But there are other cla.s.ses on which it can act with safety as well as profit, and one of these is made up by the germinally insane. According to the census of 1910, there are 187,791 insane in inst.i.tutions in the United States; there are also a certain number outside of inst.i.tutions, as to whom information can not easily be obtained. The number in the hospitals represented a ratio of 204.3 per 100,000 of the general population. In 1880, when the enumeration of insane was particularly complete, a total of 91,959 was reported--a ratio of 188.3 per 100,000 of the total population at that time. This apparent increase of insanity has been subjected to much a.n.a.lysis, and it is admitted that part of it can be explained away. People are living longer now than formerly, and as insanity is primarily a disease of old age, the number of insane is thus increased. Better means of diagnosis are undoubtedly responsible for some of the apparent increase. But when every conceivable allowance is made, there yet remains ground for belief that the proportion of insane persons in the population is increasing each year. This is partly due to immigration, as is indicated by the immense and constantly increasing insane population of the state of New York, where most immigrants land. In some cases, people who actually show some form of insanity may slip past the examiners; in the bulk of cases, probably, an individual is adapted to leading a normal life in his native environment, but transfer to the more strenuous environment of an American city proves to be too much for his nervous organization. The general flow of population from the country to large cities has a similar effect in increasing the number of insane.
But when all is said, the fact remains that there are several hundred thousand insane persons in the United States, many of whom are not prevented from reproducing their kind, and that by this failure to restrain them society is putting a heavy burden of expense, unhappiness and a fearful dysgenic drag on coming generations.
The word "insanity," as is frequently objected, means little or nothing from a biological point of view--it is a sort of catch-all to describe many different kinds of nervous disturbance. No one can properly be made the subject of restrictive measures for eugenic reasons, merely because he is said to be "insane." It would be wholly immoral so to treat, for example, a man or woman who was suffering from the form of insanity which sometimes follows typhoid fever. But there are certain forms of mental disease, generally lumped under the term "insanity," which indicate a hereditarily disordered nervous organization, and individuals suffering from one of these diseases should certainly not be given any chance to perpetuate their insanity to posterity. Two types of insanity are now recognized as especially transmissible:--dementia prec.o.x, a sort of precocious old age, in which the patient (generally young) sinks into a lethargy from which he rarely recovers; and manic-depressive insanity, an over-excitable condition, in which there are occasional very erratic motor discharges, alternating with periods of depression. Const.i.tutional psychopathic inferiority, which means a lack of emotional adaptability, usually shows in the family history. The common type of insanity which is characterized by mild hallucinations is of less concern from a eugenic point of view.
In general, the insane are more adequately restricted than any other dysgenic cla.s.s in the community; not because the community recognizes the disadvantage of letting them reproduce their kind, but because there is a general fear of them, which leads to their strict segregation; and because an insane person is not considered legally competent to enter into a marriage contract. In general, the present isolation of the s.e.xes at inst.i.tutions for the insane is satisfactory; the princ.i.p.al problem which insanity presents lies in the fact that an individual is frequently committed to a hospital or asylum, kept there a few years until apparently cured, and then discharged; whereupon he returns to his family to beget offspring that are fairly likely to become insane at some period in their lives. Every case of insanity should be accompanied by an investigation of the patient"s ancestry, and if there is unmistakable evidence of serious neuropathic taint, such steps as are necessary should be taken to prevent that individual from becoming a parent at any time.
The hereditary nature of most types of epilepsy is generally held to be established,[81] and restrictive measures should be used to prevent the increase of the number of epileptics in the country. It has been calculated that the number of epileptics in the state of New Jersey, where the most careful investigation of the problem has been made, will double every 30 years under present conditions.
In dealing with both insanity and epilepsy, the eugenist faces the difficulty that occasionally people of the very kind whose production he most wishes to see encouraged--real geniuses--may carry the taint. The exaggerated claims of the Italian anthropologist C. Lombroso and his school, in regard to the close relation between genius and insanity, have been largely disproved; yet there remains little doubt that the two sometimes do go together; and such supposed epileptics as Mohammed, Julius Caesar, and Napoleon will at once be called to mind. To apply sweeping restrictive measures would prevent the production of a certain amount of talent of a very high order. The situation can only be met by dealing with every case on its individual merits, and recognizing that it is to the interests of society to allow some very superior individuals to reproduce, even though part of their posterity may be mentally or physically somewhat unsound.
A field survey in two typical counties of Indiana (1916) showed that there were 1.8 recognizable epileptics per thousand population. If these figures should approximately hold good for the entire United States, the number of epileptics can hardly be put at less than 150,000.
Some of them are not anti-social, but many of them are.
Feeble-mindedness and insanity were also included in the census mentioned, and the total number of the three kinds of defectives was found to be 19 per thousand in one county and 11.4 per thousand in the other. This would suggest a total for the entire United States of something like one million.
In addition to these well-recognized cla.s.ses of hopelessly defective, there is a cla.s.s of defectives embracing very diverse characteristics, which demands careful consideration. In it are those who are germinally physical weaklings or deformed, those born with a hereditary diathesis or predisposition toward some serious disease (e.g., Huntington"s Ch.o.r.ea), and those with some gross defect of the organs of special sense. The germinally blind and deaf will particularly occur to mind in the latter connection. Cases falling in this category demand careful scrutiny by biological and psychological experts, before any action can be taken in the interest of eugenics; in many cases the affected individual himself will be glad to cooperate with society by remaining celibate or by the practice of birth control, to the end of leaving no offspring to bear what he has borne.
Finally, we come to the great cla.s.s of delinquents who have hitherto been made the particular object of solicitude, on the part of those who have looked with favor upon sterilization legislation. The chronic inebriate, the confirmed criminal, the prost.i.tute, the pauper, all deserve careful study by the eugenist. In many cases they will be found to be feeble-minded, and proper restriction of the feeble-minded will meet their cases. Thus there is reason to believe that from a third to two-thirds of the prost.i.tutes in American cities are feeble-minded.[82]
They should be committed to inst.i.tutions for the feeble-minded and kept there. It is certain that many of the pauper cla.s.s, which fills up almshouses, are similarly deficient. Indeed, the census of 1910 discovered that of the 84,198 paupers in inst.i.tutions on the first of January in that year, 13,238 were feeble-minded, 3,518 insane, 2,202 epileptic, 918 deaf-mute, 3,375 blind, 13,753 crippled, maimed or deformed. A total of 63.7% of the whole had some serious physical or mental defect. Obviously, most of these would be taken care of under some other heading, in the program of restrictive eugenics. While paupers should be prohibited from reproduction as long as they are in state custody, careful discrimination is necessary in the treatment of those whose condition is due more to environment than heredity.
In a consideration of the chronic inebriate, the problem of environmental influences is again met in an acute form, aggravated by the venom of controversy engendered by bigotry and self-interest. That many chronic inebriates owe their condition almost wholly to heredity, and are likely to leave offspring of the same character, is indisputable. As to the possibility of "reforming" such an individual, there may be room for a difference of opinion; as to the possibility of reforming his germ-plasm, there can be none. Society owes them the best possible care, and part of its care should certainly be to see that they do not reproduce their kind. As to the borderland cases--and in the matter of inebriety borderland is perhaps bigger than mainland--it is doubtful whether much direct action can be taken in the present state of scientific knowledge and of public sentiment. Education of public opinion to avoid marriage with drunkards will probably be the most effective means of procedure.
Finally, there is the criminal cla.s.s, over which the respective champions of heredity and environment have so often waged partisan warfare. There is probably no field in which restrictive eugenics would think of interfering, where it encounters so much danger as here--danger of wronging both the individual and society. Laws such as have been pa.s.sed in several states, providing for the sterilization of criminals _as such,_ must be deplored by the eugenist as much as they are by the pseudo-sociologist who "does not believe in heredity"; but this is not saying that there are not many cases in which eugenic action is desirable; for inheritance of a lack of emotional control makes a man in one sense a "born criminal."[83] He is not, in most respects, the creature which he was made out to be by Lombroso and his followers; but he exists, nevertheless, and no ameliorative treatment given him will be of such value to society as preventing his reproduction.
The feeble-minded who make up a large proportion of the petty criminals that fill the jails, must, of course, be excluded from this discussion except to note that their conviction a.s.sists in discovering their defect. They should be treated as feeble-minded, not as criminals.[84]
Those who may have been made criminals by society, by their environment, must also be excepted. In an investigation, the benefit of the doubt should be given to the individual. But when every possible concession is made to the influence of environment, the psychiatric study of the individual and the investigation of his family history still show that there are criminals who congenitally lack the inhibitions and instincts which make it possible for others to be useful members of society.[85]
When a criminal of this natural type is found, the duty of society is unquestionably to protect itself by cutting off that line of descent.
This, we believe, covers all the cla.s.ses which are at this time proper subjects for direct restrictive action with eugenic intent; and we repeat that the problem is not to deal with cla.s.ses as a whole, but to deal with individuals of the kind described, for the sake of convenience, in the above categories. Artificial cla.s.s names mean nothing to evolution. It would be a crime to cut off the posterity of a desirable member of society merely because he happened to have been popularly stigmatized by some cla.s.s name that carried opprobrium with it. Similarly it would be immoral to encourage or permit the reproduction of a manifestly defective member of society of the kinds indicated, even though that individual might in some way have secured the protection of a cla.s.s name that was generally considered desirable.
Bearing this in mind, we believe no one can object to a proposal to prevent the reproduction of those feeble-minded, insane, epileptic, grossly defective or hopelessly delinquent people, whose condition can be proved to be due to heredity and is therefore probably transmissible to their offspring. We can imagine only one objection that might be opposed to all the advantages of such a program--namely, that no proper means can be found for putting it into effect. This objection is occasionally urged, but we believe it to be wholly without weight. We now propose to examine the various possible methods of restrictive eugenics, and to inquire which of them society can most profitably adopt.
CHAPTER X
METHODS OF RESTRICTION
The means of restriction can be divided into coercive and non-coercive.
We shall discuss the former first, interpreting the word "coercive" very broadly.
From an historical point of view, the first method which presents itself is execution. This has been used since the beginning of the race, very probably, although rarely with a distinct understanding of its eugenic effect; and its value in keeping up the standard of the race should not be underestimated. It is a method the use of which prevents the rectification of mistakes. There are arguments against it on other grounds, which need not be discussed here, since it suffices to say that to put to death defectives or delinquents is wholly out of accord with the spirit of the times, and is not seriously considered by the eugenics movement.
The next possible method castration. This has practically nothing to recommend it, except that it is effective--an argument that can also be made for the "lethal chamber." The objections against it are overwhelming. It has hardly been advocated, even by extremists, save for those whose s.e.xual instincts are extremely disordered; but such advocacy is based on ignorance of the results. As a fact, castration frequently does not diminish the s.e.xual impulses. Its use should be limited to cases where desirable for therapeutic reasons as well.
It is possible, however, to render either a man or woman sterile by a much less serious operation than castration. This operation, which has gained wide attention in recent years under the name of "sterilization,"
usually takes the form of vasectomy in man and salpingectomy in woman; it is desirable that the reader should have a clear understanding of its nature.
Vasectomy is a trivial operation performed in a few minutes, almost painlessly with the use of cocain as a local anaesthetic; it is sometimes performed with no anaesthetic whatever. The patient"s s.e.xual life is not affected in any way, save in the one respect that he is sterile.
Salpingectomy is more serious, because the operation can not be performed so near the surface of the body. The s.e.xual life of the subject is in no way changed, save that she is rendered barren; but the operation is attended by illness and expense.
The general advantage claimed for sterilization, as a method of preventing the reproduction of persons whose offspring would probably be a detriment to race progress, is the accomplishment of the end in view without much expense to the state, and without interfering with the "liberty and pursuit of happiness" of the individual. The general objection to it is that by removing all fear of consequences from an individual, it is likely to lead to the spread of s.e.xual immorality and venereal disease. This objection is ent.i.tled to some consideration; but there exists a still more fundamental objection against sterilization as a program--namely, that it is sometimes not fair to the individual. Its eugenic effects may be all that are desired; but in some cases its euthenic effects must frequently be deplorable. Most of the persons whom it is proposed to sterilize are utterly unfit to hold their own in the world, in compet.i.tion with normal people. For society to sterilize the feeble-minded, the insane, the alcoholic, the born criminals, the epileptic, and then turn them out to shift for themselves, saying, "We have no further concern with you, now that we know you will leave no children behind you," is unwise. People of this sort should be humanely isolated, so that they will be brought into compet.i.tion only with their own kind; and they should be kept so segregated, not only until they have pa.s.sed the reproductive age, but until death brings them relief from their misfortunes. Such a course is, in most cases, the only one worthy of a Christian nation; and it is obvious that if such a course is followed, the s.e.xes can be effectively separated without difficulty, and any sterilization operation will be unnecessary.
Generally speaking, the only objection urged against segregation is that of expense. In reply, it may be said that the expense will decrease steadily, when segregation is viewed as a long-time investment, because the number of future wards of the state of any particular type will be decreasing every year. Moreover, a large part of the expense can be met by properly organizing the labor of the inmates. This is particularly true of the feeble-minded, who will make up the largest part of the burden because of their numbers and the fact that most of them are not now under state care. As for the insane, epileptic, incorrigibly criminal, and the other defectives and delinquents embraced in the program, the state is already taking care of a large proportion of them, and the additional expense of making this care life-long, and extending it to those not yet under state control, but equally deserving of it, could probably be met by better organization of the labor of the persons involved, most of whom are able to do some sort of work that will at least cover the cost of their maintenance.
That the problem is less serious than has often been supposed, may be ill.u.s.trated by the following statement from H. Hastings Hart of the Russell Sage Foundation:
"Of the 10,000 (estimated) mentally defective women of child-bearing age in the state of New York, only about 1,750 are cared for in inst.i.tutions designated for the care of the feeble-minded, and about 4,000 are confined in insane asylums, reformatories and prisons, while at least 4,000 (probably many more) are at large in the community.
"With reference to the 4,000 feeble-minded who are confined in hospitals for insane, prisons and reformatories and almshouses, the state would actually be the financial gainer by providing for them in custodial inst.i.tutions. At the Rome Custodial Asylum 1,230 inmates are humanely cared for at $2.39 per week. The same cla.s.s of inmates is being cared for in the boys" reformatories at $4.66; in the hospitals for insane at $3.90; in the girls" reformatory at $5.47, and in the almshouse at about $1.25. If all of these persons were transferred to an inst.i.tution conducted on the scale of the Rome Custodial Asylum, they would not only relieve these other inst.i.tutions of inmates who do not belong there and who are a great cause of care and anxiety, but they would make room for new patients of the proper cla.s.s, obviating the necessity for enlargement. The money thus saved would build ample inst.i.tutions for the care of these people at a much less per capita cost than that of the prisons, reformatories and asylums where they are now kept, and the annual per capita cost of maintenance would be reduced from 20 to 50 per cent., except in almshouses, where the cost would be increased about $1 per week, but the almshouse inmates compose only a small fraction of the whole number.
"I desire to emphasize the fact that one-half of the feeble-minded of this state are already under public care, but that two-thirds of them are cared for in the wrong kind of inst.i.tutions. This difficulty can be remedied without increasing the public burden, in the manner already suggested. That leaves 15,000 feeble-minded for whom no provision has yet been made. It must be remembered that these 15,000 persons are being cared for in some way. We do not allow them to starve to death, but they are fed, clothed and housed, usually by the self-denying labor of their relatives. Thousands of poor mothers are giving up their lives largely to the care of a feeble-minded child, but these mothers are unable to so protect them from becoming a menace to the community, and, in the long run, it would be far more economical for the community to segregate them in inst.i.tutions than to allow them to remain in their homes, only to become ultimately paupers, criminals, prost.i.tutes or parents of children like themselves."
Some sort of provision is now made for some of the feeble-minded in every state excepting eleven, viz.: Alabama, Arizona, Florida, Georgia, Louisiana, Nevada, New Mexico, South Carolina, Tennessee and Utah and West Virginia. Delaware sends a few cases to Pennsylvania inst.i.tutions; other states sometimes care for especially difficult cases in hospitals for the insane. The District of Columbia should be added to the list, as having no inst.i.tution for the care of its 800 or more feeble-minded.
Alaska is likewise without such an inst.i.tution.
Of the several hundred thousand feeble-minded persons in the United States, probably not more than a tenth are getting the inst.i.tutional care which is needed in most cases for their own happiness, and in nearly every case for the protection of society. It is evident that a great deal of new machinery must be created, or old inst.i.tutions extended, to meet this pressing problem--[86] a problem to which, fortunately, the public is showing signs of awakening. In our opinion, the most promising attempt to solve the problem has been made by the Training School of Vineland, New Jersey, through its "Colony Plan."
Superintendent E. R. Johnstone of the Training School describes the possibilities of action along this line, as follows:[87]
There are idiots, imbeciles, morons and backward children. The morons and the backward children are found in the public schools in large numbers. G.o.ddard"s studies showed twelve per cent. of an entire school district below the high school to be two or three years behind their grades, and three per cent. four or more years behind.
It is difficult for the expert to draw the line between these two cla.s.ses, and parents and teachers are loth to admit that the morons are defective. This problem can best be solved by the establishment of special cla.s.ses in the public schools for all who lag more than one year behind. If for no other reason, the normal children should be relieved of the drag of these backward pupils. The special cla.s.ses will become the clearing houses. The training should be largely manual and industrial and as practical as possible. As the number of cla.s.ses in any school district increases, the cla.s.sification will sift out those who are merely backward and a little coaching and special attention will return them to the grades. The others--the morons--will remain and as long as they are not dangerous to society (s.e.xually or otherwise) they may live at home and attend the special cla.s.ses. As they grow older they will be transferred to proper custodial inst.i.tutions. In the city districts, where there are many cla.s.ses, this will occur between twelve and sixteen years of age. In the country districts it will occur earlier.
These inst.i.tutions will be the training schools and will form the center for the training and care of the other two groups, i. e., the imbeciles and idiots. Branching out from the training schools should be colonies (unless the parent inst.i.tution is on a very large tract of ground, which is most advisable). These colonies, or groups of comparatively small buildings, should be of two cla.s.ses. For the imbeciles, simple buildings costing from two to four hundred dollars per inmate. The units might well be one hundred. A unit providing four dormitories, bath house, dining-halls, employees" buildings, pump house, water tank, sewage disposal, laundry, stables and farm buildings can be built within the above figures providing the buildings are of simple construction and one story. This has been done at Vineland by having the larger imbecile and moron boys make the cement blocks of which the buildings are constructed.
For the idiots the construction can be much the same. Larger porches facing the south and more toilet fixtures will be necessary, and so add a little to the cost.
The colony should be located on rough uncleared land--preferable forestry land. Here these unskilled fellows find happy and useful occupation, waste humanity taking waste land and thus not only contributing toward their own support, but also making over land that would otherwise be useless.
One reason for building inexpensive buildings is that having cleared a large tract--say 1,000 acres--the workers can be moved to another waste tract and by brushing, clearing of rocks, draining and what not, increase its value sufficiently to keep on moving indefinitely.
Many of these boy-men make excellent farmers, dairymen, swineherds and poultry raisers under proper direction, and in the winter they can work in the tailor, paint, carpenter, mattress and mat shops.
Nor need this be confined to the males alone. The girl-women raise poultry, small fruits and vegetables very successfully. They pickle and can the products of the land, and in winter do knitting, netting and sewing of all kinds.
No manufacturer of to-day has let the product of his plant go to waste as society has wasted the energies of this by-product of humanity. And the feeble-minded are happy when they have occupation suited to their needs. If one will but see them when they are set at occupations within their comprehension and ability, he will quickly understand the joy they get out of congenial work.
Colonies such as Mr. Johnstone describes will take care of the able-bodied feeble-minded; other inst.i.tutions will provide for the very young and the aged; finally, there will always be many of these defectives who can best be "segregated" in their own homes; whose relatives have means and inclination to care for them, and sufficient feeling of responsibility to see that the interests of society are protected. If there is any doubt on this last point, the state should itself a.s.sume charge, or should sterilize the defective individuals; but it is not likely that sterilization will need to be used to any large extent in the solution of this problem. In general it may be said that feeble-mindedness is the greatest single dysgenic problem facing the country, that it can be effectively solved by segregation, and that it presents no great difficulty save the initial one of arousing the public to its importance.
Similarly the hereditarily insane and epileptic can best be cared for through life-long segregation--a course which society is likely to adopt readily, because of a general dread of having insane and epileptic persons at liberty in the community. There are undoubtedly cases where the relatives of the affected individual can and should a.s.sume responsibility for his care. No insane or epileptic person whose condition is probably of a hereditary character should be allowed to leave an inst.i.tution unless it is absolutely certain that he or she will not become a parent: if sterilization is the only means to a.s.sure this, then it should be used. In many cases it has been found that the individual and his relatives welcome such a step.
The habitual criminals, the chronic alcoholics, and the other defectives whom we have mentioned as being undesirable parents, will in most cases need to be given inst.i.tutional care throughout life, in their own interest as well as that of society. This is already being done with many of them, and the extension of the treatment involves no new principle nor special difficulty.
It should be borne in mind that, from a eugenic point of view, the essential element in segregation is not so much isolation from society, but separation of the two s.e.xes. Properly operated, segregation increases the happiness of the individuals segregated, as well as working to the advantage of the body politic. In most cases the only objection to it is the expense, and this, as we have shown, need not be an insuperable difficulty. For these reasons, we believe that segregation is the best way in which to restrict the reproduction of those whose offspring could hardly fail to be undesirable, and that sterilization should be looked upon only as an adjunct, to be used in special cases where it may seem advantageous to allow an individual full liberty, or partial liberty, and yet where he or she can not be trusted to avoid reproduction.