Part 4

The paper of A. has for its object to examine closely these three arguments based upon very extensive data taken partly from demographic statistics and partly from researches made personally by him or which he caused to be made, especially in the Municipal Statistical Offices of Rome and Cagliari, and in the Obstetrical Clinic of Bologna. The principal results are here indicated.

A. The rule of a greater number of conceptions in Spring observed in temperate regions suffers notable exceptions in tropical and arctic regions. Hence there is a weakening of the idea that in it one should recognise the atavistic heritage of a special season for reproduction which the human race had originally shown, analogous to what one finds to-day in many species of animals. On the other hand, neither the frequency of multiple births, of miscarriages, or of stillbirths, nor the length of life of offspring nor their intellectual capacity show any correlation whatever with the season of conception. The frequency of stillbirths, however, and the length of life of the offspring show a clear correlation with the season of birth, in the sense that those born in temperate seasons show a lower rate for stillbirths and a greater length of life.

B. The age of the mother at the time of parturition does not show any regular influence on the size and weight of the child. It has a very sensible influence on the frequency of miscarriages and of stillbirths; this increases with the increase in age. The age of the mother at the time of marriage exercises a decisive influence upon the vitality of the offspring: the greater the age of the mother at the time of marriage the less will be the vitality of the children.

The age of the father at the birth of his child has some influence on the number of stillbirths among his children. This influence--at any rate above a given age--increases with the increase in the father's age. It can neither be disproved nor affirmed that the age of the father at the time of marriage has an influence upon the vitality of the children; it is certain, however, that if any influence of that kind exists it is much less intense than that exercised by the age of the mother.

There has also been an enquiry as to the effect upon the characters of the offspring exerted by (1) order of birth; (2) difference in age of the parents; and (3) the age of the woman at the first menstruation.

C. Persons who die at a more advanced age have children in greater number and endowed with greater length of life. For some classes of the unfit (mad, consumptives, suicides) it can be proved beyond question that the number of children born is less and their mortality greater than among married people generally. Those who die of heart disease or of cancer show a number of children slightly higher than the general average of married persons; but that can be attributed to the fact that their age at death is greater than the average age at death of married people.

MATERNITY STATISTICS OF THE STATE OF RHODE ISLAND, STATE CENSUS OF 1905.

(Abstract.)

By Frederick L. Hoffman, LL.D., F.S.S.,

_Statistician of the Prudential Insurance Company of America._

As a contribution to the practical study of eugenics the decennial maternity statistics of Rhode Island are of exceptional interest and importance.

In 1905, of 36,766 native-born married women 26,329 (71.6%) were mothers, and 10,477 (28.4%) childless. Of 32,960 foreign-born married women 27,207 (82.5%) were mothers, and 5,753 (17.5%) childless. Contrasting these percentages, the fact requires only to be stated to emphasize its profound and far-reaching social as well as political significance.

Considered with reference to religious belief, 72.7% of Protestant and 80.3% of Roman Catholic married women were mothers. Of married women of Jewish faith 88.0% were mothers.

At ages 25-34, the proportion of native-born mothers having only one child was 35.1%, against 22.6% for the foreign-born; the proportion of mothers having from six to ten children was 6.8% for the native-born, against 12.9% for the foreign-born. At all ages a similar disproportion is apparent.

Vastly more important than the multitude of general social and economic facts are these statistics of what, for want of a better term, may be called _human production_, and which disclose what must be considered the most alarming tendency in American life. Granting that excessively large families are not desirable, at least from an economic point of view, it cannot be questioned that the diminution in the average size of the family, and the increase in the proportion of childless families among the native-born stock is evidence of physical deterioration, and must have a lasting and injurious effect on national life and character.

Section IV.

Medicine and Eugenics.

THE PROPHYLAXIS OF HEREDITARY SYPHILIS AND ITS EUGENIC EFFECT.

(Abstract.)

By Dr. H. Hallopeau.

Syphilis is strongly _dysgenic_; it causes the production of profoundly damaged children; in preventing it the physician co-operates effectively with eugenic action. In order to prevent the propagation of this disease we must have recourse to _administrative prophylaxis_, _prophylaxis by persuasion_, and _prophylaxis by medical measures_.

_Administrative prophylaxis_ must act especially by multiplying gratuitous consultations and in securing, as far as possible, hospital treatment for persons affected by transmissible lesions, especially for prostitutes.

To the physician belongs the duty of acting by _persuasion_ in pointing out to syphilitics that they have no right to have children so long as they are liable to transmit their disease to their offspring.

We must abort syphilis if it is in the stage of primary invasion: this invasion is not, as was believed until recently, confined to the chancre and its accompanying swellings; it includes all the intermediate stage; in order to destroy the tripanosomes we must use repeated injections of _benzosulfoneparaminophenylarsinate of soda_, commonly known as _hectine_ (Mouneyrat), the only specific medicament which is well borne locally.

Results similar to those we have just shown are obtained by making, in a given region, two or three injections of salvarsan. However, the comparison between the two medications is altogether in favour of that by hectine. Indeed, experience proves that the secondary generalization is noticeably more frequent after injections of salvarsan, and, besides, these are far from being always painless. We have made known to the Académie of Medicine a case in which, within 48 hours, they caused the death of a young man in good health. Several similar cases have since been notified, particularly by Dr. Gaucher. Confidently believing in the axiom "Primo non nocere," we explicitly declare ourselves adversaries of a practice which brings such accidents in its train.

In the secondary stage, we must have recourse simultaneously to various specific agents.

Procreation may be permitted when six months after the abortive treatment Wasserman's reaction, after several trials, has given uniformly negative results.

The physician thus accomplishes a profoundly eugenic work in favouring and accelerating the production of unspoilt children.

THE EFFECT OF ALCOHOL ON THE GERM-PLASM.

(The New Alcohol Legislation in Norway.)

(Abstract.)

By Dr. Alfred Mjoën.

The injurious effect of alcohol depends not only upon the amount taken, but also upon other factors, as, _e.g._, upon its dilution, and upon the kind of nourishment taken with it. There can be no doubt that alcohol under a certain percentage neither injures nor can injure either the somatic cells, or what is more important for race-hygiene, the germ cells. And, on the other hand, it must be regarded as proved that alcohol over a certain percentage is injurious to the quality of the offspring, not alone where the mother drinks (influence upon the embryo), but also where the father alone is a drinker (destruction of the germ). The latest investigations in this field confirm this assumption.

There is, it is true, a middle class of beverages whose influence upon the germ-plasm (posterity) has not been established, or can be established at all. As a general rule, one may lay down the rule: _The injurious effect of an alcoholic beverage upon individuals or race increases from a certain percentage progressively with its increasing contents of alcohol._

Therefore, I propose to divide alcoholic liquors into classes, and to deal with them according to the amount of their contents of alcohol, _i.e._, according to their injuriousness.

All casks, bottles, etc., coming into the market are to be furnished with the class-mark (_e.g._, I., II., III., branded upon the cord).

For example, in the case of beer, the first class (under 2-1/4%), shall be obtainable everywhere. For this class there will be claimed, besides a reduction of duty, also a facility for sale and some concessions. Class I. (up to 2-1/4%) will be charged with 2 ore; Class II. (2-1/4--3-3/4%) with 8 ore; and Class III. (3-3/4--5%) with 15-16 ore per litre. Beer over 5% or 5-1/2% will be prohibited([3]).

[Footnote 3: This proposal was favourably received by the Norwegian minister Knudsen, and brought before the Storthing as a Government measure. The proposal has been accepted as part of the election programme of the Radicals, the Socialist Democrats, and all total abstinence organisations.]

The class system permits of a simple, cheap, and practicable control, and, indeed, a control which is not confined to the brewery or to any single stage of preparation, but which follows the article over the whole country from its origin to its consumption. When alcoholic drinks are marked with their class and placed under State control, the consumers will themselves easily exercise the control. And the public will gradually become accustomed to form an opinion upon the influence of the various articles upon the working capacity and the health, not only of the individual, but also of the family and the race. State and country authorities will, with State-controlled classes, more easily see justice done on all sides. This last advantage will, naturally, only avail in those lands where the permission to sell alcoholic liquors is vested in the local authorities. The progressive class system will also give the State, the municipalities, and also private labour organisations an opportunity to support those restaurants and inns which supply nothing but pure and harmless liquors, and consumption will undergo a slow and gradual change to the lightest drinks.

At the present time the lightest kinds of beer are too heavily taxed in comparison with the heaviest kinds, and the latter in turn are too heavily taxed in comparison with brandy. From the point of view of race-hygiene, the fight must be directed especially against the fourth and most dangerous class, namely, all kinds of brandy (prohibition or Ivan Bratt's system), as well as against the mixed wines, which are so often adulterated and injurious.

ALCOHOLISM AND DEGENERACY.

Statistics from the Central Bureau for the Management of the Insane of Paris and the Department of the Seine from 1867 to 1912.

(Abstract.)

By M. Magnan,

_Chief Physician to the Central Bureau, Member of the Academy of Medicine_,

And Dr. Fillassier.

From 1869 to 1912 the number of sick persons received at the Central Bureau of the St. Anne Asylum has gone on steadily increasing: occasionally signs of a falling off are noticed, quickly compensated by the number of entries for the following years.

Among these patients a great number are driven to the asylum by the abuse of alcoholic drinks. Some of these are simple alcoholics, _i.e._, those who owe their insanity entirely to excessive drinking; the others make up the numerous group of degenerates, who are for the most part descendants of alcoholics, and on whom fall all the forms of physical, intellectual, and moral degradation.

For these last, alcohol has been but the touch of the trigger which has put in action their disposition towards insanity; the attack of mania, when past, leaves revealed psychic troubles, which, but for the turning of the balance by alcohol, would have remained in the latent condition, but which, once developed, remain often for a much longer time; so we see the increase in the number of these patients--occasional drunkards--keeping pace with that of chronic alcoholics.

These will specially call forth the interest of the members of the Eugenic Congress. From the clinical point of view they exhibit great importance; for showing as they do all the episodic syndromes of degeneracy, all the mental forms of it may be seen--maniacal, melancholic, idiotic: insanities polymorphous or systematic, fixed ideas, monomanias connected with words or numbers, every sort of phobia, obsession, impulse, and symptomatic manifestation of great importance. When their objective lies in sexual perversion, theft, arson, murder, etc., these various states raise the most delicate questions whether from the point of view of philosophy, psychology, sociology, or forensic medicine.

This class of society, in the grip of this poison, is unfortunately not sterile; their miserable descendants come to dock in the asylum; so much so that if we mass together the various elements, if we add the unfortunates permanently disabled, such as epileptics, and the increasing crowd of feeble-minded, idiotic, tuberculous children, the mind recoils aghast at the gravity of the danger. The necessity of an implacable war against alcoholism, which crowds our asylums, our hospitals, and our homes with insane persons, and sends a constant stream to our prisons and reformatories--such a war must be the principal aim of the Eugenics Congress.

For long the evil genius of mankind, alcoholism has to-day laid its clutch on women, and the admission figures now show their numbers on the increase every year.

Such are the lessons which may be learnt from the report of Magnan and Fillassier.

EUGENICS AND OBSTETRICS.

(Abstract.)

By Dr. Agnes Bluhm, _Berlin._

1. Among the agencies under social control which impair the racial qualities of future generations, an important place is taken by the Science of Medicine, especially by Obstetrics. For the increase of obstetrics increases the incapacity for bearing children of future generations.

2. The great difference in the capacity for bearing children between the primitive and civilized races depends only in part on the lessened fitness of the latter due to the increase of skilled assistance.

3. Incapacity for bearing children can be acquired; it develops, however, abundantly on the grounds of a congenital predisposition.

4. In so far as the latter is the case, obstetrics contributes towards the diffusion of this incapacity.

5. The most serious obstacles to delivery are effected by deformities of the pelvis, in at least 90% of which heredity plays a part. In this connection, rickets, the predisposition to which is inherited, takes the foremost place.

6. German medical statistics make it appear probable that incapacity to bear children is on the increase.

7. Medical help in childbirth brings, undoubtedly, numerical advantage to the race, but it endangers the quality of the race in other ways than through the fostering of unfitness for bearing.

8. The danger of the increase of incapacity for bearing through the increase of assistance in childbirth can be combatted:--

(_a_) Through the renunciation of descendants by women unfitted to bear children.

(_b_) Through an energetic campaign against rickets, to which only the predisposition can be inherited.

(_c_) Through the permeation of obstetrics with the spirit of eugenics, so that the obstetrician no longer proceeds according to a settled rule (living mother and living child), but in each separate case takes into consideration the interests of the race.

HEREDITY AND EUGENICS IN RELATION TO INSANITY.

(Abstract.)

By F. W. Mott, M.D., F.R.S.,

_Physician to Charing Cross Hospital and Pathologist to the London County Asylums._

What is insanity? Every case of insanity is a biological problem, the solution of which depends upon a knowledge of what a man was born with--Nature--and what has happened after birth--Nurture. The increase of registered insanity in London; the causes of the increase. (1) The standard of insanity has been raised. (2) The increase of accommodation for reception of the insane. The diminishing death rate in asylums causing a progressive accumulation. The diminished number of recoveries. (3) The large proportion of old people admitted to asylums formerly in the infirmaries.

_Nurture._--The correlation of pauperism, insanity and feeble-mindedness, alcohol, syphilis, and tuberculosis in relation to insanity and feeble-mindedness. Congenital mental deficiency as distinguished from hereditary mental deficiency. Chronic poisoning of the blood by these agencies in relation to a lowered specific vitality of the germ cells. Environment in relation to mental energy and will power.

_Nature._--The study of pedigrees in hospital and asylum patients showing the importance of heredity in nervous and mental diseases. The nature of the neuropathic tendency; its transmission in different forms of nervous and mental disease in successive generations. Its latency and re-appearance in stocks. Relation of neurasthenia to the neuropathic taint. Conclusions arrived at in relation to heredity and insanity from a study by a card system of 3,118 related persons who are at present, or who have been, in the London County asylums. Among the 20,000 inmates at present resident, 715 are so closely related as parents and offspring or brothers and sisters. Nature is always trying to end or mend a degenerate stock if left to itself. Analysis of data regarding first attack of insanity in 464 parents and their 508 offspring; the signal tendency to the occurrence of the disease in a more intense form and at an earlier age in the offspring. This "antedating" or "anticipation" in relation to Nature's process of elimination of the unfit. Nearly 50 per cent. of the offspring affected 20 years earlier than the parent. The same found in uncles and aunts with nephews and nieces, only not nearly so marked. Seeing that the unfit are at present able to survive; does nature end or mend degenerate stocks, or have the lines of neuropathic inheritance only been partially cut off by this tendency to "anticipation"? What we want to know is: What is the fate of all the offspring of an insane parent or parents; for there are a great many facts which show that a disease may be latent and re-appear in a stock when the conditions of mating or environment are unfavourable? A collection of pedigrees is required which will prove conclusively that the offspring of insane parents, who are free from the insane manifestations during adolescence, will breed children who will not become insane. Supposing it were shown that cases discharged as recovered had the seeds of insanity, by the fact that their progeny were feeble-minded, epileptic, or insane, it would be a clear indication of taking measures to prevent them handing on the disease. Recurrent insanity--the birth of children in the sane intervals. Analysis of pedigrees with a dual neuropathic inheritance of maternal and paternal stocks compared with single neuropathic inheritance. Conclusion that a child born of neuropathic inheritance in both ancestral stocks stands, on an average, the chance of being insane four times as great as when only one stock is affected. Are there any types of insanity especially liable to be transmitted in the same form or another form? The prediction of the racial value of an individual inheritance can only be predicted by a study of what a man was born with--Nature, and what happened after birth--Nurture.

THE PLACE OF EUGENICS IN THE MEDICAL CURRICULUM.

(Abstract.)

By H. E. Jordan,

_Chairman of the Eugenics Section of the American Association for the Study and Prevention of Infant Mortality._

The Science of Eugenics deserves a place in the medical curriculum for three reasons. Firstly: Medicine is fast becoming a science of the prevention of weakness and morbidity; their permanent not temporary cure, their racial eradication rather than their personal palliation. Eugenic conduct is undeniably a factor in attaining the speedy achievement of the end of racial health. Eugenics, embracing genetics, is thus one of the important disciplines among the future medical sciences. The coming physician must have adequate training in matters relating to heredity and Eugenics. Secondly: as the general population becomes better educated in matters of personal and racial health and hygiene it will more and more demand advice regarding the prevention of weakness in themselves and their offspring. The physicians are logically the men who must give it. Thirdly: physicians will be more efficient public servants if they approach their work with the Eugenic outlook on life.

Instruction in Eugenics, in the form of a number of special lectures on the subject, is already given in some of our medical schools. This indicates at least that the need is felt and the importance of such knowledge to the best physician recognised. Since not all of the better medical schools give such courses, however, we may infer that there are obstacles in the way. What is the nature of these?

One such may be the lack of adequate preparation on the part of the students in the fundamentals of biology to properly comprehend the import and application of Eugenic facts. This obstacle is speedily being removed; for considerable biological training is already a medical course prerequisite. But there may be a lack of properly prepared teachers to present this subject to even properly prepared medical students. This obstacle is also fast disappearing. Once the demand for this kind of help is voiced, there will appear properly trained teachers to instruct physicians.

Another obstacle may be raised by short-sighted and self-seeking physicians, for whom less illness and weakness may mean less work and a reduced income. But this is, perhaps, only a relatively very small factor in, and also only a passing phase of, the opposition, and will soon correct itself.

The most encouraging prospect for this new scheme of activity is the deep interest shown by young medical students in matters of heredity and Eugenics.

A HEALTHY SANE FAMILY SHOWING LONGEVITY IN CATALONIA.

(Abstract.)

By Professor I. Valenti Vivo.

I. A healthy family showing longevity in Catalonia: the greater part of them died over 60 years of age from acute sickness. All belonged to the districts of Barcelona and Gerona. A record of their ability in medical science, art and agriculture, their average fertility.

II. Communication on Biometrika: Licentiates in medical science, 50 scholars, 1910: 70 in 1912. Dates: Cephalic index, stature, span, dynamometer, age, district.

SOME REMARKS ON BACKWARD CHILDREN.

(Abstract.)

By Dr. Raoul Dupuy.