Being Well Born Part 18

Pedigree of family with artistic (dark upper section), literary (dark right section) and musical (dark left section) ability (from Davenport).]

=The Elimination of the Grossly Unfit Urgent.--=But even if, under present conditions of partial knowledge and lack of an adequate standard, the constructive phase of eugenics must be left in the main to the awakening conscience of the individual as humanity improves in general enlightenment, the second phase, the elimination of the grossly unfit is one of the greatest social obligations that confronts us to-day. For if there is an alarming amount of mental impairment in civilized nations, and if the problems of pauperism, inebriety, prost.i.tution and criminality are closely interwoven with the problems of mental unsoundness, as we have every reason to believe from available data, then any means which will operate toward securing normally functioning brains will at the same time operate toward diminishing, defects and delinquencies. And inasmuch as a considerable proportion of defects, both mental and physical, are inheritable, it is obvious that if we can diminish the number of children born into the world with defective brains or bodies we have made a long stride in the right direction.

[Ill.u.s.tration: FIG. 38

Inheritance of ability (from Kellicott after Whetham).]

=Suggested Remedies.--=But how go about it? Various schemes have been proposed, of which the chief are as follows:

1. Laws restricting marriage.

2. Systems of mating with the purpose of covering up and gradually diluting out defective traits.

3. Segregation during the reproductive period.

4. Sterilization.

5. Education in the principles of eugenics.

=Inefficacy of Laws Which Forbid Marriage of Mental Defectives.--=The utter inefficacy of the first proposition, namely the enactment of laws restricting marriage, at least as regards the socially unfit whose condition is based on impaired mentality, has been demonstrated time and again. If they are forbidden marriage, they merely have children without getting married. Most states have laws to prevent the marriage of such individuals but these laws are almost wholly ineffective in preventing procreation on their part. We might as well recognize once for all that in such cases nothing short of close custodial care or sterilization will accomplish the end desired.

As to the second proposition, systems of mating with the purpose of covering up and gradually diluting out defective traits, this has been shown to be possible with certain types of defectives. Whether it is desirable or not is a different question.

[Ill.u.s.tration: FIG. 39

Inheritance of ability (chart condensed and incomplete) in three markedly able families (from Kellicott after Whetham):

1, Charles Darwin; 2, his cousin, Francis Galton, founder of the modern eugenic movement.]

=Systems of Mating Impracticable in the Main.--=By systems of mating, it should be said, is not meant the arbitrary marrying of two individuals w.i.l.l.y-nilly, but rather it is the prevention from marriage of two individuals having similar defects. In general the facts at our command indicate that in the majority of cases the offspring from a marriage of an insane, feeble-minded or epileptic person with a normal individual free from all neuropathic taints are normal or at most show but slight effects of the taint. But what normal individual would knowingly marry into such a stock? With few exceptions such traits where inheritable are apparently negative, that is, not represented by some positive abnormal factor but due to the lack of some element or elements necessary to the proper working of the normal brain. In the offspring of such a union the necessary missing factors are supplied by the normal parent. Or in Mendelian phraseology, the defective traits are recessive and are dominated by the normality of the other parent. Such offspring, however, while apparently normal of body are not normal of germ-plasm, inasmuch as half of their germ-cells will carry the abnormality of the defective parent as earlier explained (page 119) under Mendelism. We have already seen (page 119) how by continually marrying into strong strains the liability to recessive defect can be diluted out until the descendants are no more likely to have defective children than are members of our ordinary population. If, however, as is estimated in Bulletin No. 5 of the _Eugenics Record Office_, about thirty per cent. of our general population already carry recessive neuropathic taints, it certainly is a hazardous proceeding to attempt thus to breed out nervous defects unless one is absolutely sure of the normality of the strain into which it is proposed to marry. The great difficulty is in determining whether or not there is a defective ancestry in a given stock. We have at present no criteria for identifying normal individuals who have defective germ-plasm. As a practical test, however, if no defect has appeared in the stock for three or four generations back, the marriage would be relatively as safe as are the marriages of our average population to-day.

=Corrective Mating Presupposes Knowledge of Eugenics.--=But such a scheme of corrective mating presupposes a relatively high degree of intelligence and judgment on the part of the partic.i.p.ants, and this is just what we do not have and in the nature of things can not get, in the types of feeble-minded, epileptic and degenerate strains we are striving to eliminate. All our evidence shows that when unrestricted there is a marked tendency for feeble-minded to mate with feeble-minded, degenerate with degenerate. About sixteen per cent. of the feeble-minded, in fact, come from consanguineous marriages. If we try to legislate them into specific types of marriage then we encounter the same futility pointed out under our discussion of restrictive legislation, they will produce offspring without the formality of marriage.

In certain cases of insanity and in other than neuropathic defects one can see how the system might be inaugurated with greater prospects of success, but even then a knowledge of the principles of eugenics would be necessary to the partic.i.p.ants, or in other words we could only accomplish our end through our fifth proposition, education.

=Segregation Has Many Advocates.--=As to the third proposition, segregation during the reproductive period, this seems to have a larger number of advocates than any other coercive measure. While on theoretical grounds it is plausible enough, when we face the actual putting of the method into practise we are confronted by the fact that tremendous sums of money would be required to sequestrate and maintain colonies or industrial refuges.

When one realizes that no state now provides for more than a small minority of its defectives, and knowing also of the pressure that must be brought to bear on legislatures to secure sufficient funds to provide for these cases of extremest urgency, one can not be overly optimistic about the practicability of extensive sequestration.

E. R. Johnstone, the superintendent of a large training school for feeble-minded in New Jersey, points out that no state in the Union is providing for many more than one-tenth of her feeble-minded and epileptics. If his estimate is true, to place in inst.i.tutions, treat and train all its feeble-minded and epileptics would even now almost swamp any state treasury. But what _will_ it be in the future if we permit this unrestricted nine-tenths to go on and multiply their kind?

Leaving out of account the enormous sums spent in private charities even now from one-fifth to one-seventh the total public expenditures of almost any one of our states is going to maintain its defectives, dependents and criminals. From the 1912 report of the secretary of state, in the state of Wisconsin, for instance, I learn that of the total expenses for 1912, sixteen per cent. was for charitable and penal inst.i.tutions. The situation is even worse in some other states. Think of it! Think what a large total of expense it becomes! And the expense is far secondary from the humanitarian standpoint to the misery involved.

In the _Survey_ of May 24, 1913, we find Mr. Hastings H. Hart, Director of the Department of Child Helping of the Russell Sage Foundation, proposing very specifically "a working program for the extinction of the defective delinquent," which involves segregation during the reproductive period. He gives the number of feeble-minded under public care as 20,000 in inst.i.tutions for the feeble-minded, 16,000 in almshouses, 5,000 in hospitals for the insane, and 26,000 in prisons and reformatories, or a total of 67,000 already under custodial care. And he a.s.serts that as nearly as can be judged, this is one-third of the feeble-minded persons in the United States.

Between this estimate that one-third of our feeble-minded are in inst.i.tutions and Doctor Johnstone's that we are not providing for many more than one-tenth of our feeble-minded and epileptic, there is a wide discrepancy, but I know of no accurate data[20] whereby the matter can be settled definitely. One point of difference may be that Doctor Johnstone specifically includes epileptics and another may be one of definition of feeble-minded. However, supposing that we could get them all into inst.i.tutions, inst.i.tutional care at present by no means also implies prevention of propagation. It is not an unusual history of feeble-minded women in our county poor-houses that they alternate between periods of housework in some family and periods of residence in the almshouse, the return to the latter being only too often to bear an additional child.

Not a few students of the problem, however, advocate a rigid segregation as the only reasonable preventive measure, no matter what the expense.

They point out that the cost is mounting up higher each year and that we are only increasing it ultimately by procrastination. They urge, moreover, that when counting the cost of the segregation of the feeble-minded we should bear in mind also that we are reducing the expenses of our other charity and penal inst.i.tutions, since much of degeneracy, pauperism and petty criminality centers in mental enfeeblement. Some believe that colonies can be established which are in considerable measure self-supporting. Doctor Johnstone, for instance, although his estimates of the number of feeble-minded and epileptic is one of the highest, sketches out in a recent paper (in _Pediatrics_, August, 1912) a plan which he considers feasible.

But what a.s.surance have we that we can prevent the production of defectives by segregation? In reply may be cited a recent experiment on an extensive scale. Cretinism is a condition due to disease of the thyroid glands. It is characterized by goiter, marked deformities and imbecility.

It is hereditary and has been very prevalent in certain valleys of southern Switzerland and northern Italy. Cretin mated with cretin and consequently a large new supply was constantly produced. In recent years in certain communities the s.e.xes have been segregated (see _Eugenic Review_, 1910, Jordan) with the result that in such places cretinism has about disappeared.

Coming now to the fourth solution proposed, namely, sterilization,[21] let us consider some of its alleged advantages and disadvantages.

=Sterilization.--=First of all, since there is some considerable popular misunderstanding on the subject, it should be made plain that by sterilization is not necessarily, nor in fact generally, meant as.e.xualization, or the removal of the reproductive glands. On the contrary, in the male, sterilization is ordinarily accomplished by an operation known as _vasectomy_, in which a small piece of each sperm duct is removed. Such reports on it as I have found indicate that it is a comparatively simple minor operation which involves no special inconvenience or hardship on the subject beyond the deprivation of offspring. In fact, according to Doctor Sharp's report, in the majority of cases where it has been put into practise the patient has usually submitted voluntarily after having the details of the situation explained to him and has often advised fellow delinquents to do likewise.

Even should later developments show that a mistake had been made, in all probability the matter could be remedied by a second operation in which the cut ends of the ducts can be reunited. This has been accomplished experimentally in dogs, and furthermore, in men rendered sterile by occlusion of the duct through inflammatory diseases, the sterility has been remedied by removing the blocked area and reuniting the ends of the duct on either side.

In women the corresponding operation--a section of the oviduct--is termed _salpingectomy_. Here, however, the operation is a more serious one as it usually involves opening the abdominal cavity and the accompanying hazard of infection, a danger sufficiently great that it is safe to say that the operation will be resorted to more rarely than vasectomy in man.

=As a Eugenic Measure.--=Sterilization as a eugenic measure has many advocates and perhaps more opponents; and among the latter, it must be said, are many competent and thoughtful students of the subject who recognize existing conditions and deplore their continuance as much as any one. They maintain that while we may have to come to it as a last resort, we are yet too ignorant of the actual effects of the operation, or are too little informed on the inheritability of the specific traits we are trying to eradicate, to launch forth on so radical a program. We must not forget that when we put sterilization into effect we are going to have to deal with individual cases, not general averages.

=To What Conditions Applicable.--=And just here, it seems to me, is the crux of the situation. When confronted by the defective individual, in a practical case, just what criteria are we going to use to determine whether this particular individual should be sterilized or not? Nearly all of the twelve states which have sterilization laws specify insanity, feeble-mindedness, epilepsy and criminality.

=In Insanity.--=When it comes to insanity I strongly suspect that those who have the selection of the examining board will have difficulty in finding an alienist who is willing to take the responsibility of deciding on just which insane individuals shall be operated on and which not. For among the insane there are so many kinds and degrees of mental unsoundness, and these are of such varying and as yet unknown eugenical significance, that a positive decision is frequently out of the question.

Of the twenty-seven or more recognized forms of insanity who knows with any considerable degree of certainty which are heritable, which not? Shall we treat all manic-depressives alike? Shall we treat them as, for instance, we would those suffering from dementia prec.o.x? Who will take the responsibility of answering positively? Again, what shall we do in cases of paresis, or general paralysis of the insane, an affliction which probably invariably has syphilis as its antecedent? Yet it const.i.tutes one of the commonest forms of insanity found in asylums. Doctor George H.

Kirby, director of Clinical Psychiatry, Manhattan State Hospital, says that with one exception there are more admissions of paretics to Manhattan State Hospital than sufferers from any other form of mental disorder. He continues, "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 surprisingly large number of children in these families are feeble-minded, nervous, or in other ways abnormal." But here, it is clear, the patient has done the damage before he reached the hospital, nor was it paresis as such that did the harm but the syphilitic infection of which paresis itself was but the outcome.

Certainly the one fact which stands out conspicuously when we face most concrete cases, is that at present we need more urgently than sterilization laws for the insane, exhaustive studies of the inheritability of specific mental infirmities that we may know with some degree of certainty which warrant sterilization.

Yet on the other hand one of the most disquieting facts that confronts us to-day is the large number of patients who are on parole from our hospitals for the insane, subject to recall. What shall we do with them?

Shall we submit them to the tremendous hardship of still remaining under custodial care although to all intents and purposes sane, or shall we make their release contingent upon their submission to vasectomy or salpingectomy?

In a few cases such as Huntington's ch.o.r.ea (Figs. 26, 27, pp. 114, 115) we can proceed with a fair degree of a.s.surance, for we know that this dreadful malady is transmitted as a positive trait and that in all probability half of the children of an afflicted individual will inherit the defect. Such patients, if they ever rally sufficiently temporarily to leave the hospital, or where encountered outside the hospital should certainly be restrained from procreation. It is questionable if even their children, though apparently normal, should be allowed to have offspring, for usually the disorder does not manifest itself until middle life and then it is too late to try to prevent its transmission since the affected individual has already probably married and had children. But Huntington's ch.o.r.ea is a comparatively rare form of insanity, and one of only a few about which our knowledge as regards its transmissibility is fairly satisfactory.

=In Feeble-Mindedness.--=When we come to inst.i.tutions for the feeble-minded, however, there seems to be much more unanimity of opinion among physicians in charge of such inst.i.tutions that sterilization would be an effective and satisfactory disposition to make of many cases, if we are to release the patients in question from custody. Unquestionably in cases of imbecility it is easier than in insanities to pa.s.s conclusive judgment on the inheritability of the condition in a large cla.s.s of cases.

Practically all are agreed that either permanent custodial care through the reproductive period or sterilization should be enforced. Some maintain that such individuals should remain permanently in inst.i.tutions anyway and that therefore to sterilize them is needless, while others urge that if sterilized many capable of making their own living could be freed and allowed to do so.

According to G.o.ddard the feeble-minded woman is about three times as likely to find a mate as a feeble-minded man, hence it would seem to be of much greater importance to sterilize the woman than the man.

Again it might be urged with much justification, that even though sterilized, the feeble-minded individual because of lack of self-control will transgress s.e.xually and will thus certainly become a menace to society in the spread of venereal diseases. If Mr. Hart's estimate is anywhere near correct, that there are 60,000 feeble-minded women in the United States of child-bearing age, and that 13,000 are already in custody, then the task of getting all women of this cla.s.s into custody is not so insurmountable as would at first appear.

=In Cases of Epilepsy.--=As to epilepsy, I find a very decided difference of opinion among physicians. Some consider it, on account of its apparently strong inheritability, together with the shocking crimes perpetrated by epileptic criminal types, one of the most serious menaces, while others point out that we know nothing of the real cause of epilepsy, that there are all degrees and shades, that it is probably referable to different causes in different cases and that no one is able to say what the offspring of any given epileptic will be.

As to criminal types, here again we face the difficulty of deciding any particular case. Let us suppose that twenty-five per cent. of criminals are mental defectives, how shall we sift them out from the seventy-five per cent. who are supposed to be eugenically normal? Doubtless in many of the twenty-five per cent. cla.s.s, the indications of defective mentality are sufficiently evident to prevent mistakes, but a considerable number of uncertain status must also remain near the border-line.

=Sterilization Laws.--=Although twelve of our states already have sterilization laws, only two, Indiana and California, seem to have made any active attempt to enforce them. The situation is too new yet in Wisconsin, Michigan and Pennsylvania for these states to have shown what they intend to do. Although the Indiana law says, "it shall be compulsory for each and every inst.i.tution" to maintain the practise, it has fallen into disuse since 1911, presumably because the governor believed the law unconst.i.tutional. It is of interest to see the motive underlying the law in various states. In the majority it is purely eugenic. In Connecticut it is mainly eugenic though partly therapeutic. In California it is apparently in part therapeutic, since it is stated as being for the physical, mental or moral benefit of inmates of various state inst.i.tutions, and in part punitive and eugenic, since individuals twice committed for s.e.xual offenses or three times for other crimes are subject to the operation.

In Washington and Nevada the object is purely punitive, the persons specified being habitual criminals and persons adjudged guilty of carnal abuse of female persons under ten years of age, or of rape. In these states also the court orders the operation instead of leaving it to the decision of a board of medical experts.

=Social Dangers in Vasectomy.--=It has been urged against vasectomy that it will work untold harm because it relieves of the responsibility of a probable parentage. This argument does not appeal to one as very weighty as far as the imbecile or other degenerate is concerned, because one of the very traits characteristic of such individuals is lack of any sense of responsibility. By this same token, however, we have a very good argument for sequestration as against sterilization, for the degenerate, even though sterilized, will not be restrained s.e.xually and will be likely to disseminate venereal diseases or commit rape. Furthermore, there will be the temptation to sterilize and liberate certain types that would otherwise have been kept permanently in custody.