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The biological, economic and sociological bearings of feeblemindedness have overshadowed the fact that it is fundamentally and essentially a medical question. This subject should receive more attention in the medical schools. At the present time only a few schools in this country give any instruction whatever in the subject. General hospitals and dispensaries should have out-patient departments for the diagnosis and treatment of feeble-mindedness. These clinics would also provide for the instruction of students. No medical student should graduate until he has a general knowledge of the causes, varieties, prognosis and treatment of feeble-mindedness.

Every physician in general practice will find cases of feeble-mindedness among his patients. He has the unwelcome task of informing the parents of the misfortune of their child. He is called upon to advise as to treatment and life-long care and protection.

The prevention of the accidental type of feeble-mindedness largely depends upon the knowledge and skill of the physician in recognizing and in removing or modifying the environmental conditions which may cause the defect.

The recognized field of mental defect has been gradually extended and widened, and clinical types and degrees of feeble-mindedness are recognized by the alienist which are not yet familiar to the medical profession generally. It is most important that the physician should recognize the so-called "border-line" cases, where the intellectual defect is apparently slight, and is overshadowed by the immoral and criminal tendencies. These cases may be glib and plausible often bright-looking and attractive, but are unable to apply themselves at school or at work without constant supervision, and are wholly indifferent to the consequences of their behavior and actions. The inability to get or keep a situation or to support themselves is most significant. These cases often present a bad family history, a personal history showing backwardness in infancy and school life, and the presence of various physical stigmata of feeble-mindedness. Psychological tests of these adolescents or adults show that they have a mental age of only seven or eight or nine years. In fact, they are cases of real feeblemindedness differing only in degree and not in kind from the more obvious varieties.

The growing appreciation of the medico-legal bearings of feeblemindedness, the increasing tendency of the courts to inquire into the mental status of persons accused of crime, and the widespread movement to recognize and treat mental defect in the public schools have created an urgent demand for the services of physicians skilled in the diagnosis of mental defect which cannot be met at the present time. Indeed, the social worker, the charity visitor, the teacher and the court official often recognize cases of feeble-mindedness which they are unable to properly treat and control because they cannot secure the co-operation of suitably qualified physicians. A medical diagnosis of feeble-mindedness is necessary before a case can be properly or legally considered.

If, as we believe, the prevalence of feeblemindedness can be most effectively reduced by educational methods, the remedy largely depends upon the medical profession. The physician has knowledge of family histories and tendencies. He has access to family councils. His advice in individual cases is eagerly sought and generally followed. He has exclusive opportunity to teach and inculcate certain accepted principles of practical eugenics.

The most important point is that feeblemindedness is highly hereditary, and that each feeble-minded person is a potential source of an endless progeny of defect. No feeble-minded person should be allowed to marry, or to become a parent. The feeble-minded should be guarded or segregated during the child-bearing period.

The normal members of a definitely tainted family may transmit defect to their own children, especially if they mate with one with similar hereditary tendencies. These potential carriers of defect should mate with sound stock, if they marry at all. If the hereditary tendency is marked and persistent, the normal members of the family should not marry. Certain families should become extinct. Parenthood is not for all.

Persons of good heredity run a risk of entailing defect upon their descendants when they marry into a family with this hereditary taint. Intelligent people are often willing to forego a proposed marriage if the possibilities of heredity are fully understood. The immediate sacrifice is less painful than the future devoted to the hopeless care of feeble-minded children. What can be more tragic than the familiar cry of the agonized mother, "If I had only known?"

The well-informed physician has the pleasant privilege of allaying the fears of those who misinterpret and magnify the possibilities of morbid heredity in their own families. It should be remembered that a single case of defect of accidental origin, with no hereditary tendency, is not likely to be followed by other cases in the same family. Indeed, a case of this sort may be found in a family where the other members are of exceptionally brilliant and gifted mentality. The ordinary family is safe and sound and whole, and is extremely unlikely to produce feeble-minded children.