excellence_. Entire families were carried off by it, and, seeing a
tuberculous father or mother and then tuberculous children, it was
assumed that the infection had been transmitted to the children by
heredity. As a matter of fact, the disease was spread by infection. In
former years, little care was exercised about destroying the sputum;
the patients would spit indiscriminately on the floor, and the sputum,
drying up, would be mixed with the dust and inhaled. Often the
children crawling on the floor would introduce the infective material
directly, by putting their little fingers in their mouths.
It is now known that tuberculosis is not a hereditary disease, that
is, that the germs are not transmitted by heredity. _The weak
constitution_, however, which favors the development of tuberculosis,
is inherited. And children of tuberculous parents, therefore, must not
only be guarded against infection, but must be brought up with special
care, so as to strengthen their resistance and overcome the weakened
constitution which they inherited.
That a person with an active tuberculous lesion should not get married
goes without saying. But, it is a good rule to follow for a
tuberculous person not to marry for two or three years, until all
tuberculous lesions have been declared healed by a competent
physician. As a rule, a tuberculous patient is a poor provider, and
that also counts in the advice against marriage. Then sexual
intercourse has, as a rule, a strong influence on the development of
the disease. Unfortunately the sexual appetite of tuberculous patients
is not diminished, but, rather, very frequently heightened; and
frequent sexual relations weaken them and hasten the progress of the
disease.
As to pregnancy, that has an extremely pernicious effect on the course
of tuberculosis, and no tuberculous woman should ever marry. If such a
one does marry or if the disease develops after her getting married,
means should be given her to prevent her from having children. During
the pregnancy, the disease may not seem to be making any
progress--occasionally the patient may even seem to improve--but after
childbirth the disease makes very rapid strides and the patient may
quickly succumb. In the early days of my practice I saw a number of
such cases. If precautions are taken against pregnancy, then
permission to indulge in sexual relations may be given, provided it is
done rarely and moderately.
If a patient who has tuberculosis conceals the fact from the future
partner, a fraud is committed, and the marriage is morally annullable.
It has been declared legally annullable by a recent decision of a New
York judge.
=Heart Disease=
Heart disease also is no longer considered hereditary. Nevertheless,
heart disease, if at all serious, is a contraindication to marriage.
First, because the patient's life may be cut off at any time. Second,
sexual intercourse is injurious for people having heart disease; it
may aggravate the disease or even cause sudden death. It is more
injurious even than it is in tuberculosis. Third--and this concerns
the woman only--pregnancy has a _very_ detrimental effect upon a
diseased heart. A heart that, with proper care, might be able to do
its work for years, often is suddenly snapped by the extra work put
upon it by pregnancy and childbirth. Sometimes a woman with a diseased
heart will keep up to the last minute of the delivery of the child and
then suddenly will gasp and expire. In the first year of my practice I
saw such a case, and I never have wanted to see another. Women
suffering from heart disease of any serious character should not,
under any circumstance, be permitted to become pregnant.
=Cancer=
No man will knowingly marry a woman, and no woman will marry a man,
afflicted with cancer. However, this question often comes up in cases
where the matrimonial candidates are free from cancer, but where there
has been cancer in the family.
Cancer is not a hereditary disease, contrary to the opinions that have
prevailed, and, if the matrimonial candidate otherwise is healthy, no
hesitation need be felt on the score of heredity. The fear of
hereditary transmission of the disease has caused a great deal of
mischief and unnecessary anxiety to people. Scientifically conducted
investigations and carefully prepared statistics have shown that many
diseases formerly considered hereditary are not hereditary in the
least degree.
Should it, however, be shown that in one family there were _many_
members who died of cancer, it would indicate that there is some
disease or dyscrasia in that family, and the contracting of a marriage
with any member of that family would be inadvisable.
=Exophthalmic Goiter= (=Basedow's Disease=)
Exophthalmic goiter is a disease characterised by enlargement of the
thyroid gland, protrusion of the eyeballs, and rapid beating of the
heart. The disease is confined almost entirely, though not
exclusively, to women, and I should not advise any exophthalmic woman
to marry; neither should I advise a man to marry an exophthalmic
goiter woman. It is a very annoying disease, while sexual intercourse
aggravates all the symptoms, particularly the palpitation of the
heart. The children, if not affected by exophthalmic goiter, are
liable to be very neurotic.
_Simple goiter_, that is, enlargement of the thyroid gland (chiefly
occurring in certain high mountainous localities, such as
Switzerland), is not so strongly dysgenic as is exophthalmic goiter.
Still, goiter patients are not good matrimonial risks.
Of course, there are always exceptions. I know an exophthalmic goiter
woman who brought up four children, and very good, healthy children
they are. But in writing we can only speak of the average and not of
exceptions.
=Obesity=
Obesity, or excessive stoutness, is an undue development of fat
throughout the body. That it is hereditary, that it runs in families,
there is no question whatsoever. And, while with great care as to the
diet and by proper exercise, obesity may, as a rule, be avoided in
those predisposed, it none the less often will develop in spite of all
measures taken against it. Some very obese people eat only one-half or
less of what many thin people do; but in the former, everything seems
to run to fat.
Obesity must be considered a dysgenic factor. The obese are subject to
heart disease, asthma, apoplexy, gallstones, gout, diabetes,
constipation; they withstand pneumonia and acute infectious diseases
poorly, and they are bad risks when they have to undergo major
surgical operations. They also, as a rule, are readily fatigued by
physical and mental work. (As to the latter, there are remarkable
exceptions. Some very obese people can turn out a great amount of
work, and are almost indefatigable in their constant activity.) Each
case should be considered individually, and with reference to the
respective family history. If the obese person comes from a healthy,
long lived family and shows no circulatory disturbances, no strong
objections can be raised to him or to her. But, as a general
proposition, it must be laid down that obesity is a dysgenic factor.
But bear in mind that obesity and stoutness are not synonymous terms.
=Arteriosclerosis=
Arteriosclerosis means hardening of the arteries. All men over fifty
are beginning to develop some degree of arteriosclerosis; but, if the
process is very gradual, it may be considered normal and is not a
danger to life; when, however, it develops rapidly and the blood
pressure is of a high degree, there is danger of apoplexy.
Consequently, arteriosclerosis and high blood pressure must be
considered decided bars to marriage.
It must be borne in mind that the sexual act is, in itself, a danger
to arteriosclerotics and people with high blood pressure, because it
may bring about rupture of a blood-vessel. There are many cases of
sudden death from this cause of which the public naturally never
learns. Married persons who find that they have arteriosclerosis or
high blood pressure should abstain from sexual relations altogether or
indulge only at rare intervals and moderately.
=Gout=
A consideration of gout in connection with the question of heredity
will show how near-sighted people can be, how they can go on believing
a certain thing for centuries without analyzing, until somebody
suddenly shows them the absurdity of the thing. Gout was always
considered a typical hereditary disease; for it was seen in the
grandfathers, fathers, children, grandchildren, and so on. So,
certainly, it must be hereditary! It did not come to our doctors'
minds to think that perhaps, after all, it was not heredity that was
to blame, but simply that _the same conditions_ that produced gout in
the ancestors likewise produced it in their descendants.
We know now that gout is caused by excessive eating, excessive
drinking, lack of exercise, and faulty elimination. And, since, as a
general thing, children lead the same lives that their fathers did,
they are likely to develop the same diseases as their fathers did. A
poor man who leads an abstemious life doesn't develop gout, and if his
children lead the same abstemious lives they do not develop gout.
(There are some cases of gout among the poor, but they are very rare.)
But if they should begin to gorge and live an improper life they would
be prone to develop the disease.
The disease, therefore, cannot in any way be considered hereditary. In
matrimony, gout in either of the couple is not a desirable quality,
but it is not a bar to marriage; and, if the candidate individually is
healthy and free from gout, the fact that there was gout in the
ancestry should play no rôle.
=Mumps=
Mumps is the common name for what is technically called parotitis (or
parotiditis). Parotitis is an inflammation of the parotid glands. The
parotid glands are situated, one on each side, immediately in front
and below the external ear, and they are between one-half and one
ounce in weight. They belong to the salivary glands; that is, they
manufacture saliva, and each parotid gland has a duct through which it
pours the saliva into the mouth. These ducts open opposite the second
upper molar teeth.
We might be surprised to be told that these parotid glands can have
anything to do with the sex organs, but there is no other remote organ
that has such a close and rather mysterious relationship with the
sex-glands as have the parotids. When the parotid glands, either one
or both, are inflamed, the testicles or ovaries are also liable to be
attacked by inflammation. The inflammation of the testicles may be so
severe as to cause them to shrivel and dry up; or, even when no
shrivelling, no atrophy of the testicles occurs, they may be so
affected as to become incapable of producing spermatozoa. Moreover, in
cases where the testicles of a mumps patient seemingly were not
attacked--that is, where the patient was not aware of any
inflammation, having no pain and no other symptoms--the testicles may
have become incapable of generating spermatozoa.
Besides the testicles, the prostate gland, the secretion of which is
necessary to the fertility of the spermatozoa, may also become
affected and _atrophied_.
It is, therefore, a very common thing for men who had the mumps in
their childhood to be found sterile.
As to the sexual power of mumps patients, that differs. Some patients
lose their virility entirely; others remain potent, but become
sterile.
The same thing happens to girls attacked by mumps. They may have a
severe inflammation of the ovaries (ovaritis or oöphoritis) or the
inflammation may be so mild as to escape notice. In either case, the
girl when grown to womanhood may find herself sterile.
A man who never had any venereal disease, but who has had mumps,
should have himself examined for sterility before he gets married. As
explained in the chapter "Marriage and Gonorrhea," we can, in the
case of a man, easily find out whether he is fertile or sterile. But,
in the case of a woman, we can not. Time, necessarily, has to answer
that question. In all cases, mumps reduces the chances of fertility,
and no man or woman who once had mumps should get married without
informing the respective partner of the fact. There should be no
concealment before marriage. When the partners to the marriage
contract know of the facts, they can then decide as to whether or not
the marriage is desirable to them.
=Hemophilia, or Bleeders' Disease=
Hemophilia is a peculiar disease, consisting in frequent and often
uncontrollable hemorrhages. The least cut or the pulling of a tooth
may cause a severe or even dangerous hemorrhage. The slightest blow,
squeeze or hurt will cause _ecchymoses_, or discolorations of the
skin. The peculiarity of this hereditary disease is, that it attacks
almost exclusively the males, but is transmitted almost exclusively
through the female members. For instance, Miss A., herself _not_ a
bleeder, comes from a bleeder-family. She marries and has three boys
and three girls; the three boys will be bleeders, the three girls will
not; the three boys marry and have children; their children will
_not_ be bleeders; the three girls marry, and _their male_ children
will be bleeders.
What is the lesson? The lesson is, that boys who are bleeders may
marry, because they will most likely _not_ transmit the disease; but
girls who come from a hemophilic family, irrespective of whether they
themselves are hemophilics or not, must not marry, because most likely
they _will_ transmit the disease.
=Anemia=
Anemia is a poor condition of the blood. The blood may contain an
insufficient number of red blood cells or an insufficient percentage
of the coloring matter of the blood, that is, hemoglobin. A special
kind of anemia affecting young girls is called chlorosis.
Anemia and chlorosis cannot be considered contra-indications to
marriage, because they are usually amenable to treatment. In fact,
some cases of anemia and chlorosis are due to the lack of normal
sexual relations, and the subjects get well very soon after marriage.
But it is best and safest to subject anemic patients to a course of
treatment and to improve their condition before they marry.
=Epilepsy=
While epilepsy--known commonly as fits or falling sickness--is not as
hereditary as it was one time thought to be, its hereditary character
being ascertainable in only about 5 per cent. of cases, nevertheless,
it is a decidedly dysgenic agent, and marriage with an epileptic is
distinctly advised against. Where both parents are epileptics, the
children are almost sure to be epileptic, and such a marriage should
be prohibited by law. Under no circumstances should parents who are
both epileptic bring children into the world. It should be the duty of
the State to instruct them in methods of preventing conception.
=Hysteria=
Hysteria is a disease the chief characteristics of which are a _lack
of control_ over one's emotions and acts, the _imitation_ of the
symptoms of various diseases, and an _exaggerated_ self-consciousness.
The patient may have extreme pain in the region of the head, ovaries,
spine; in some parts of the skin there is extreme hypersensitiveness
(hyperesthesia), so that the least touch causes great pain; in others,
there is complete anesthesia--that is, absence of sensation--so that
when you stick the patient with a needle she will not feel it. A very
frequent symptom is a choking sensation, as if a ball came up the
throat and stuck there (globus hystericus). Then there may be spasms,
convulsions, retention of urine, paralysis, aphonia (loss of voice),
blindness, and a lot more. There is hardly a functional or organic
nervous disorder that hysteria may not simulate.
Of late years our ideas about hysteria have undergone a radical
change, and we now know that most, if not all, cases of hysteria are
due to a repression or non-satisfaction of the sexual instinct or to
some shock of a sexual character in childhood. Only too often a girl
who was very hysterical before marriage loses her hysteria as if by
magic upon contracting a _satisfactory_ marriage. On the other hand, a
healthy girl can become quickly hysterical if she marries a man who is
sexually impotent or who is disagreeable to her and incapable of
satisfying her sexually.
While hysteria, in itself, is not hereditary, it, nevertheless, is a
question whether a strongly hysterical woman would make a satisfactory
mother. The entire family history should be investigated. If the
hysteria is found to be an isolated instance in the given girl, it may
be disregarded, if not extreme; but if the entire family or several
members of it are neuropathic, the condition is a dysgenic one.
Marriage may be contracted, provided no children are brought into the
world until several years have elapsed and the mother's organization
seems to have become more stable. In some cases, a child acts as a
good medicine against hysteria. In short, every case must be examined
individually on its merits, and the counsel of a good psychologist or
psychoanalyst may prove very valuable.
=Alcoholism=
A good deal depends upon what we understand by alcoholism. The
fanatics consider a person an alcoholic who drinks a glass of beer or
wine with his meals. This is nonsense. This is not alcoholism, and
cannot be considered a dysgenic factor. But, where there is a distinct
habit, so that the individual _must_ have his alcohol daily, or if he
goes on an occasional drunken "spree," marriage must be advised
against. And where the man (or woman) is what we call a real drunkard,
marriage not only should be advised against, but most decidedly should
be prohibited by law.
Alcoholism, as a habit, is one of the worst dysgenic factors to reckon
with. First, the offspring is liable to be affected, which is
sufficient in itself to condemn marriage with an alcoholic. Second,
the earning powers of an alcoholic are generally diminished, and are
likely gradually to diminish more and more. Third, an alcoholic is
irritable, quarrelsome, and is liable to do bodily injury to his wife.
Fourth an alcoholic often develops sexual weakness or complete sexual
impotence. Fifth, alcoholics are likely to develop extreme jealousy,
which may become pathological, even to the extent of a psychosis.
If both the husband and wife are alcoholics, then marriage between
them which results in children is not merely a sin, but a crime.
We do not now come across cases so often as we used to of women
marrying drunkards in the hope or with the hope of reforming them. But
such cases still happen. This is a very foolish procedure. Let the man
reform first, let him stay reformed for two or three years, and then
the woman may take the chance, if she wants to.
=Feeblemindedness=
Feeblemindedness, in all its gradations--including idiocy, imbecility,
moronism, and so on--is strongly hereditary and is one of the most
dysgenic factors we have to deal with. It is the most dysgenic of all
factors. It is more dysgenic than insanity. Marriage with a
feebleminded person not only should be advised against, but should be
prohibited by law. A feebleminded man has much fewer chances for
marriage than has a feebleminded woman. Feebleminded girls, even to
the extent of being morons, if pretty (as they often are) have very
good chances of getting married, not infrequently getting for husbands
young men of good families who themselves of course are not very
strong mentally, but still are far from being considered feebleminded.
There are many cases of brilliant men--more than the public has any
idea of--who married pretty, shy, demure, but withal feebleminded,
girls, and the result has been in the largest percentage of cases very
disastrous. In many cases all the children are feebleminded, or if not
feebleminded, so weak mentally that it is impossible to make them go
through any college or school. All the private tutoring is often in
vain. And the brilliant father's heart breaks. It must be borne in
mind that feeblemindedness or weak mentality is much more difficult to
detect in a woman than it is in a man. Weakmindedness in a woman often
passes for "cuteness," and as among the conservatives a woman is not
expected to be able to discuss current topics, her intellectual
caliber is often not discovered by the blinded husband until some
weeks after the marriage ceremony.
As any instruction in the use of contraceptives would be wasted on the
feebleminded, the only way to guard the race against pollution with
feebleminded stock is either to segregate or to sterilize them.
Society could have no objection against the feebleminded marrying or
indulging in sexual relations, provided it could be assured that they
will not bring any feebleminded stock into the world. After the man
and the woman have been sterilized there is no objection to their
getting married.
Where a normal, able or brilliant husband finds out too late that his
wife's mentality is of rather a low order he is certainly justified in
using contraceptives; and if he is determined to have children he will
be obliged to divorce his wife. Of course this applies also to the
wife of a weak minded husband.
=Insanity=
Insanity may be briefly defined as a disease of the mind. We will not
here go into a discussion as to what constitutes real insanity, as to
what is understood by insanity in the legal sense of the term, and so
on, except to note that we have two divisions.
One is functional insanity. This may be temporary, or periodical, and
is due to some external cause, is curable, and is not hereditary. For
instance, a person may get insane from a severe shock, from trouble,
from anxiety, from a severe accident (such as a shipwreck), from a
sudden and total loss of his fortune, of his wife and children (by
fire, earthquake, shipwreck or railroad accident). Such insanities are
curable and are not transmissible. Another example is what is known as
puerperal insanity. Some women during childbirth, due probably to some
toxic infection, become insane. This insanity may be extreme and
maniacal in character. Still, it often passes away in a few days
_without leaving any trace_ and may never return again, or, if it does
return, it may return only during another childbirth. This kind of
insanity is not transmissible.
The second division is what we call organic insanity. This expresses
itself in mania and melancholy, so-called manic-depressive insanity.
This is due to a degeneration of the brain-and nerve-tissue and is
hereditary.
But, our entire conception as to the hereditary transmissibility of
insanity has undergone a radical change. There is hardly another
disease the fear of whose hereditary character is responsible for so
much anguish and torture. In former years, when there was an insane
uncle or aunt or grandparent that fact weighed like a veritable
incubus on the entire family. Every member of the family was tortured
by the secret anguish that maybe he or she would be next to be
affected by this most horrible of all diseases--disease of the mind.
If an ancestral member of the family became insane at a certain age,
every member of that family was living in fear and trembling until
several years had passed _after_ that critical age, and only then
would they begin to breathe freely. Indeed, many people became insane
from the very fear of becoming insane. It cannot be subject to any
doubt that many people do become mentally unbalanced from the fear
that they will become unbalanced. Fear has a tremendous influence on
the purely bodily functions, but its influence on the mental functions
is incomparably greater, and a person will often get that which he
fears he is going to get.
Now the hereditary character of insanity is not taken in the same
absolute sense in which it was formerly. While we still consider it a
dysgenic factor, yet we recognize the paramount importance of
environment; and we know that by proper bringing-up, using the
expression bringing-up in its broadest sense--including a proper
mental and physical discipline--any hereditary taint can be
counteracted. In connection with this subject, the following very
recent statistics will prove of interest.