Aspects of Infant and Child Orthogenesis
The Psychological Clinic Copyright, 1912, by Lightner Witmer, Editor. Vol. VI, No. 6 November 15, 1912
- Author:
Wallace Wallin, Ph.D.,
Director Psychological Clinic, School of Education, ir University of Pittsburgh, Pa.
Tlie mental and physical health of children is a national asset which the State is under obligation to preserve and develop, for the indefinite improvement of humanity and the cause of the young child are inseparably interwoven. The problem of infant mortality, therefore, cannot be viewed apart from the larger problem of race conservation; and in the final analysis the problem of race conservation involves not only race preservation but a twofold process of human orthogenesis: first, a process of physical orthogenesis, or orthosomatics, by which I refer to any process through which malfunctioning physical organs may be made to function aright, or by means of which healthy organs may be continued at normal functioning, so that the physical organism may develop to its maximal potential; and secondly, a process of mental orthogenesis, or ortliophrenics, by which I refer to any process, mental or physical, of righting any malfunctioning mental power, so that the mind may realize its highest developmental possibilities. On such a theory the immediate purpose of a constructive community program?and only such a program will prove genuinely efficacious?of race conservation or human orthogenesis, may be stated as irreducibly three-fold: First, salvation; i.e. the salvation of every born babe, fit or unfit, from a premature grave. Perhaps it were better to follow the example of the Greeks, a nation of ancient eugenists, and allow the unfit, provided they could be infallibly diagnosed, to perish by exposing them to death. But this expedient can be dismissed at once, because the-very thought is abhorrent to the twentieth century mind.
Secondly, improvement; i.e. the maximal uplift or upbuilding bodily and mental, of every surviving babe, whether fit or unfit, 1 Head before the American Association for Study and Prevention of Infant Mortality at the annual meeting in Cleveland, Ohio, October 3, 1912. so that it may reacli its maximal potential of social efficiency. The duty to preserve the unfit babe, once it is born, implies the duty to provide it with that nurture and protection which will bring it to its highest estate.
Thirdly, elimination; i.e. the eradication of the social misfits, not by the impossible expedient of enforced selective euthanasia, chloroforming or infanticide, but by the reduction of the birth rate of the unfit stock, and the increase of the birth rate of normal, healthy babies.
If the immediate or ultimate aim of the infant mortality crusade cannot be reduced beyond the above triple minimum, it is evident that a scheme of constructive planning must include remedial, corrective and preventive work, by the control of environmental and hereditary factors. While much of the conflict between the groups of environmental and hereditary infant welfare workers is due to the paucity of demonstrated facts in this field, which enables one group to attribute all or nearly all the blame for infant mortality, or for racial depopulation and degeneracy, to environment, while the other group just as confidently holds heredity responsible;2 yet it is probably true that the greater part of the controversy is due to one-sided views as to the basal aims to be realized, and accordingly the methods to be employed in an infant mortality crusade. On the one hand, there are some euthenists who limit the legitimate scope of the work to the saving of life from premature extinction, and who underrate, if they do not entirely neglect, a program of subsequent diagnosis, care and training; while on the other hand there are those who admit that a follow-up program of orthogenic reconstruction undeniably possesses value for the individual, but who insist that it has no beneficent influence on race improvement, that permanent race improvement can result only from eugenical breeding, and that environment is of minor importance. The student of orthogenics, however, regards it as impossible of practical achievement and fatal to the realization of the highest orthogenic results in the work of race reconstruction, to attempt to divorce the above aims, to neglect one at the expense of either of the other two, and to create a wide gulf between the euthenical and eugenical factors of control.
Few of the factors productive of infant mortality have been studied under
thoroughly satisfactory conditions of analytical control; hence the value of many of the statistical findings is questionable. Yet these discrepant findings are constantly used in support of the most divergent claims. There is great need of genuine scientific research in this field. Too much of it is pseudo-scientific. In. the time that remains I propose to present a brief statement of the points of view, claims, evidence and the measures advocated by the two schools of infant conservationist workers, and to offer a few suggestions for a fairly comprehensive program of euthenical and eugenical work.
Euthenics.
The euthenist claims that the major percentage of infant deaths are due to a maladjusted environment, or to detrimental factors which are under environmental control. He tells us: That the vast majority (some say 90 per cent) of babies are well born;
That adverse environmental influences are not more destructive of the biologically inapt than the biologically apt infant; That since the hereditary factors exert a minor influence during early life, the eugenically fit will succumb during infancy quite as readily as the eugenically unfit; That most infants die of preventable digestive disorders caused by bad feeding, bad food, food infected particularly by the house fly, or by injurious drugs or beverages, and of preventable respiratory diseases, caused by bad air and dirt; and That in the final analysis, therefore, the causes of infant morbidity and mortality are chiefly sociological, psychological and economic, a combination of ignorance, carelessness, indifference, neglect, filth, vice and poverty.
Thus it was found in a study of 44,226 deaths under age one, in !New York, Philadelphia, Boston and Chicago that acute gastro-intestinal disorders were responsible for 28 per cent, and acute respiratory diseases for 18.5 per cent of the deaths (L. E. Holt) ; while the corresponding mortality figures in England and Wales during the period’from 1892 to 1901 were 57.5 per cent and 25.3 per cent, respectively. Of the 49,000 infants avIio die under age two every year in the United States from cholera infantum, it is maintained that the majority are poisoned by flies.
Moreover, the euthenist contends that the real causes are often mistakenly or fraudulently reported. Thus premature births or still births which constitute about 25 per cent of the mortality figures both in England and America, and which are alleged to be due to impairment of biological capital or neuropathic taint, are often due to abortion produced by arbortifacients or criminal operations, or to infanticide, or to overwork and starvation of the mothers (as they are frequently found among factory mothers). Likewise in some cases in which the cause is reported as parental alcoholism,, the inebriety is only indirectly responsible for the deaths. Often the real cause is overlaying?the crushing or smothering of the infant by the narcotized parent. This circumstance seems to explain why so many infants die between Saturday night and Sunday morning?42 per cent of 4G1 cases reported in an English study.
With the emphasis placed on such factors as the above, it is evident that the eutlienist will look to the control of environmental factors for his orthogenic measures. Among the control measures which may be mentioned are the following: The complete extermination of the house fly; The establishment of scientific standards of ante- and postnatal maternity and infancy nurture and care; Relieving mothers from excessive toil, hunger, or emotional tension before, during and following the period of confinement, by the establishment of expectant refuges, lying-in hospitals or maternity nurseries, or nursing mothers’ restaurants, where wholesome food may be dispensed to the mother free of charge or at small expense, or by the legislative pensioning or endowment of motherhood, or by the issuing of a form of motherhood insurance; The compulsory registration and periodical inspection of baby farms, or foundling homes;
The licensing and supervision of foster mothers; The establishing of medically supervised milk stations or social consultation centers, where properly modified, pasteurized or sterilized milk may be supplied, and where mothers may receive instruction and demonstrations in the scientific care of infants; or the establishment of community educational health centers of the Milwaukee type, for the training of mothers, nurses, social workers, midwives8 and doctors in infant feeding, care and hygiene, and in home and neighborhood sanitation; I he establishing of public summer baby tents;
The development of measures to substitute breast feeding for bottle feeding; 1 lie legal imposition of fines on mothers who can but will not nurse their sickly babies; The substitution by legal enactment of bottle teats for bottle tubes; Our first municipal school for midwives was established in New York in 1011. CHILD ORTHOGENESIS. 157 Tlie frequent systematic inspection of the mouths of young children adequately to control the “disease of the people,” dental caries; The after-care or supervision of sick children during convalescence ; The expert community supervision of infants until they statutorily come under the supervision of school boards; The annual examination of pupils in the schools by medical and psychological inspectors, with a view to the discovery and correction of physical disabilities and mental deviations or abnormalities, whether developed or latent;4 The community supervision, regulation and socialization of urban recreation; The education of the youths of both sexes in sex hygiene; and The education of girls and young wives for motherhood in littlemothers’ classes or in continuation home schools. Concerning the desirability of instituting systematic, organized plans for putting into effect some of the above measures, there ought to be little difference of opinion. There is, at least, little reason to doubt the efficacy of many of these measures. To cite merely four instances: by the employment of various corrective, remedial and preventive measures in jSTew York City the infant death rate between 1881 and 1002 was reduced 62 per cent; by providing infant supervision by means of district nurses the mortality in ISTew York City last year was reduced to 1.4 per cent among 10,087 supervised babies (the cost of the supervision amounted to about 50 cents per child per month?the same as in Milwaukee) ; by arranging to give mothers a ten-day rest period before confinement 10 per cent was added to the weight of infants in Paris; and by the simple expedient of feeding infants from the breast instead of from the bottle the mortality in various cities has been reduced in amounts varying from 50 per cent to 15 per cent. Obviously, the first efforts of any organized plan of human conservation should aim so to environ every babe that it may obtain a decent fighting chance for survival beyond the cradle. By the proper control of environmental factors I believe that we can eradicate 75 per cent of infant mortality, provided the work 4 The last two measures are partly in practical force in New York City (and Boston), where a Division of Child Hygiene, of the Department of Health, has been established under municipal control with the duty of supervising the ‘health of children from birth to the legal working age. It is some such community organization as this for which I shall plead, though I prefer to have it established as a part of the public school system, with various additions to its functions. is organized 011 a community basis instead of being left to individual initiative or direction. Individual effort because of ignorance, caprice, poverty 01* inefficiency, will mean desultory or worthless action, or no action at all. Nothing short of organized community action will enable us to eradicate the preventable mortality of infants. My first plea, therefore, is for the development of comprehensive plans 011 a community basis for preserving and conserving the lives of infants.
But I shall equally lay stress upon a second desideratum, namely the organization of community development supervision of the child during the entire groivtli period. That there is need of such supervision in this day of disintegrating homes there can be no doubt. The problem of the individual child only begins after the battles of the first years of life have been won, and after the child has become more or less emancipated from dependence 011 his mother 01* caretaker. The momentous period of individualization which now begins is fraught with grave perils at every turn. All along the child will have to cope with insidious destructive environmental influences which tend to abort, deflect or retard his normal development. Can we safely entrust the responsibility for normal development under modern urban conditions to the child or parent? Do not practically all children and most parents lack the requisite knowledge, insight and foresight ? Is it not, therefore, the duty of the community or State to supplement the home care, and systematically to direct the child’s development, so that he may come to a true knowledge and appreciation of the ideals which the State regards as essential to its perpetuity? Clearly it is in the interest of the State that the child be so safeguarded from injury and disease and so trained that he may reach his maximal physical, mental and moral potential, to the end that he may become a productive civic unit and not a social drajr.
That the State has already assumed a paternalistic function toward her children is shown by the general establishment of compulsory systems of public day schools and special institutions, and by the more recent establishment of systems of school medical inspection. While I am of opinion that the public school systems are the community’s logical agency for accomplishing the orthogenic work required by the infant as well as the child, neither the public schools nor the school medical inspection systems have as yet been adequately organized to carry out a satisfactory program of orthosomatic and orthophrenic work. The public schools are making heroic attempts to adapt their machinery to the varying physical and mental needs of every pupil, but school officers and administrators have thus far failed to appreciate that the mental and educational problems connected with the mentally exceptional child cannot properly be handled until the direction of the work is taken out of the hands of the dilettanti and placed in the hands of psycho-educational experts, who are not only skilled in methods of psycho-clinical diagnosis, but who are also capable of functioning as consulting experts in the various branches of corrective pedagogy. Likewise school medical inspection has failed to deliver, partly (1) because many school medical inspectors have no specialized training in the diagnosis of the physical defects of children, and lack expert knowledge of school hygiene and sanitation and the prevention of defects and disorders; partly (2) because the work is confined almost entirely to mere inspection and tabulation of defects instead of including corrective treatment, with the result that in many schools the percentage of pupils who actually have their handicaps removed varies from 5 to 25 per cent;5 and partly (3) because emphasis is placed almost entirely on the discovery and correction of existent defects, instead of on the discovery and prevention of the causes of the defects (that is, the conditions which produce adenoids, enlarged tonsils, carious teeth, etc.).
In order that the schools may serve as an organized agency for carrying out an effective program of orthogenic work for every child of school age,c the following plan of work is proposed: 1. Every child on entering school should be given an expert examination for the detection of latent or manifest abnormalities of mental, moral and physical development, the mental examination to be made by a skilled clinical psychologist who is an expert in psycho-clinical methods and in the differential, corrective pedagogy adapted to various types of mental deviates;7 and the physical examination to be made by a physician specially EIn a Chicago school the principal told me that in one of her investigations she found that only 5 per cent of the defective pupils had taken any measures to have their defects removed. It is said that in New York last year, as a result of visits to the pupils’ homes by inspectors and nurses, 86 per cent of the defects discovered were treated.
6 The schools may well care for the child from the time of birth, in the department of orthogenics which I propose. This would entail the employment of nurses, who would devote themselves to the care of habies and young children. All the records would be filed in the one central school bureau. 7 Neither the introspective-experimental psychologists nor the average medical practitioners have the qualifications for this type of diagnosis. See J. E. Wallace Wallin, Clinical Psychology: What it is and what it is not. Science, 36: 1912. trained in the detection of the diseases, the physical defects, and physico-developmental abnormalities of childhood.
2. Children found in these examinations to be mentally or physically deviating should immediately receive appropriate orthogenic treatment, whether this be hygienic, corrective or preventive, or whether it be physiological, pedagogical or psychological. By thus securing diagnosis and treatment while the child’s brain is plastic we shall be able to accomplish the highest orthogenic results. We shall be able to prevent the formation of injurious pedagogical habits which result from the malfunctioning of the psycho-physical organism and which, once established, are often hard to eradicate. To obtain maximal results, the child deviate must be classified early.
3. Specially trained teachers, and special classes or institutions should be provided for the mental and physical deviates. School medical and dental dispensaries should be established for the free treatment of all properly certified indigent cases. It is economic suicide for the State to pay for the education of pupils who are largely uneducable because of physical handicaps. To spend large sums of money in the discovery of physical handicaps without providing the machinery for the correction of defects is also economic suicide.
4. Physical training should be systematically required of every child during his entire school course. Health education must be given the same emphasis as mental education. 5. Children shown by the expert examinations and the results of special training, to be socially and mentally incompetent, should be segregated in colonies for permanent oversight. They should be sent to such institutions as soon as their incompetency is measurably certain, at least before they reach puberty. No mental incompetents should be permitted at large in society, unless the home situation is such as to insure adequate protective oversight for the child. 6. Hie medical and psychological work throughout should contemplate not only the discovery and correction of defects or deviations which interfere with normal development, but also the discovery and removal of the conditions, whatever their nature, which produce physical or mental disabilities. The keynote of the whole plan must be prevention rather than cure. The problem does not so much concern the excision of adenoids or enlarged tonsils, as the removal of the conditions which cause them. Tlieie is not time to argue the practical efficacy of a comCHILD ORTHOGENESIS. 1G1 prehensive program of orthogenic work along the lines indicated, above, but I wish briefly to refer to an experiment undertaken to discover whether or not the mental efficiency of a group of children actually could be raised by orthosomatic mouth treatment. There is great need for the scientific investigation of the mental effects of various physical disorders or defects, because the extravagant claims which are often made as to the marvellous mental improvement which follows the correction of physical defects are usually based on the casual and sympathetic observation of a few favorable cases and not 011 actual performances as determined by controlled objective measurements.
For some time it had been my desire to carry out a research of this kind, particularly in relation to the so-called “disease of the people,” dental caries, in view of Osier’s statement, “that there is not any one single thing more important in the whole range of hygiene than the hygiene of the mouth.” The opportunity came during the academic year 1910-1911. The subjects of the experiment were a squad of 27 girls and boys in Marion School, Cleveland, who were suffering from disorders of the teeth and gums and an unhygienic condition of the oral cavity. During the first few months of the experimental year these pupils had their teeth polished and repaired, and their gums hardened. They were taught how to brush their teeth and gums properly, and how to chew their food. At two sittings before treatment began they were given five psychological tests, namely: tests of capacity to memorize three-place digits, of rapidity of writing free word associates opposite supplied antecedents, of ability to add columns of ten one-place digits, to write antonyms opposite a series of supplied words, and to draw a stroke through the “A’s” which were distributed promiscuously in successive lines of capitals. The medians of the scores in the two series of tests before treatment were used as the normal 01* comparative standards of performance. During the course of the treatment, and after its termination, these five tests, somewhat modified but nevertheless uniform in difficulty, were given under the same experimental conditions in four successive sittings. The difference between the median scores in the first two and the median scores in the last four sittings (or the last two may be used) thus represents the index of improvement.
The detailed results of this attempt to measure under controlled objective conditions the orthophrenic effects of operative and hygienic dental treatment liave been presented elsewhere.8 Here the briefest summary must suffice.
The amounts of average improvement were as follows: in ability to memorize, 19 per cent; in spontaneous association, 42 per cent; in adding, 35 per cent; in associating antonyms, 129 per cent; and in the capacity to perceive, attend and react, as determined by the “A” test, GO per cent. The median improvement for all tests thus amounts to 57 per cent, truly a significant gain. Even if it be conceded that only one-lialf of the gain is solely attributable to the heightened mental ability resulting from the physical improvement of the pupils, the gain would still be very considerable. In corroboration of the mental improvement shown by the psychological tests may be mentioned the following facts. Most of the members of this experimental squad were pedagogically retarded in their school work from one to four years. But during the experimental year only one failed of promotion, while six completed 38 weeks of work in 24 weeks, and one boy did two years of work in one year. During the preceding year many of the pupils were quite irregular in their attendance, owing to toothache, bodily indispositions or distaste for school work, and five pupils were truants. During the experimental year the truancy disappeared, while certain so-called incorrigible boys became quite manageable. No phase of the modern child reclamation movement merits deeper scientific study than the relation of normal physical, mental and pedagogical growth and development to a comprehensive, broadly conceived community plan of physical and mental orthogenesis. One of the pregnant conclusions from the above research is this: that no community can hope to realize proper dividends upon its school investments unless the pupils are first made so physically and mentally fit that they can profit from the instruction and training. What sense is there in spending a lavish amount of money trying to teach pupils whose capacity for development is partly or entirely blocked by various disabilities ? That is an economic question. Our present policy in many cases seems like economic suicide. What right have we to force the child to plod along on a road to knowledge which has been rendered impassable because of uncorrected incapacities ? That is a humanitarian or moral question. Moreover, what profit is there in permitting the child to impair the racial vigor by this sort of 8 J. E. Wallace Wallln, Experimental Oral Euthenics, Dental Cosmos, 54: 1912, pp. 404 IT, and 545 ff. Also, Experimental Oral Orthogenics, The Journal of Philosophy, Psychology and Scientific Methods, 9 : 1912 290 ff neglect ? That is a eugenical question. I incline to tlie unorthodox view that there is a eugenical side to euthenical reclamation work, for may it not be possible by the orthosomatic and orthophrenic work suggested above gradually to elevate the vital index of the growing generation and thus eventually to improve the inheritable qualities of the race ? Will not a slow orthogenic transformation of the somatic protoplasm gradually produce a beneficent transformation of the germinal protoplasm, just as the continuous indulgence in alcohol is thought by some investigators to produce a gradual deterioration of the reproductive cells ? Whether or not this view is-scientifically justifiable, I want specially to emphasize the following vital eugenical aspect of the above community plan of school orthogenic work, namely: the truth that the practical efficacy of applied eugenics largely depends on the systematic study of children in the schools, so that all eugenically unfit children may be identified during the pre-pubescent years. Only through systematic cooperative child study on the part of teacher, educator, psychologist, biologist and physician will we be enabled to distinguish with certainty between the transmissible and therefore eugenically important qualities and the non-heritable and therefore eugenically irrelevant qualities, so that our eugenic duty toward a given child may be patent certainly not later than at the dawn of adolescence. The urgent need for improved differential eugenical diagnoses will appear presently. But before proceeding further let us summarize the argument of the preceding pages:
It is the inalienable right of every child born into the world, whether fit or unfit, to receive such parental and community care as shall remedy or prevent sickness and disease, and as shall correct or mitigate constitutional or acquired physical defects and mental and moral disabilities, to the end that he may be able to appropriate in maximal degree the instruction and training which the community bestows upon him, and to the end that he may become a fit progenitor of healthy offspring.
But if this proposition is true, is it not equally true that it is the inalienable right of every child to be ivell bom, to be saved from impending death, premature decrepitude or inaptitude before instead of after birth? Otherwise stated, is it not the inalienable right of the State to demand that no socially unfit stock must be born, and to enforce that demand by all the police power which it possesses ? To these questions the eugenist makes affirmative reply. Eugenics.
The eugenist affirms that human beings, like the lower animals, breed true. Like produces like, fit answereth unto fit, unfit follows unfit. Therefore the problem of human orthogenics is fundamentally a problem of breeding viable, untainted infants by means-of eugenically fit matings.
If the euthenist has unbounded faith in the efficacy of the environment, the eugenist has a no less religious faith in his heredity formularies. We are told:
That the influence of the environment is less than one-fifth, nay less than one-tenth, that of heredity (Karl Pearson) ; That most infant deaths are due to lack of biological capital; That 30 per cent of infant mortality is due to inherited syphilis alone;
That the congenitally syphilitic child is far more prone to contract the various contagious diseases than the non-syphilitic; That constitutional inferiority always spells increased susceptibility to disease; That more than one-third of tubercular cases in institutions come from tubercular families, which it is assumed are tubercular because of inherited tubercular diathesis; That from GO to 90 per cent (Tredgold) of the amented feebleminded are hereditary cases, and that a large percentage of the insane (16 per cent, Koch), and epileptic (50 per cent, Barr, and Spratling), and criminals and social offenders are the victims of heredity; That alcohol is a veritable race poison, producing both individual and racial degeneracy; That parental alcoholism causes atrophy or pathological changes of the reproductive mechanism; That it is responsible for 5 to 10 per cent of feeble-mindedness, from 10 to 20 per cent of epilepsy, 30 per cent of male insanity, and a large percentage of pedagogical backwardness in school children, for a large percentage of mortality soon after birth, for infantilism, deformities, nervous disorders, deficiencies of weight, and disease in children, and for the inability of mothers to nurse their offspring (Bunge found that only 2.1 per cent of daughters of confirmed drunkards were able to suckle their infants); That female inebriety particularly is a prolific cause of the ruin of infant life, inebriety in the expectant mother being responsible for a large percentage of sterility, abortion, miscarriages, premature births and still births (Latenen: only 42 per cent of 600 children of 120 female inebriates lived CHILD ORTHOGENESIS. 165 more than two years; 55.8 per cent lived less than two years. Lonnett: of 107 English women dying of alcoholism before 29 years old, 8 bore no children, 99 bore G delicate and deformed children; but 29 vigorous children were born before the mothers became alcoholic); That the death rate is greatest for the later pregnancies of maternal inebriates (33.7 per cent of deaths among first born; 72 per cent, among the sixth to the tenth born; still births among first born, 6.2 per cent; among last born, 17.2 per cent) ;
That increase in national sobriety has actually been attended with a decrease in infant mortality (English study; Latenen’s study of 20,000 from 5846 families indicated that the number of deaths and miscarriages decreased as the amount of alcohol consumed decreased);
But that both the number of premature and still births and the number of infants who barely escape these conditions are increasing in civilized countries (Kaye, whose finding is based on English statistics), while likewise our neuropathic stock is increasing faster than the general population, so that the army of dependents, defectives and delinquents threatens to engulf our civilization (one medical alarmist, Ivellogg, predicts that in the year 2012 no children at all will be born!) ;
That the preservation of unfit babies by euthenical means materially augments the increase of the degenerates; That state systems of granting annual bonuses or allowances for each child born are pernicious, because only that part of the population which is barely living above the poverty line would take advantage of them, and this would tend to augment the ranks of the lower social strata; That material prosperity, eugenically considered, is no panacea for racial degeneracy, because it tends to produce alcoholism, premature debauchery and syphilis (as shown by a study of prosperity in the wine-producing canton of Luchon, France. The schools have received a crop of dullards seven years after good wine years) ;
That the potential limits of every individual’s level of functioning are fairly definitely fixed by heredity; that since the limits cannot be radically altered or lifted by nurture or training, each individual will tend to achieve his maximal success only in so far as he follows his initial aptitudes, propensities or bent; and that therefore the improvement of human capacity is primarily a matter of eugenical mating and only secondarily a matter of teaching and training.
What now are the measures which are proposed by the eugenist for elevating the standard, of parenthood ? The strictly engenical measures have to do either with the regulation of reproduction or mating, i.e. scientific breeding; or with the protection of the germ plasm from injury or deterioration (and possibly with the safeguarding of the foetus from injury, starvation, or infection). The specific measures most frequently advocated are the enforced limitation of marriages to the eugenically fit, as determined by statutorily required physical and mental examinations of applicants for marriage certificates; the compulsory sterilization, under legal safeguards, of all persons adjudged socially incompetent; the quarantining of all persons who are carriers of infectious social diseases; and the permanent sequestration in state colonies of all the epileptic, insane and feeble-minded, chronic inebriates, syphilitics, rapists and sexual perverts. The student of orthogenics finds himself in sympathetic accord with the fundamental aims of the eugenic movement. In our efforts to fashion a race of human thoroughbreds nothing less than the eugenical ideal is wholly satisfying. Moreover, we have a right to judge any proposed euthenical measure in the light of the eugenical ideal. Any euthenical measure which is manifestly anti-eugenical should not be encouraged. Legislators may well pause before favorably considering those measures now being advocated in various civilized nations which are threatened with depopulation. The probable immediate effect of paying bounties out of the public treasury to mothers for the support of babies would be the increase of neuropathic stock, so that society would ultimately succumb under the ever increasing burden. But while the eugenical conception is impregnable as an ideal, the student who is seriously interested in the cause of eugenics must recognize that there are almost insuperable difficulties in the way of the effective application of its principles, and that progress in the work will depend upon the measure in which these difficulties are successfully overcome. We may group these difficulties into four classes:
Psychological and sociological difficulties.
Effective reform of human practices is scarcely possible without the aid of the emotional forces of human nature. But man’s emotional development has not kept pace with his intellectual progress. Emotionally human nature is very much the same today as it was in the days of primitive man. This is explainable on the assumption that the emotions are merely the subjective .side of the instincts. Therefore, in trying to transform the sex life of the race we are obliged to deal with a set of emotions which are connected with one of the three oldest and most basal instincts of the race, namely the sexual instinct. isTow it is at least supremely difficult, if not utterly impossible, suddenly to change instinctive racial reactions by mere instruction, demonstration, exhortation or legal enactment. An instinct has become deeply imbedded in the very fabric of the psycho-biological life of the individual as a result of age-long racial conflicts, by slow and painful processes of elimination and survival. Therefore, instincts have acquired a degree of stability, pertinacity and emotional intensity which renders them almost invulnerable to merely rational appeal, and which leaves but one way to transform them, namely the evolutionary method of gradual elimination and survival.
To illustrate: as a result of thousands of years of painful tribal struggle and warfare those tribes were gradually selected for survival who abandoned the practice of consanguineous marriage and incestuous intercourse between near relatives. Through painful experience the inexorable truth was slowly forced into the consciousness of the race that such unions weakened the stamina of the tribe, and therefore must be rigorously interdicted. Not only did such practices arouse the disapproval, contempt and condemnation of the organization, but they gradually awakened in the individual a feeling of disgust which in time became instinctive. The intense repugnance which the normal mind to-day feels toward consanguineous or incestuous intercourse rests more upon an instinctive than a rational basis. The taboo pronounced on such unions as these is founded on the deepest psychic subsoil of the racial consciousness, and has become incorporated in the very habitudes, customs and traditions of the race, obtaining thereby a sanction which is more authoritative than that conferred by command or arbitrary legal enactment. The eugenic problem would be easily solved if there existed a racial instinct of repulsion against anti-eugenical matings?if there were a universally instinctive taboo on marriages between the biologically unfit. It is a question whether such a feeling of disgust, instinctive in its elemental intensity, can be instilled into the consciousness of lovers by mere teaching, enlightenment, or prohibition. Sexual attraction is an instinctive psycho-biological phenomenon less subject to regulation by scientific or legal prescription, than by blind impulse, custom, tradition, or con168 THE PSYCHOLOGICAL CLINIC. vention. Most free matings will be determined by certain intangible secondary sexual characteristics, certain fetiches peculiar to each individual, while the restricted matings will be determined by the conventional requirements of social station and wealth? unless, indeed, the eugenic creed can be transformed into a vital national religion.
Just as there are deep seated psychological instincts or emotional forces which tend to frustrate the enforcement of eugenic marriages, so the racial instinct of sexual modesty will offer the hardest obstacle to the effective and universal enforcement of laws requiring health examinations before marriage licenses may legally be issued. Even if such laws were generally enacted, will not the forces of sex frequently overleap all legal restraints and defy prisons and chains ?
In the same way, the chief obstacles to the legal enforcement of the practice of vasectomizing the unfit are of a psychological nature; various sentiments and prejudices, and man’s instinctive recoil against any interference with the processes or impulses of nature. If it were possible to vasectomize the whole army of misfits, and to stop entirely the manufacture of alcohol throughout the earth, the problem of eugenics would be largely solved. The chief obstacle against the total elimination of the liquor curse, again, is also psychological: the instinct of appetite, and certain mental states which are induced by the consumption of narcotics. Finally there are the maternal instinct and filial ties to thwart any effective plan of colonizing without exception all degenerates or eugenical misfits.
It has been necessary thus to emphasize the fact that there are certain psychological forces, certain instincts, emotions, customs, conventions and folk ways, which are anti-eugenic in nature, and which must be reckoned with in any well-conceived plan of eugenics. The fact that these eugenically hostile forces exist in the very citadel of humanity makes it all the more essential that the eugenist wage a relentless campaign for the increase and dissemination of verifiable and convincing knowledge of heredity, so that eugenic truths may lay hold on the deepest feelings and sentiments of the race and become in fact a national faith, tradition or religion. Then will it be possible to make eugenic enactments on the statute books genuinely effective. 2. Administrative and legal difficulties.
The adequate enforcement of eugenical measures in the present stage of civilization requires much governmental machinery. But because of the facts which we have just considered, it is not probable that adequate laws can be secured, or can be enforced if secured. Public sentiment would not support the enormous legislative levies which would be needed to colonize the vast army of misfits (already in New York from one-fifth to one-seventh of the state revenues go to the support of the institutions for defectives) and the popular outcry, based on prejudice, blind emotion, impulse or instinct, against the sterilization of at least all those misfits who remained at large in society, would nullify the law. As a consequence a large number of degenerates would always be found in society polluting the race stream. Compulsory physical and mental examinations of all parties to marriage contracts would serve a useful eugenic purpose; but the laws would be powerless to prevent a man or woman from contracting, say, contagious venereal disease after the bill of health had been issued. After all, the problem is not so much to get proper laws enacted as to secure the public sentiment which will demand their enforcement. There is no remedy for these difficulties, except a campaign of discovery and diffusion of eugenic facts, so that the public conscience may eventually be stirred. 3. Diagnostic difficulties.
Our third obstacle is the lack of a reliable or infallible criterion of eugenical unfitness, or of anyone competent to pronounce infallibly on all but the obvious cases. Who is competent to decide whether or not a given individual possesses desirable or undesirable hereditable determiners ? Who is able to say unequivocally that a given individual is eugenically defective and that he can only give issue to tainted progeny ? Who can determine with scientific exactness that certain determiners are lacking in “X” and that the same determiners are likewise lacking in his intended consort ? Who is able to determine whether a so-cnlled normal person may not be the carrier of defective strains, just as healthy persons may be disease carriers, so that unions between such normals may be just as non-eugenical as unions of obvious degenerates? It must be confessed, I believe, that the gaps in our knowledge of the laws of human heredity from the biological side are still deplorably wide. As far as concerns the psychological identification of mental defectives, our present technique enables us to locate the extreme types, but not the borderland cases. One of our best schemes of mental classification is the Binet-Simon scale. But after having personally used this scale almost daily for more than two years in the study of the feeble-minded, epileptic, insane, juvenile delinquents and backward children, I am free to confess that while the great utility of the scale cannot be questioned, it is not by any means the marvellous, unerring machine which it is claimed to be by certain over-zealous exploiters, even for the purpose merely of measuring the degree of mental arrest. jSTevertheless, with improved measuring scales of intellectual capacity, supplemented by the scales of personal, social, motor-industrial and pedagogical efficiency,9 and by developmental and heredity charts, the difficulties pertaining to the accurate diagnosis of mental cases will probably not prove insuperable. The establishment of adequate, reliable mental development scales is a large task, which cannot be done within a reasonable time without liberal public or private subsidy. One of the reasons for supporting such work is the extreme feasibility of experimentation in heredo-psychologv. In the psychological field it is easy to test and experiment on fit as well as unfit individuals, while in the biological field human heredity experimentation is almost impossible. This brings us to the statement of the final obstacle confronting applied eugenics, namely:
Experimental difficulties.
If it were possible to apply the principles of experimental genetics to human breeding as those principles are now applied to the breeding of domestic animals, many of the controverted problems could be brought to a fairly expeditious adjudication. Just because this seems impossible of achievement, the propagandist must beware lest he bring disrepute upon the eugenics movement by advocating precipitate, ill advised or premature action. There is danger that zeal may get the better of wisdom, and that state and national laws may be passed which we shall later come to rue. In the absence of experimental demonstration, who shall say that the laws of human heredity are Mendelian and not Galtonian in character ? What warrant is there for affirming that such socially significant complex mental traits as honesty, courage, virtue, initiative, concentration, perseverance, intelligence, judgment, reasoning, kindness and loyalty nre unit characters and are transmissible as simple determiners ? Woods affirms that they do not behave as unit characters and are not transmissible as such. But it is just such mental characters as these that it is important to transmit, for fundamentally the difference between g4# J? E- Wallace Wallln, Human Efficiency, Pedagogical Seminary, 1911, a social fit and misfit is a difference in mental qualities; the age of brute or muscular force lias been superseded by the age of intellectual or mind force.
Since the important question, therefore, is to determine whether socially significant complex human mental traits are heritable, and since this cannot be directly determined for man by the method of experimental genetics, what is to be done ? The following brief outline of both practical conservational and eugenical research work is suggested. 1. Conservational bureaus or agencies should be established on a community basis in the cities and commonwealths, for the purpose of scientifically supervising the health, growth, hygiene and educational development of the child from birth to the period of late adolescence. A community plan of this character has already been sketched in an earlier section of this paper. I incline to the opinion that the work should be organized in connection with the public school systems, not merely because this public agency is already in existence, nor because it Avould prevent the duplication of material plants, nor yet because the people have confidence in the public school systems; but because I believe that the integral function of the public schools is not only instruction or training but also the conservation of the mental, moral and physical health of the children entrusted to their care. 2. One of the specific functions of this bureau, or of some other organization, should be the biographical charting of all babies born into the world, or at least of all infants of presumptively degenerate stock. The biographical charts, on which the entries should be made shortly after birth, should contain such facts as the following: date, order, circumstances, condition, weight and height at birth; the mental and physical condition, eating and drinking habits, overwork and accidents of the mother before and at the time of birth; a record of the hereditary factors in the direct and indirect ancestral lines; a statement of the housing and environmental conditions. Later entries would indicate whether the child was breast or bottle fed, and for how long, and contain a record of his diseases, accidents, developmental retardations or accelerations, mental and physical peculiarities or abnormalities. This card, or a duplicate, might accompany the child to school, where it would be properly filed and where it would be supplemented by annual entries made by the teachers, the school nurse or social worker, the school psychologist and physician. These entries would show the child’s physical and mental con172 THE PSYCHOLOGICAL CLINIC. dition, as determined by anthropometric, medical and psychological tests, and his pedagogical progress from year to year. The data thus secured (to be made available only to the officers of instruction, diagnosticians, and research workers) would not only be of value for the intelligent guidance, care, development and training of the child, but they would enable us to locate and diagnose more speedily and effectively the social incompetents, and also contribute material of great value to the science of human eugenics.
3. A number of specific medical, psychological, pedagogical and anthropometric investigations, because of their practicability and the light which they will shed on various eugenical factors, should be prosecuted on a large scale. For example: what is the difference in the rate of mental and physical development between children of alcoholized or caffeinized or narcotized parents and children of abstainers from alcohol and caffeine and tobacco ? If there is a difference, does it appear during early childhood, during early adolescence, or later? Do the differences eventually disappear, so that both classes of children eventually reach their normal type, just as some spccies of animals whose development has been artificially or experimentally retarded later recover their losses ?
Likewise, what is the relation between narcotized parentage and mental and physical defects, deformities and abnormalities, and arrested epiphyseal development in the offspring? To answer these questions extensive serial psychological, anthropometric, physiological and radiographic tests need to be made of children of alcoholized and non-alcoholized parentage.
A number of studies already made indicate that this is a fruitful field for protracted research. Thus in some of the special classes in London and Birmingham 40 per cent of the pupils are reported as having intemperate parents, while the corresponding percentage for pupils of the same age in the regular classes was only G per cent. Of like tenor is the reported fact that in some cantons in France the schools have been flooded with an army of laggards seven years after good wine years. In an investigation carried out on the students of Murdoch Academy, in Utah, it appeared that the offsj )ring of non-narcostimulant parents were superior to those of the stimulant parents in all of the 22 mental and physical traits examined; that as the amount of caffeine consumed daily was increased there was observed a progressive deterioration in the height, weight and bodCHILD ORTHOGENESIS. 173 ily condition of the offspring; that the mental and physical inferiority was increased when the parents nsed both coffee and tea, when they nsed tobacco, and particularly when they used alcohol also; 79 per cent of the narcotized parents had lost one or more infants, while only 49 per cent of the abstainers had suffered such losses. It required from eight-tenths to one year longer for the narcotized progeny to graduate from the grades, and their average age was one year and seven months older in the Academy.10
A parallel study11 of the effects of coffee drinking by children on their own development enforces a conclusion previously reached, that a sharp separation cannot be made between the eugenical and euthenical aspects of various environmental factors. Statistics were compiled for 4G4 children in two schools for a period of one month. The drinkers averaged from one and one-half to four pounds less in weight, one-half to one inch less in height, three pounds less in strength of grip, 2.3 per cent, less in conduct as concerns those who drank one cnp only per day, and 7.8 per cent less as concerns those who drank four cups or more. The rank in lessons was from 2.0 per cent less, up to 29.G per cent less for those who drank four or more cnps.
By prosecuting on an adequate scale standardized researches in heredo-psychology, heredo-pedagogy and heredo-biology, analogous to those to which reference has been made above, we shall eventually secure the groundwork of facts needed by both euthenics and eugenics in order that they may attain the dignity of authentic sciences.
?Cf. .1. E. Hickman, in Journal of Philosophy, Psychology and Scientific Methods, 1012: 9, 234. 11 Charics Keen Taylor, Effects of Coffee Drinking upon Children. The Psychological Clinic, .Tune 15, 1912, p. 50 f.
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