Fig. 30

Photograph of young rabbits from the same litter, the smaller one stunted by lead-poisoning of its father (Courtesy of Professor L. J. Cole).

The Expectant Mother Should Have Rest.—The mere matter of rest on the part of the pregnant mother is, judging from the work of Pinard, a Frenchman, and his pupils, an important one. In a number of detailed investigations they have shown that rest on the part of the working mother during the last three months before the child is born results in the production of markedly larger and more robust children than those born of mothers equally healthy but who have not had such rest. Moreover the danger of premature birth is considerably lessened.

Too Short Intervals Between Children.—Too short an interval between childbirths would also seem to be an infringement on the rights of the child as well as of the mother. Thus Doctor R. J. Ewart (“The Influence of Parental Age on Offspring,” Eugenic Review, October, 1911) finds that children born at intervals of less than two years after the birth of the previous child still show at the age of six a notable deficiency in height, weight and intelligence, when compared with the children born after a longer interval, or even with first-born children.

Our Duty to Safeguard Motherhood.—Doubtless the unventilated factory and tenement also do their share, even though we can give no exact quantitative measure of it. Obviously, it becomes a civic duty to protect as much as possible all members of our social system from such injurious factors as have just been discussed. It is particularly necessary to safeguard mothers before confinement, especially working mothers.

Expectant Mothers Neglected.—According to the claims of life insurance men, expectant mothers are the most neglected members of our population. Doctor Van Ingen, of New York City, estimates that ninety per cent. of women in this country are wholly without prenatal care. Yet every prospective mother should be taught the probable meaning of such symptoms as headache, hemorrhages, swelling of the feet and disturbed vision. She should realize the importance of submitting a sample of urine for analysis at least once a month before childbirth and twice a month for a while thereafter. She should be specially informed regarding work, exercise, diet and dress. A recent government bulletin written by Mrs. Max West which may be had free by writing to the Children’s Bureau, Department of Labor, Washington, D. C., gives much useful information on this subject.

ALCOHOLISM

Unreliability of Much of the Data.—One of the most important poisons that plays a prominent part among ante-natal influences is alcohol. But when it comes to a study of the problem of alcoholism from the standpoint of heredity and parental influences we meet with many difficulties, prominent among which are the inaccuracy and unreliability of many of the statistics brought forward in this connection. Many of the results are vitiated by the prejudices of propagandists who propose to make a case either for or against alcohol as a beverage whether or not the facts justify their conclusions. When one tries to view the matter with an open mind he finds that there is a deplorable lack of statistics which are not susceptible to more than one interpretation. However, using as much as possible what seems to be unbiased data, the evidence is almost wholly against alcohol as a beverage, at least to any immoderate extent.

Alcohol a Germinal or Fetal Poison.—The bad effects as far as offspring are concerned reveal themselves in the main under the category of “false heredity,” i. e., germinal or fetal poisonings rather than of heritable changes induced in the germ-cells. Most investigators feel that there are too many criminal, imbecile, insane and unhealthy persons among the offspring of drunkards to dismiss the matter as a coincidence. In an investigation of Imbault, for example, we find recorded of one hundred tuberculous children that while forty-one were of tuberculous parentage, thirty-six per cent, were the offspring of inebriates. Furthermore Imbault cites the observations of ArrivÉ on 1,506 cases of juvenile meningitis to the effect that this malady is twice as frequent in the children of alcoholic as in those of tuberculous parentage. It has been proved by Nicloux (L’Obstetrique, Vol. 99, 1900) that in dogs and guinea-pigs alcohol passes through the placenta and may be detected in fetal tissues; hence it is in position to influence the fetus. He found that in a very short time the amount of alcohol in the blood of the fetus about paralleled that in the blood of the mother.

Progressive Increase in Death-Rate of Offspring of Inebriate Women.—In an investigation on the effects of parental alcoholism on the offspring, Sullivan (Journal of Mental Science, Vol. 45, 1899) gives some important figures. To avoid other complications he chose female drunkards in whom no other degenerative features were evident. He found that among these the percentage of abortions, still-births and deaths of infants before their third year was 55.8 per cent. as against 23.9 per cent. in sober mothers. In answer to the objection that this high percentage may be due merely to neglect, and not to impairment of the fetus by alcoholism, he points out the fact based on the history of the successive births, that there was a progressive increase in the death-rate of offspring in proportion to the length of time the mother had been an inebriate, thus:

Views of a Psychiatrist on Alcohol.—Forel, who for years was the psychiatrist at the head of a large insane asylum at Zurich, Switzerland, has this to say about the effects of narcotic poisons and alcohol in particular:

In another passage he[6] remarks as follows:

Another interpretation of Bezzola’s results has been suggested to the effect that the license of these periods enables the defective members of the community, such as the feeble-minded, an opportunity of mating more readily and that consequently the result is direct inheritance of idiocy and allied defects instead of idiocy produced through alcoholic poisoning of the parental germ-cell.

Other Views.—There are indeed many competent investigators who believe that alcoholism in parents has little or no part in the direct production of mental defects in children. For instance, Tredgold quotes Doctor Ireland’s observations that although at New Year, when the fishermen return, the whole population of certain villages in Scotland gets drunk, there is no noticeable excess of defectives born nine months later, and remarks further that, “I have histories of idiots conceived under such circumstances, but so I have of normal children, and my opinion is, that while this may be a cause in some cases, the number of instances in this country at any rate is exceedingly small.” Again, Goddard, one of our best known American students of feeble-mindedness, who has made careful study of this point under especially favorable conditions, feels that his data do not prove that alcoholism of either the father or the mother causes feeble-mindedness in the child. He concludes, “Everything seems to indicate that alcoholism itself is only a symptom; that it for the most part occurs in families where there is some form of neurotic taint, especially feeble-mindedness.” Goddard, however, in common with many other observers, notes that miscarriages and deaths in infancy are far higher among inebriates than among abstainers.

Doctor MjÖen cites an interesting parallel between the increase of feeble-mindedness in Norway and a period from 1816 to 1835, when every one was permitted to distil brandy. In some districts many of the farmers distilled brandy from corn and potatoes, and in such regions during this period feeble-mindedness increased nearly one hundred per cent. Later the home distillation of brandy was stopped. According to Doctor MjÖen, “The enormous increase in idiots came and went with the brandy.” He is inclined to believe, however, that the alcohol operated injuriously mainly on stocks already defective.

The Affinity of Alcohol for Germinal Tissue.—Nicloux and Renault have shown that alcohol has a decided affinity for the reproductive glands. In individuals who have recently taken alcohol the proportion of alcohol in the gonads is soon almost equal to the amount found in the blood. Thus in experiments on mammals it was found that the proportion of alcohol in the ovary to that in the blood was as three to five, and in the testis as two to three. This would afford abundant opportunity for alcohol to act directly on the spermatozoon or the ovum.

A number of different investigators concur in finding that the germ-glands of the male human inebriate in many cases show more or less atrophy and other degenerative changes. In guinea-pigs which have been repeatedly intoxicated with alcohol, Stockard found that while he could detect no visible abnormality in the gonad, nevertheless their defective and weakened progeny showed that the germ-cells had been affected.

Innate Degeneracy Versus the Effects of Alcohol.—Many observations on human beings have been brought forward which at first sight seem to indicate that noticeable defects, particularly mental and nervous, occur with appalling frequency in children resulting from conception during intoxication, although, unfortunately, the evidence is rarely clear as to whether the defects are really due to the effects of the alcohol or to the fact that the parent or parents were degenerate to begin with.A very interesting human case cited by Forel on the authority of Schweighofer is that of a normal woman who had three sound children when married to a normal man. After the death of this husband she married an inebriate by whom she had three other children. One of these suffered from infantilism, one turned out to be a drunkard, and the third became a social degenerate and drunkard. Moreover the first two contracted tuberculosis, although hitherto the family stock had been free from this malady. Ultimately the woman married again and by this third husband, who was normal, she again had sound children. Similar cases might be cited, as, for example, a record of eighty-three epileptics, of whom sixty had drunken parents, but it can be urged against all of them, of course, that the defective offspring were due to an innate degeneracy of the drunken parent which made him a drunkard rather than to the effects of the alcohol he took. While one is skeptical as to the validity of this objection in all of the many cases which occur with such monotonous frequency in man, there is no way of escaping such an interpretation with the evidence at hand. It must be admitted, moreover, that there are many families with one or both parents alcoholic in which the children are not mentally defective.

Experimental Alcoholism in Lower Animals.—Many of the objections that exist in the case of man, however, do not apply in that of lower animals. If normal animals are experimentally alcoholized and are shown to produce defective offspring under such conditions, then in their cases at least, the disorders in the offspring must be due to the effects of alcohol and not to an innately degenerate condition of the parent. Disorders similar to some of those seen in the children of alcoholics do actually result in alcoholized animals of one kind or another.

Against the earlier experiments on animals it has been urged that too few individuals were used to give conclusive results, but this objection can not be brought against the recent experiments of Stockard. While he has published accounts of his work in various scientific periodicals lately, the reader will find a full statement of his own experiments, together with a review of the whole subject of experimental alcoholism in animals and the effects on progeny in The American Naturalist, Vol. XLVII, November, 1913, together with a useful bibliography.

Before taking up Stockard’s results we may select a few of the more significant experiments made earlier by other investigators.

Laitinen alcoholized rabbits and guinea-pigs. He found that the treated individuals had more still-born young than the control, and also that growth of the living young was retarded. His alcoholized rabbits and guinea-pigs produced more young than did the normal individuals used as a control. Laitinen’s studies on man, together with three other studies of the Eugenics Laboratory in London, show that in man also more children are born to alcoholics than to normal parents. Goddard’s investigations in America corroborate this fact.

Ceni found that only 43 per cent. of the eggs from alcoholized fowls developed normally, as against 77 per cent. of normal development in the controls. Moreover the eggs of alcoholic fowls were shown to be less resistant to adverse conditions than normal eggs from the fact that fluctuations of temperature at the beginning of incubation kept all the alcoholic eggs from developing perfectly, while 27 per cent. of the control eggs developed normally under the same adverse circumstances.

Hodge made a pair of dogs alcoholic. Of 23 pups obtained from the pair, 8 were deformed and 9 were dead; 4 alone were viable. From a control pair of dogs 45 pups were obtained, of which 4 were deformed, none were born dead, and 41 were viable.

Stockard’s Experiments on Guinea-Pigs.—Stockard’s experiments demonstrate that the offspring of mammals may be injured or modified in their development by treating either parent repeatedly with alcohol. The guinea-pigs used in the experiment were all first tested by normal matings and found to yield normal offspring. The alcohol was given to them by inhalation. It was found to be readily taken into the animals’ blood and to produce intoxication. While guinea-pigs alcoholized in this way as often as six times a week for two and one-half years would maintain their own bodily vigor and health apparently, the deleterious effects on their progeny were marked. The defects were general rather than specific, although the central nervous system and special sense organs were apparently affected most.

Out of 119 total young produced by the alcoholic animals, only 52, or less than 44 per cent., survived, whereas out of 64 young produced from normal parents used as a control for the experiment, 56, or over 87 per cent., survived. In some cases alcoholic males were mated with normal females, in other, alcoholic females with normal males. In still other instances both parents were alcoholic.

The results are summarized in the accompanying table (Fig. 31), taken from Stockard’s paper:

Condition of the Offspring from Guinea-Pigs Treated with Alcohol

Fig. 31

Table showing condition of the offspring from guinea-pigs treated with alcohol (after Stockard).

Lines four and five give a comparison between the 103 total matings of all treated individuals and 35 normal matings. In the first case almost 42 per cent. of the matings gave negative results or early abortions, whereas in the normal control matings, failure to yield a full-term litter occurred in only two cases. The 103 matings of alcoholic animals gave only 46 living litters, or about 45 per cent. On the other hand the 35 control matings produced 32 living litters, or 91½ per cent. It will be observed also that from such of the 103 matings of alcoholics as produced young there were 30 still-born, 37 which died soon after birth, and only 52 surviving young, whereas from the 35 matings of normal individuals there were only 4 still-born young, 4 which died soon after birth, and 56 surviving young.

The bottom line of the table, although, as Stockard points out, containing too few cases to prove wholly convincing, indicates that alcoholizing erstwhile normal females during pregnancy was not particularly harmful to the embryos in utero.

Some of the most interesting results were obtained when offspring termed second generation animals, derived from alcoholic parents though not themselves treated with alcohol, were mated in various ways. When such individuals were mated with normal individuals, although the litters were small, the results were normal, the normal mate having seemingly counteracted any defects which might have lurked in the second generation animal. On the other hand, out of three matings of second generation animals with alcoholic individuals, two produced still-born young, of which one was markedly deformed, while the third yielded two living young.

However, the most striking results were obtained when two second generation individuals, the offspring of alcoholic parents, were bred together. Although themselves untreated, these individuals, of which 19 matings were made, produced as many or more defective young than did their alcoholic parents. Seven of the matings were unfruitful. The remaining 12 matings gave living litters consisting of 19 individuals in all. Six of these showed various nerve disorders (spasms, epileptic-like seizures, etc.) soon after birth; one was eyeless and otherwise deformed.

Stockard’s Interpretation.—Stockard’s interpretation of his experiments is as follows: “Mammals treated with injurious substances, such as alcohol, ether, lead, etc., suffer from the treatments by having the tissues of their bodies injured. When the reproductive glands and germ-cells become injured in this way they give rise to offspring showing weak and degenerative conditions of a general nature, and every cell of these offspring having been derived from the injured egg or sperm-cell are necessarily similarly injured and can only give rise to other injured cells and thus the next generation of offspring are equally weak and injured and so on. The only hope for such a line of individuals is that it can be crossed by normal stock, in which case the vigor of the normal germ-cell in the combination may counteract, or at any rate reduce, the extent of injury in the body cells of the resulting animal.”

He also believes that various deformities and developmental arrests such as harelip and cleft-palate may similarly be cases of transmission rather than true inheritance, due to the weakening of the germ-cells in some way, or to some lack of full vigor in the uterine environment.

Further Remarks on the Situation in Man.—Returning now to the question of alcoholism in man, it seems in view of the strong circumstantial evidence in the case of man himself, together with the result of experiments on animals, that little doubt remains that excessive alcoholism might result in the production of defective offspring. On the other hand an antecedent degeneracy or neural instability undoubtedly plays an important part in many cases, in the original production of drunkards, and when such occurs, it, as well as the direct effects of alcoholic poisoning, must be reckoned with in the effects on progeny. Studies carried on by Pearson, Elderton and Barrington of the Eugenic Laboratory in London lead these investigators to the conclusion that extreme alcoholism is a result not a cause of degeneracy. That is, the degeneracy is due to the defective stock, not to alcohol. They cite in evidence their records of four thousand school children of alcoholic and of sober parents, which fail to show any unfavorable effect of alcohol on offspring. Some of their critics, however, maintain that they did not choose subjects who were sufficiently alcoholic to give the injurious results that might legitimately be expected among the offspring of excessive drinkers or habitual drunkards.

Where children show a hereditary inclination toward drink, unquestionably one of the strongest factors is the inheritance of the same disposition, the same unstable nervous constitution and its accompanying lack of self-control which led the parent to drink, rather than the inheritance of the effects of the drink on the parent. For in many cases a parent may not become a drunkard until after the children who also become drunkards are born. That the tendency to drink immoderately is frequently due to a strain of feeble-mindedness or epilepsy becomes more evident every day. In many of the so-called “periodical” drunkards, the accompanying features of their periodic attacks of drink-craving, such as clouding of memory, restlessness and depression, are those commonly associated with ordinary epileptic attacks.

Probably Over Fifty Per Cent. of Inebriety in Man Due to Defective Nervous Constitution.—Branthwaite, an English authority on drunkenness, finds that about sixty-three per cent. of the inebriates who come to his notice are mentally defective. In alcoholic insanities heredity is a potent factor. It is coming to be realized more and more that pronounced alcoholism is due in a large percentage of cases, perhaps over half, to a defective nervous make-up. While it is true that many drunkards would not develop without free access to alcohol, on the other hand many would never develop without a bad heredity back of them, which gives them a peculiar nervous constitution that renders alcohol an undue stimulus. In a recent report of the New York State Hospital Commission it is stated that in fifty-four per cent. of the cases of alcoholic insanity, a family history of insanity, epilepsy or nervous disease exists. Thus in the presence of alcohol most of these unfortunates are helpless pawns of a hereditary weakness.

So when the question of alcoholism is viewed from all angles, the children of the human drunkard would seem to run a double menace of misfortune, since they may be subject both to the direct poisoning effects of alcohol and the results of an inheritable degeneracy.

Factors to Be Reckoned With in the Study of Alcoholism.—In any thoroughgoing study of alcoholism in man many factors will have to be reckoned with. First of all there is the question of inherent lack of control. This is probably the principal thing inherited where heredity truly enters as a factor. That example and social environment are important factors in addition to or in place of heredity is clear, too, when we observe that often it is the boys only who take after a drunken father, for there is no evidence that the inherited tendency when it really exists is at all sex-linked. Again, in certain occupations carried on under unwholesome influences relief is frequently sought in alcoholic stimulants, and such custom may easily crystallize into habit. Furthermore, the accustoming young children to doses of alcohol, or the unborn young to alcohol through the body of a drunken mother, may be strongly contributory toward establishing inebriety in certain cases. As we have seen from an abundance of experimental data on animals, moreover, the nurture effects on germ-cells may result in the production of weakened offspring. Such offspring in the case of man are probably less able to withstand temptations of all kinds and hence readily succumb to the habit-forming effects of alcohol if once its use is begun. Lastly, it must not be forgotten that alcoholism in the father usually means poverty and the subsequent accompaniment of malnutrition and neglect of the children, and this in itself may not only account for poor development of the latter, but may also be strongly contributory toward establishing the habit of alcoholism in them.

An inherent bias plus most of the other conditions just enumerated is the not unusual lot of the offspring of drunkards.

Venereal Diseases.—There is yet another very considerable class of maritally unfit who in any conscientious discussion of unfitness for marriage or of racial improvement must be considered. I refer to those who are afflicted with the diseases which are inseparably associated with the so-called “social evil.” To gonorrhea, one of the most prevalent of these diseases, more than one-fourth of our total one hundred and ten thousand blind in the United States are said to owe their affliction. Milder types of eye disease may also result from such infections. As much as eighty per cent., or some say practically all blindness in children born blind is caused by it, the infection occurring at the time of birth or within a few days thereafter. The terrible consequences of this disease to the innocent wife would alone make its discussion imperative.

The Seriousness of the Situation.—Unfortunately the insidious nature of gonorrheal infections is unknown to most persons. A cure is apparently effected, yet as a matter of fact the germs may live for years and, if in the male, later be transmitted to the wife, subjecting her to a future of invalidism and misery. Reliable statistics from various medical authorities reveal the appalling fact that seventy-five per cent. or more of the surgical operations for inflammatory pelvic disorders peculiar to women, such as pus tubes and peritonitis, are attributable to this disease, as is also the involuntary sterility of forty-five per cent. of childless women. Unwelcome as the fact is there is an abundance of evidence to show that a large percentage of men in particular have at some period of their life been infected with venereal disease. Of our fourteen million males in the United States under the age of thirty we find estimates by some specialists in venereal diseases to the effect that five million of them, that is, one out of three, suffer from some one of the social diseases or their consequences. Doctor Hugh Cabot, one of the chief surgeons of the Massachusetts General Hospital at Boston, a member of the faculty of the Harvard Medical School and president of the American Association of Genito-Urinary Surgeons, has this to say about the situation: “We have of late years heard much about the frequency and serious consequences of tuberculosis; it has been dubbed the ‘white plague,’ and so active has been the campaign that a wide-spread understanding of this serious disease has resulted. It may safely be averred that in the urban population at least there are two, and perhaps three, individuals with syphilis to every one with tuberculosis. The frequency of gonococcus infection is much higher.” He believes that over half the male population acquire a gonococcus infection at some period of their career. While as a layman, one can not but feel that a specialist’s estimate may run unduly high because of the fact that he is encountering an inordinate proportion of such maladies every day, still such specialists are in position to get at the truth as no other person can and their calculations are probably not grossly in error. In any event any one who has progressed in worldly knowledge beyond the naÏvetÉ of a child must recognize the appalling prevalence of these maladies.

Infantile Blindness.—So serious has the matter of infantile blindness become that some state boards of health and some city health departments supply all physicians and midwives with specially prepared packages containing cotton and nitrate of silver solution for preventive or curative treatment of the eyes of all new-born children. At the time of the first bath each eye is carefully washed with a separate pledget of cotton saturated with boric acid solution. Each then receives a drop of the silver solution, which is made just strong enough to kill any gonococci that might be present without itself inflaming the eye. Water used in bathing the baby’s body of course is not allowed to come in contact with its eyes. Such treatment should be given every child no matter how unsuspicious the circumstances may be. German authorities who have been following this method now for some years assure us that nineteen-twentieths of the blindness of infancy can thus be prevented.

Syphilis.—As to syphilis, another and even more terrible of these diseases, we have before us the absurd fact that while thousands upon thousands of dollars are being spent to establish a rigid inspection and preventive measures against the spread of a very similar disease in the horse, this malady in man is allowed to pass unchallenged and we are confronted by the gruesome certainty that there are hundreds of these diseased persons about us to-day who, on their mere affirmation that they are unmarried and of age, will be given the right to marry and thus produce families of infected children irrevocably doomed to early death or to lifelong misery.

While syphilis is most commonly spread through relations between the sexes, it may be acquired in various other ways, as for example, through a cut in shaving with the same razor an infected individual has used. It is commonly transmitted from parent to child. Practically every prostitute is a center of dissemination. Katherine Bement Davis has shown in her studies made at the New York State Reformatory for Women that while ordinary clinical tests show that apparently only twenty-one per cent. of these women are infected with venereal disease, more careful laboratory tests showed at least ninety per cent. to be infected.

Syphilis is caused by Treponema pallidum, a small unicellular animal parasite. Given access to the blood by any means whatever, possibly even through an abrasion in the lip by means of a kiss, it multiplies rapidly and any part or organ of the body may be attacked. Usually a small sore occurs at the point of entrance to the body, but often it heals up readily with little indication of the seriousness of the infection.

The development of the malady is insidious and long continued. As a matter of clinical convenience physicians divide its progress into successive stages although in reality the transitions are frequently variable and ill marked. The symptoms that arise within the first few months or even years are readily controlled by appropriate treatment, but to insure a cure prolonged and most thoroughgoing treatment is imperative. The symptoms disappear so completely after a short period of treatment that it is very difficult to persuade the average patient that he is not yet cured. Two years at least are none too short a period of treatment, yet the majority of patients, fully convinced that they are merely being exploited by the physician as a source of revenue, drift away at the end of a few months. As a matter of fact, however, the germs usually persist long after the obvious symptoms of the disease have disappeared, and in consequence many of the most serious results of syphilis may not manifest themselves for a period of perhaps ten, twenty or thirty years.

Some of the Effects.—It is now known that paresis, also termed general paralysis or softening of the brain, is probably invariably due to syphilis. The work of Flexner and Noguchi on paresis and tabes dorsalis show that always in such afflictions the tissues of the central nervous system have been invaded by the parasite. The original infection, however, may have occurred so long before as to have been almost forgotten by the patient. Thus many an apparently robust man is stricken down in the prime of life. Earlier and prolonged treatment would in all probability have eradicated the germs and thus prevented the mental breakdown, which can not be cured by any known treatment. Postmortem examination always shows that the Treponema has wrought wide-spread damage in the brain. The frequency of paresis may be realized when one learns that in some regions it is responsible for about one-fifth of all cases of insanity sent to hospitals for the insane. It ranks next to the highest as a cause of insanity. Statistics show that in the state of New York more deaths result annually from paresis than from smallpox, tetanus, malaria, dysentery and rabies all combined.

In some cases the disease attacks the membranes of the brain and the small blood vessels giving rise to a still different type of mental disorder. Practically all patients with locomotor ataxia owe their condition to an antecedent syphilis. Moreover it is one of the important causes of arterio-sclerosis, or hardening of the blood vessels, and is also a prominent factor in certain forms of heart-disease, as well as by no means an unimportant cause of blindness in children.

As to specific cases of the effects of this disease on descendants the literature of the subject is crowded full. While it is needless to conduct the reader through a chamber of horrors by reviewing clinical cases, it is desirable to point out in a general way some of the effects. Doctor George H. Kirby, director of Clinical Psychiatry, Manhattan State Hospital, says:

Still other investigators give details of physical afflictions and distortions, of suppressed development, of inordinate percentages of stillbirths—perhaps the most merciful lot for the little victims—but sufficient has been said to indicate the full horror of the situation.

Goddard,[7] although not minimizing the terrible nature of the disease, finds little evidence in his studies that syphilis in parents is a specific cause of feeble-mindedness.

A Blood Test.—Fortunately a delicate blood test known as the Wasserman test has been discovered by means of which, through an examination of a few drops of blood, any trace of syphilitic poison which exists in the body may usually be detected. This is true even though the individual may at the time show no visible symptoms of syphilis. The test is therefore of great value in detecting the latent germs of syphilis in individuals who have apparently been cured, and also often in making an early diagnosis of paresis. The Wasserman test, however, is reliable only in the hands of a skilled operator. It may occasionally give a positive reaction when syphilis does not exist and on the contrary a negative when it is present. The luetin test is also now applied by some specialists, but is too new a test to have come into general use. It works on the same principle as the tuberculin test for tuberculosis. Some army physicians now also give what is termed a provocative Wasserman. That is, in a suspicious case which gives only negative results by an ordinary Wasserman, they can get, if syphilis really exists, a positive reaction after giving small doses of potassium iodide or salvarsan.

It should be well understood by every one that syphilis is usually curable provided the patient is given modern scientific treatment by a competent physician. I emphasize competent because there are so many quacks in this field that one undergoing treatment can not be too careful in assuring himself of the competency of the physician. In even a case of long standing, where the symptoms have been in abeyance for a number of years, the disease can be cured provided it has not developed into an active cerebro-spinal type, and even the latter can be much benefited by proper treatment. The great danger of the cerebro-spinal type is that it will result in paresis or locomotor ataxia.

As long as the blood of a patient shows a positive Wasserman reaction, marriage should certainly not be consummated. If after a proper course of treatment by a well-informed physician, the patient shows a negative Wasserman when tested by a competent examiner, he probably would not infect his wife or offspring, although prudence would require that he wait at least six months or a year before marriage, and marrying then only if later tests remain negative.

The only way for a patient to be sure that he is not harboring the cerebro-spinal form would be to have a spinal puncture made and the cerebro-spinal fluid examined. While the cerebro-spinal phase often does not occur until long after the primary infection, cases are known in which it has appeared within a few weeks. Evidence that the central nervous system is frequently invaded early in the course of the disease is increasing. Marriage of an individual suffering from the cerebro-spinal form should not take place, since such a one is almost sure to become a burden on the family or the state.

Many Syphilitics Are Married.—It may seem to some that in a treatise on being well-born the subject of syphilis might be ignored as not being especially pertinent, but the supposition that no considerable percentage of syphilitics marry is not borne out by the facts. Seventy-five per cent. of men with insanity due to syphilis who are admitted to hospitals are married. The insanity in such cases is mainly the result of infections in earlier years, often long before marriage. While syphilis, strictly speaking, is not inherited, that is, does not become part and parcel of the germ-plasm, still the frequency of its direct transmission to offspring is so appalling that the outcome, as far as the immediate child is concerned, is quite as disastrous as the most thoroughgoing real inheritance could be.

Why Permit Conditions to Continue as They Are?—When one faces the easily ascertained facts regarding venereal disease, it seems incredible that we, an intelligent people, can go on complacently handing our daughters and sisters over to the surgeon’s knife and a life of personal misery, and even in not a few instances to become mothers of incurably defective children, yet the dire fact confronts us that we do. We can no longer excuse ourselves on the plea of ignorance, for the grisly record may now be read in many medical and not a few popular treatises, and we find the theme entering even into the modern drama, as witness Brieux’s Damaged Goods. Further indifference to these conditions can only be attributed to culpable apathy or prudery.

The extreme dangers to which parents are subjecting their daughters if they do not demand a clean bill of health on the part of their prospective husbands are obvious. Fathers and mothers perfectly willing to inquire into their future son-in-law’s social connections, his income, securities, or business chances become strangely “modest” when it comes to determining whether he is physically fit for marriage.

One great cause of ignorance in the past was the prudish taboo against frank discussions of venereal diseases which has thrown the veil of silence about the subject. To-day, however, it is coming to be recognized that these maladies are diseases and not a standard of social propriety, and that like most other diseases the surest way to secure prevention and gradual eradication is through the enlightenment of the public. They are prevalent in all classes of society. Moreover, it must not be forgotten that there is no form of venereal disease which may not be innocently acquired. Even where acquired through transgression of moral law an ignorant attitude toward the sexual instinct is often at the bottom of the difficulty.

Medical Inspection Before Marriage.—Ante-nuptial medical inspection is certainly as necessary to the welfare of society as the certification of age and of the single state now required by law. No one objects to a medical examination pertaining to venereal and other diseases when it comes to taking out a life insurance policy, and why there should be any more objection to it as a preliminary to marriage is a mystery. A few states already have compulsory ante-nuptial medical inspection. The laws have been enacted too recently to judge adequately of their working. There has been much debate in Wisconsin as to whether their law (Chapter 738, Laws of 1913), which went into effect January 1, 1914, is constitutional and whether it requires a Wasserman test. The Wisconsin law applies to males only. The Supreme Court of the state has declared it constitutional and that its requirement of “the application of the recognized clinical and laboratory tests of scientific search” involves only such examination as the ordinary licensed physician is equipped to make and can reasonably be expected to make for three dollars, the maximum fee specified in the law.

A number of the physicians of the state are still dissatisfied with the wording, although most do not oppose the principle of the law. Many believe that it should apply to the women as well as to the men, and others feel that the law should be extended to cover still other kinds of marital unfitness. Most of the practitioners with whom I have discussed the matter appreciate the motive underlying the law and are endeavoring to make it successful.

The general public of the state as a whole seems to be in favor of the provision. At least one hears much favorable comment and little dissension among those who understand its purpose. The very controversy over it which sprang up after its passage proved to be of great benefit in the education of the public regarding the necessity of such measures. Such physicians as I have been able to question report that the candidates for marriage rarely object to the requirement, but on the contrary strongly favor it. Especially where they have suffered from venereal disease earlier in life most are eager to know their condition and to have medical advice. To my own mind this last fact is the most significant of all, as it will give every candidate for marriage a chance to know the truth. Most men are not so much brutal or vicious as ignorant in such matters. The vast majority of those unfit for marriage as a consequence of venereal disease will, when they realize the danger their condition imposes on wife and children, take every possible means to put themselves into proper condition.

Desirable as the Wasserman test may be, it requires special laboratory facilities and equipment as well as a specially trained examiner to make it a reliable test. Moreover it can not be given by the general practitioner for the very moderate fee that must obtain in a pre-nuptial examination compelled by law. If it or the serum test for gonorrhea are to be applied then the legislative body of the state will find it necessary to establish a special public laboratory or laboratories for their application. This, however, is not a matter of particular difficulty and would be capital well invested in any state.

The Perils of Venereal Disease Must Be Prevented at Any Cost.—However, no matter what the cost may be to the state, no matter what the exaction from the individual, the grave perils of venereal disease to society must be prevented. We owe it to the cause of humanity that there be fewer victims born into a world of eternal night, that from a parentage of polluted blood there spring no longer hosts of children with feeble misshapen bodies or with tarnished intellects, death-marked at the door of life.

Bad Environment Can Wreck Good Germ-Plasm.—In conclusion it is evident from our discussion of prenatal influences that not all of being well-born is concerned with heredity in its proper sense, since the unborn young may be influenced either directly or indirectly by environmental conditions which are in no sense products of heredity, although as far as the immediate child is concerned the result may be quite as disastrous where the influence is a baneful one. As to the production of beneficial prenatal effects, while parents can do nothing toward modifying favorably such qualities as are predetermined in their germ-plasm, nevertheless they must come to realize that bad environment can wreck good germ-plasm. They can see to it that they keep themselves in good physical condition by wholesome temperate living, and thereby insure as far as possible healthy germ-cells for the conception and good nutrition for the sustenance of their progeny. Their one sacred obligation to the immortal germ-plasm of which they are the trustees is to see that they hand it on with its maximal possibilities undimmed by innutrition, poisons or vice.