CHAPTER VI_Being Well-Born: An Introduction to Eugenics

PRENATAL INFLUENCES

=All That a Child Possesses at Birth Not Necessarily Hereditary.--=We come

now to the more specific discussion of what may happen to offspring of

mammals, and particularly man, in the interval between fertilization and

birth; that is, during the intra-maternal period. We have already seen

that anything affecting the offspring during this period has to be

reckoned as environmental, our formula reading, Mammal = germ +

intra-maternal environment + external environment. It is evident, then,

that all that a child possesses at birth is not necessarily hereditary,

since the unborn child may be influenced by conditions prevailing in

either parent.

=The Myth of Maternal Impressions.--=In order to clear the way for more

urgent matters let us first inquire into the question of the production of

changes in the unborn child as a result of "maternal impressions." As the

tale generally goes, structural changes are produced in the unborn child

corresponding to some mental experience of the mother, usually a vivid

impression of strong emotion, but when a given individual is pinned down

to sources, it is usually a case of hearsay.

Stock examples are: The mother sees a mouse with the result that a

mouse-shaped birthmark occurs on the child; or she sees a crushed hand

and in consequence bears a child later with some of the bones of the hand

missing; the mother touches her body when frightened and thus marks the

unborn child on the corresponding part of the body; or she produces beauty

in the child by long contemplation of a picture of a beautiful child; and

so on almost endlessly. The favorite is usually the production of a red

birthmark or marks on the child's body by strong desire on the part of the

mother for strawberries, tomatoes, etc.--the fruit must be red since the

mark is red--or by fright from seeing a fire. As a matter of fact it is

not uncommon for the capillary blood vessels of the skin of a new-born

infant to remain dilated in spots instead of contracting as they normally

should do. The result is more or less of a red or "flame" spot. It is easy

to see, therefore, why such birthmarks are so frequently referred back by

the credulous mother to her desire for or fear of some red object.

An analysis of the case of a child shuddering at the sight of peaches is

of interest in this connection. The child showed the greatest aversion to

peaches, particularly to the fuzzy covering. The mother's explanation was

that peaches were unusually plentiful the year the child was born and that

she had worked hour after hour at peeling and canning peaches shortly

before his birth until she had become thoroughly sick of them. This

acquired aversion on her part she believed had been transferred to the

child. A few questions revealed the fact, however, that the mother,

herself, had never liked peaches and when asked if they were distasteful

to any other member of her own family she exclaimed, "Oh, yes, my mother

would shudder and shake if a peach were brought near her." And there we

have it. The idiosyncrasy was an inherited one as many similar

peculiarities are. The mental impression produced in the mother by her own

experience with peaches had nothing to do with its occurrence in the

child.

Very frequently also one encounters the mother who is sure she has

engendered musical ability in her child by constant practise and study of

music during pregnancy. The child is musical; what better evidence does

one want! It seems never to occur to such a mother that the child is

musically inclined because she herself is, as is evinced by her own desire

in the matter even if she is not a skillful performer.

When we take into account the extreme credulity of many people, the

unconscious tendency of mankind to give a dramatic interpretation to

events where causes are not certainly known, the hosts of coincidences

that occur in life, and the multitude of cases where something should

happen but nothing does, we are compelled to believe that the whole matter

of direct specific influence of the mother's mind on the developing fetus

is a myth. After seeing the conditions which prevail in Mendelism, for

example, it will take strong faith to believe that a mother with duplex

brown eyes can "think" or "will" blue eyes on her baby, yet this would be

a mild procedure compared to some we are asked to accept by believers in

the transmission of maternal impressions. Most of all, however, when we

recall the actual relation between the embryo and the mother--a narrow

umbilical cord is the sole means of communication between the two--the

physical impossibility of a connection between some particular mental

happening of the mother and a corresponding specific modification in the

fetus becomes evident. For there are no nerves in the umbilical cord, the

only path of communication between mother and fetus being the indirect one

by way of the blood stream. Even this method of communication is limited

inasmuch as the mother's blood does not circulate through the blood

vessels of the fetus. Gaseous and dissolved substances are merely

interchanged through the thin walls of the capillary blood vessels in the

placenta.

=Injurious Prenatal Influences.--=However, the denial that a particular

mental impression of the mother is associated with a particular structural

defect in a child does not carry with it the implication that prenatal

influences of all kinds are negligible factors. On the contrary any

deleterious effect which can reach the fetus through absorption from the

blood of the mother may be of grave consequence. There is not the least

doubt that malnutrition or serious ill-health on the part of the mother

often has a prejudicial effect on the unborn offspring. Severe shock or

grief, worry, nervous exhaustion, the influence of certain diseases,

poisons in the blood or tissues of the parent, such as lead, mercury,

phosphorus, alcohol and the like, may all act detrimentally, but they

operate either by rendering nutrition defective, by direct poisoning, or

by generating toxins in the blood of the parent which then poison the

fetus. Among the latter may be mentioned the toxic products of

tuberculosis and certain other bacterial diseases. Such factors operating

on the unborn young or even on the germ-cells may cause malformations,

arrests of development, instabilities of the nervous system, and general

physical or mental weakness. The effects are general, however, and not

specific.

To distinguish certain of these prenatal effects, particularly those of

certain diseases or poisons, from true hereditary influences they are

frequently spoken of as cases of _transmission_ rather than inheritance

from parents. Some writers use the technical term _blastophthoria_, or

false-heredity, extending the meaning so as to include also any damage

that might be inflicted on the germ-cells.

=Lead Poisoning.--=By way of illustration of how certain cumulative

poisons may act we may examine a tabulation of eighty-one cases of lead

poisoning as reported by Constantin Paul (Fig. 29, p. 164).

The table requires little comment. The disastrous effects of such

poisoning are apparent in every class of cases. The sixth class where the

husband alone was exposed to lead shows that the poison can operate

directly through the germ-cell. Other observers note that in the children

of workers in lead, there is a distressing frequency of feeble-mindedness

and epilepsy.

That lead poisoning operating through the germ-cells of the father can

affect the development of the young harmfully is well shown in Fig. 30, p.

165, which is a photograph of two young rabbits from the same litter The

white young one is from a normal albino mother mated to an albino father

which had received lead treatment. The pigmented young one is from the

same albino mother by a normal pigmented father. Although the white

father was considerably larger than the pigmented father, nevertheless the

young of the former, because of the harmful effects of the lead, is

distinctly smaller and less lively. A number of litters, each from the

same mother but in part from a lead-poisoned father and in part from a

normal father, have been secured. All show more or less the same results.

The experiments are still in progress in the department of experimental

breeding at the University of Wisconsin.

--------------------------------------------------------------------

|Number of cases.

| +----------------------------------------

| |Number of pregnancies.

| | +---------------------------------

| | |Abortions, premature labor, and

| | | stillbirths.

| | | +---------------------------

| | | |Infants born living.

| | | | +--------------------

---------------------|-----|------|-----|------|--------------------

symptoms of plubism | 4 | 15 | 13 | 2 | within 24 hours.

| | | | |

been normal | 5 | 36 | 29 | 7 | in first year.

| | | | |

five pregnancies | 1 | 5 | 5 | 0 | healthy child.

| | | | |

there | 3 | 3 | 3 | 0 | healthy children.

| | | | |

lead poisoning | 6 | 29 | 21 | 8 |

exposed to lead | ? | 32 | 12 | 20 | four in second,

--------------------------------------------------------------------

FIG. 29

Tabulation of eighty-one cases of lead poisoning recorded by Constantin

Paul (from Adami).

[Illustration: Fig. 30

Photograph of young rabbits from the same litter, the smaller one stunted

by lead-poisoning of its father (Courtesy of Professor L. J. Cole).]

=The Expectant Mother Should Have Rest.--=The mere matter of rest on the

part of the pregnant mother is, judging from the work of Pinard, a

Frenchman, and his pupils, an important one. In a number of detailed

investigations they have shown that rest on the part of the working mother

during the last three months before the child is born results in the

production of markedly larger and more robust children than those born of

mothers equally healthy but who have not had such rest. Moreover the

danger of premature birth is considerably lessened.

=Too Short Intervals Between Children.--=Too short an interval between

childbirths would also seem to be an infringement on the rights of the

child as well as of the mother. Thus Doctor R. J. Ewart ("The Influence of

Parental Age on Offspring," _Eugenic Review_, October, 1911) finds that

children born at intervals of less than two years after the birth of the

previous child still show at the age of six a notable deficiency in

height, weight and intelligence, when compared with the children born

after a longer interval, or even with first-born children.

=Our Duty to Safeguard Motherhood.--=Doubtless the unventilated factory

and tenement also do their share, even though we can give no exact

quantitative measure of it. Obviously, it becomes a civic duty to protect

as much as possible all members of our social system from such injurious

factors as have just been discussed. It is particularly necessary to

safeguard mothers before confinement, especially working mothers.

=Expectant Mothers Neglected.--=According to the claims of life insurance

men, expectant mothers are the most neglected members of our population.

Doctor Van Ingen, of New York City, estimates that ninety per cent. of

women in this country are wholly without prenatal care. Yet every

prospective mother should be taught the probable meaning of such symptoms

as headache, hemorrhages, swelling of the feet and disturbed vision. She

should realize the importance of submitting a sample of urine for analysis

at least once a month before childbirth and twice a month for a while

thereafter. She should be specially informed regarding work, exercise,

diet and dress. A recent government bulletin written by Mrs. Max West

which may be had free by writing to the Children's Bureau, Department of

Labor, Washington, D. C., gives much useful information on this subject.

ALCOHOLISM

=Unreliability of Much of the Data.--=One of the most important poisons

that plays a prominent part among ante-natal influences is alcohol. But

when it comes to a study of the problem of alcoholism from the standpoint

of heredity and parental influences we meet with many difficulties,

prominent among which are the inaccuracy and unreliability of many of the

statistics brought forward in this connection. Many of the results are

vitiated by the prejudices of propagandists who propose to make a case

either for or against alcohol as a beverage whether or not the facts

justify their conclusions. When one tries to view the matter with an open

mind he finds that there is a deplorable lack of statistics which are not

susceptible to more than one interpretation. However, using as much as

possible what seems to be unbiased data, the evidence is almost wholly

against alcohol as a beverage, at least to any immoderate extent.

=Alcohol a Germinal or Fetal Poison.--=The bad effects as far as offspring

are concerned reveal themselves in the main under the category of "false

heredity," i. e., germinal or fetal poisonings rather than of heritable

changes induced in the germ-cells. Most investigators feel that there are

too many criminal, imbecile, insane and unhealthy persons among the

offspring of drunkards to dismiss the matter as a coincidence. In an

investigation of Imbault, for example, we find recorded of one hundred

tuberculous children that while forty-one were of tuberculous parentage,

thirty-six per cent, were the offspring of inebriates. Furthermore Imbault

cites the observations of Arrive on 1,506 cases of juvenile meningitis to

the effect that this malady is twice as frequent in the children of

alcoholic as in those of tuberculous parentage. It has been proved by

Nicloux (_L'Obstetrique_, Vol. 99, 1900) that in dogs and guinea-pigs

alcohol passes through the placenta and may be detected in fetal tissues;

hence it is in position to influence the fetus. He found that in a very

short time the amount of alcohol in the blood of the fetus about

paralleled that in the blood of the mother.

=Progressive Increase in Death-Rate of Offspring of Inebriate Women.--=In

an investigation on the effects of parental alcoholism on the offspring,

Sullivan (_Journal of Mental Science_, Vol. 45, 1899) gives some

important figures. To avoid other complications he chose female drunkards

in whom no other degenerative features were evident. He found that among

these the percentage of abortions, still-births and deaths of infants

before their third year was 55.8 per cent. as against 23.9 per cent. in

sober mothers. In answer to the objection that this high percentage may be

due merely to neglect, and not to impairment of the fetus by alcoholism,

he points out the fact based on the history of the successive births, that

there was a progressive increase in the death-rate of offspring in

proportion to the length of time the mother had been an inebriate, thus:

-------------------------------------------------------------

|No. of|Per cent.|Per cent. dying| Total

|cases |born dead| before 3 |percentage

-----------------|------|---------|---------------|----------

First births | 80 | 6.2 | 27.5 | 33.7

Second births | 80 | 11.2 | 40.8 | 50.0

Third births | 80 | 7.6 | 45.0 | 52.6

Fourth and fifth | 111 | 10.8 | 54.9 | 65.7

Sixth to tenth | 93 | 17.2 | 54.8 | 72.0

-------------------------------------------------------------

=Views of a Psychiatrist on Alcohol.--=Forel, who for years was the

psychiatrist at the head of a large insane asylum at Zurich, Switzerland,

has this to say about the effects of narcotic poisons and alcohol in

particular:

"The offspring tainted with alcoholic blastophthoria suffer various

bodily and physical anomalies, among which are dwarfism, rickets, a

predisposition to tuberculosis and epilepsy, moral idiocy, and idiocy

in general, a predisposition to crime and mental diseases, sexual

perversions, loss of suckling in women, and many other misfortunes."

In another passage he[6] remarks as follows:

"But what is of much greater importance is the fact that acute and

chronic alcoholic intoxication deteriorates the germinal protoplasm of

the procreators.... The recent researches of Bezzola seem to prove

that the old belief in the bad quality of children conceived during

drunkenness is not without foundation. Relying on the Swiss census of

1900, in which there figure nine thousand idiots, and after careful

examination of the bulletins concerning them, this author has proved

that there are two acute annual maximum periods for the conception of

idiots (calculated from nine months before birth); the periods of

carnival and vintage, when the people drink most. In the wine-growing

districts the maximum conception of idiots is enormous, while it is

almost nil at other periods. Moreover, these two maximum periods come

at the time of year when conception is at a minimum among the rest of

the population, the maximum of normal conceptions occurring at the

beginning of summer."

Another interpretation of Bezzola's results has been suggested to the

effect that the license of these periods enables the defective members of

the community, such as the feeble-minded, an opportunity of mating more

readily and that consequently the result is direct inheritance of idiocy

and allied defects instead of idiocy produced through alcoholic poisoning

of the parental germ-cell.

=Other Views.--=There are indeed many competent investigators who believe

that alcoholism in parents has little or no part in the direct production

of mental defects in children. For instance, Tredgold quotes Doctor

Ireland's observations that although at New Year, when the fishermen

return, the whole population of certain villages in Scotland gets drunk,

there is no noticeable excess of defectives born nine months later, and

remarks further that, "I have histories of idiots conceived under such

circumstances, but so I have of normal children, and my opinion is, that

while this may be a cause in some cases, the number of instances in this

country at any rate is exceedingly small." Again, Goddard, one of our best

known American students of feeble-mindedness, who has made careful study

of this point under especially favorable conditions, feels that his data

do not prove that alcoholism of either the father or the mother causes

feeble-mindedness in the child. He concludes, "Everything seems to

indicate that alcoholism itself is only a symptom; that it for the most

part occurs in families where there is some form of neurotic taint,

especially feeble-mindedness." Goddard, however, in common with many other

observers, notes that miscarriages and deaths in infancy are far higher

among inebriates than among abstainers.

Doctor Mjoeen cites an interesting parallel between the increase of

feeble-mindedness in Norway and a period from 1816 to 1835, when every one

was permitted to distil brandy. In some districts many of the farmers

distilled brandy from corn and potatoes, and in such regions during this

period feeble-mindedness increased nearly one hundred per cent. Later the

home distillation of brandy was stopped. According to Doctor Mjoeen, "The

enormous increase in idiots came and went with the brandy." He is

inclined to believe, however, that the alcohol operated injuriously mainly

on stocks already defective.

=The Affinity of Alcohol for Germinal Tissue.--=Nicloux and Renault have

shown that alcohol has a decided affinity for the reproductive glands. In

individuals who have recently taken alcohol the proportion of alcohol in

the gonads is soon almost equal to the amount found in the blood. Thus in

experiments on mammals it was found that the proportion of alcohol in the

ovary to that in the blood was as three to five, and in the testis as two

to three. This would afford abundant opportunity for alcohol to act

directly on the spermatozoon or the ovum.

A number of different investigators concur in finding that the germ-glands

of the male human inebriate in many cases show more or less atrophy and

other degenerative changes. In guinea-pigs which have been repeatedly

intoxicated with alcohol, Stockard found that while he could detect no

visible abnormality in the gonad, nevertheless their defective and

weakened progeny showed that the germ-cells had been affected.

=Innate Degeneracy Versus the Effects of Alcohol.--=Many observations on

human beings have been brought forward which at first sight seem to

indicate that noticeable defects, particularly mental and nervous, occur

with appalling frequency in children resulting from conception during

intoxication, although, unfortunately, the evidence is rarely clear as to

whether the defects are really due to the effects of the alcohol or to the

fact that the parent or parents were degenerate to begin with.

A very interesting human case cited by Forel on the authority of

Schweighofer is that of a normal woman who had three sound children when

married to a normal man. After the death of this husband she married an

inebriate by whom she had three other children. One of these suffered from

infantilism, one turned out to be a drunkard, and the third became a

social degenerate and drunkard. Moreover the first two contracted

tuberculosis, although hitherto the family stock had been free from this

malady. Ultimately the woman married again and by this third husband, who

was normal, she again had sound children. Similar cases might be cited,

as, for example, a record of eighty-three epileptics, of whom sixty had

drunken parents, but it can be urged against all of them, of course, that

the defective offspring were due to an innate degeneracy of the drunken

parent which made him a drunkard rather than to the effects of the alcohol

he took. While one is skeptical as to the validity of this objection in

all of the many cases which occur with such monotonous frequency in man,

there is no way of escaping such an interpretation with the evidence at

hand. It must be admitted, moreover, that there are many families with one

or both parents alcoholic in which the children are not mentally

defective.

=Experimental Alcoholism in Lower Animals.--=Many of the objections that

exist in the case of man, however, do not apply in that of lower animals.

If normal animals are experimentally alcoholized and are shown to produce

defective offspring under such conditions, then in their cases at least,

the disorders in the offspring must be due to the effects of alcohol and

not to an innately degenerate condition of the parent. Disorders similar

to some of those seen in the children of alcoholics do actually result in

alcoholized animals of one kind or another.

Against the earlier experiments on animals it has been urged that too few

individuals were used to give conclusive results, but this objection can

not be brought against the recent experiments of Stockard. While he has

published accounts of his work in various scientific periodicals lately,

the reader will find a full statement of his own experiments, together

with a review of the whole subject of experimental alcoholism in animals

and the effects on progeny in _The American Naturalist_, Vol. XLVII,

November, 1913, together with a useful bibliography.

Before taking up Stockard's results we may select a few of the more

significant experiments made earlier by other investigators.

Laitinen alcoholized rabbits and guinea-pigs. He found that the treated

individuals had more still-born young than the control, and also that

growth of the living young was retarded. His alcoholized rabbits and

guinea-pigs produced more young than did the normal individuals used as a

control. Laitinen's studies on man, together with three other studies of

the Eugenics Laboratory in London, show that in man also more children are

born to alcoholics than to normal parents. Goddard's investigations in

America corroborate this fact.

Ceni found that only 43 per cent. of the eggs from alcoholized fowls

developed normally, as against 77 per cent. of normal development in the

controls. Moreover the eggs of alcoholic fowls were shown to be less

resistant to adverse conditions than normal eggs from the fact that

fluctuations of temperature at the beginning of incubation kept all the

alcoholic eggs from developing perfectly, while 27 per cent. of the

control eggs developed normally under the same adverse circumstances.

Hodge made a pair of dogs alcoholic. Of 23 pups obtained from the pair, 8

were deformed and 9 were dead; 4 alone were viable. From a control pair of

dogs 45 pups were obtained, of which 4 were deformed, none were born dead,

and 41 were viable.

=Stockard's Experiments on Guinea-Pigs.--=Stockard's experiments

demonstrate that the offspring of mammals may be injured or modified in

their development by treating either parent repeatedly with alcohol. The

guinea-pigs used in the experiment were all first tested by normal matings

and found to yield normal offspring. The alcohol was given to them by

inhalation. It was found to be readily taken into the animals' blood and

to produce intoxication. While guinea-pigs alcoholized in this way as

often as six times a week for two and one-half years would maintain their

own bodily vigor and health apparently, the deleterious effects on their

progeny were marked. The defects were general rather than specific,

although the central nervous system and special sense organs were

apparently affected most.

Out of 119 total young produced by the alcoholic animals, only 52, or less

than 44 per cent., survived, whereas out of 64 young produced from normal

parents used as a control for the experiment, 56, or over 87 per cent.,

survived. In some cases alcoholic males were mated with normal females, in

other, alcoholic females with normal males. In still other instances both

parents were alcoholic.

The results are summarized in the accompanying table (Fig. 31), taken from

Stockard's paper:

CONDITION OF THE OFFSPRING FROM GUINEA-PIGS TREATED WITH ALCOHOL

-----------------------------------------------------------------

|Number of Matings

| +--------------------------------------

| |Negative Result or Early Abortion

| | +---------------------------------

| | |Stillborn Litters

| | | +----------------------------

| | | |Number Stillborn Young

| | | | +---------------------

| | | | | +----------------

| | | | | | +---------

--------------------|-----|----|----|------|----|------|---------

normal [female] | 59 | 25 | 8 | 15 | 26 | 21 | 33

alcoholic [female]| 15 | 3 | 3 | 9 | 9 | 9 | 10

alcoholic [female]| 29 | 15 | 3 | 6 | 11 | 7 | 9

SUMMARY | 103 | 43 | 14 | 30 | 46 | 37 | 52

normal [female] | 35 | 2 | 1 | 4 | 32 | 4 | 56

by normal | 3 | 0 | 0 | 0 | 3 | 0 | 4

by alcoholic | 3 | 0 | 2 | 5 | 1 | 0 | 2

| | | |1 def.| | |

by 2d generation | 19 | 7 | 0 | 0 | 12 | 6 | 13

| | | | | |1 def.|

during pregnancy | 4 | 0 | 0 | 0 | 4 | 1 | 7

-----------------------------------------------------------------

FIG. 31

Table showing condition of the offspring from guinea-pigs treated with

alcohol (after Stockard).

Lines four and five give a comparison between the 103 total matings of all

treated individuals and 35 normal matings. In the first case almost 42 per

cent. of the matings gave negative results or early abortions, whereas in

the normal control matings, failure to yield a full-term litter occurred

in only two cases. The 103 matings of alcoholic animals gave only 46

living litters, or about 45 per cent. On the other hand the 35 control

matings produced 32 living litters, or 91-1/2 per cent. It will be

observed also that from such of the 103 matings of alcoholics as produced

young there were 30 still-born, 37 which died soon after birth, and only

52 surviving young, whereas from the 35 matings of normal individuals

there were only 4 still-born young, 4 which died soon after birth, and 56

surviving young.

The bottom line of the table, although, as Stockard points out, containing

too few cases to prove wholly convincing, indicates that alcoholizing

erstwhile normal females during pregnancy was not particularly harmful to

the embryos _in utero_.

Some of the most interesting results were obtained when offspring termed

second generation animals, derived from alcoholic parents though not

themselves treated with alcohol, were mated in various ways. When such

individuals were mated with normal individuals, although the litters were

small, the results were normal, the normal mate having seemingly

counteracted any defects which might have lurked in the second generation

animal. On the other hand, out of three matings of second generation

animals with alcoholic individuals, two produced still-born young, of

which one was markedly deformed, while the third yielded two living young.

However, the most striking results were obtained when two second

generation individuals, the offspring of alcoholic parents, were bred

together. Although themselves untreated, these individuals, of which 19

matings were made, produced as many or more defective young than did their

alcoholic parents. Seven of the matings were unfruitful. The remaining 12

matings gave living litters consisting of 19 individuals in all. Six of

these showed various nerve disorders (spasms, epileptic-like seizures,

etc.) soon after birth; one was eyeless and otherwise deformed.

=Stockard's Interpretation.--=Stockard's interpretation of his experiments

is as follows: "Mammals treated with injurious substances, such as

alcohol, ether, lead, etc., suffer from the treatments by having the

tissues of their bodies injured. When the reproductive glands and

germ-cells become injured in this way they give rise to offspring showing

weak and degenerative conditions of a general nature, and every cell of

these offspring having been derived from the injured egg or sperm-cell are

necessarily similarly injured and can only give rise to other injured

cells and thus the next generation of offspring are equally weak and

injured and so on. The only hope for such a line of individuals is that it

can be crossed by normal stock, in which case the vigor of the normal

germ-cell in the combination may counteract, or at any rate reduce, the

extent of injury in the body cells of the resulting animal."

He also believes that various deformities and developmental arrests such

as harelip and cleft-palate may similarly be cases of transmission rather

than true inheritance, due to the weakening of the germ-cells in some way,

or to some lack of full vigor in the uterine environment.

=Further Remarks on the Situation in Man.--=Returning now to the question

of alcoholism in man, it seems in view of the strong circumstantial

evidence in the case of man himself, together with the result of

experiments on animals, that little doubt remains that excessive

alcoholism might result in the production of defective offspring. On the

other hand an antecedent degeneracy or neural instability undoubtedly

plays an important part in many cases, in the original production of

drunkards, and when such occurs, it, as well as the direct effects of

alcoholic poisoning, must be reckoned with in the effects on progeny.

Studies carried on by Pearson, Elderton and Barrington of the Eugenic

Laboratory in London lead these investigators to the conclusion that

extreme alcoholism is a _result_ not a _cause_ of degeneracy. That is, the

degeneracy is due to the defective stock, not to alcohol. They cite in

evidence their records of four thousand school children of alcoholic and

of sober parents, which fail to show any unfavorable effect of alcohol on

offspring. Some of their critics, however, maintain that they did not

choose subjects who were sufficiently alcoholic to give the injurious

results that might legitimately be expected among the offspring of

excessive drinkers or habitual drunkards.

Where children show a hereditary inclination toward drink, unquestionably

one of the strongest factors is the inheritance of the same disposition,

the same unstable nervous constitution and its accompanying lack of

self-control which led the parent to drink, rather than the inheritance of

the effects of the drink on the parent. For in many cases a parent may not

become a drunkard until after the children who also become drunkards are

born. That the tendency to drink immoderately is frequently due to a

strain of feeble-mindedness or epilepsy becomes more evident every day.

In many of the so-called "periodical" drunkards, the accompanying features

of their periodic attacks of drink-craving, such as clouding of memory,

restlessness and depression, are those commonly associated with ordinary

epileptic attacks.

=Probably Over Fifty Per Cent. of Inebriety in Man Due to Defective

Nervous Constitution.--=Branthwaite, an English authority on drunkenness,

finds that about sixty-three per cent. of the inebriates who come to his

notice are mentally defective. In alcoholic insanities heredity is a

potent factor. It is coming to be realized more and more that pronounced

alcoholism is due in a large percentage of cases, perhaps over half, to a

defective nervous make-up. While it is true that many drunkards would not

develop without free access to alcohol, on the other hand many would never

develop without a bad heredity back of them, which gives them a peculiar

nervous constitution that renders alcohol an undue stimulus. In a recent

report of the New York State Hospital Commission it is stated that in

fifty-four per cent. of the cases of alcoholic insanity, a family history

of insanity, epilepsy or nervous disease exists. Thus in the presence of

alcohol most of these unfortunates are helpless pawns of a hereditary

weakness.

So when the question of alcoholism is viewed from all angles, the children

of the human drunkard would seem to run a double menace of misfortune,

since they may be subject both to the direct poisoning effects of alcohol

and the results of an inheritable degeneracy.

=Factors to Be Reckoned With in the Study of Alcoholism.--=In any

thoroughgoing study of alcoholism in man many factors will have to be

reckoned with. First of all there is the question of inherent lack of

control. This is probably the principal thing inherited where heredity

truly enters as a factor. That example and social environment are

important factors in addition to or in place of heredity is clear, too,

when we observe that often it is the boys only who take after a drunken

father, for there is no evidence that the inherited tendency when it

really exists is at all sex-linked. Again, in certain occupations carried

on under unwholesome influences relief is frequently sought in alcoholic

stimulants, and such custom may easily crystallize into habit.

Furthermore, the accustoming young children to doses of alcohol, or the

unborn young to alcohol through the body of a drunken mother, may be

strongly contributory toward establishing inebriety in certain cases. As

we have seen from an abundance of experimental data on animals, moreover,

the nurture effects on germ-cells may result in the production of weakened

offspring. Such offspring in the case of man are probably less able to

withstand temptations of all kinds and hence readily succumb to the

habit-forming effects of alcohol if once its use is begun. Lastly, it must

not be forgotten that alcoholism in the father usually means poverty and

the subsequent accompaniment of malnutrition and neglect of the children,

and this in itself may not only account for poor development of the

latter, but may also be strongly contributory toward establishing the

habit of alcoholism in them.

An inherent bias plus most of the other conditions just enumerated is the

not unusual lot of the offspring of drunkards.

=Venereal Diseases.--=There is yet another very considerable class of

maritally unfit who in any conscientious discussion of unfitness for

marriage or of racial improvement must be considered. I refer to those who

are afflicted with the diseases which are inseparably associated with the

so-called "social evil." To _gonorrhea_, one of the most prevalent of

these diseases, more than one-fourth of our total one hundred and ten

thousand blind in the United States are said to owe their affliction.

Milder types of eye disease may also result from such infections. As much

as eighty per cent., or some say practically all blindness in children

born blind is caused by it, the infection occurring at the time of birth

or within a few days thereafter. The terrible consequences of this disease

to the innocent wife would alone make its discussion imperative.

=The Seriousness of the Situation.--=Unfortunately the insidious nature of

gonorrheal infections is unknown to most persons. A cure is apparently

effected, yet as a matter of fact the germs may live for years and, if in

the male, later be transmitted to the wife, subjecting her to a future of

invalidism and misery. Reliable statistics from various medical

authorities reveal the appalling fact that seventy-five per cent. or more

of the surgical operations for inflammatory pelvic disorders peculiar to

women, such as pus tubes and peritonitis, are attributable to this

disease, as is also the involuntary sterility of forty-five per cent. of

childless women. Unwelcome as the fact is there is an abundance of

evidence to show that a large percentage of men in particular have at

some period of their life been infected with venereal disease. Of our

fourteen million males in the United States under the age of thirty we

find estimates by some specialists in venereal diseases to the effect that

five million of them, that is, one out of three, suffer from some one of

the social diseases or their consequences. Doctor Hugh Cabot, one of the

chief surgeons of the Massachusetts General Hospital at Boston, a member

of the faculty of the Harvard Medical School and president of the American

Association of Genito-Urinary Surgeons, has this to say about the

situation: "We have of late years heard much about the frequency and

serious consequences of tuberculosis; it has been dubbed the 'white

plague,' and so active has been the campaign that a wide-spread

understanding of this serious disease has resulted. It may safely be

averred that in the urban population at least there are two, and perhaps

three, individuals with syphilis to every one with tuberculosis. The

frequency of gonococcus infection is much higher." He believes that over

half the male population acquire a gonococcus infection at some period of

their career. While as a layman, one can not but feel that a specialist's

estimate may run unduly high because of the fact that he is encountering

an inordinate proportion of such maladies every day, still such

specialists are in position to get at the truth as no other person can and

their calculations are probably not grossly in error. In any event any one

who has progressed in worldly knowledge beyond the naivete of a child must

recognize the appalling prevalence of these maladies.

=Infantile Blindness.--=So serious has the matter of infantile blindness

become that some state boards of health and some city health departments

supply all physicians and midwives with specially prepared packages

containing cotton and nitrate of silver solution for preventive or

curative treatment of the eyes of all new-born children. At the time of

the first bath each eye is carefully washed with a separate pledget of

cotton saturated with boric acid solution. Each then receives a drop of

the silver solution, which is made just strong enough to kill any

gonococci that might be present without itself inflaming the eye. Water

used in bathing the baby's body of course is not allowed to come in

contact with its eyes. Such treatment should be given every child no

matter how unsuspicious the circumstances may be. German authorities who

have been following this method now for some years assure us that

nineteen-twentieths of the blindness of infancy can thus be prevented.

=Syphilis.--=As to _syphilis_, another and even more terrible of these

diseases, we have before us the absurd fact that while thousands upon

thousands of dollars are being spent to establish a rigid inspection and

preventive measures against the spread of a very similar disease in the

horse, this malady in man is allowed to pass unchallenged and we are

confronted by the gruesome certainty that there are hundreds of these

diseased persons about us to-day who, on their mere affirmation that they

are unmarried and of age, will be given the right to marry and thus

produce families of infected children irrevocably doomed to early death or

to lifelong misery.

While syphilis is most commonly spread through relations between the

sexes, it may be acquired in various other ways, as for example, through a

cut in shaving with the same razor an infected individual has used. It is

commonly transmitted from parent to child. Practically every prostitute is

a center of dissemination. Katherine Bement Davis has shown in her studies

made at the New York State Reformatory for Women that while ordinary

clinical tests show that apparently only twenty-one per cent. of these

women are infected with venereal disease, more careful laboratory tests

showed at least ninety per cent. to be infected.

Syphilis is caused by _Treponema pallidum_, a small unicellular animal

parasite. Given access to the blood by any means whatever, possibly even

through an abrasion in the lip by means of a kiss, it multiplies rapidly

and any part or organ of the body may be attacked. Usually a small sore

occurs at the point of entrance to the body, but often it heals up readily

with little indication of the seriousness of the infection.

The development of the malady is insidious and long continued. As a matter

of clinical convenience physicians divide its progress into successive

stages although in reality the transitions are frequently variable and ill

marked. The symptoms that arise within the first few months or even years

are readily controlled by appropriate treatment, but to insure a cure

prolonged and most thoroughgoing treatment is imperative. The symptoms

disappear so completely after a short period of treatment that it is very

difficult to persuade the average patient that he is not yet cured. Two

years at least are none too short a period of treatment, yet the majority

of patients, fully convinced that they are merely being exploited by the

physician as a source of revenue, drift away at the end of a few months.

As a matter of fact, however, the germs usually persist long after the

obvious symptoms of the disease have disappeared, and in consequence many

of the most serious results of syphilis may not manifest themselves for a

period of perhaps ten, twenty or thirty years.

=Some of the Effects.--=It is now known that _paresis_, also termed

general paralysis or softening of the brain, is probably invariably due to

syphilis. The work of Flexner and Noguchi on _paresis_ and _tabes

dorsalis_ show that always in such afflictions the tissues of the central

nervous system have been invaded by the parasite. The original infection,

however, may have occurred so long before as to have been almost forgotten

by the patient. Thus many an apparently robust man is stricken down in the

prime of life. Earlier and prolonged treatment would in all probability

have eradicated the germs and thus prevented the mental breakdown, which

can not be cured by any known treatment. Postmortem examination always

shows that the _Treponema_ has wrought wide-spread damage in the brain.

The frequency of paresis may be realized when one learns that in some

regions it is responsible for about one-fifth of all cases of insanity

sent to hospitals for the insane. It ranks next to the highest as a cause

of insanity. Statistics show that in the state of New York more deaths

result annually from paresis than from smallpox, tetanus, malaria,

dysentery and rabies all combined.

In some cases the disease attacks the membranes of the brain and the small

blood vessels giving rise to a still different type of mental disorder.

Practically all patients with _locomotor ataxia_ owe their condition to an

antecedent syphilis. Moreover it is one of the important causes of

_arterio-sclerosis_, or hardening of the blood vessels, and is also a

prominent factor in certain forms of heart-disease, as well as by no means

an unimportant cause of blindness in children.

As to specific cases of the effects of this disease on descendants the

literature of the subject is crowded full. While it is needless to conduct

the reader through a chamber of horrors by reviewing clinical cases, it is

desirable to point out in a general way some of the effects. Doctor George

H. Kirby, director of Clinical Psychiatry, Manhattan State Hospital, says:

"We find that when either the father or the mother suffers from

paresis that many other members of the family may be infected with

syphilis, and furthermore, we find that a large number of children in

these families are feeble-minded, nervous, or in other ways abnormal.

Doctor Plant examined a group of 100 children, the offspring of cases

of paresis, and found that 45 per cent. were plainly damaged mentally

or physically, or in both fields; the blood test showed that one-third

of these 100 children had the syphilitic poison in their systems.

"Another investigator found in a group of 139 children, the

descendants of parents who had syphilitic nervous disease, that over

25 per cent. were definitely feeble-minded or affected with some

serious nervous disorders.

"Other studies indicate that there exists a close relation between

syphilis and many of the hitherto unexplained cases of

feeble-mindedness, including idiocy, imbecility, infantile paralysis,

and some forms of epilepsy. While the question is not yet settled, it

appears that syphilis is the real cause of many of these cases of

mental defect in children."

Still other investigators give details of physical afflictions and

distortions, of suppressed development, of inordinate percentages of

stillbirths--perhaps the most merciful lot for the little victims--but

sufficient has been said to indicate the full horror of the situation.

Goddard,[7] although not minimizing the terrible nature of the disease,

finds little evidence in his studies that syphilis in parents is a

specific cause of feeble-mindedness.

=A Blood Test.--=Fortunately a delicate blood test known as the Wasserman

test has been discovered by means of which, through an examination of a

few drops of blood, any trace of syphilitic poison which exists in the

body may usually be detected. This is true even though the individual may

at the time show no visible symptoms of syphilis. The test is therefore of

great value in detecting the latent germs of syphilis in individuals who

have apparently been cured, and also often in making an early diagnosis of

paresis. The Wasserman test, however, is reliable only in the hands of a

skilled operator. It may occasionally give a positive reaction when

syphilis does not exist and on the contrary a negative when it is present.

The _luetin_ test is also now applied by some specialists, but is too new

a test to have come into general use. It works on the same principle as

the tuberculin test for tuberculosis. Some army physicians now also give

what is termed a provocative Wasserman. That is, in a suspicious case

which gives only negative results by an ordinary Wasserman, they can get,

if syphilis really exists, a positive reaction after giving small doses of

potassium iodide or salvarsan.

It should be well understood by every one that syphilis is usually curable

provided the patient is given modern scientific treatment by a _competent_

physician. I emphasize competent because there are so many quacks in this

field that one undergoing treatment can not be too careful in assuring

himself of the competency of the physician. In even a case of long

standing, where the symptoms have been in abeyance for a number of years,

the disease can be cured provided it has not developed into an active

cerebro-spinal type, and even the latter can be much benefited by proper

treatment. The great danger of the cerebro-spinal type is that it will

result in paresis or locomotor ataxia.

As long as the blood of a patient shows a _positive_ Wasserman reaction,

marriage should certainly not be consummated. If after a proper course of

treatment by a well-informed physician, the patient shows a _negative_

Wasserman when tested by a competent examiner, he probably would not

infect his wife or offspring, although prudence would require that he wait

at least six months or a year before marriage, and marrying then only if

later tests remain negative.

The only way for a patient to be sure that he is not harboring the

cerebro-spinal form would be to have a spinal puncture made and the

cerebro-spinal fluid examined. While the cerebro-spinal phase often does

not occur until long after the primary infection, cases are known in which

it has appeared within a few weeks. Evidence that the central nervous

system is frequently invaded early in the course of the disease is

increasing. Marriage of an individual suffering from the cerebro-spinal

form should not take place, since such a one is almost sure to become a

burden on the family or the state.

=Many Syphilitics Are Married.--=It may seem to some that in a treatise on

being well-born the subject of syphilis might be ignored as not being

especially pertinent, but the supposition that no considerable percentage

of syphilitics marry is not borne out by the facts. Seventy-five per cent.

of men with insanity due to syphilis who are admitted to hospitals are

married. The insanity in such cases is mainly the result of infections in

earlier years, often long before marriage. While syphilis, strictly

speaking, is not inherited, that is, does not become part and parcel of

the germ-plasm, still the frequency of its direct transmission to

offspring is so appalling that the outcome, as far as the immediate child

is concerned, is quite as disastrous as the most thoroughgoing real

inheritance could be.

=Why Permit Conditions to Continue as They Are?--=When one faces the

easily ascertained facts regarding venereal disease, it seems incredible

that we, an intelligent people, can go on complacently handing our

daughters and sisters over to the surgeon's knife and a life of personal

misery, and even in not a few instances to become mothers of incurably

defective children, yet the dire fact confronts us that we do. We can no

longer excuse ourselves on the plea of ignorance, for the grisly record

may now be read in many medical and not a few popular treatises, and we

find the theme entering even into the modern drama, as witness Brieux's

_Damaged Goods_. Further indifference to these conditions can only be

attributed to culpable apathy or prudery.

The extreme dangers to which parents are subjecting their daughters if

they do not demand a clean bill of health on the part of their prospective

husbands are obvious. Fathers and mothers perfectly willing to inquire

into their future son-in-law's social connections, his income, securities,

or business chances become strangely "modest" when it comes to determining

whether he is physically fit for marriage.

One great cause of ignorance in the past was the prudish taboo against

frank discussions of venereal diseases which has thrown the veil of

silence about the subject. To-day, however, it is coming to be recognized

that these maladies are diseases and not a standard of social propriety,

and that like most other diseases the surest way to secure prevention and

gradual eradication is through the enlightenment of the public. They are

prevalent in all classes of society. Moreover, it must not be forgotten

that there is no form of venereal disease which may not be innocently

acquired. Even where acquired through transgression of moral law an

ignorant attitude toward the sexual instinct is often at the bottom of the

difficulty.

=Medical Inspection Before Marriage.--=Ante-nuptial medical inspection is

certainly as necessary to the welfare of society as the certification of

age and of the single state now required by law. No one objects to a

medical examination pertaining to venereal and other diseases when it

comes to taking out a life insurance policy, and why there should be any

more objection to it as a preliminary to marriage is a mystery. A few

states already have compulsory ante-nuptial medical inspection. The laws

have been enacted too recently to judge adequately of their working. There

has been much debate in Wisconsin as to whether their law (Chapter 738,

Laws of 1913), which went into effect January 1, 1914, is constitutional

and whether it requires a Wasserman test. The Wisconsin law applies to

males only. The Supreme Court of the state has declared it constitutional

and that its requirement of "the application of the recognized clinical

and laboratory tests of scientific search" involves only such examination

as the ordinary licensed physician is equipped to make and can reasonably

be expected to make for three dollars, the maximum fee specified in the

law.

A number of the physicians of the state are still dissatisfied with the

wording, although most do not oppose the principle of the law. Many

believe that it should apply to the women as well as to the men, and

others feel that the law should be extended to cover still other kinds of

marital unfitness. Most of the practitioners with whom I have discussed

the matter appreciate the motive underlying the law and are endeavoring to

make it successful.

The general public of the state as a whole seems to be in favor of the

provision. At least one hears much favorable comment and little

dissension among those who understand its purpose. The very controversy

over it which sprang up after its passage proved to be of great benefit in

the education of the public regarding the necessity of such measures. Such

physicians as I have been able to question report that the candidates for

marriage rarely object to the requirement, but on the contrary strongly

favor it. Especially where they have suffered from venereal disease

earlier in life most are eager to know their condition and to have medical

advice. To my own mind this last fact is the most significant of all, as

it will give every candidate for marriage a chance to know the truth. Most

men are not so much brutal or vicious as ignorant in such matters. The

vast majority of those unfit for marriage as a consequence of venereal

disease will, when they realize the danger their condition imposes on wife

and children, take every possible means to put themselves into proper

condition.

Desirable as the Wasserman test may be, it requires special laboratory

facilities and equipment as well as a specially trained examiner to make

it a reliable test. Moreover it can not be given by the general

practitioner for the very moderate fee that must obtain in a pre-nuptial

examination compelled by law. If it or the serum test for gonorrhea are to

be applied then the legislative body of the state will find it necessary

to establish a special public laboratory or laboratories for their

application. This, however, is not a matter of particular difficulty and

would be capital well invested in any state.

=The Perils of Venereal Disease Must Be Prevented at Any Cost.--=However,

no matter what the cost may be to the state, no matter what the exaction

from the individual, the grave perils of venereal disease to society

_must_ be prevented. We owe it to the cause of humanity that there be

fewer victims born into a world of eternal night, that from a parentage of

polluted blood there spring no longer hosts of children with feeble

misshapen bodies or with tarnished intellects, death-marked at the door of

life.

=Bad Environment Can Wreck Good Germ-Plasm.--=In conclusion it is evident

from our discussion of prenatal influences that not all of being well-born

is concerned with heredity in its proper sense, since the unborn young may

be influenced either directly or indirectly by environmental conditions

which are in no sense products of heredity, although as far as the

immediate child is concerned the result may be quite as disastrous where

the influence is a baneful one. As to the production of beneficial

prenatal effects, while parents can do nothing toward modifying favorably

such qualities as are predetermined in their germ-plasm, nevertheless they

must come to realize that bad environment can wreck good germ-plasm. They

can see to it that they keep themselves in good physical condition by

wholesome temperate living, and thereby insure as far as possible healthy

germ-cells for the conception and good nutrition for the sustenance of

their progeny. Their one sacred obligation to the immortal germ-plasm of

which they are the trustees is to see that they hand it on with its

maximal possibilities undimmed by innutrition, poisons or vice.