Part 19 (1/2)
In prophylaxis of the family the first indication is to stop the production of degenerates. Two measures have attracted considerable attention, and from their seeming simplicity have met with much favour.
The first is regulation of marriage. This, as a means of preventing degeneracy, has been much over-estimated. Laws claiming to regulate marriage have ignored two factors. In the first place the graver degeneracies only are taken into account. From what has been shown as regards the tendency of the degenerate to intermarry, and from the fact that restraints on marriage inevitably result in illicit relations.h.i.+ps of permanent character (equally productive of degenerates whose defects have been increased by the condition in which they are born), the only procedure likely to be of value in this relation is to regard marriage simply as a contract designed for certain ends and permit its annulment for fraud, for concealment of defects (intentionally or otherwise) incompatible with the procreation of healthy children. In its essence this is the English common law theory. Its principle is recognised by the divorce codes of various continental European countries. Furthermore, it is on this principle that the Pope not infrequently annuls marriages, divorce not being recognised by the Church of which he is the head. It is certainly best for the stability of the family that unhealthy unions should have the least permanency possible.
Another element in prophylaxis, castration, ignores completely the rights of individuals under the English common law (and, so far as the United States is concerned, a provision of its const.i.tution). Although sacrificing these important guards against that degeneracy in the body politic which inevitably reflects itself in degeneracy in the individual, this procedure fails to accomplish its end, since it ignores completely the principle of transformation in heredity. The distance between the criminals (whom it is proposed to castrate) and the hysteric offspring of good family is not so great that the progeny of one will not be as degenerate as the progeny of the other. Whatever may be said of the value of this procedure as a deterrent, its use as a prophylactic is comparatively small.
Much better results are obtainable by guarding women from the factors of degeneracy during p.u.b.erty and during matronhood. Many nations whose laws ostentatiously regulate marriage in a manner most oppressive to individual liberty entail by their customs over-work in a spasmodic manner during p.u.b.erty and during matronhood. Nations whose customs permit women and dogs to be harnessed together as beasts of burden, to carry the hod and to dig trenches for sewers, gas, and waterpipes, cry out very loudly against the dangerous license of the English-speaking nations in permitting women to intrude on male occupations. There is no doubt but that women (and it may be said a large majority of men) are now through evolution unsuited to occupations involving spasmodic expenditure of force, and well suited to those implying continuity. As Bachhofen, Reclus, and Otis T. Mason have shown, two-thirds of the occupations of this last type have been created by women. Man, as Havelock Ellis demonstrates, in accordance with the law of evolutionary advance, is adjusting himself to these occupations.
Attempts to regulate employment of women in unhealthy trades are a step in the right direction so far as prevention of a factor of degeneracy is concerned, since it can be carried out without that disregard of personal liberty which is more dangerous in such attempts at regulation than the defect to be regulated.
The periods of menstruation and pregnancy in degenerate women require (from what has been said on maternal impressions) special attention suited to the individual, and not prescribed indiscriminately for all cla.s.ses. An excellent ill.u.s.tration of the dangers of Procrustean prescription is the instance where the vegetarianism of the mother during pregnancy was followed by the production of ill-nourished offspring. Diet during pregnancy undoubtedly can exercise a great influence for good, but this diet must ignore the ”longings” of pregnant women, which are simply the bulimia, or abnormal appet.i.te for food, produced by irritation of the medulla.
In dealing with the toxic factors the question of legal regulation of the opium and alcohol habits requires attention. There is very little doubt but that the routine prescription of alcohol and opium (in the shape of paregoric and soothing syrup) by the laity for painful menses, teething, toothache, &c., underlies many cases of degeneracy in the offspring. This prescription is the more dangerous because it is recommended in the hidden guise of nostrums by hysterics with blatant alcoholophobia. One of the most energetic female advocates of the legal prohibition of alcohol beverages endorsed very emphatically the nostrum of one of her hysteric supporters which contained 50 per cent. alcohol and 1 per cent. each of cocaine and morphine. As the persons largely under the influence of such endors.e.m.e.nt were hysterics whose zeal for reform was largely an expression for desire for notoriety, the dangers of its use during menstruation cannot well be over-estimated. To reach this serious source of degeneracy from alcohol and the narcotics, statement on each bottle of the exact composition of nostrums should be exacted by law.
Government could exercise a potent influence for good on alcohol abuse by improvement of sanitary conditions in the tenement or apartment house districts. Experience in New York and elsewhere has shown that improvement in tenement houses produces decided decrease in the number of dram shops in tenement-house neighbourhoods. The earlier tenement-houses in New York, as elsewhere, were originally dwellings intended for one family. As these were replaced by houses specially built for tenements, with proper sanitary arrangements and improved ventilation, not only did a tremendous decrease occur in the infantile death-rate, but a decrease also in the patronage of dram shops. In many instances it was apparent that alcoholic abuse had grown out of poverty. Foul air and crowded quarters had begotten not only a desire for stimulants but a desire for social intercourse. The dram shop met social needs as a club. It is along this line that Government can make best use of its police powers.
The Government, in exercise of its police powers directed to sanitary ends, could enable the trade unions to secure improved sanitation in shops in which occupations unhealthy by themselves or because of environment, are carried on. In this way improved sanitation of unhealthy occupations could be best secured.
The prophylaxis of degeneracy in the mother and father may be summed up as simply the prevention of a state of neurasthenia, or nervous exhaustion, whether this condition (involving the functions of growth, motion and sensation, which, as Marinesco has shown, exist in every neuron and its processes) exhibit itself in the general nervous system or in the organs connected with alimentation, elaboration, and excretion. Every factor of acquired degeneracy produces what is practically this condition of neurasthenia ere exerting any influence in the production of degeneracy.
In other words, the neurasthenia of the ancestor becomes the neurosis of the descendant. Therefore the neurasthenia requires in its treatment in the ancestor the removal of the exciting cause and the treatment of the effect by physiologic rest in the truest sense of the word. In a general way, therefore, the ordinary principles of hygiene applied to each individual case will suffice to prevent development of this neurasthenia.
The part of Government in this is very small. It is true here that, as remarked by Johnson--
”How small of all that human hearts endure, That part which kings or laws can cure!”
Training of the individual rather than governmental regulation must be the factor to prevent degeneracy in the ancestor. Indeed governmental regulation by injuring self-reliance (that factor so easily destroyed and so hardly regained) may itself be a potent factor in degeneracy.
Prophylaxis of degeneracy in the individual should commence with the birth of the child. Whatever may be said of hypothetical ante-natal training, there is no doubt that considerable benefit can be accomplished during the first months of life. As the great aim of training is to secure self-control, it must be obvious that to accustom an infant to expect attention at every moment it cries, whether the cry be the expression of need or not, is to weaken, not to strengthen, its self-control.
Furthermore, regularity in bodily functions is a great source of strength.
The child can be trained during the first months of life by careful attention to its wants on the one hand, and as careful inattention to its caprice on the other, so that all its functions become equably regular and automatic. With this regularity many of the factors underlying caprice, peevishness, and anger can be prevented in the earliest months of life.
Unless there be enormous deficiency in the a.s.sociating fibres a good start can then be made toward the creation of a secondary ego. It is at this period and during that of the first dent.i.tion that training is too often neglected or perverted in such a way as to strengthen the primary ego at the expense of the secondary. At this period the extent of training needed may be judged by the amount of stigmata, few though they be, present in the child. With the period of the first dent.i.tion certain mental and nervous stigmata manifest themselves. If the child be liable to convulsions on the slightest causes, if it manifest screaming fits without apparent reason, if it be frequently a.s.sailed by night terrors, serious attention is needed, and this attention should be directed not only to its mental and nervous condition, but also to its functions of a.s.similation, elaboration, and excretion. Here dangerous degeneracy may show itself which is not apparent elsewhere. The training of the child should be conducted along the lines recommended during the first months of life. The essential principles governing this have been excellently outlined by Jules Morel.[264] The treatment of all degenerates, and consequently their preservation from the evils that threaten them, ought to begin in their earliest infancy. First avoid exaggerating hereditary predisposition when serious neurosis has occurred in the parental line. Too often such a conclusion is adopted, and hope of recovery in the descendants is abandoned because one of the parents or the grandparents was affected with insanity by reason of organic disease of the brain. Preliminary examination of the neurotic needs to be made before one is enabled to judge as to the effects of heredity. Only after a careful examination can the extent of heredity be determined. The proof will be beyond doubt when in parents and in their children stigmata of anatomic and physical degeneration are abundantly found.
In dealing with the question of the education of the child, the signs of fatigue expressed in the ears and face should receive attention. Attempts are being made in the schools of Chicago and elsewhere to determine these.
The following schedule prepared by Colin A. Scott for the Chicago Public Schools is an excellent means towards this end:--
_Eye_:--Each eye should be examined separately and in a good light.
Hold a card over one eye while the other is being examined. In using the optometer, find the place where vision of the dots is the easiest and most distinct. In using Snellen's test card, place the pupil at the distance marked upon the card. Have him begin at the top and read down as far as he can, first with one eye and then with the other. He should be able to read a majority of the test type. Test with optometer, and in reporting use the number on the stem preceded by F for far-sightedness, and N for near-sightedness.
Place the card for astigmatism at the distance marked upon it. Cover one eye and ask pupil to indicate, without moving nearer, the circles which appear blacker or lighter than the others. Bring the card nearer and find at how many feet distant he still sees any of the circles darker or lighter than the others. At a sufficient distance every one betrays some degree of astigmatism, which is of consequence as a defect only when capable of detection within the distance indicated upon the card. Outside of this point astigmatism may be reckoned as absent and marked 0 in the report. Note if the pupil suffers habitually from inflamed eyelids, and inquire if he complains of tired and painful eyes or headaches after reading, studying, or using his eyes in other similar ways. Note any other defect of formation or position of either eye. Test the movement of the eyes by moving a coin to about eighteen inches of the eyes.
Test each ear with the same watch in the same place and position.