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READ AT VINELAND MEETING, 1905

S.D. RISLEY, M.D. PHILADELPHIA.

AN adequate study of the question presented for your consideration in-troduces us at once to some of the most profound and intricate problems involving the social structure of our race. To meet these problems wisely will require the united and best endeavor of the physician and the jurist and the wisest exercise of a broad and scientific philanthropy.

In no direction possibly has greater advance been made during the past century on medico-sociologic lines than in our knowledge of the defective classses of the population; this knowledge, however, has served only to afford a more adequate comprehension of the extreme complexity of the problem of how we can best deal with these unfortunates. Careful study of the social evolution of the race has, on the one hand, taught us the hopeless condition of the habitual criminal, the mentally defective and pauper classes. In large measure discouragement has thus far been the result of our endeavor to re-form the one or train to useful citizenship the other. The higher ethical considerations cause us to stand aghast at the suggestion that they be left, as indeed they were before the advent of the Christian era, to the unobstructed operation of the law of selection. This law, harsh, and utterly void of sym-pathy as at first sight it seems, was nevertheless the natural method of progress for the race; but under modern social conditions with its altruistic ideals, based upon the recognition of a universal brotherhood, the weak and unfortunate are protected against the operation of the law which ordained their destruction. In the eye of the law of selection they were reprobate. We have sought for their physical redemption but have been taught the futility of our well-meant endeavors. We have fed and clothed the pauper, and sought to imbue him with the spirit of thrift and self-help, but like "the sow that was washed he has returned to wallow in the mire." Instead of hanging the thief, as was done in former times, he has been placed in a reformatory, taught useful trades and his mind stored with moral precepts; "but can the Ethiopian change his skin or the leopard his spots?" The criminal too often remains the criminal still. He, too, is reprobate. We have reared asylums and training schools for the feebleminded, and have sought to protect and to train them into useful lives only to discover that they too are the victims of a physical and moral reprobation.

At the beginning of a new century we stand before the problems of de-generacy and criminology, in some measure discouraged, yet thoughtful. From the standpoint of ethics we must regard these unfortunates as our wards. From the view point of social evolution we must declare then unfit; we can discover no rational basis for their protection in the inalienable right of liberty of action and the choice of pursuit. They remain an ulcer on our social tissue. Christian ethics has reared for them almshouses, asylums and hospitals. The state has immured them in reformatories and prisons for the protection of the community against their frailties and their deeds. Science has grouped them in classes apart, as the irresponsible victims of heredity and disease, or of alienation by natural laws. What shall we do with them? What course can we take which shall neither wound our compassion nor thwart our sense of justice and equity, and at the same time permit us to follow wisely the teaching of science? To give freedom of action to these unfortunates is only to perpetuate the evils we recognize as inseparable from their existence, and to multiply sorrow; it would prove to be the opening wide of a Pandora's box to permit the escape and free riot of monstrous, indescribable things which a Hercules with a thousand lives could not vanquish in untold generations. It is not necessary in this presence, even did time permit, to discuss the plans which have been suggested and those which have been put in operation for the betterment of the idiot amid the imbecile, the pauper and the criminal, or to point out the discouraging result of these well meant and scientifically conducted experiments. No hope except by custodial care has ever been inspired, even in the minds of the most sanguine, for the low-grade imbecile and idiot; but for the middle and high-grade defective hope was excited, by the frequent display of cun-ning ingenuity so often witnessed, that, by suitable training in well equipped schools, the ban of heredity, the blighting, congenital incubus, might in suffi-cient degree be lifted from his life to send him forth into the world to a lim-ited but useful citizenship. But increasing experience has served to show that the improvement, even in the most promising examples of the result of train-ing, is but short-lived, and that even under the continued stress of the school environment the ban of degeneration very soon once more asserts its sway and they settle back into the mire whence they had been digged. Any study of the statistics which have been rapidly accumulating during recent years serves to show the malignant, immutable influence of heredity in the defective and criminal classes. To permit them to propagate is not only to perpetu-ate their kind to rapidly multiply the associated evils in our social structure. McKim, recognizing the evils to society growing out of the unfortunate lives of these defective classes, witnessing the very intimate relation between degen-eracy, epilepsy, inebriacy, and crime, has not hesitated to advocate even the painless taking of the life of such by the state, expecting by this radical treatment to end at least the propagation of their kind. This is certainly a radical measure, a severe blow to our compassion but serves to suggest, at least one author's appreciation of the ghastly features of the social evil which our "softness," the ethical basis of our modern civilization has per-mitted to grow up in our midst. Not only are vast numbers of hereditary paupers, imbeciles, inebriates, and criminals being born annually in our midst to swell the number of these degenerates, but they are entering through the too widely open door of our immigration system.

While modern study has done much therefore, to instruct the physician and the student of sociology as to the essentially unimprovable character of these unfortunates, and the hopeless future which hangs darkly over their lives, the community at large, the average citizen is not sufficiently informed of the teachings of science regarding them and stands sadly in need of instruction as to the essential nature of the malady which characterizes the defective classes. The complexity of the problems involved is appalling. Allusion has thus far been made only to the obviously defective but, between these and the obviously normal individual exists a broad fringe, the fimbriated border of which extends downward into the dank mire of degen-eracy, penetrating more deeply its mass with each succeeding generation, and constantly furnishing recruits to the submerged strata. How shall these serious considerations be planted in the public mind in such a manner as to secure adequate comprehension of their serious importance, for ex-ample, in assuming the important and serious relations and responsibilities of the marriage contract. It is obvious that the factors in the problem before us are numerous but principally two.

In the first place, viewed from the standpoint of the already submerged individual whether criminal or imbecile, society should assert its right to prevent the propagation of his kind. It should come to understand that the law of heredity is well nigh immutable in its operation; that the child of the feeble-minded parent is more firmly fixed under the law of degeneracy than were his parents; that the child of the feeble-minded parents or of the crim-inal and the inebriate begins his vicious life not only earlier but pursues it with a momentum not equaled by the parent. The community at large has yet to learn that the child who 'comes into the world gin begotten,' as Gilbert Parker has written, "has the instinct for liquor in his brain, like the scent of the fox in the nostrils of the hound." A fact equally true of imbecile begotten offspring. We cannot hope "to gather grapes of thorns or figs of thistles." The downward momentum of the law of degeneration is upon these unfortunate classes of our population. Observation seems to demon-strate that no admixture of pure blood is efficient in removing the stain of degeneracy.

It should be understood therefore, in the second place, that these classes are recruited from the fimbriated social border, composed of the children of the unrecognized high-grade imbecile and epileptic, of the silly half-witted consumer of nervines and stimulants; of the opium habitué and the drunkard, and from the offspring of the feeble, and diseased parent. That therefore, even if McKim's drastic remedy should be adopted, or if asexualization should be legalized by the state for the disposal of the de-generates now under custodial care in asylums, reformatories and prisons, it is obvious that it would result in failure to free these institutions permanently so long as the bed left vacant by execution or at least by the physiological ending of the sexual life of those rendered innocuous by surgical means, is immediately occupied by a recruit from the social fringe already alluded to.

It is plain that the ultimate remedy must be the control of the sources of degeneracy. This control lies primarily in a broader education of the community regarding the hereditary transmission of family traits and peculiar-ities. It should be taught without hesitation that marriage contracted by individuals who are the victims of alcoholism, of the opium or cocaine habit, of epilepsy or of any form of mental alienation or disease; by individuals the tendency of whose lives is peculiar and erratic does not safeguard the social interests of the coming generation. That certain forms of inebriacy are, in a large percentage of the cases, but one manifestation of degeneracy and should be grouped with certain phases of epilepsy, with prostitution, pauperism, and crime has been abundantly proved. The hunger of the ner-vous system for nervines, stimulants, opiates, etc., manifested by large groups of persons moving to and fro in the midst of our social structure, is well known to be the result of some congenital blight which has fallen upon the vitality of the individual. Too frequently there is associated with these tend-encies not only an attractive person hut mental qualities closely allied to genius but wanting, on careful analysis, in that balance which gives repose and guides the individual calmly but steadily in the straight and narrow way of a virtuous and contented life. The very abnormalities of such characters furnish striking features which attract attention, and between the sexes, foster those associations, which result in marriage. It is obvious therefore, that not only should the state stand ready to authorize measures for preventing the propagation of degenerates recognized as such, but should also provide for wise regulation of the marriage contract. We hear much discussion of later years regarding uniform legislation in the United States for the restriction and regulation of divorces, but the enormities of the divorce courts daily brought to our attention by the public press would in some measure be prevented if marriage were entered upon under wiser state regula-tions, and with greater knowledge and circumspection upon the part of the contracting parties. Legislation upon the lines indicated has been regarded as against public policy since it would tend, it has been argued, to retard the growth of the population and would foster illicit relations. Whether this is true or not the experience of one state legislature which has sought to restrict the marriage of the unfit has proved how extremely difficult is the task to which it has committed itself. The ridicule and opposition of a large section of the public press; the antagonistic views expressed by individuals, espe-cially women, set forth in published interviews has served to demonstrate how difficult it will be in the present state of public understanding to secure legislation which will prevent unsuitable marriages. It is plain therefore that a wider knowledge of the conditions is necessary in order to create public sentiment in opposition to the union of the unfit, and will in the end be far more potent for good than restrictive legislations. This public education must come largely through the teaching of the physician.

As conditions are at present in the United States, two young persons who by chance are thrown together acquire a mutual fondness for each other. They are too young to he controlled by anything but the physiologic instincts which mutually attract them. The serious and complex problems which we are discussing, are to them a sealed book. They are ignorant and in their ignorance go blindly forward until their feet are entangled for weal or woe in the meshes of the labyrinthine net which has spread in their unguarded pathway. They need advice, but who shall advise? The parents are less ignorant than the children only in so far as they have experienced the serious responsibilities which are sure to follow marriage; the teaching of science regarding the marriage relation is to them also a sealed book. If parents can be taught that the marriage of the unfit is not to secure the happiness of their children but to entail untold misery instead; if a young man can be made to understand that the silly, neurasthenic, untruthful girl will retain these qualities to the end and will bear to him a progeny of like-minded children who will bring "his gray hairs in sorrow to the grave;" if the young woman contemplating mar-riage can be made to see that her reckless, lawless, drinking, thriftless lover will not reform his ways under her gentle influence because these habits are but the outward expression of an inborn vice, penetrating and ramifying the warp and woof of his moral, physical and mental being; then, and only then, can we hope to stem the flood of recruits annually plunging downward to join the ranks of the submerged unfortunates who are failures in life at least or fill our eleemosynary institutions, reformatories, and prisons.

Having said so much regarding the origin and hopeless nature of degeneracy it becomes us to inquire as to our obvious duty to the imbecile placed in our custody. Broadly stated the community and the state require at our hands two things. First, that the community shall be protected from the harmful influence of these unfortunates. To this end they have been recog-nized as a distinct class of individuals and as such are set apart. Second, that once set apart and placed under the training or custodial supervision of professional men, especially trained for this service to the state, their physical condition should be ameliorated and their lives rendered more peaceful and happy by every device known to science and shown by experience to be efficient, safe and helpful. This ideal of duty is fully in accord with the ethical and altruistic ideals of our age.

I need not in this presence speak at length or in detail of the pathologic state of a considerable percentage of imbecile children; of their incorrigibility and their nervous disorders; of the absence of self-control; of the fatal dom-inance of their sexual lives; not only as out manifestations of the feebleness of their mental state, but also as a powerful reactionary influence in originat-ing and establishing more firmly their nervous derangements and sinking them more and more deeply in the quagmire of their degenerate lives. Every one at all familiar with them will know of these things.

As physicians, it does not fall within our province to deal, except in an advisory way or as educators of. the community, with legislation designed to safeguard the marriage contract, but it is our plain duty to accept the teach-ings of science in our treatment and management of the imbecile children under care in asylums and training schools. The baneful influence of the abnormal sexual dominance which characterizes the lives of these persons manifests itself in aggravating the nervous disorders already existing. Self--abuse, so prevalent among the feeble-minded, has long been held to be an im-portant etiologic factor in epilepsy and deranged mental states and other ner-vous disorders of ill-defined types. To remove from the imbecile this vicious tendency would in many cases render him or her more docile and amenable to efficient training. Their general health would improve and their lives, in some measure, be lifted from the slough of degradation. Where this has been done the incorrigible individual soon becomes an industrious member of the feeble-minded community of which he forms a part. While he may never be equal to the tasks and responsibilities of citizenship, he will be healthier, happier and at the same time cease to be a menace to succeeding generations.

So long as the imbecile is confined within the precincts of our institutions reared for his protection and control, he is not a serious menace to the com-munity, but it is well known that the parents of these wards are prone to remove them from custody for the purpose of reaping the benefit accruing to the family from their labor. This is frequently done as soon as improvement in their condition is manifested as the result of their training.

They are often by this means turned loose in their respective communities and soon manifest their vicious tendencies. Asexualization would at least render them innocuous. Under the aseptic precautious of modern surgery the necessary surgical procedure is practically free from danger and in the male does not require an anesthetic, since all that is required is to cut the vas defrens, and cause no deformitory. Under suitable legal restrictions its application would not be abused. Unfortunately a wide-spread prejudice exists against the legalization of the procedure as was recently exhibited in Penn-sylvania when the governor vetoed a bill which after a second attempt had passed both the house and senate. The message which accompanied the veto afforded a striking example of the strange psychologic tyranny of prejudice even over a mind trained at the bar and on the bench; but lacking in that mental calm and unerring judicial scrutiny probably never acquired except in the laboratory, where the human mind is drilled to accept only what is dem-onstrably and inevitably true by the unerring fiat of natural law.

Prejudice, prae-judicium, is a product of the sub-conscious mind, the fruitage of preconceived notions which, without the control afforded by in-duction from observed facts, reasons deductively and reaches conclusions based upon premises quite as liable to be erroneous as true.

It is not the contention of this paper that asexualization is justifiable in all imbecile children, but that as a therapeutic measure in selected cases it is to be commended.

Many intelligent parents give their consent without hesitation and in one instance the mother of an imbecile boy voluntarily made the request that it should be done for the reason that she had discovered that the boy's periodical visits home from the Training School were a menace to the household. But what shall be done in the case of the child descended from feeble-minded parents who are therefore incompetent to decide?