DEGENERACY OF THE BODY
As degeneracy checks the natural course of embryonic development it
necessarily finds expression in the body as well as in the skull. One most
striking condition is that by which development of the bones enclosing the
spinal cord is checked. The spinal cord is at first essentially a
notochord as in the lowest types of vertebrates. The structures
surrounding the cord are not divided into vertebrae. This condition is
permanent in the lancelet. Around the notochord is later formed a species
of membrane which protects it, called the perichord. This condition is the
second stage of development of the cord and is the permanent condition in
the lampreys. Later still the cartilaginous vertebrae develop, and then
these ossify at the point in the perichord which is to form a vertebra,
bows of dense tissue form which unite behind. In front similar bows form
to constitute the bodies of the vertebrae. These bows remain ununited in
some of the lower fish and at certain stages in the human embryo. As
degeneracy checks the union of the bows of the vertebrae, imperfection, and
even absence, of the union occur, which is called spina-bifida (Fig. 96).
This condition when complete is rarely compatible with life. In a partial
state it is often found among degenerates.[220] The seat of the trouble is
frequently covered by an excessive development of hair (hypertrichosis),
especially in the small of the back; this, which occurs very frequently in
degenerates, resembles the tail which the ancients represented as that of
the fauns.[221]
[Illustration: FIG. 96.]
As the vertebrae unite irregularly, deviations or bends of the spine occur
very frequently among degenerates. These may be of any of the types known
to surgeons. In man the spinal column terminates in two bones. One of
those (composed of five vertebrae) begins at eighteen years to unite slowly
into a single bone called the sacrum. The bones of the sacral vertebrae
form processes similar to those which are formed from the vertebrae of the
chest region. These serve to cover the nerves of the sacral region. The
bone immediately below the sacrum, called the coccyx, is essentially the
representative of the tail in man. At a certain stage of human
development, as in the tadpole, the tail disappears, the nine vertebrae
forming the coccyx unite together and become a very diminutive bone which
loses nearly all vertebral characteristics. Sometimes this bone retains
its embryonic peculiarities to such an extent that it simulates in some
degenerates a rudimentary tail. Of this many instances are on record. A
greater degree of this condition has been found to occur, with comparative
frequency, amongst the lowest negro races. In this respect these are below
the anthropoid apes, where the tail, considered from the tail standpoint,
has degenerated as in man for the benefit of the organism as a whole.
[Illustration: FIG. 97.]
The ribs and breastbone develop from the processes of the vertebrae. It is
probable that every vertebra originally had ribs. Traces of these exist in
most vertebrae in the human embryo. In man, as a rule, there are but twelve
vertebrae which develop true ribs. In degenerates, as in the gibbon, a
thirteenth pair sometimes appears. Normally, the two lowest ribs are,
however, very imperfectly developed as compared with the other ten, and
one is sometimes absent. The rib develops from the ends of the vertebral
bows, which, coming in contact with the muscle plates of their own segment
of the body, are by the resulting bulging forced to expand, and later come
together through the formation of the breastbone. Checking of these
conditions produces various deformities of the chest which have been
divided into "funnel-shaped" and "dropper" deformities.[222] Frequently
the entire chest wall is arrested early in life (Fig. 97). The relation
between the muscle plates and the course of development of the chest is
illustrated by the fact that an arrest of development of important muscles
often coexists with deformities of the chest. The human limbs are
developments from the fin-folds as found in fishes and the human embryo.
In one of these the fins are divided into four segments. The upper segment
contains one long bone, the humerus (or arm bone), or the femur (or thigh
bone). The second segment contains two long bones, the radius and ulna (or
arm bones), or the tibia and fibula (or leg bones). The third segment
consists of nine small bones, the carpals of the wrist or the tarsals of
the ankle. The fourth segment consists of five separate digits. These
limbs pass through three stages in embryonic development as to their
position, which may be designated as amphibian, reptilian, and mammalian.
Many of these bones fuse together (carpals and tarsals). The digits have
long before the late fish stage been formed of more than one bone. At
times this condition persists even after the completion of human embryonic
development. Limb anomalies resulting from checks of development causing
either excess or arrest of development are far from uncommon among
degenerates, but are not so common as anomalies of form and proportion.
Among such anomalies may be mentioned joined limbs (symelia), or the more
or less complete absence of limbs (ectromelia), or the absence of a
peripheric segment (hemimelia), or the complete or partial absence of a
central segment (phocomelia). Among the other important degeneracies of
the limbs are supernumerary digits. These Annadale[223] classifies as:
First, a deficient digit loosely attached to the hand or foot or to
another digit. Second, a more or less developed digit free at its
extremity and articulating with other bones. Thirdly, a fully developed
separate digit. Fourth, a digit united along its whole length with another
digit. The first three types have been called polydactylia. The last has
been called syndactylia. There is finally a condition in which union
between the digits results in the disappearance of some of the fingers and
toes (Fig. 98). This condition is called ectrodactylia. Supernumerary
digits to the extent of six fingers and six toes are exceedingly common in
the families of degenerates. The influence of heredity in this particular
has been well demonstrated. The Kelleia family of Malta was one of the
earliest reported. The condition may last for five generations,[224] but
often disappears on marriage with normal persons outside the community or
family. A family of the Arabian Hyabites, named Boldi, confined marriages
to their own tribe. They all have twenty-four digits. Children born with a
normal number are killed as being the offspring of adultery. The
inhabitants of Cycaux, France, till the end of the eighteenth century, had
nearly all supernumerary digits either on the hands or feet. Isolated in a
mountainous region, they for years intermarried. On communication being
opened, they emigrated or married strangers, and sexdigitism vanished.
Maupertius reports the case of a German family whose members had
twenty-four digits for many generations.[225] One of them refused to
acknowledge a normal child. In one instance in the United States
supernumerary digits lasted through five generations. A case reported[226]
some years ago was the following: The first instance of the appearance of
the deformity was in a man, born of a degenerate family in 1752, who had
six toes on one foot. His son was born with six toes on one foot, but the
daughter was normal. This daughter had five children; among them were a
son and daughter, each of whom had six fingers on one hand. The
granddaughter had eight children, including one son with six toes on one
foot. Another son had two daughters, each having six fingers on each hand,
and one daughter having twenty-four digits. This last girl had three
children; the son was doubly deformed like his mother, while a second son
had six fingers on each hand, the toes being normal. One of the two
daughters of the fourth generation (with only the hands affected) had
eight children, several of whom were normally developed, but the rest were
deformed as follows: One daughter had an osseous thickening at the end of
the digits, one son had twenty-four digits, another had twelve fingers,
the toes being normal in number.
[Illustration: FIG. 98.]
[Illustration: FIG. 99.]
I have elsewhere cited an instance from Kiernan in which unilateral
sexdigitism was found in four generations of Norwegian degenerates.
Not unfrequently polydactylia is associated with the absence or union or
decrease in size of bones of the limbs. It happens that the upper or
lower extremities may be increased or diminished disproportionately
through the body. This disproportion in size of the fingers and toes is
exceedingly frequent. Big digits (macrodactylia, Fig. 99) are
comparatively rare, and may only involve a supernumerary bone in the
thumb. Short digits (microdactylia) are much more frequent. This state may
be constituted by the absence of one bone or the union of two bones, or
the shortening of metacarpal or metatarsal bones, or the shortness of
several phalangeal bones. There may be increased disproportion between the
different fingers. The method of determining this is by comparison with
the middle finger. This disproportion may vary greatly. Fere is of opinion
that shortening of all the fingers constitutes a grave mark of degeneracy.
Relative shortness is exceedingly common.
Under the conditions of development of the limbs from the fin-fold, it
follows that these may be checked completely so that the condition
approximates the earlier development from the fish. On the other hand the
large bones of the arm and thigh may be checked while the digits and the
two lower bones (radius and ulna, tibia and fibula) go on to full
development as do the digits. Sometimes the arms develop completely while
the lower extremity remains in the fin-fold state. On the other hand the
arms may be checked and remain in the fin-fold state while the legs go on
to full development. Sometimes the bones of the arm and forearm are
checked while the digits go on to full development. The lower extremities
are sometimes fused together. This condition, from its resemblance to the
like state in the seal, is called phocomelia, or seal limbs. They are
also called sirens, on account of the resemblance to the sirens of
mythology.[227]
[Illustration: FIG. 100.]
Other expressions of degeneracy, albeit sometimes secondary, are club-foot
and club-hands (Fig. 100). In many instances these are retentions of
positions assumed by the limbs of the foetus in the course of evolution,
and are therefore, in the adult, expressions of degeneracy. Club-foot was
an expression of degeneracy which appeared in Byron, the poet, as a
consequence of the degeneracy present in both the Byrons and the Gordons,
as Kiernan has shown.[228] Commenting on this condition as found in
Byron, F. S. Coolidge, of Chicago, remarks: "Byron undoubtedly suffered
from double congenital club-foot, the deformity being worse on the right."
While in Coolidge's opinion congenital club-foot unquestionably arises
from different causes, it is, however, so frequently an accompaniment of
severe forms of mal-development and of congenital brain defects, that
there can be no doubt but that imperfect constitutional development is one
of its causes. That the deformity with the many limitations which it
involves may tend to create morbidness is very likely to be an additional
symptom of the degeneracy which, in certain cases, is the underlying cause
for the deformity. Dareste, who has studied the club-foot and the
club-hand from the standpoint of experimental teratology, finds that in no
small number of cases club-foot and club-hand result from checked
development. Absence of the kneecap or patella may, as H. N. Moyer has
shown, be an expression of degeneracy.[229]
The conditions resultant on checked development may appear in any of the
bony or muscular structures. At times muscles checked in development pass
on to conditions present in the lower apes.[230] Sometimes the checked
development of bones results in artery courses which are present in some
of the lower animals. Just above the bend of the elbow in the embryo is an
opening through which an artery passes in many quadrupeds. In adult man,
as a rule, this has disappeared, but not rarely in degenerates the opening
persists with the artery through it.
Hernias, of all varieties, are noticeably hereditary,[231] but what is
hereditary is not the rupture, but the laxity of the orifice of the cavity
of the abdomen. As descent of the testicles from the abdomen (where they
are embryonically in man and normally in many animals) is often delayed
and even does not occur in degenerates, hernia of the groin variety is
particularly apt to occur in them. These hernias are often found united
with defects of the testicles as well as deficiencies of the chest.
Deformities of the nose are also especially apt to coexist with these.
Degenerate women frequently have supernumerary milk glands arranged on the
abdomen as in some lemurs, while males may have supernumerary breasts of
either male or female type. These breasts may be represented by nipples
alone. In either sex arrested development of the face, middle ear, and
palate often coexists with these supernumerary breasts.
The degeneracies of the body combine so frequently with those of the skull
and the brain as to indicate a common origin. Polydactylia is found with
almost all the degeneracies of the body. It occurs with all the
degeneracies of the eye, from those which are purely atavistic like
coloboma to those like retinitis pigmentosa and amauroses, which are
atavistic in origin. Hare-lip, cleft palate, and deformities of the jaws
and teeth are often found associated with all the bodily degeneracies and
the nutritive, intellectual, and moral degeneracies as well. Phocomelia
with brain deformity has been found associated with them. Anomalies of the
genital organs are also quite frequently associated with these and with
finger anomalies. In the subjects of juvenile obesity are frequently
associated unstable mentality and will-power, and delayed or precocious
sexual maturity. My own observations have shown this condition to be
frequently associated with the jaw and teeth degeneracies.
[Illustration: FIG. 101.]
Aside from their general significance as stigmata of degeneracy, anomalies
of the external ear have been found frequently associated with
mal-development of lungs, kidneys, liver, and intestines. Hidden
spina-bifida is often associated with the same anomalies, and not rarely
with irregular development of the genital organs of both sexes. Albinism
or deficient pigment in the skin and hair is not only often associated
with grave degeneracies, intellectual and moral, but appears combined with
mal-development of the spleen, liver, and kidneys. The opposite state
(melanoderma, or black skin) is often associated with similar deformities,
especially with early precocity in development. It has also been found in
connection with hairlessness and irregularities in development of the
teeth and jaws.
The deformities of the chest and their resulting interferences with
respiration are not only associated with conditions like narrowing of the
pulmonary artery, of the aorta, and with cardiac deformities, but also
lead to diminution of the respiratory power and, in consequence, to
conditions predisposing to pneumonia and consumption. They are also, as my
own observation has shown, associated with deformities of the face, of the
nose, of the mouth cavity, of the palate, and of the jaws. These
conditions result in mouth breathing and in other conditions which
predispose to the attacks of microbes. The deformities of the arterial
system coexisting with checked development of the chest are apt to extend
to the blood vessels of the kidneys, and therefore to retain these in the
embryonic condition, thus predisposing them to disease. To a somewhat
lesser degree this arterial condition coexisting with checked development
of the chest or with the other arrested conditions of development
associated with it, may extend to the liver in such a degree as to prevent
it destroying the toxins of typhoid fever and allied diseases, thereby
increasing the dangers from these disorders. The same influence may be
exerted on the spleen and suprarenal capsules, thus interfering with the
physiologic guards these organs furnish against disease and its results.
Not infrequently do these last conditions tend to give an epileptic
character to degeneracies which would otherwise be destitute of it. With
the interference with the proper blood supply, due to checked conditions
of the organs named, may occur gout, diabetes, and many forms of
rheumatism with their secondary consequences.
The imperfect and irregular action of the lungs associated with the
arrests in development of the face, nose, palate, jaws, and chest may
produce an irregular blood supply to the brain, which will exaggerate the
mental instability of the degenerate.
Among the conditions which are expressions of degeneracy of the body,
combined with degeneracy of the head and face, are three conditions known
as infantilism, masculinism, and feminism. Practically all three are
arrests of development of the promise of the child type. Owing to the
struggle for existence which occurs at puberty between the old type of the
chondrocranium and its new type as supplemented by the dermal bones, the
nervous system takes a distorted ply which arrests both the bodily,
nervous, and mental development at certain points. In infantilism the
arrest is of the future promise of the child, so that the body and face
remain at the childish point, or the body and nervous system are checked,
or finally the nervous system or certain organs alone are checked while
the body goes on to full development. Not infrequently the face is
arrested at any period from birth to puberty (Fig. 101). Hence the reason
many persons retain their youthful appearance throughout life. These
people are often vain and egotistic. The mental stamina is weak, and they
are frequently unreliable, while the females are often prostitutes or
prurient prudes, hysteric reformers or gossip mongers.
[Illustration: FIG. 102.]
The female type, from the standpoint of bodily and nervous development,
most nearly approximates the promise of the child type, and checks of
development will result in masculinism and feminism. In the first the
female has proceeded so far in development as to have female organs and
their functions while retaining traces of a predominant character of the
lower male type. In the second, the male has proceeded along the line of
evolution toward the female type, but ere sex has been fixed, further
development has been checked and the male type is finally assumed as the
predominant one. Both sexes proceed embryologically from an indifferent
type nearly resembling the hermaphroditic type found in the lower
vertebrates. The arrest of development may therefore take place at any
point in the embryonic evolution. The male may preserve only the female
breasts[232] (Fig. 102), while normal in other respects; or, again (Fig.
103), present cryptorchidism or sloping shoulders, and be otherwise
masculine. On the other hand, his nervous system may have taken such a ply
that at the period of puberty the sexual instincts may be female in type.
In some instances, this may extend merely to an extreme modesty toward
males, to an intense liking for female occupations and disgust for male
occupations. In the female precisely analogous conditions may occur. In
certain cases the sex side is entirely dormant until awakened at puberty.
Education of these cases of arrested development may give the sex
direction rather than any in-born tendency. In one case, a male who had
undergone arrest of development in his evolution towards the female type
was brought up as a girl, had unusually pleasing womanly qualities; as a
result was married twice to intensely devoted husbands, and the real sex
was never even suspected until post-mortem examination revealed that the
supposed woman was a male. In other cases where the nervous system has
taken one sexual ply, while the body has taken another, an exceedingly
unfortunate class of beings results. This class of beings needs especially
careful training during puberty and adolescence. In some instances in
addition to the sexual distortion there exist in these beings conditions
of mental defect and moral obliquity. In the last case they approximate
the criminal type. In the first case residence in an insane hospital
protects the community and these beings against themselves. In some
instances no mental defect nor, in a strict sense, moral obliquity occurs.
Here the patient requires very careful study from every standpoint.[233]
There is in the higher and lower races a tendency in different directions
as to the predominance of sex. The woman of the lower races more nearly
resembles the male of the race. The male of the higher races more nearly
resembles in structure the female of his race than does this female the
females of the lower race. This is in part due, in the course of
evolution, to the intrusion of the male on female occupations, since all
occupations, other than war, hunting, and fishing, were created by
women.[234] The male, however, in the higher races, while thus taking on
the female intellectual and aesthetic qualities, retains the male sexual
characteristics, mentally and physically, but in accordance with the law
of evolution, these manifest themselves less explosively as in the case of
the female. As the victim of masculinism or feminism is a degenerate the
explosive manifestations are more marked. Every one of the stigmata of
degeneracy already described may coexist with any one of the three
conditions named: infantilism, masculinism, and feminism.
[Illustration: FIG. 103.]
[Illustration: FIG. 104.]
Among the most striking manifestations arising from arrest of development
in certain directions with possible hypertrophy in others, are the
conditions known as giantism and dwarfism (_see_ Frontispiece). Both these
conditions may be expressions of atavism to no very remote ancestors and
present little if any evidences of degeneracy. In other cases degeneracy
may be well marked, and the condition be due to imperfect gland action,
such as disorder of the pituitary body, which causes very frequently an
enlargement of many of the bones of the body, and very often a uniform
enlargement of all the bones. Indeed, as Marie has said, giantism is
acromegaly occurring during the period of adolescence. In many instances
the opposite condition, dwarfism, occurs during infancy from causes which
check the further growth of the body, although the general functions
remain unchanged. Dwarfism is very apt to be attended by preservation of
the intellectual faculties without evidence of degeneracy, other than the
egotism shown in extreme vanity. Moral defects are, however, more apt to
occur in dwarfism than in giantism, in which last condition mental defect
is apt to occur, varying from a simple good-humoured stupidity to
feeble-mindedness. In proportion as the central nervous system has been
affected will the stigmata of degeneracy appear in both conditions. As the
line between disease and disordered function is not thinly drawn in these
cases, disorders like rickets or local bony tendencies to extensive growth
may coexist with both conditions. Infantilism is peculiarly apt to occur
with giantism, and while less frequent in dwarfism it also occurs, but is
then especially apt to be associated with rickets.
Closely akin to these conditions are leontiasis ossium and acromegaly,
both of which are characterised by similar trophoneurotic defects. The
first of these conditions may occur precedent to puberty and cease in its
completion. Kiernan has observed this in the case of an imbecile on Ward's
Island, who lived until the age of 75, after spending more than sixty
years in the charitable institutions of New York. His ancestry was of the
criminal and defective classes. Acromegaly is characterised by abnormal
growth, chiefly in the bones of the head, face, and extremities. As a
rule, the disorder begins at the completion of puberty, although it
occasionally occurs at the onset of the climacteric. The illustration
given (Fig. 104) presents the characteristic features of the disease. In
this case there are local evidences of congenital defect. The prevailing
trend of opinion is that this condition is due to irregular action of the
pituitary body which controls osseous development.
[Illustration: FIG. 105.]
As already pointed out in the chapter on Heredity and Atavism, the arrests
of development may affect one side of the body, while the other pursues
the direct course of development. This may show itself in over-growth, as
well as in under-growth, on the affected side. The person may appear, even
from the centre of the forehead down, as if the halves of the bodies of
two different persons had been joined in one. Conditions may vary from
this extreme type to a state in which a lack of proper nerve and blood
supply on the undeveloped side predisposes to attacks of disease, as
already pointed out.
Not rarely does it happen that acromegaly attacks the side most deficient
in nerve supply. The same is true of allied disorders affecting the growth
of the muscles.
The conditions of development may be such that both sides are equally
defective in nerve supply, so that when acromegaly occurs it may attack
both sides equally. This is particularly apt to be the case with the lower
extremities, and enlarged feet (Fig. 105) are not an uncommon result.
[Illustration: FIG. 106.]
The feet, in addition to the condition already described as being common
in both extremities, exhibit special stigmata of their own in consonance
with the evolutionary advance which the foot has shown as compared with
the hand in man's evolution. In the lower races the hollow of the foot
does not exist, and the condition known as flat-foot occurs (Fig. 106).
This is usually associated with low instep. It occurs among the stigmata
of degeneracy, and is not rarely associated with grave moral defects and
intellectual distortions. It and other feet degeneracies have been found
frequently among paranoiacs, moral imbeciles, and prostitutes. This is
particularly true of the prehensile power of the foot.[235]