great cause of ignorance in the past was the prudish taboo against frank discussions of venereal diseases which has thrown the veil of silence about the subject. To-day, however, it is coming to be recognized that these maladies are diseases and not a standard of social propriety, and that like most other diseases the surest way to secure prevention and gradual eradication is through the enlightenment of the public. They are prevalent in all cla.s.ses of society. Moreover, it must not be forgotten that there is no form of venereal disease which may not be innocently acquired. Even where acquired through transgression of moral law an ignorant att.i.tude toward the s.e.xual instinct is often at the bottom of the difficulty.

=Medical Inspection Before Marriage.--=Ante-nuptial medical inspection is certainly as necessary to the welfare of society as the certification of age and of the single state now required by law. No one objects to a medical examination pertaining to venereal and other diseases when it comes to taking out a life insurance policy, and why there should be any more objection to it as a preliminary to marriage is a mystery. A few states already have compulsory ante-nuptial medical inspection. The laws have been enacted too recently to judge adequately of their working. There has been much debate in Wisconsin as to whether their law (Chapter 738, Laws of 1913), which went into effect January 1, 1914, is const.i.tutional and whether it requires a Wa.s.serman test. The Wisconsin law applies to males only. The Supreme Court of the state has declared it const.i.tutional and that its requirement of "the application of the recognized clinical and laboratory tests of scientific search" involves only such examination as the ordinary licensed physician is equipped to make and can reasonably be expected to make for three dollars, the maximum fee specified in the law.

A number of the physicians of the state are still dissatisfied with the wording, although most do not oppose the principle of the law. Many believe that it should apply to the women as well as to the men, and others feel that the law should be extended to cover still other kinds of marital unfitness. Most of the pract.i.tioners with whom I have discussed the matter appreciate the motive underlying the law and are endeavoring to make it successful.

The general public of the state as a whole seems to be in favor of the provision. At least one hears much favorable comment and little dissension among those who understand its purpose. The very controversy over it which sprang up after its pa.s.sage proved to be of great benefit in the education of the public regarding the necessity of such measures. Such physicians as I have been able to question report that the candidates for marriage rarely object to the requirement, but on the contrary strongly favor it. Especially where they have suffered from venereal disease earlier in life most are eager to know their condition and to have medical advice. To my own mind this last fact is the most significant of all, as it will give every candidate for marriage a chance to know the truth. Most men are not so much brutal or vicious as ignorant in such matters. The vast majority of those unfit for marriage as a consequence of venereal disease will, when they realize the danger their condition imposes on wife and children, take every possible means to put themselves into proper condition.

Desirable as the Wa.s.serman test may be, it requires special laboratory facilities and equipment as well as a specially trained examiner to make it a reliable test. Moreover it can not be given by the general pract.i.tioner for the very moderate fee that must obtain in a pre-nuptial examination compelled by law. If it or the serum test for gonorrhea are to be applied then the legislative body of the state will find it necessary to establish a special public laboratory or laboratories for their application. This, however, is not a matter of particular difficulty and would be capital well invested in any state.

=The Perils of Venereal Disease Must Be Prevented at Any Cost.--=However, no matter what the cost may be to the state, no matter what the exaction from the individual, the grave perils of venereal disease to society _must_ be prevented. We owe it to the cause of humanity that there be fewer victims born into a world of eternal night, that from a parentage of polluted blood there spring no longer hosts of children with feeble misshapen bodies or with tarnished intellects, death-marked at the door of life.

=Bad Environment Can Wreck Good Germ-Plasm.--=In conclusion it is evident from our discussion of prenatal influences that not all of being well-born is concerned with heredity in its proper sense, since the unborn young may be influenced either directly or indirectly by environmental conditions which are in no sense products of heredity, although as far as the immediate child is concerned the result may be quite as disastrous where the influence is a baneful one. As to the production of beneficial prenatal effects, while parents can do nothing toward modifying favorably such qualities as are predetermined in their germ-plasm, nevertheless they must come to realize that bad environment can wreck good germ-plasm. They can see to it that they keep themselves in good physical condition by wholesome temperate living, and thereby insure as far as possible healthy germ-cells for the conception and good nutrition for the sustenance of their progeny. Their one sacred obligation to the immortal germ-plasm of which they are the trustees is to see that they hand it on with its maximal possibilities undimmed by innutrition, poisons or vice.

CHAPTER VII

RESPONSIBILITY FOR CONDUCT

Since both physical and mental attributes are unquestionably inherited, it becomes a matter of importance to inquire into the nature of the ent.i.ty we call personality. To what extent is human conduct a product of parentage?

Although apparently free agents are we in reality only by infinitely subtle indirections making the responses, forming the habits, establishing the characters which result merely from the blind impulsions of an inherent const.i.tution? If so, who is praiseworthy, who blameworthy? Are men

"But helpless pieces of the Game He plays Upon this chequer-board of Nights and Days."

=All Mental Process Accompanied by Neural Process.--=Whatever the ultimate decision of psychologists may be regarding the relation of mind to the sensory and nervous mechanism of man it is certain that there is so close an a.s.sociation between them that the least alteration in the mechanism means a parallel effect in the mind, or in the words of Huxley, "every psychosis is definitely correlated with a neurosis." The rind or _cortex_ of gray matter which const.i.tutes the surface of the large cerebral hemispheres of the human brain is regarded as the seat of consciousness.

The development of the mental powers in the infant is dependent on the development of the elements of this cortical substance and the waning of the mental faculties in old age goes hand in hand with its atrophy.

Abnormal arrangements, injuries or omissions in it mean mental unsoundness. How the activity of the structural mechanism gives a reaction in consciousness is not understood, but we know that in the living being the two phenomena are inseparably linked. Whether we accept the hypothesis that consciousness is an actual product of the structural mechanism or the hypothesis that the latter is only an instrument for the manifestations as consciousness of an outside force or ent.i.ty, just as the telegraphic instrument manifests the existence of electricity, is neither here nor there for our purposes. On either supposition the degree and manner of expression are determined by the structure of the mechanism. Our main problem is to decide as nearly as possible how much of the mechanism is rigidly inherited, how much is at birth largely undestined, so that its ultimate outcome is in part a product of the forces which play upon it, or in other words of education and training.

=Gradation in Nervous Response from Lower Organisms to Man.--=To comprehend fully the basic nature of human neural responses one must seek the roots in the behavior of lower organisms. For there is found in a simpler form many of the fundamental activities and the first dim gropings which emerge in man as memory, reason and will. As we ascend the scale of animal life we find a continuous advance in neural complexity and nervous response that in many respects grades up closely to the human type.

A windmill or a weather-vane points toward the source of the wind, obviously not because either exercises any special choice in the matter, but because it is constructed on such lines of symmetry that when the wind strikes it, if it slants the slightest to left or right, the more exposed surface receives the greatest pressure and thus swings the body back into the line of least resistance.