The Hygiene of Eugenic Generation.1
The Psychological Clinic Copyright, 1914, by Lightner Witmer, Editor. Vol. VIII, No. 5. October 15, 1914 :Author: J. E. Wallace Wallin, Ph.D.,
Director Psycho-educational Clinic, St. Louis Public Schools. Eugenic or generative hygiene is preventive individual and race hygiene raised to the nth. power. No measures for individual or collective betterment are more fundamental than the hygiene of generation. To be well born is the fundamental prerequisite of being well bred. Generative hygiene contemplates not only the regulation of the function of mating, but also the establishment of those conditions which will insure normal healthy generative processes in the father and mother. In addition to the requirement of eugenic marriages, it is also necessary to safeguard the health and development of the foetus. Moreover, since the prenatal and postnatal child are one and the same indivisible person, we should not draw the line of cleavage too sharply between the eugenical and euthenical factors of development. An attempt to draw a sharp eugenic line between, on the one hand, the hereditary prenatal factors, and on the other hand, the environmental prenatal (congenital) and postnatal factors of normal development is indefensible and pernicious. In practice generative hygiene cannot be narrowly circumscribed by academic distinctions, but must comprise all the orthogenic factors which condition normal development prior to and during conception, during the period of gestation, (and possibly during the first postnatal period of life, at least so far as concerns the item of breast feeding). In this paper time limitation compels me to restrict my remarks to the consideration of those hygienic measures, the application of which will make for the improvement of the inborn qualities of men, certainly as affects congenital fcraits, if not the hereditary, in the narrow Galtonian sense of the latter term. I shall state and attempt briefly to support four fundamental theses.
1 An address delivered, in part, befor# the Eugenics Section of tha Pittsburgh Academy of Arts and Sciences, May 15, 1914.
1. Society should prevent degenerate or anti-eugenical matings. It is alleged that about 15 per cent of the present generation produces 50 per cent of the next generation, and that this producing minority represents the poorer, lower or eugenically inferior elements of the population. Without conceding that this estimate is strictly correct, it is within the bounds of truth to say that all enlightened students of race betterment are agreed that palpable degenerates should not be permitted to marry. But we are not all agreed that the eugenically unfit can be diagnosed infallibly, or even to a measurably satisfactory extent. So far as relates to mental degenerates there are now in general use two methods of study by which it is hoped to make eugenic diagnoses:?first, the hereditary study of ancestral strains by the methods of heredity research; and secondly, the psychological observation or testing or study of the level of intelligence and of mental deviation.
Present day heredity studies are usually conducted with either a distinct Galtonian or Mendelian bias. In the United States the Mendelian bias is unmistakable. Judging by the recent publications of various American Mendelians, feeblemindedness, insanity, epilepsy and other anti-eugenic mental conditions can now be subsumed under the Mendelian formula, and almost unerringly explained by it. Some American Mendelians indeed go as far as to assert that, given certain conditions of ancestral strains, they can now forecast with almost mathematical precision the relative incidence in future generations of normality, feeblemindedness, insanity, or epilepsy. To these and other claims of the American school of Mendelian enthusiasts, I am still compelled to maintain the attitude of the discreet Missourian. I shall in no way here concern myself with pointing out the confusing, blundering, slipshod, inaccurate, unscientific ways in which many? fortunately not all?of the published heredity charts have been worked up and interpreted. I need merely refer to the recent exhaustive analysis and annihilating criticism of Heron2 which, unless refuted by other means than innuendo, rhetoric or mere denial, invalidate the results of many of the American investigations of feeblemindedness, epilepsy, and insanity. While I cannot quite subscribe to all of Heron’s conclusions, my observations of the work of heredity field-workers and my own study of the heredity of the mentally abnormal cases coming to my clinic, have convinced me that the prevailing methods of gathering heredity data have been no less unscientific than Heron has found to be the methods of tabulating the data and interpreting the charts. It should be emphasized that * David Heron. Mendelism and the Problem of Mental Defect. I. A Criticism of Recent American Work. Eugenics Laboratory Publications, London, 1913. the accurate scientific determination of the etiological heredity factors of mental abnormalities is frequently just as difficult, abstruse, and technical as the scientific differential diagnosis of bodily diseases or mental deviations. The one essential preliminary to making reliable hereditary, no less than medical or psychological, diagnoses is prolonged training in the scientific methods of collecting, examining, analyzing, and interpreting facts?in other words, a thorough grounding in the canons of scientific induction. Many heredity charts are based on the sheerest guess work, on data gathered by persons quite lacking in scientific discrimination and quite unskilled in the art of hereditary, psychological, or medical diagnosis. It is one thing to send out field workers, usually teachers, nurses, and social workers who are novices in the methodology of scientific research, to interview parents, relatives, friends, enemies, clergymen, physicians, and court officers with regard to the mental condition of the contemporary or ancestral relatives of the cases under investigation; and then on the basis of the field-workers’ reports, have someone else who has probably never seen or examined a single relative, construct awe-inspiring heredity charts, with a multitude of squares and circles, definitely and most minutely labeled and evaluated. But it is quite a different matter to assume that because certain symbols have been stamped on a piece of cloth, the correctness of the marking or the accuracy of the hearsay or snapshot estimations and diagnoses has thereby been conclusively established. Once the accuracy of the heredity diagnosis has been established, it is quite a different thing to assume that the condition of feeblemindedness or insanity found in a given forebear is the all-sufficient or determining cause of the feeblemindedness or insanity found in the “tainted’’ offspring. Unfortunately this assumption is usually made by the average field-worker without further ado. The presence of feeblemindedness in the direct or indirect ancestral lines is regarded as the sufficient explanation of the feeblemindedness found in the descendants. This reasoning is based on the fallacious assumption that what goes before must necessarily be the cause of that which follows, that when an antecedent resembles a consequent it must be the producing agent of the consequent, although, as is well known, there may be no causal relation whatever between sequential events. The fact is, there is frequently a plurality of causes responsible for any case of biologic variation, and no one but an experienced expert?and quite frequently not even the expert? will be able to determine indubitably which is cause or which is accidental antecedent or accompaniment. The apparent accuracy of many heredity charts is wholly deceptive and misleading. In my own clinic, I am constantly confronted with such cases as this: a feebleminded child with diphtheria or typhoid at, say, three, and with a grandfather or uncle or cousin who was alleged to be “feebleminded,” “queer” or “peculiar”. What is the prime etiological factor here? How should such a case be charted? As inherited, or acquired feeblemindedness? There is no unequivocal reply. Let us disabuse ourselves of the smug belief that heredity diagnoses are so easy that they can be made by anyone, or that we have located the causative agent when we have put a certain square or circle upon a chart. There are hundreds of thousands of mentally abnormal individuals in whom the etiological factors lie concealed in deepest obscurity. It is the duty of every sincere eugenist relentlessly to combat careless or unscientific heredity work wherever found?while it is also his duty to commend the really good work done?because it is being accepted at its face value by the uncritical, and because it is therefore leading to the enactment of precipitate legislation which in the end must bring discredit upon the science of eugenics.
The absurd belief that any so-called heredity field worker is competent to make scientific diagnoses after taking short courses on heredity field work, is akin to the dogma which has been promulgated in certain quarters, namely, that Binet testers are thoroughly qualified to make reliable psychological diagnoses of cases after taking a summer course on subnormal children and mental tests. This doctrine is responsible for the claims, made on the alleged basis of scientific tests (Binet tests by amateurs),3 that over 2 per cent of all elementary school children, that from 50 to 100 per cent (and nearer 100 per cent than 50 per cent) of voluntary prostitutes and juvenile delinquents and rather more than less than 50 per cent of adult criminals, are feebleminded. As a matter of fact, there is no psychic measuring rod in existence by which we can automatically or mechanically identify accurately high grade mental degenerates or defectives, by which we can unerringly distinguish between high grade feebleminded and backward cases, and by which we can determine whether the abnormality in high grade defectives is or is not anti-eugenic in character.4 But it is precisely the eugenically unfit persons who grade nearest the standard of mental normality whom it is most necessary to identify, because these individuals are the most numerous, they are the most prolific breeders and constitute the gravest social and moral offenders. It is quite easy to identify the lowest ‘ For a discussion of what is meant by amateurs in this field of work, see “The Mental Health of the School Child.” New Haven, Yale University Press, 1914.
In spite of the fact that this statement has been made on the best evidence a number of times
during the last few years we still (December, 1913) read pronouncements by reputable physicians and psychologists like the following: “We recognize as feebleminded anyone who doesn’t pass the twelve-year Binet test.” Think of the army of high school and even college students who would be condemned to feeblemindedness on the basis of this arbitrary dictum! grades of defectives by existing methods, but they are usually sterile and hence set no eugenic problem. Not only so; it is quite probable that many normal persons are carriers of transmissible degenerate strains, but there is at present no infallible method, whether psychological, hereditary, or medical, by which these individuals can be identified. Moreover, germ plasm which originally was eugenically fit probably may become impaired by external causes, so that dominants may be transformed into recessives, thus inverting the Mendelian laws. Even if Mendelism can be shown to apply, so complex is the mechanism of heredity on Mendelian principles that with only ten pairs of characteristics it is possible to form upward of 1000 kinds of germinal cells in one million different combinations. Therefore, while we all believe in the dominant force of heredity and in the teachings of negative eugenics so far as concerns the prevention of palpably degenerate matings, the ordinary field worker and the ordinary mental tester are frequently utterly unable reliably to differentiate between the eugenically fit and unfit, and even the scientific experts in heredo-biology and heredo-psychology are quite unable infallibly to identify all the high grade cases of eugenic unfitness or all cases of pure simplex or duplex normal stock. Nor do I know that there is any experimental or scientific warrant for the dictum that “weakness should marry strength.” In the first place, I do not know that there is any authority who can make out an infallible chart of the eugenically weak or the eugenically strong traits which exist in the parties of a given marriage union, whether normal or high grade defective. In the second place, I know of no one who can guarantee that when weakness marries strength, the progeny will all be normal or that the weak traits will not eventually crop out as recessives in later generations.
The cautions which I have sounded against slipshod hereditary and psychological diagnoses may be reinforced by reference to a recent clinic case:
A young man of Russian-German descent, 21 years 1 month old at the time of the examination in January, 1914, the fourth of six children, born in Pennsylvania, removed to Germany at the age of six, remained there eleven years, returning to America four years ago.
The history of the case indicates that he was born on time, but the birth conditions were difficult, requiring an instrumental delivery after 48 hours of labor; that animation had to be established by slapping; that the mother was very nervous during gestation; that the child was very puny for some time after birth; that he was bottlefed; that he was unable for some time to assimilate various artificial foods, but finally began to grow rapidly on Mellin’s Food and Swiss condensed milk.
At four he had whooping-cough, and hurt his head severely by running against a hinge on a door, which rendered him unconscious for a while, but he apparently recovered. At five he fell into a lime kiln, but only his hands were slightly burned before he was rescued. Somewhat later, after his removal to Germany, his caretaker reported that he had had a strange spell: crying out in his sleep, kicking, and jumping out of bed in a frenzy of excitement, although apparently unconscious throughout the entire performance. Spells of crying and kicking, without any attempt to wander about in the room, recurred several times during the following two weeks. (The boy reported that he had had an epileptic seizure at a much later date.) A short time after these occurrences he was vaccinated. After the operation his arm swelled greatly, and became discolored with dark blue spots. He was obliged to have it bandaged and supported on a table for a week. At seven he had measles; and at fourteen it was believed that he practiced self-abuse for a time. As a child and a youth he was more or less queer: he never took any interest in games or sports, and never had any intimate boyhood friendships. He had a continuous record of outbursts, beating and slapping his sisters, engaging in fights and brawls with comrades and teachers, of lying and stealing, and of bragging and boasting. His relations with his mother were almost always strained. His school history is one record of incompatibility and maladjustment. He entered a kindergarten in America at about six; the next year (in 1898) he removed to Germany and entered a second kindergarten, from which he was dismissed because of unruly conduct. In 1899 he had a private tutor for about a year. In 1900 he was placed^in a boarding school, but was removed because he “could not fit in with the other pupils,” and was kept at home for a while. In 1902, in a boys’ boarding school, he proved to be stubborn, wilful, cowardly, morally obtuse, disobedient and disrespectful to teachers and elders. In 1903 he was permitted to remain less than a year in a higher school for a small group of select boys because of his thieving habits. He explained that he ” stole because the others stole from me.” In 1903 and 1904 he was placed in another private school. Here he did his best work because he became attached to one of the instructors, apparently because the latter gave him money, bought him toys and candy, and aided him unfairly in his lessons. At this time he manifested a desire to become a chauffeur, and rebelled against the scholastic and religious training. His parents suspected that there were secret understandings or clandestine relations between the instructor and the boy, and therefore removed him to a private school of the aristocracy, where most of the teachers were young students. Here he was always getting into trouble and indulging in fist fights. He knocked a young teacher flat, because he claimed he did him an injustice. The director then dismissed him on the ground that he was not normal. He was returned home, and spent the summer of the same year (1906) in an informal vacation school. Here he led a free, natural life, without espionage, studying nature. Here he also had his first romance. The young girl proposed that he kiss her, but he did not do so because, as he alleged, he “did not know just how.” This youthful romance upset the routine of his life for some time: he could neither study nor work, for “he was always thinking of her.”
While staying at home he was constantly clashing with his mother. She punished him severely (he was “beaten until black and blue”), taunted him for his failures, nagged at him and forced him to apply himself to intellectual pursuits. He was so nervous and irritable that he could not endure his sister’s piano practice, and accordingly started to demolish the instrument with a hammer. He would waylay the postman to see if any school circulars were sent to his parents. He ran away, and when the police were notified he tried to kill himself by hanging by a cord attached to a gas fixture. He was sent to an asylum for the insane, where he remained for six weeks, and where he was examined by three physicians, who pronounced him “not demented” but deficient and in need of protective oversight, and who counselled him to control his temper.
In 1909 he was sent to a preparatory day school, but was unable to make his examinations, “because he could not concentrate.” In spite of this uninterrupted record of maladaptation in various school environments, the mother reports that she did not see anything wrong or abnormal with him until the age of fourteen: the father, however, reports that he was not normal from the age of eight. He is said to have completed higher mathematics and ancient and modern history, and to read English, German and French, although he has “no aptitude for languages.” At this time he again expressed a desire to become a chauffeur.
In 1910 he returned with his parents to America. His first exploit here was to run away from a boarding-house in which he had been placed under kindly supervision. For some time he led the life of a vagabond, sleeping in parks and out-houses, and getting his food no one knew where. He broke into a house in New Jersey and was sent to jail. On his release he joined “robber bands” and came in contact with immoral women. He was finally taken in hand by the Salvation Army, in New York City, and was sent to a half-brother, a landscape architect, in Minneapolis, who found a place for him as a clerk; but one day he struck his brother’s wife because she would not let him wear her husband’s new coat. He was thereupon placed in a private boarding-house, but soon enlisted in the navy. At the Norfolk Training School he got along fairly well until he began to steal?”but not,” as he affirmed, “before the others stole from me.” Here he was court-martialed several times for insubordination. On the battle-ship Minnesota he alleges that he was constantly teased and bullied by the sailors. On ship he was in disgrace most of the time. His entire income disappeared in fines. He talked freely of his “scrapes” to the social worker, of sailors clubbing officers, of his getting possession of money from drunken sailors, of his attempt to desert with another man at Vera Cruz. Finally he knocked a lad down because, as he says, “he stole from me,” was court-martialed and dishonorably discharged in July, 1913?after about two and a half years of service. The boys on the battle-ship took up a collection and sent him to his parents.
His record since his return home has been one of insolence, disobedience, defiance, unemployment, and loafing. He left his first place, where he was taking care of a garden and a horse, because he was once asked to bring someone home at 11:00 P. M. After a week at home loafing and job-hunting he secured a job in a club-house which he held for three weeks. This was followed by a week’s layoff at home. Then he worked one week each in two hotels. After holding another job for about a week he returned home in September. Then he disappeared for about five weeks. On his return he said he had been taking care of chickens in a country place. Here he said two men threatened to shoot him. He now took a correspondence course in railroad engineering, but made no progress because he “failed to apply himself.” Then he wanted to enter an automobile school, but clashed with his mother, became insolent, struck her in the face (she spat on him) and knocked his father down when he interfered. For their safety he was arrested on November 6th and incarcerated in the city jail for three weeks. He was released on parole for one year, with instructions to stay away from his parents. His parents supported him in a boarding-house in another part of the city. His mother then arranged to have him enter an automobile school. He backed out at first, finally entered the school, but at the end of the first day came home drunk, furiously angry because he had been allowed only $5.00 instead of $8.00 a week for his lodging and board, and threatened to kill his father.
At this point the aid of the psychological clinic was invoked. The anthropometric examination showed that he was under-developed, but only to a slight extent, in standing and sitting (particularly) stature, weight, strength of grip, and in lung capacity. He had a number of carious teeth. On the mental side, however, he was very considerably retarded. His rating by the Binet tests was 10.6. His memory span was decidedly limited. In the motor speed test (form board) he measured twelve years. He did the simpler of the Healy puzzle tests but failed on the more difficult one. He failed on the clock-hand test (age XV), was unable to reproduce the central thought of a passage read to him (adult test), but just about passed the president-king test (age XV). To the question: If a horse weighs 1400 lbs. when standing on four legs, how much will he weigh when standing on three? he replied: “I cannot tell you. There is more weight in certain parts.” To the question: If three men standing on top of a high tower can see six miles, how far can each one see? he replied: “Two miles.” He said he did not smoke or drink, but late reports indicate that he does both. His chief defects, as observed by the examiner, were inability to concentrate or persevere, unwillingness to make serious effort or to work at his maximal potential, an all-too-ready tendency to be content with saying “I don’t know,” or “I didn’t study that up,” or to view the performance with supercilious scorn. He frequently intimated that he did not need to attempt answers if he did not want to, and that he did not see how the testing was going to help him get a job. He had been induced to come to the clinic in order that he might have his vocational fitness determined. His bearing throughout was more or less arrogant, he had an exaggerated opinion of his own worth, said that he would not under any circumstances take a position in a factory or mill (it was beneath his dignity), and that his only interest was in the automobile business. He seemed to feel that his parents were wealthy, and ought to support him in luxury; he entertained a warped attitude toward life; seemed to be lacking in feeling dynamic; and manifested evident emotional instability and abnormality of disposition. He complained that he had never been given a chance to make good, and did not leave the clinic in the best spirit. After the examination he called upon the social worker again and again, although not always in a gentlemanly way, pleading with her to aid him; but he made it clear that he would not take any job that did not happen to appeal to his fancy. Finally, in order to guarantee him a chance at his frequently expressed vocational choice, the social worker managed to secure funds from the Association for the Improvement of the Poor with which to provide him with a two weeks’ course in an automobile school. Money for board and lodg130 THE PSYCHOLOGICAL CLINIC. ing was supplied by the parents. It was impressed upon his mind that he would now get the chance he had been seeking, but if he did not stick to the work and make good the clinic could do nothing further for him. He seemed delighted over the prospect, and expressed his gratitude. But he remained in the school only one and a half days, and during this time he learned about as much as the ordinary student learns in two hours. When seen by the social worker his feeling of gratitude had entirely evaporated. He said he had not wanted to take the course in the first place?that the social worker had coaxed him to take it; that he saw nothing in it for him; and offered as a pretext for his intention to quit, the fact that his tuition had not been paid, although he had been assured that provision had been made to take care of his expenses. He was told that he could expect no further financial aid from the clinic or from his home, and that he would now have to shift for himself. After this he continued to call on the social worker almost daily, sometimes with a rude, surly manner, sometimes in an apologetic mood, sometimes comporting himself like a well-bred gentleman, sometimes leaving the house without bidding good-night. He made frequent appeals for another chance in another automobile school. He likewise continued to call at his parents’ home, but was not always able to gain admittance. February 3, 1914, he forced his entrance through a window and stole a concert ticket, and on February 5th, on the advice of the clinic, he was arrested on the charge of incorrigibility, with a view to having him incarcerated in the state reformatory for industrial training under proper restraint. But since the judge failed to commit him, he was persuaded to spend a week in the observation ward of a hospital, and as a result of this further study he was committed on March 3d to an institution for the mentally disordered. On March 12th he had a disagreement with a patient, put a towel around his neck and attempted to choke him. Since the time he was disciplined for this offense his conduct has been fairly satisfactory.
I have given this history in some detail because this boy is a fair representative of a large army of abnormals who are not always recognized as sufficiently abnormal to require special educational care or social supervision, although they are an actual or potential menace in one way or another to society; who are usually allowed to drift along until they become confirmed social parasites, vagabonds or criminals, and for whose training and restraint society has thus far largely failed to provide the right kind of institution.
But now to the two points which I desired to illustrate by means of this case history. In the first place, is this boy feebleminded? Undoubtedly so, if judged by a Binet diagnosis by a Binet tester, for he measured only 10.6 years, thus being retarded about 10.5 years. But equally certainly not, if judged by the entire symptom-complex. His inferiority in the intelligence tests is not so much due to sheer lack of intelligence as to his abnormal attitudes, his lack of feeling dynamic or his excessive emotivity, his incapacity or unwillingness to apply himself. He belongs to that large army of borderland cases who are not quite feebleminded nor yet palpably insane, but which make up the group of “unstables” who occupy the twilight zone between the distinctly amented on the one hand, and the mentally disordered on the other hand?a group of moral and mental inferiors, sometimes manifesting traits of high grade moral imbecility (or heboidophrenia), and sometimes presenting the aspects of constitutional inferiority, or psychopathic constitution, or masked or psychic epilepsy. These twilight states between sanity and insanity and between subnormality {i.e. feeblemindedness) and normality cannot be diagnosticated by mere schemes of intelligence tests. Incidentally it may be said that these types of abnormal individuals should be diagnosed much earlier in their careers than is usually done. They should be picked out in the elementary and secondary schools, and be subjected to appropriate educational and physical treatment.
In the second place, is the boy eugenically unfit? Certainly he ought not to marry as long as he remains industrially incompetent, as long as his perspective of life is distorted, and as long as he manifests pronounced emotional instability and violent outbursts of temper. But is he unfit for eugenic procreation? We are in no position to dogmatize about this. The ancestral history is largely negative in respect to neuropathic taint. One paternal aunt died of tuberculosis, two paternal uncles died of heart disease, and one maternal brother died insane. The latter is said to have been perfectly normal until he received a severe blow on the head from a falling saddle. After recovery a second violent attack occurred during his honeymoon voyage across the ocean and was said to have been brought on by seasickness. Shall we say that the taint of insanity was inherent, and that the accident merely removed the barriers? Or shall we say that the disease was of accidental origin? There is no conclusive evidence for either view.
Coming to the boy’s immediate family, we find that the oldest child, a sister, was prematurely born dead. The mother attributes the fatal prematurity to a severe fright caused by a fire which broke out in the room she was occupying. The second child died at the age of one from sunstroke. Her head was left exposed to a hot sun by a careless attendant. The other children are apparently normal except a sister attending a boarding school, who is said to be capricious, high tempered, indiscreet, and a flirt. She likes the sensational, and has kleptomaniac tendencies. The father is a well-educated, cultured gentleman who has held responsible government and ecclesiastical positions here and abroad, while the mother also possesses a good education, having at one time taught in a high school. However, she is said to be very high spirited, and is subject to occasional violent outbursts of temper which often culminate in a fainting spell with loss of consciousness and stiffening of the limbs instead of convulsive movements. The husband reports that her hysterical manifestations date back at least to the time of their marriage. On her way to America before marriage she was in a shipwreck. From this experience she suffered a severe nervous shock. Shall we say that the abnormal manifestations of the mother are hereditary, or that they are due to the severe nervous shocks caused by fright experienced in a shipwreck and in a fire? An unequivocal answer is scarcely possible. Shall we say that the abnormalities of the son are due to a neuropathic taint transmitted by the mother, or that it is due to difficult birth, to the head blow received at the age of five, to the punishment he received from his mother, and to the influence of her abnormal behavior, or to a combination of environmental and hereditary factors? Is it not clear that when the factors are so complicated as in this case?and this case is typical of thousands of others?we are not solving the problem by stamping an heredity symbol on a chart, and assuming the correctness of the symbol. Who is ready to affirm that this boy, provided he could be trained to live a normal life and to marry a normal girl, would be unfitted for eugenic procreation? Who is able to demonstrate that he would or would not be so fitted? The fact is, eugenic diagnosis is not far enough advanced to permit of unequivocal answers in thousands of cases difficult to diagnose. While it is important, therefore, that we recognize the difficulties involved in the correct diagnosis of anti-eugenic stocks, it must not be forgotten that the most important factor in eugenical hygiene is the prevention of the propagation of inherently, that is hereditarily, weakened, defective, and degenerate strains.
2. Society should adopt measures to prevent the syphilization of the unborn child. Numerous investigations have been made to determine the influence of parental syphilis upon the foetal and post-foetal child, but the results have often led to disagreement and controversy. That parental syphilis is at least one of the causes of the abortion, miscarriage, or early mortality of many both eugenically fit and unfit infants seems to me to be strongly indicated by the available evidence. The importance of this conclusion, if true, may be judged from the following figures:?
According to the best estimates, from one-fifth to one-fourth of all the children born die before the age of one year, and one-third before the age of five years. At least one-third of infant mortality is due to prenatal causes, to prematurity and still-births. If the prematures (all infants weighing less than five pounds) weigh only four pounds or less, 98 per cent of them die, unless they are properly cared for in incubator hospitals (in such hospitals in France the mortality rate has been reduced to from 15 to 25 per cent), while if they weigh somewhat over four pounds the mortality varies from 15 per cent for breast fed to 41 per cent for bottle fed infants. Fully one-half of the deaths within the first month of life in New York City in 1911 to 1912 were due to prematurity or congenital weakness (Henry Koplik), while 80 per cent of the deaths in the first week in the state of Michigan from 1910 to 1912 were due to prematurity, deficient vitality, and congenital malformations. The percentage of still-born in Germany in 1906 amounted to 3 per cent of all births, and in New York City in 1911 and 1912, 5 per cent (Henry Koplik). The proportion of prematures, still-births and births which barely escape these conditions, varies greatly in different localities but it is thought to be increasing in all civilized countries (Kaye). In certain districts in England the number of still-births increased from 47.3 per 1000 in 1901 to 56.3 per 1000 in 1905.
Now, since prenatal syphilis may be transmitted with full virulence to the offspring and since it is almost certainly transmitted when the mother suffers from the secondary symptoms, it would be strange if it did not somehow affect the causation of prematurity, still-birth at term, congenital debility and early infant mortality. Positive studies indicate that it exerts a very perceptible influence. One authority finds that when the father is infected, nearly 40 per cent of the babies perish, while the mortality when the mother is also infected, ranges between 60 and 80 per cent. Onethird die within the first six months, while the chance of dying under fifteen is seven times greater for the syphilitic than for the nonsyphilitic (Prince Morrow). Of 206 syphilitic pregnancies in France, abortions occurred in 36, still-births in 8, and deaths soon after birth in 69, giving a mortality of 55 per cent. Fifty of the living children were syphilitic, while only 43 were in good health (Jullien). In another group of 154 syphilitic pregnancies, there were 120 abortions or still-births, 26 deaths soon after birth and only 8 survivals (Le Pileur). In the Foundling Asylum in Moscow, the mortality among 2038 syphilitic infants amounted to 70 per cent. One authority maintains that the number of still-births among illegitimate children amounts to 50 per cent more than among those born in wedlock, but another writer (Weinberg) states that the difference amounts to only one per cent. The latter investigator, however, admits that the illegitimates suffer from congenital debility?undoubtedly due in part to syphilis infection?and are thus more predisposed to morbidity, inanition, atrophy, and gastrointestinal disorders which lead to death later. Moreover, it is to be remembered that there are thousands of abortions of illegitimates that never become a matter of record. It is probably true that most congenitally syphilitic children are healthy at birth and do not show the symptoms until between the first and sixth week. Nevertheless, it is more difficult to cure infantile than adult syphilis and more difficult to cure the congenital than the acquired type. Indeed, debilitated children, whatever the cause of the debility, offer little hope for progressive amelioration. Thus the death reductions in New York City during the last thirty years amounted to 70 per cent for contagious diseases, 38 per cent for respiratory diseases, 37 per cent for diarrhea cases, but only 4 per cent for congenital debility cases. The susceptibility of syphilitic children to the following diseases is said to be greater than for non-syphilitic children by the ratios indicated:?
Typhoid . nearly 2| times Scarlet Fever ” 3 ” Measles ” 3| ” Diphtheria ” 7 ” Thirty per cent of the cases with tubercular hip disease; 40 per cent of the cases with gastroenteritis, and 60 per cent of the cases with tubercular meningitis, are congenital syphilitics (Prince Morrow). Congenital syphilis lessens both the constitutional and local resistance and leaves many, if not most, of the surviving children delicate, thin, poorly nourished, suffering from bone disorders and malformations, and with delayed development of dentition, speech, walking, physical growth, and puberty. The arrest at times amounts to actual infantilism. At three or four the child may be without teeth, and at ten or eleven he may have the physical growth of the six year old. In intelligence or morality he sometimes becomes imbecilic or insane, or a moral degenerate or pervert. Although the evidence is not conclusive, congenital syphilis is probably one of the causes of insanity (of 25 per cent of inherited insanity, say some) and feeblemindedness. One authority found a syphilitic family history in 80 per cent of 40 carefully investigated cases of juvenile dementia (“juvenile general paralysis”?F. W. Mott). A careful study of the family histories of 90 feebleminded patients over sixteen years of age showed that one or the other of the parents were syphilitic in 14.4 per cent of the cases (E. B. Sherlock). Likewise a positive Wasserman was secured in 15.4 per cent of 330 idiots, although only 3 per cent could be classed as syphilitic suspects (H. R. Dean). On the other hand, in an investigation of 2400 pauper idiots in London, clear evidences of congenital syphilis were found in only 1.17 per cent of the cases, although it was suspected in a larger number (G. E. Shuttleworth and F. Beach). Other investigators give the percentage as 2 (Langdon Down, Kerlin) and 2.5 (A. F. Tredgold). There are, of course, many cases of congenital syphilis which can be recognized only with difficulty, even with the aid of refined laboratory technique. Were these cases added the percentage would be somewhat increased. Nevertheless, parental syphilis is, I believe, only a minor cause of actual feeblemindedness; but this question cannot be satisfactorily settled until we have gathered extensive parallel data for normal cases. On the other hand, gonococcus infection is probably the chief cause of sterility, and of 75 per cent of infant blindness. The sterility and the blindness probably affect the fit as well as the unfit stock in equal measure.
Venereal diseases thus constitute one of the arch destroyers of human stock which may be inherently noble and in every way eugenically fit. The racial injury is just as positive even if the hereditary qualities are but slightly affected. One of the important eugenic measures, therefore, is the desyphilization of the human race. The campaign against the black plague would be easy if human beings could be persuaded to live virtuous lives. But many persons cannot be persuaded thus to live by the logic of fact or by appeal to conscience and must therefore be brought to bay, so far as possible, through the instrumentality of prohibitive legislation. The fight must go on until laws have been placed on the statute books everywhere requiring the registration of infected persons, together with the prohibition of marriage or intercourse between such persons until they are cured. If this does not prove effective, we may, for the sake of the preservation of racial purity, be forced to follow the example of the army surgeons in various civilized countries who compel soldiers who will not live within the moral law to use prophylactics. This practice may not conform to our traditional principles of morality, but it seems to me that humanity is in the process of evolving a new ethical code based upon eugenical imperatives. Any measure will merit the eugenical sanction if the ultimate result is the permanent improvement or preservation of the human stock. Is not the enforced use of venereal prophylactics better than the wholesale slaughter of potentially robust innocents and the possible pollution of the race stream?
3. The procreation of mentally and physically robust offspring is endangered by the alcoholization of the parents and of the embryonic and foetal life. Here again the evidence is not conclusive. The investigators of the Francis Galton Laboratory for National Eugenics have come to two important conclusions: first, that parental alcoholism is almost a negligible factor in eugenic procreation; and, secondly, that practically all of the investigations save their own are irrelevant or worthless. While admitting that the investigations of human alcoholism rather suggest than indubitably demonstrate that alcohol is a race poison, it seems to me that many of the conclusions based on animal experimentation amount to positive demonstration, and that the results thus reached can be applied analogically to the question of human heredity. Most suggestive, as indicating the possibility of injuring the reproductive and somatic cells of the offspring by parental indulgence in alcohol are certain experiments on normal guinea-pigs which were obliged to inhale controlled quantities of the fumes of alcohol or ether for six days weekly during extensive periods of time, amounting to three years in some cases. In order to secure normal stock for this experiment pigs were first tested by normal matings. The treatment did not affect the health or development of the pigs. The alcoholized males and females, as well as the unalcoholized descendants of alcoholized parentage, were mated with both normal and alcoholized stock.
The results showed that “an alcoholized male guinea-pig almost invariably begets defective offspring even when mated with a vigorous normal female,” and that the effects were nearly as bad on the second generation (Stockard). Of 103 full term matings 42 per cent gave negative results or early abortions, 13.5 per cent gave still-born litters, 45 per cent resulted in living litters, containing 89 young of whom only 58 per cent survived. On the other hand, the 35 control normal matings gave 94 per cent of full term litters, about | per cent of still-born litters, 91.5 per cent of living litters, containing 60 young of whom 93 per cent survived. The proportion of alcohol in the testes and in the ovary compared with the proportion in the blood has been found to be as 2 to 3 and 3 to 5, respectively (Nicloux and Renauet). Alcohol, therefore, apparently can act deleteriously directly on the spermatozoa and eggs before or during the period of impregnation.
Studies of human alcoholism indicate that alcohol produces almost instantaneous changes in the constituents of the blood (Richardson), lessening the normal resistance of the red corpuscles (Laitenen) and producing temporary paralysis of the phagocytes (Metchnikoff), while in women it may also temporarily paralyze the ovum and produce ovarian degeneration (Lancereaux). In the male alcohol has similar effects on the blood and the spermatozoa, and leads to testicular degeneration or atrophy. In 39 chronic alcoholics atrophy of the testicular tissue was found in 37 cases (Weichselbaum), while azoospermia was found in 60 per cent of autopsied alcoholics (Simonds).
If the above conclusions are correct, alcoholic indulgence before and during conception and maternal indulgence during pregnancy should be especially sinister for the offspring. The embryo of a drunken mother is like another drunkard, for both are nourished by the same blood stream. When the mother’s blood is saturated with alcoholic poison it is improbable that the embryo will be normally nourished. So well known is the fact of alcoholic arrest, that some expectant mothers in Switzerland deliberately use alcohol in order to lessen the pains of childbirth. Although alcoholized infants may be bom healthy looking, they tend to manifest diminished power of growth. The difference between the weights of babies of drinkers and abstainers has amounted to 3.6 per cent and 4.4 per cent for boys and girls, respectively, while at 7 and 8 months the corresponding figures amounted to 2.2 per cent and 7.2 per cent.
That there is a causal relation between alcoholism and sterility, abortion, prematurity, still-birth, inability to lactate, infant mortality and degeneracy is indicated by numerous studies. Of 107 English women investigated who died of alcoholism before the age of 29, 8 bore no children, while 99 bore only 6 delicate and deformed children. But twenty-nine vigorous children were born to these mothers before they became alcoholic (Lonnet). A similar inquiry based on thirteen inebriate women showed that the children born before the onset of the inebriety were normal, while those born after its onset were ‘weak-minded’ (R. J. Paris). Of the 600 infants born of 120 female inebriates in whom the factors making for degeneracy (such as tuberculosis, nervousness, syphilis) were eliminated except alcoholism, 55.8 per cent were still-born or died before the age of two, mostly of convulsions, and the mortality was 2times greater for these infants than for infants of sober mothers (W. C. Sullivan). During the period from 1874 to 1904 the stillbirths from each 1000 conceptions in France amounted to 5.36 for certain absinthe districts (southern part), 4.48 for certain alcoholic districts, but only 3.62 for certain non-alcoholic districts (Henri Schmidt). oontobi)
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