CHAPTER VII

PROSTITUTION, FEEBLE-MINDEDNESS AND VENEREAL DISEASES

_In this chapter it is shown that the feeble-minded parent is many times as prolific as the normal parent. A considerable percentage of girls living in prostitution are mentally defective, and if careful statistics were collated it would be found that 95 per cent. of these women come from large families. The feeble-minded should be instructed how to prevent conception, thereby diminishing prostitution and its invariable accompaniment,—venereal disease._

_SOME PROBLEMS OF THE SOCIAL EVIL. Hon. Chas. N. Doodnow, Judge of the Morals Court, Chicago. “The Light.” B. S. Steadwell, Editor. Jan.-Feb., 1915._

The Court of Morals conducted an investigation of prostitution along three lines, social, physical and mental. In the first report, April 10th, to December 31st, 1913, 639 cases were examined, representing every race, creed, and nationality. 334 were colored, 298 white, 2 Armenian, 1 Japanese. Occupations: 225 housework, 174 waitresses, 136 laundresses, 83 clerks or cashiers, 6 seamstresses, 4 stenographers, 1 trained nurse, 1 manicurist, 24 scrub women, 110 had no occupation. Venereal disease in infectious stage was diagnosed in 108 cases. 315 showed evidence of having syphilis, and of the remaining 116, had bacteriological tests been made, 50% at least would have been found victims of the disease. As to intelligence, over 400 were mentally deficient, two were found to be insane, and 68 were little more than imbeciles, having mental capacity of less than a seven year old child. Later statistics of 100 women going through the Court were taken showing again that usually their work was of a character which required the least skill and mental effort, and that 97% either were, or had been afflicted with disease, and that the majority were mentally deficient. We did not have any imbeciles, or idiots from the Morals Court, though quite a number of the morons were of the low grade type bordering on the imbecile group. In other words, 89.37% of our cases are feeble-minded, or borderland. If we leave out the borderland cases it shows that 85% of our cases, exclusive of the insane, alcoholics, and drug habitues are distinctly feeble-minded. This finding is interesting since it corresponds to our findings in the Boys’ Court, where we found 84.49% were feeble-minded. It is therefore to be clearly seen here that with the girl defective-delinquent, as with the boy, the basic cause is feeble-mindedness. This is the intrinsic cause, which environment and other causes on the whole, are extrinsic.

_REPORT OF CHICAGO MORALS COURT. December, 1913._

Dr. W. J. Hickson of the Psychopathic Laboratory tested 126 cases excluding insane, alcoholics and drug addicts, for the Chicago Morals Courts, and found 85.83% distinctly feeble-minded.

Of 639 prostitutes examined by a woman physician for the Chicago Morals Court, over 400 were mentally deficient; 2 were found to be insane; 68 were little above imbeciles, having mental capacities of less than a seven year old child.

The State Training School for Girls, at Geneva, Ill., has a population of about 400, of whom a great majority have been committed for sexual immorality. Dr. Olga Bridgman reports that of 118 consecutive cases that were examined upon entry, 105 (or 89%) were graded as feeble-minded. 14 of the 118 had been committed as dependents or uncontrollable. Of the 104 remaining all of whom had been sexually immoral 101 were graded as feeble-minded while only 3 were found normal according to the Binet test.

_THE LAW OF POPULATION. Its Consequences and its Bearing upon Human Conduct and Morals. Annie Besant. Asa K. Butts, Publisher. 1879._

The more marriage is delayed the more prostitution spreads. Prostitution is an evil we should strive to eradicate, not to perpetuate, and late marriage, generally adopted would most certainly perpetuate. Marriage is deferred owing to the ever increasing difficulty of maintaining a large family in anything like comfort. Celibacy is not natural to man or to woman, all bodily needs require their legitimate satisfaction, and celibacy is a disregard of natural law. Until nature evolves a neuter sex, celibacy will ever be a mark of imperfection. P. 27–8.

But the knowledge of these scientific checks would, it is argued, make vice bolder, and would increase unchastity among women by making it safe. And if so, are all to suffer, so that one or two already corrupt at heart may be preserved from becoming corrupt in act? Are mothers to die solely that impure women may be held back, and wives to be sacrificed that the unchaste may be curbed. As well say that no knives must be used because throats may be cut, no matches sold because incendiarism may result from them, no pistols allowed, because murders may be committed by them. P. 38.

_SLAVERY OF PROSTITUTION. A Plea for Emancipation. Maude E. Miner, Secretary of the New York Probation and Protective Association. McMillan Co., 1916._

The study of young women in prostitution shows that mental deficiency is an important factor in delinquency. 34%, or approximately ⅓ of 577 delinquent young women at Waverly House were so retarded in mental development as to be considered feeble-minded, and others were mentally retarded enough to need protection and over-sight. Close knowledge of the individual girls convince us that their deficiency facilitates their entrance into prostitution. P. 43.

Explanation of the mental deficiency of these wayward girls which has predisposed them to prostitution is usually found in bad inheritance. P. 44.

A feeble-minded girl was found to be one of 13 illegitimate children to whom her mentally deficient mother had given birth. P. 46.

Over-crowding in rooms, tenements, and neighborhoods is an obvious menace. In congested sections of the lower part of New York, large families, to which these girls belong, were herded into two or three narrow rooms, 12 in three small rooms, seven in two rooms, or a family of five eating and sleeping and living in a single room. P. 55.

Have we realized that every feeble-minded girl is a potential prostitute? Have we realized that feeble-minded mothers give birth to large numbers of children doomed to mental deficiency? Have we realized what this will ultimately mean in deterioration of human stock and in the complication of social problems? To stop the stream which is bringing into prostitution large numbers of mentally deficient girls and women, we must safe-guard these girls and prevent them from having offspring. Evidence presented to the Royal Commission on the Care and Control of the Feeble-minded in Great Britain, and careful studies in America, show conclusively that mental deficiency tends strongly to be inherited, and that feeble-minded mothers are more prolific than normal women. P. 267.

_DOWNWARD PATHS. An Inquiry into the Causes which Contribute to the Making of the Prostitute. With a foreword by A. Maude Royden. T. Bell & Sons, Ltd. London._

It is astonishing to find experts denying the element of economic pressure as a factor in the creation of the prostitute. It is an influence constantly present and it is only when we interpret it to mean actual physical starvation that we can say it is rarely a determining factor. Economic pressure does not begin with starvation, it ends there. There is again the long strain of underfeeding and overwork, of the absence of interest, variety and color, and all that makes life worth living to a human being. Poverty often means isolation, and isolation the absence of all those ties which keep us in our place in the social order, and make it worth while to preserve our self-respect. To be without this is to be constantly in danger and it is economic pressure which has thrust many over the brink of the precipice, though few would say their fall was due to actual starvation. P. 10.

Intimately connected with this aspect of the question is that of home and housing, especially of the child. The age at which children are first corrupted is almost incredibly early, until we consider the nature of the surroundings in which they grow up. Insufficient space, over-crowding, the herding together of all ages and both sexes, these things break down the barriers of a natural modesty and reserve. Where decency is practically impossible, unchastity will follow, and follow almost as a matter of course. There are certainly natural defences in the right instincts of young people brought up in the right kind of home, which we look for in vain among those who have never had space enough for growth, or privacy enough for refinement. P. 11.

We must allot to bad housing and over-crowding a foremost place, not only as undermining the physical health which conduces to normal sexual relationship, but also as a danger to the wholesome innocence of youth. P. 21.

It cannot be too strongly impressed upon persons interested in the housing problem that over-crowding means a violation of childhood in every degree, from the indecencies of mere childish horse-play to complete debauchery. P. 22.

There are two types of feeble-minded girls who are almost inevitably destined to prostitution. There is first the large proportion whose sexual inclinations are abnormally strong, or whose power of self-control over natural impulses is abnormally weak. 2—There is the large class who are non-resistant. They have no active impulse to seek out men, but they will yield to any one who approaches them. There are three important factors that drive the feeble-minded into prostitution by excluding them from other occupations. 1—They often lose their characters at a very early age. A marked characteristic of the feeble-minded is the precocity of their sexual impulse. 2—It is easy enough for any feeble-minded girl to get and keep light, unskilled work at girl’s wages, but not so easy for her to pass like the girl of normal intelligence, from girl’s to woman’s work at the age of 17 or 18, for she is rarely worth woman’s wages. Therefore she finds herself bored by monotonous work and low pay just at the time that she is particularly attractive to man, and her sexual impulses are at their strongest. Very naturally the feeble-minded girl with her incapacity to perceive the consequences turns from her unsatisfying employment to the new life of excitement and easy gain that offers itself. 3—If feeble-minded girls do succeed in getting respectable situations they are very likely to lose them because of their lack of intelligence and general inefficiency. And even if they should discharge their duties in a satisfactory manner they have a curious distaste for staying for any time in one place, and tend to drift from situation to situation. P. 127–128.

Another characteristic of the feeble-minded is their notorious fertility. The superior fertility of the feeble-minded has been proved beyond dispute by statistical inquiry.

_DELINQUENCY AND MENTAL DEFICIENCY. Dr. Olga Bridgman. The Survey, June 13, 1914._

Report of examination of 118 consecutive admissions at the Illinois Training School for Girls at Geneva. Of the 118, 105, or 89%, showed a retardation of three years or more, thus ranking as mentally deficient, 6% were backward, being one or two years retarded, and six, or 5% were graded as normal. According to the Binet tests then, 97% of the children sent to this institution are mentally defective.

_COMMERCIALIZED PROSTITUTION IN NEW YORK CITY. George Kneelands. Century Co., New York, 1913. (Chapter by Katherine B. Davis on a Study of Prostitutes Committed from New York City to the State Reformatory for Women at Bedford Hills.)_

It is difficult to get at the actual truth as to the number of children the unmarried women have had. The Table shows the admission of 209 women on this point. There are 73 unmarried women who admit having had children, 16 were pregnant at the time of entering, and 18 had previously been pregnant. 428 claimed to have had no children. In this connection it may not be amiss to note the fact that an unmarried woman who has had a child is more apt to belong to the mentally defective class. Of the 647, 20.09% were shown to have hereditary degenerate strains, and 20.56% venereal disease. Page 180.

FEEBLE-MINDEDNESS

_SOCIAL HYGIENE. March 1915. Vol. 1, No 2. Recent Progress in Social Hygiene in Europe. James B. Reynolds, Counsel, The American Social Hygiene Association._

Recent studies of prostitutes there (in Europe) as here have strikingly brought to light the significant relationship between prostitution and mental defectiveness. A far reaching contribution to the solution of the problems of sex education and prostitution was the Mental Deficiency Act of 1913 for England and Wales. This Act was based on the Report of a Royal Commission on the Care and Control of the Feeble-minded which made a careful and exhaustive study of the entire subject, including the methods of treatment of the mentally defective in all countries. The Commission declares that a great proportion of the evidence unmistakably indicates that mentally defective children are greatly lacking in self-control and peculiarly open to suggestion and hence specially susceptible to the influence of depraving companions. The testimony of numerous experts who appeared before the Commission is highly illuminating on these points. Dr. Kerr, medical officer of the London County Council, declared that sooner or later many of these children will be found in the hands of the police, or in maternity hospitals. Dr. Ashby, late medical officer of the Manchester Special Schools stated that the mental defectives tend to an increase of the criminal and immoral classes. Dr. Whittell, Medical Superintendent of the Suffolk County Asylum, argued that the natural and physical evolution of this class is apt to result in various offenses of sexual, or perverted sexual, nature. Dr. Corner, Lecturer on Mental Diseases in the North East London Post Graduate Hospital, said, “One of the most common and dangerous characteristics of the feeble-minded is that they tend to sink socially.” Another expert testified that mentally defective girls in large cities are subject to overwhelming temptations and pressure toward sexual immorality, while still another, looking to the larger aspects of the problem, called attention to the danger resulting from the immoral laxness of mentally defective girls, and the lowering of the mental stamina of the whole nation by the increase of a population of defective intellect. Sir Francis Galton went so far as to declare that mentally defective women commonly become prostitutes. The feeble-minded, as distinguished from idiots, are an exceptionally fecund class, mostly of illegitimate children, and a terrible proportion of their offspring are born mentally deficient. All these experts were in agreement that mentally defective girls are in great danger of becoming immoral, hence prostitutes.

_DEGENERACY, ITS CAUSES, SIGNS AND RESULTS. Eugene S. Talbot, M.D. Walter Scott, Ltd., London; Chas. Scribner’s Sons, N. Y. 1898._

Pauline Tarnowsky in her study “Etudes Anthropometriques sur les Prostituées” finds that in Russia prostitution is crime in women taking the line of least resistance. She concludes from her researches, which mine tend to verify, that the prostitute as a rule is a degenerate being, the subject of an arrest of development, tainted with a morbid heredity, and presenting stigmata of physical and mental degeneracy fully in consonance with her imperfect evolution. C. Andronico of Messina, Italy, arrived some time previously at the same conclusions as those of Tarnowsky.

_FEEBLE-MINDEDNESS, ITS CAUSES AND CONSEQUENCES. Henry Herbert Goddard, Director of the Research Laboratory of the Training School at Vineland, N. J., for Feeble-minded Boys and Girls. McMillan Co., 1914._

Among the different causes for the social evil feeble-mindedness has been suggested, but nowhere has it been given the prominence that is due it. Anyone who understands feeble-mindedness, especially the moron, cannot expect anything less than that great numbers of these girls will fall into the life of prostitution. As to the actual statistics on this subject we have almost none. One very significant record comes from Geneva, Illinois, made by Dr. Bridgman. She found that of 104 girls in the Reformatory who were committed for an immoral life 97% were feeble-minded. This does not by any means indicate that 97% of prostitutes are feeble-minded, because it is only natural to expect that the feeble-minded ones would be the ones to be caught and sent to an institution. These figures, nevertheless, give us some idea of the prevalence of feeble-mindedness in this traffic. Many competent judges estimate that 50% of prostitutes are feeble-minded. Pages 14–15.

The 327 cases here presented constitute a unitary group. They have not been selected. They are of all ages and grades of defect. Page 7.

Our 327 families naturally fall into six fundamental groups, as follows: 4—Accident Group, 57; 5—No Cause, 8; 6—Unclassifiable, 27. Pages 47–48.

The following table gives an idea of the fecundity of these groups of women.

No. of Mothers No. of Children Average Hereditary 139 992 7.1 Probably Hereditary 27 168 6.2 Neuropathic 36 204 5.6 Accident 50 258 5.1 No Cause 8 258 5.7 Unclassified 27 118 4.3 ——— ————— ——— 287 1,786 6.2

In addition to the mentality, whether normal or feeble-minded, record has been kept of certain diseases and conditions supposed to be more or less associated with feeble-mindedness in a causal relation. These are the following: 1—Alcohol; 2—Tuberculosis; 3—Sexual Immorality; 4—Paralysis, Insanity, Epilepsy, Neurotic Condition, Syphilis, Criminality, Deafness, Blindness, Migraine, Goitre, Vagrancy. Page 473.

Sexual immorality is closely associated with hereditary feeble-mindedness. Closely connected with the subject of sexual immorality is the one of illegitimacy. Our records show 278 illegitimate children of whom 259, or 93% are in the pure Hereditary group, 12 in the Probably Hereditary group, 3 in the Neuropathic, and 4 in the Accident group. There is nothing new in these facts. They are simply confirmatory of what we have found in other lines. Page 499.

The feeble-minded person is not desirable; he is a social encumbrance, even a burden to himself. In short, it were better, both for him and for Society had he never been born. Should we not then in our attempt to improve the race begin by preventing the birth of more feeble-minded? Page 558.

_THE FEEBLE-MINDED A SOCIAL DANGER. A. F. Tredgold, L.R.C.P., London. M.R.C.S., England. Medical Expert to the Royal Commission on the Feeble-minded, etc. Eugenics Review. Vol. 1, April, 1909. Pub. Eugenics Education Society, London._

In England and Wales on January 1st, 1906 there were a total of 138,529 persons in the country who were defective in mind. This corresponds to 4.03 per thousand population, or to one mentally defective person in every 248. In England and Wales on January 1st, 1906, there were no less than 125,827 insane persons. If we add these to the number of the mentally deficient which I have just stated, we find that in this country there is one person out of every 130 who suffers from severe disease of the mind. P. 98–99.

According to the Registrar General, the average number of births to a marriage in the whole population of this country is 4.6. I have ascertained that the average number of births in these degenerate families is no less than 7.3. It is obvious that if this alarming propagation is not checked, the time must inevitably come when our nation will contain a preponderance of citizens lacking in that intellectual and physical vigor which is absolutely essential to progress. P. 98.

_RASSENVERBESSERUNG. Translated from the Dutch of Dr. J. Rutgers. Second Edition, Dresden, 1911._

A not insignificant factor in the use of houses of prostitution is furnished by married men who in the “old fashioned” way wish to “protect” their wives, in order not to be burdened with too many children. Neo-Malthusianism is also the best weapon against this class of supporters of prostitution. P. 73.

_MASSACHUSETTS COMMISSION FOR INVESTIGATION OF THE WHITE SLAVE TRAFFIC._

This investigation under Dr. Walter Fernald, included a physical examination study of family and personal history, social reactions, and standards, etc. Out of the 300 prostitutes 154 were feeble-minded (all doubtful were called normal). The 154 were so pronounced as to warrant legal commitment. None of them had the mentality of a normal child of 12 years old. Majority were that of 10 or 9 years old.

_INVESTIGATION OF VIRGINIA STATE BOARD OF CHARITIES._

This investigation presents a very high percentage of aments among the prostitute residents of the Richmond red light district. Of 120 persons tested the examiner found 42 or 35% imbeciles and 58 or 48.3% to be morons. That is 100 or 83.3% were mentally defective and only twenty or 16.7% were declared normal. Out of this number 93 were found to be between the ages of 20 to 30 and 16 between 30 to 40. All in the child-bearing age, as one will note. That 100 out of the 120 needed institutional care, that they should not reproduce their kind, was of course apparent.

_THE MENTALITY OF THE CRIMINAL WOMAN. A Comparative Study of the Criminal Woman, the Working Girl and the Efficient Working Woman in a Series of Mental and Physical Tests. Jean Weidensall, formerly Director of the Department of Psychology, Laboratory of Social Hygiene, Bedford Hills, N. Y. Warnick and York Inc. 1916._

Tests applied to a group of children of working age by the Bureau of Educational Guidance of Cincinnati were also used on a group of 20 maids at Vassar as a norm for testing the women committed to Bedford. 100 reformatory subjects were used for the tests. It is a matter for question whether loss of the parent is the cause of the child’s leaving school and going to work early and of the ultimate unsocial conduct in the case of the Bedford group, or whether loss of parent, retardation, misconduct, etc., are not for the most part but manifestations of the same thing—irresponsibility, mental, physical and social inferiority on the part of both parents and child. The facts at our disposal and eugenic investigations lead us to believe that the latter is in the larger measure true. Out of 100 women recorded 30 had had from one to five illegitimate children. Of the 100 tests for syphilis and gonorrhoea, 45% positive, 4% doubtful, 51% negative, for syphilis. 60% positive, 22% doubtful, 18% negative for gonorrhoea. At best strong character cannot be the rule among individuals ⅔ of whom have less intelligence than that possessed by the average individual among a group of children of 15, (of whom half are themselves retarded), and almost surely not when they have been too untrained industrially and too unschooled socially to have acquired simple every-day habits of restraint and inhibition. Even the more intelligent third of the reformatory subjects differed very obviously and unmistakably in stability and emotional control from the group of Vassar maids.

_THE MENACE OF MENTAL DEFICIENCY FROM THE STANDPOINT OF HEREDITY.[51] By Henry H. Goddard, Ph.D., Vineland, N. J. New Jersey Training School._

Footnote 51:

Read before the conference of the Massachusetts Society for Mental Hygiene, Boston, November 19, 1915.

From the standpoint of the child, something can be done to make them a little happier; from the standpoint of society, no amount of mental hygiene can ever render them efficient citizens. Society can, by proper treatment, render them less of a menace than they are naturally, and the ills that we now suffer on account of them can be largely reduced.

It is estimated that there are from 300,000 to 400,000 mental defectives in the United States. That is based upon the United States census of 1890, in which the question was asked “Whether defective in mind, sight, hearing or speech, or whether crippled, maimed or deformed, with name of defect.” Now if anyone can estimate what proportion of the true number of the feeble-minded would be returned in answer to that question, he will be able to estimate how near the truth is the 200,000 which the census report gives. Three hundred thousand or 400,000 seems to be a conservative estimate.

I am to discuss this topic from the standpoint of heredity. It has not yet been successfully contradicted that two-thirds of this army of 300,000 or 400,000, owe their condition to heredity. A quarter of a million of these people are feeble-minded because their ancestors were feeble-minded. They have inherited the condition just as you have inherited the color of your eyes, the color of your hair, and the shape of your head. There is a tendency in these days to attribute a great deal to heredity. But of this particular thing there seems to be no question. The menace of the problem comes, not from the fact that a quarter of a million inherited their condition, but because they are transmitting that condition to their offspring. Of that quarter of a million feeble-minded persons in the United States, do you know how many are being cared for, guarded and kept from propagating their kind? About 24,000 out of 250,000 are to-day being cared for in such institutions as you have here at Waverley. The rest are living their lives, are raising families, and providing abundant opportunity for the exercise of the charitable impulses of numberless generations to come. And that condition of things is getting worse rather than better.

What shall we do? There have been two answers. Some say, “Segregate, shut them up. Keep the sexes apart.” We are told that if we could do this for a generation our problem would be largely solved. The two-thirds in which the condition is largely hereditary would be eliminated. I want to assure you that the problem is larger than that. In the first place, looked at from the practical standpoint, we do not seem to be able to segregate. We are taking care of 24,000, and there are at least 250,000 to be cared for. If the State of New York cared for its estimated proportion of mental defectives, it would require thirty institutions of 1,000 each. They find it hard to raise money for the three or four institutions they now have. Their appropriations are cut every year. In the State of Massachusetts there are at least 14,000 feeble-minded persons. It would require ten institutions the size of Waverley,—a demand upon the public treasury which we are not willing to meet. I have not found anyone yet who is optimistic enough to think that we shall meet the demand within any reasonable length of time,—a time so short that we can safely rely upon that as a solution of the problem.

I have said that this quarter of a million, this army of feeble-minded people, are propagating. They are propagating a progeny of feeble-minded at somewhere from two to six times as fast as the intelligent people are propagating their kind. That is another serious part of the problem. I should like to digress from my particular field for a moment to make a suggestion on the other side. It makes one feel pessimistic when we find that the good stock here in New England—the stock than which there is no better in the world—is gradually disappearing for lack of issue. Of one family after another one reads all too frequently, “The last of his family has passed away.” We are told sometimes that two children in a family are all that can be properly reared; that it is better to rear two children and rear them properly than to rear a larger family and rear them badly. If _two children in a family_ are all that our best and finest and nobler families can properly raise, _how many children_ ought to be raised in a family of these low-grade people? The average in the United States is, for all classes, something less than two, and the average for these defectives is from four to twelve. In that little family that we ran across down in New Jersey, which we call the Kallikaks, you will recall that the good side started from six ancestors. That is to say, Old Martin Kallikak, after he married, had seven children, one of whom died without marrying. From the six who lived and married, sprang all the normal descendants. Martin’s illegitimate son, the child of the feeble-minded girl, was the only one on the bad side, and yet to-day the number of descendants from the illegitimate mating is practically the same as the number descended from the six legitimate children. You can see that it does not take many generations for the progeny of the unrestrained feeble-minded to equal and even outstrip the normal. Our good stock is multiplying very slowly. Our poor stock—the lowest strata of society—multiplies in what might really be called a brutal ratio. If civilization is to advance, our best people must replenish the earth. I think it should be a part of our religion to replenish the world with good, clean people.

We need to know vastly more than we know to-day before we can give definite answers, except in the case of marriage between two feeble-minded persons. Now, that being the case, the argument that I want to make to you is: the propagation of the feeble-minded is going on at an enormous rate. If we could do, and if we did, everything that we wanted to do, and that we knew enough to do, we should be getting only at the surface of the problem, and should be sure in only about one case out of the six possibilities. Now if that is the case, my friends, does it seem that we ought to put off attacking the problem until we cannot stand it any longer? Or does it mean that we had better attack it right away? Is it not best to begin hunting for these defective children wherever they may be found? And they can be found in the school, in our juvenile courts, in our almshouses, in our insane hospitals, in our reform schools, in our homes for cripples, in our asylums for the blind,—in short, wherever there is a dependent group there is an undue proportion of these mental defectives.

Some will say, “If they are in almshouses they are being cared for.” In reality they are being raised and brought to manhood and womanhood and then sent out, to propagate their kind. Fifty years ago the problem was not as serious as it is to-day, because these defectives were out in the world by themselves, getting killed by a runaway horse, or falling into machinery, or in some way meeting an untimely death. To-day we are exceedingly careful; we are protecting them in every possible way; we are taking care of them in our institutions and giving them every advantage, and then sending them out into the world—a menace to the rest of humanity.

It would be a dreadful thing if all these problems were solved and we didn’t have any people to give our money and charity to. I suppose we should become hard-hearted if we didn’t have any to befriend. Perhaps we want to keep enough of these unfortunates so that we can still contribute to their safety and welfare. But, my friends, when we realize the suffering, the terrors, the losses of all kinds that these people unintentionally, unwittingly cause us, we have another side of the problem. The menace of the feeble-minded is not a figure of speech. It is no undue sentimentalism that assures us that we need to take care of this group of people. We need to study them very seriously and very thoroughly; we need to hunt them out in every possible place and take care of them, and see to it that they do not propagate and make the problem worse, and that those who are alive to-day do not entail loss of life and property and moral contagion in the community by the things that they do because they are weak-minded.

_HEALTH FIRST AND MATRIMONY AFTERWARD. By Edward C. Spitzka, M.D. The Semi-Monthly Magazine Section of the Boston Globe, the Washington Post, the Philadelphia North-American, the Pittsburgh Dispatch, the Chicago Tribune, the St. Louis Globe-Democrat, the Cincinnati Enquirer, etc. May 11, 1913._

We cannot tell men and women how they should mate in order to insure positive types of offspring. But we can state, emphatically, and without reserve, that persons suffering from certain diseases should not enter into the marriage relationship, at peril of the health and happiness of children that may be born to them and the well being of the community at large.

I believe that municipal and state governments should take cognizance of this fact. Eventually it will be regarded as a matter for Federal, perhaps for international action. Every candidate, man or woman, applying for a marriage license should be required to present a physician’s certificate declaring him or her to be free from insanity and certain virulent transmissible diseases.

What then are these diseases? I will list them in the order of importance as menaces to humanity.

1. Constitutional insanity.

2. The two great forms of constitutional venereal disease: syphilis and gonorrhoea—the former as a source of danger to both the marriage partner and offspring, the latter to the marriage partner only.

3. Deformities that are likely to be associated with the transmission of serious defects of the nervous system, such as cleft palate, hermaphroditism, etc.

4. Epilepsy of the standing of more than one generation.

Medical statistics prove that a proportion of three out of every five children born to imbecile parents are certain to be weak-minded, and that the marriage of such unfortunates is a calamity to the race. Syphilis persists from generation to generation. Any sufferer from this disease who marries before he is certain that it has been eradicated from his system is guilty of a crime against society.

I have hesitated about including epilepsy in this list. It is undoubtedly transmissible to the offspring, though transmission does not occur in every case. A conservative ruling would be that an epileptic who is believed to be the first of his line to contract the disease should be permitted to marry, in the event of his being declared cured. But the epileptic sons and daughters of epileptic parents should, under no circumstances, be licensed to marry.

NOTE: The late Dr. Spitzka, along with other authorities quoted as being opposed to the marriage of the unfit, was concerned with the diseased offspring which almost invariably result from such marriages. Except in the case of gonorrhoea, which can be transmitted to the marriage partner, he did not object to the union itself, provided the latter remained childless. He would have recommended the use of contraceptives, as the solution of the problem, had he not been prohibited by the law from doing so.

_HEREDITARY SYPHILIS IN THE LIGHT OF RECENT CLINICAL STUDIES. Pamphlet. Borden S. Veeder, M.D., St. Louis, Mo. From the American Journal of the Medical Sciences, October, 1916. No. 4, Vol. CXII. P. 522._

In the present state of our knowledge we can summarize the evidence as pointing to the view that in hereditary syphilis the mother is always infected, although very frequently the infection is latent and that true germinal infection does not occur.

SYPHILIS AS A SOCIAL PROBLEM. No accurate figures are available as to the incidence of hereditary syphilis. The disease is not reportable, and even if it were it is doubtful if the records obtained in this way would be of any value, as the condition is frequently overlooked, and when recognized would be concealed in many cases because of the stigmata attached. With improved methods of diagnosis we are beginning to learn that it is far more common than previously thought, as many conditions in which the etiology was obscure have been found to be the result of a syphilitic infection. Hospital statistics are of little value in this connection. In St. Louis we have been particularly interested in hereditary syphilis, and have admitted many cases to the Children’s Hospital for study which would normally have been cared for in the out-patient clinic, and hence the proportion of syphilis to the total number of admissions is relatively high. We have seen between 300 and 350 children with an hereditary infection in three and a half years and have undoubtedly failed to recognize a number of cases. We have also found many cases of latent syphilis by testing the apparently healthy children of syphilitic families. What is more important is the number of obscure clinical conditions which have been found to be syphilitic in origin.

The importance and cost of syphilis to the family and the community is not generally appreciated. About this point we have collected some interesting information: For a period of about a year an attempt was made to obtain extensive data in regard to the family of every syphilitic child coming to the clinic, to examine all of the other living children as well as the parents, and to test the blood of each member by the complement-deviation method. In this way data was assembled for 100 syphilitic families. Many marriages (10 to 30 per cent.) remain sterile as a result of syphilis and others (13 per cent. according to Haskell) result only in abortions. Our material includes only those families in which a living child came under our direct observation and care.

In these 100 syphilitic families 331 pregnancies occurred which resulted as follows:

Abortions 100 or 30.2 per cent. Stillbirths 31 or 9.3 per cent. Living births 200 or 60.5 per cent.

Thus 40 per cent. of the pregnancies terminated in the death of the fetus before term. If the parents had been healthy and of the same social strata we might have expected 30 to 35 deaths before term, or a mortality of 10 per cent. instead of 40 per cent.

Considering next the 200 living births: At the time the data were collected 39 were dead and 161 alive, but 12 of the 161 died during the course of the investigation. Of the 161 examined 107 had both clinical signs of syphilis and a positive Wassermann; 5 were clinically positive but gave negative tests (in all of these the family gave a history of syphilis); 16, although negative as regards clinical manifestations, gave positive reactions, and therefore belong to the group of latent syphilitics. Thus but 33 of the 161 living children were free from the infection, and if we attribute the deaths occurring before term to syphilis, we find that of the 331 pregnancies in 100 syphilitic families but 10 per cent. escaped the infection. The toll is summarized in the following table:

331 PREGNANCIES IN 100 SYPHILITIC FAMILIES

131 or 40 per cent. died before term } 51 or 15 per cent. died after birth } 55 per cent. dead 116 or 35 per cent. living but syphilitic 35 per cent. syphilitic 33 or 10 per cent. living and free from 10 per cent. escaped syphilis ——— 331

If we add to this record and take into consideration the physical condition of the parents—both of whom were syphilitic in almost all of our cases—we begin to grasp the appalling importance of syphilis from a social standpoint.

In order to show this in another way, studies[52] were made in our clinic in which the waste (total deaths to total pregnancies) occurring in 100 families in which we were treating children with contagious disease, and in 100 families selected at random from our records, were contrasted with the waste in 100 syphilitic families. These groups are designated as C. R. and S. respectively and the data briefly summarized in the following table:

Footnote 52:

Jeans and Butler, Hereditary Syphilis as a Social Problem, Am. Jour. Dis. Child., 1914, viii, 327.

Total Deaths Born living Per cent. Group pregnancies before now dead Total waste birth

C. 444 46 70 116 26

R. 442 42 59 101 22

S. 453 116 104 220 48

The increase in the waste for the syphilitic group of 100 per cent. does not represent the total waste, as it is fair to assume that three-quarters of the living children are syphilitic and many of these defective.

SYPHILIS. None of the causes supposed to be potent causes of feeble-mindedness is so difficult of investigation, so enigmatical as Syphilis. Not only in the popular mind but in the professional thought, it is given a prominent place, yet of all the causes there is perhaps none for which there is less evidence. This does not necessarily mean it is not a cause, but simply that it is not proved. The terrible nature of the disease, the serious results that it is known to produce, such as miscarriage, deaths in infancy, general paralysis of the insane, the fact that it is one of the two diseases that can be transmitted from the mother to the child because the germs can pass through the chorion cells, the fact of its close connection with sexual immorality, all tend to render it in the minds of most people a horror of which anything can be believed. It is well understood by the medical profession that a mating which shows, first a number of miscarriages followed by deaths in infancy, and finally live offspring, is a picture that means syphilis in one or both of the parents almost without question. In conclusion, there is abundant evidence that syphilis produces miscarriages and early death.

It is claimed that syphilis is responsible for 42 per cent. of abortions and miscarriages, the remaining 58 per cent. embracing all cases of whatever character, artificial or otherwise.

SYPHILIS IN THE OFFSPRING OF SYPHILITIC PARENTS

_FAMILIAL SYPHILIS. By P. C. Jeans, M.D., “American Journal of Diseases of Children.” January, 1916. Vol. XI. pp. 11–19._

As the result of syphilis numerous families remain sterile. The figures for sterility vary from 10 per cent. to 30 per cent., depending on the material studied. When there is an embryo there is a variety of fates to which it may come. Many marriages result only in abortions (nearly 13 per cent. in Haskell’s material[53]). Since the starting point in our material was a syphilitic child, we have no data bearing on this phase.

Footnote 53:

Haskell: Jour. Am. Med. Assn., 1915, lxiv, 890.

Among our syphilitic patients all the living children of 100 families have been examined, Wassermann tests made and the family history studied. In these 100 families there were 331 pregnancies. Of these 100 (30.2 per cent.) were abortions, 31 (9.3 per cent.) still births and 200 (60.4 per cent.) living births. Of the 200 living births 35 children died early and 4 died late, and 161 remained alive and were examined. Of these, 12 are now dead. Of the 35 who died early, 5 gave an undoubted history of syphilis and a number gave suspicious histories. Of the four who died late, one was an idiot. Of the 161 examined, 107 were clinically positive and had positive Wassermann tests. Five were clinically positive and had negative Wassermann reactions. Sixteen, who showed no evidence of syphilis, gave positive Wassermann reactions. Thirty-three, who gave no clinical proof of syphilis, gave a negative Wassermann reaction.

Of the five who were clinically positive but gave negative Wassermann reactions, one was a young infant who had snuffles and a large spleen. The mother and sister both gave a positive history and a positive Wassermann reaction. Shortly after beginning treatment the baby developed a syphilitic rash. The baby was removed from the hospital and a second Wassermann was not done. The second case was a nursing baby. The mother had active syphilis and was taking treatment. The baby had an active process in the nose. The third case was a 7-year-old girl who had a markedly sunken nose and who for that reason was the starting point for investigating that family. Both the mother and younger brother gave a positive Wassermann. The fourth case was a 4-year-old girl whose mother and younger sister were both positive and the patient had a general rash which was thought to be syphilitic. The fifth case was a 3-year-old boy with a positive history, and who had had some treatment. His mother and younger brother both had syphilis.

A negative Wassermann reaction is obtained in the presence of active syphilis only under certain definite conditions. As had been noted in cases not of this series, very young babies, even with undoubted active syphilis, not infrequently give a negative Wassermann. It has also been noted that even small amounts of mercury tend to cause a positive blood to react negatively.

H. Boas[54] states that of fifty-seven babies of syphilitic mothers giving negative Wassermann reactions at birth, thirteen during a three months’ period of observation developed syphilitic manifestations and a positive Wassermann, and two others showed syphilitic changes at necropsy, having had no manifestations during life.

Footnote 54:

Quoted by Haberman: Jour. Am. Med. Assn., 1915, lxiv, 1146.

LATENT SYPHILIS

It is seen that 10 per cent., of the children examined had latent syphilis, i.e., a positive Wassermann and no clinical evidence of syphilis. One of these children gave a history of epiphysitis at 3 months. Other than this no early history was acknowledged by any of the mothers. The question naturally arises, Are these children actively infected with syphilis? When we inquire into the history of those showing late manifestations, we frequently find, so far as obtainable history is concerned, that there has been no previous warning that the disease existed. One of our patients developed, as her first known symptom, an interstitial keratitis at 20 years. We know that the spirochete can lie dormant much longer than this and then manifest itself. One patient of this latent group who had taken very irregular treatment for about a year and who had never had previous manifestations, recently developed an active lesion in the throat. Another developed an interstitial keratitis after about two months of anti-syphilitic treatment. A positive Wassermann reaction in these apparently healthy children has the same significance that it does in the parent, and it is our belief that the children in this group are actively infected.

The fact that there are thirty-three children, 10 per cent. of the total pregnancies, who show no evidence of syphilis, and at the same time give a negative Wassermann reaction, is rather hopeful. Yet the pleasure to be taken in this fact is not altogether unalloyed. In this small group there were two mental defectives and an idiot, and it is impossible to say that all of this group are free from syphilitic infection. In one instance, one such negative child returned about a year after his original examination with a tertiary type of lesion and a positive Wassermann. Though no classification of those in this group showing stigmata of degeneration was attempted, it can be truthfully stated that a goodly proportion did show degenerative influences, either physical or mental.

TOTAL SYPHILIS IN THE FAMILIES STUDIED

In summing up the total syphilitic infection in these families, we find that where marital relations are uninvolved, all of the fathers and probably all of the mothers have been infected. Presuming that the abortions, stillbirths, all of the early deaths and at least one of the late deaths were due directly or indirectly to syphilitic infection, syphilis among the offspring amounts to 89 per cent. of the total pregnancies, and total syphilis in the family amounts to 93 per cent. of all its members.

SUMMARY

It is highly probable that all the mothers of syphilitic children have been infected with syphilis. Of eighty-five mothers of syphilitic children 86 per cent. gave positive Wassermann reactions. All of the remaining cases but six gave a history of infection or treatment, or both. Five of these six patients were examined at least ten years after the birth of their last syphilitic children and the infection is probably dying out.

Eighty-seven per cent. of the mothers deny all knowledge of the infection. The mothers are for the most part infected during the latent stage of the father.

Of 331 pregnancies in 100 families, 30 per cent. were abortions, 9 per cent. stillbirths, 61 per cent. living births. Of the living births 24 per cent. had died. Of those living 80 per cent. had syphilis.

Of the total pregnancies 90 per cent. were presumably syphilitic and although 10 per cent., seem free from syphilis, there is no proof that they all are. The total syphilis in these families amounts to 93 per cent. of the entire family.

For the most part our families followed Kassowitz’s rule; i.e., decreasing grades of infection in the children.

In case of syphilitic mothers bearing non-syphilitic children, it is probable that the infection in the mother is localized in places where it is not readily transmitted.

The idea that there are different strains of spirochetes receives some support from these families.

Transmission to the third generation, though not proved, is distinctly an occasional probability.

_OBSTETRICS. A Text-book for the Use of Students and Practitioners. Whitridge Williams, Professor of Obstetrics Johns Hopkins University. Obstetrician-in-Chief to the Johns Hopkins Hospital; Gynecologist to Union Protestant Infirmary, Baltimore, Md. D. Appleton and Co., 1912._

Syphilis is one of the most important complications of pregnancy as it is one of the most frequent causes of repeated abortion, or premature labor. The influence of syphilis upon pregnancy differs materially, and three classes of cases are distinguished, according as infection has taken place: 1—before pregnancy; 2—at the time of conception; or, 3—during pregnancy. When inoculation with the specific poison has occurred before conception the disease nearly always gives rise to abortion or premature labor, more frequently the latter. Le Pileur obtained a striking illustration of the disastrous effects of syphilis from a study of the reproductive histories of 130 women, before and after its inception, 3.8 per cent. of the children being born dead before, as compared with 78 per cent. after infection. In premature labor due to syphilis the child is usually dead when it comes into the world; less frequently it is born alive with definite manifestations of the disease. When the mother is suffering from the affection at the time of conception the offspring is always syphilitic. P. 495.

_THE PRACTICE OF OBSTETRICS. In Original Contributions by American Authors. Edited by Reuben Peterson, A.B., M.D., Professor of Obstetrics and Gynecology in the University of Michigan, Ann Arbor, Mich.; Obstetrician-in-Chief to the University of Michigan Hospital. Lea Bros. and Co., Philadelphia and New York, 1907._

In marked contrast to the comparatively slight interference of pregnancy with the course of syphilis is the decidedly unfavorable influence of syphilis upon the course of pregnancy. Syphilis, more often than any other infectious disease, is responsible for a great variety of pathological changes in the fetus, placenta and uterus, and for the premature interruption of gestation. Statistics show that the fetal mortality in this disease averages 50%. This figure is lower than that given in the preceding paragraphs for some of the acute infectious diseases, but considering the prevalence of syphilis among all civilized and uncivilized races, it is obvious that the effect of this disease deserves a most careful consideration, not only from the medical, but also from the economic and sociologic point of view. Fournier gives the fetal mortality for cases in which the maternal infection occurs simultaneously with fecundation as 75%, the fetal morbidity being above 91%. Page 347. (Hugo Ehrenfest, M.D.)

_A TEXT BOOK OF OBSTETRICS. Barton Cooke Hirst, M.D., Professor of Obstetrics in the University of Pennsylvania; Gynecologist to the Howard and Orthopaedic and Philadelphia Hospitals, etc. W. B. Saunders Co., Philadelphia and London, 1912._

Syphilitis as the most frequent cause of habitual death of the fetus must be excluded before another cause is sought. P. 352.

Of 657 pregnancies in syphilitic women collected by Charpentier 35% ended in abortion, and of the children that went to term a large number were stillborn. Of 100 conceptions in syphilitic women only seven children were alive a year later. P. 333.

_PRACTICAL OBSTETRICS. Thomas Watts Eden, Obstetrical Physician and Lecturer on Midwifery and Gynecology, Charing Cross Hospital; Consulting Physician to Queen Charlotte’s Lying-in-Hospital; Surgeon to In-Patient Hospital for Women. 4th Edition. C. V. Mosby Co. 1915._

Of all the systematic causes of abortion however, the most important in all respects is syphilis. In all probability more abortions are due to this disease than to any other cause. P. 220.

It will be clear from this enumeration of the conditions which cause it that abortion is not an uncommon event. From some recent statistics presented by Professor Malins to the Obstetrical Society of London it appears that in this country about 16% of pregnancies terminate by abortion, i.e., one abortion occurs to every five births of viable children, and further, it appears that abortion is nearly twice as frequent among the classes from which hospital patients are drawn as among the well-to-do. Women who are the subjects of syphilis or Bright’s disease often sustain a succession of abortions without carrying any pregnancy to term. P. 221.

_THE PRINCIPLES AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, M.D., Professor of Obstetrics at the Northwestern University Medical School; Obstetrician to the Chicago Lying-in-Hospital and Dispensary and to Wesley and Mercy Hospitals, etc. W. B. Saunders Co. 1913._

Premature labor is produced by the same factors that bring on abortion, but syphilis plays the most common role here, it being estimated that from 50% to 80% of the cases are thus caused. Next comes nephritis. Habitual abortion means that successive pregnancies are interrupted at the same period of development. Syphilis is usually found as the active factor and more especially in miscarriages of the later months. Each successive abortion occurs at a later period until a living child is born, but it perishes from congenital syphilis, and finally the disease has become so attenuated that a viable child is born. P. 419.

Obstetricians should constantly be on the alert for this protean disease. Its baneful action is often discovered when least expected and it spreads its blight on all three individuals concerned in the procreation of the species, often being transmitted to the second generation. Ricord says that in Paris one in eight is syphilitic, and while in America conditions are better, the disease is not rare and in its lesser manifestations quite common, though often not diagnosed. P. 482.

Interruption of gestation is the commonest symptom (of syphilis) and von Winckel found 61% fetal mortality. P. 483.

_THE PRACTICE OF OBSTETRICS. Designed for the use of Students and Practitioners of Medicine. J. Clifton Edgar, Professor of Obstetrics and Clinical Midwifery in the Cornell University Medical College; Visiting Obstetrician to Bellevue Hospital, New York City; Surgeon to the Manhattan Maternity and Dispensary; Consulting Obstetrician to the New York Maternity and Jewish Maternity Hospitals. 5th Edition Revised. P. Blakiston’s & Co., Philadelphia._

This (syphilis) is one of the most common causes of abortion. P. 321.

The causes of interrupted pregnancy may be placed in three classes. The maternal causes are divisible into systemic and the local. The systemic causes include obesity, marriages of consanguinity, _pregnancies in rapid succession_, etc., and the toxemia of kidney insufficiency. The local causes include all cases of acute and chronic pelvic congestion. P. 332.

Chief among the paternal causes is syphilis, tuberculosis, extreme youth or old age, great constitutional depression, exhaustion from any cause. P. 333.

_MEDICAL GYNECOLOGY. Howard Kelly, A.B., M.D., LLD., F.R.C.S., Professor of Gynecological Surgery in Johns Hopkins University, and Gynecologist to the Johns Hopkins Hospital; Fellow of the American Gynecology Society; Honorary Fellow of the Edinburgh Obstetrical Society; Hon. Fellow Royal Academy of Medicine in Ireland; Fellow British Gynecology Society, etc., etc., etc. D. Appleton & Co., New York and London, 1912._

The susceptibility of syphilis to hereditary transmission is a fundamental character of the disease. It may be transmitted to the offspring directly by the infected sperm of the father, or from the infected ovule of the mother at the time of impregnation, or the infective principle may be conveyed through the medium of the utero-placental circulation during the course of pregnancy. P. 432.

Whether the infection is communicated through the sperm solely, the ovule, or the utero-placental circulation, the uterine death of the fetus is the most habitual expression of hereditary syphilis. Hereditary syphilis is one of the most common causes of abortion. P. 434.

Clinical observation shows most conclusively that certain dystrophies and organic defects in the subjects of hereditary syphilis may be transmitted to the third generation. P. 436.

While we cannot conclude that syphilis is transmitted in its essential nature as a virulent contagious disease, to the third generation, yet it is well known that heredo-syphilis kills the product of conception, or transmits to the survivor an impaired vitality with various dystrophies, and thus constitutes a chief factor in the physical, mental and moral degeneration of the race. From an exhaustive study of heredo-syphilis, Tarnowsky concludes that syphilis has an incomparably more fatal influence upon the species and on society than on the individual. P. 437.

_PRINCE A. MORROW, M.D. Eugenics and Racial Poisons. Pamphlet published by the Society of Sanitary and Moral Prophylaxis, 105 W. 40th St., New York. 1912._

Syphilis is the only disease transmitted to the offspring in full virulence, killing them outright, or blighting their normal development. When the father alone is infected the mortality is about 38%. When the mother also becomes infected the mortality averages from 60% to 80%. Fully ⅓ of all infected children die within the first six months. Even when the subjects of inherited syphilis successfully run the gauntlet of diseases incident to infancy and childhood they do not always escape the effects of the parental disease. They are subject to various organic defects or stigma of degeneration, as they are termed. A final result of hereditary syphilis is the inability to procreate healthy children. If the subjects of inherited syphilis grow up and marry they are liable to transmit the same class of organic defects to the third generation.

_FEWER AND BETTER BABIES, OR THE LIMITATION OF OFFSPRING. Wm. J. Robinson, M.D., Chief of the Department Genito-Urinary Diseases and Dermatology, Bronx Hospital and Dispensary; Fellow of the American Medical Association and of the New York Academy of Medicine._

There are thousands of syphilitic men and women who are perfectly safe as far as their partner is concerned, but are not safe enough to become parents. They cannot infect, but they must not give birth to children for fear that the children may have the taint in them. The use of preventives settles this problem and saves the world from thousands of pitiable hereditary syphilitics. P. 126.

_MEDICAL GYNECOLOGY. Howard A. Kelly._

Two fundamental characteristics, contagiousness and susceptibility of hereditary transmission, give to syphilis an altogether special importance in relation to marriage. The statement has been made that syphilis constitutes a far greater danger to Society and the race than to the individual. The chief significance of syphilis as a racial danger comes from its hereditary effects. In addition, hereditary syphilis undoubtedly creates a terrain, or soil, favorable for the reception and germination of tubercle bacilli, and perhaps other bacilli. It does this by impoverishing the organism and diminishing the capacity of resistance against microbic invasion. From the view point of race perpetuation, syphilis is antagonistic to all the family represents in our social system. The essential aim of marriage is not simply the procreation of children, but of children born in conditions of vital health and physical vigor. The effect of syphilis is to so vitiate the procreative process as to produce abortions, or else a race of inferior beings, endowed with defects and infirmities and unfit for the struggle of life. It is this pernicious effect of syphilis upon the offspring which gives to the disease a dominant influence as a factor in the degeneration and depopulation of the race. P. 444.

When a married man has syphilis the first indication is to prevent contamination of his wife, the second is to guard against pregnancy. The interdiction of pregnancy should be absolute until time and treatment have exerted an attenuating and curative influence upon the diathesis. P. 448.

A consultation of the works of most authorities shows them to agree that the frequency of abortion to births at full term is from one in five or six to one in ten. P. 453.

_SOCIAL DISEASES AND MARRIAGE. Social Prophylaxis. Prince Morow, M.D., Emeritus Professor of Genito Urinary Diseases in the University and Bellevue Hospital Medical College, New York; Surgeon to the City Hospital; Consulting Dermatologist to St. Vincent’s Hospital, etc. Lea Bros. & Co., New York and Phil., 1904._

The influence of inherited syphilis is manifest in the production of various dystrophies, malformations, and lesions of important organs, it seriously compromises the physical development, mental vigor and vital stamina of the descendants and constitutes a harmful factor in the degeneration of the race. The social aim of marriage is not simply the production of children who are to continue the race, but of children born in conditions of vitality and physical health fit to produce a race well-formed and vigorous, not to procreate beings malformed and stamped with physical and mental infirmity, destined to early death, or to drag out a miserable existence of invalidism. P. 21.

The statistics of European observers which have been collected from both private and hospital practice show in a most positive manner the noxious influence of syphilis upon the offspring. An analysis of these statistics taken from all quarters and aspects of the social condition of the parents show that when both parents are infected the mortality is 68 per 100. P. 27.

No other disease is so susceptible of hereditary transmission, so pronounced in its influence, and so fatal to the offspring.

While death in utero may occur as the most habitual expression of hereditary syphilis, its lethal influence is not limited to the period of intra-uterine existence. The child may be born alive, but in many cases the sentence of death is not commuted, it is simply reprieved, it may be for a few months, weeks, or only days. P. 212.

_THE WORLD’S SOCIAL EVIL. A Historical Review and Study of the Problems Relating to the Subject. Wm. Burgess. With Supplementary chapter on a constructive policy by Judge Harry Olson, Chief Justice Municipal Court, Chicago. Saul Bros., Publishers, Chicago, 1914._

Based upon statements, experiences and opinions of physicians, public officials and other responsible persons, 50% to 80% of all men between the ages of 18 and 30 years contract gonorrhea. 10% to 18% of the male population contract syphilis. 40% to 60% of all operations upon women for diseases of the generative organs result from gonorrheal infection. 80% of the inflammatory diseases peculiar to women are the result of gonorrheal infection. A large per cent., some say one half, of still born and premature deaths of children is due to syphilis. 25% to 35% of all cases of insanity are caused by syphilis contracted years before. 15% to 20% of all blindness is attributed to these diseases. P. 159.

_A CONSTRUCTIVE POLICY WHEREBY THE SOCIAL EVIL MAY BE REDUCED. Harry Olson._

The large group of mentally retarded persons who may be included in the term “sub-normal” number in this country, according to the best authorities about 300,000. An important distinction must be made between two groups of the defective classes, those who may, and those who should not enjoy social privileges as members of the community. From a racial and eugenic point of view the inborn, or heredity defectives are by far the most important because the defect is germinal and therefore transmissible to the offspring. This class forms 75% or more of the defective classes. When so many as 75% of the feeble-minded are such by reason of germinal or hereditary taint, and since perhaps 50% of the women of the underworld are sub-normal, it becomes at once apparent that not only in order to reduce the number of women in public prostitution, but also to protect the race itself, we must adopt other methods of eliminating vice than those now employed. P. 358–359.

_PROCEEDINGS OF THE NATIONAL CONFERENCE ON RACE BETTERMENT. January 8–12, 1914. Published by the Race Betterment Foundation. Edited by the Secretary._

Statistical Studies. The Significance of a Declining Birth Rate. Frederick L. Hoffman, Statistician of the Prudential Insurance Company, Newark, N. J.

From an economic and social point of view a low birth rate and a low death rate would unquestionably be more advantageous than the opposite condition, which involves much needless waste of human energy and pecuniary expenditure. For reasons which require no discussion, every civilized country desires a normal increase in population, though a high degree of social and economic well-being is not at all inconsistent with even a stationary population condition such as for some years past has prevailed in France. P. 23.

All the available statistical information seems to justify the conclusion that the world’s population in general, and of the more civilized countries in particular is increasing at the present time at a more rapid rate than in earlier years—a condition largely the result of a persistent and considerable decline in the birth rate. P. 28.

The important causes of death which have increased during the five years ending 1910, as compared with the previous five years, are briefly the following:—Syphilis increased from 4.1 to 5.4, per 100,000 of population. Cancer, and other malignant tumors from 11.5 to 13.7; locomotor ataxia, and other diseases of the spinal cord from 7.3 to 8.4; all diseases of the circulatory system combined from 161.2 to 171.7; ulcers of the stomach from 2.9 to 3.6; diarrhea and enteritis under two years, from 89.0 to 96.2; diseases of the puerperal state considered as a group from 14.2 to 15.5; malformations, chiefly congenital, from 12.2 to 14.9; diseases of early infancy, chiefly congenital debility and premature births, from 73.9 to 75.0. P. 45.

GONORRHEA

_THE PRACTICE OF OBSTETRICS. In Original Contributions by American Authors. Edited by Reuben Peterson, A.B., M.D. Lea Bros. & Co., Phil. and New York. 1907._

The reciprocal relation of gonorrhea and pregnancy is most unfavorable. Gonorrhea exerts a very unfavorable effect upon pregnancy and is responsible for a large number of abortions in the early months. Finally the gonococcus is a great source of danger to the fetus whose eyes may become affected during his passage through the diseased maternal parts. P. 373.

_THE PRINCIPALS AND PRACTICE OF OBSTETRICS. Jos. B. De Lee, M.D., Professor of Obstetrics at the Northwestern University Medical School; Obstetrician to the Chicago Lying-in-Hospital and Dispensary and to Wesley and Mercy Hospitals, etc. W. B. Saunders Co. 1913._

Abortion is probably often the result of gonorrhea, acute or chronic. Chronic endometritis is most often the result of gonorrhea. P. 516.

_THE SEXUAL LIFE OF WOMAN IN ITS PHYSIOLOGICAL, BIOLOGICAL AND HYGIENIC ASPECTS. E. Heinrich Kisch, Professor of the German Medical Faculty of the University of Prague, Physician to the Hospital and Spa of Marienbad; Member of the Board of Health, etc. Translated by M. Eden Paul, M.D. Rebman Co., New York._

The physician should lend his skilled assistance in producing facultative sterility only when his own special scientific knowledge leads him to consider this urgently necessary. A woman’s life and well being must appear to him of greater importance than the existence, or non-existence of a possible infant. That this view is morally sound is shown by the fact that public opinion justifies the accoucheur in the destruction of a living child when the mother’s life is in danger. P. 395.

_EUGENICS AND RACIAL POISONS. Prince A. Morrow, M.D., Emeritus Professor of Genito Urinary Diseases in the University and Bellevue Hospital Medical College, New York; Surgeon to the City Hospital; Consulting Dermatologist to St. Vincent’s Hospital, etc. Lea Bros. Co., New York and Philadelphia, 1904._

While the gonococcus is not transmissible through heredity it carries with it serious infective risks to the offspring. Fully 80%, and some authorities declare practically all of the blindness of the new born is caused by the gonococcus.