There is but one practical and feasible program in handling the great problem of the feeble-minded. That is, as the best authorities are agreed, to prevent the birth of those who would transmit imbecility to their descendants. Feeble-mindedness as investigations and statistics from every country indicate, is invariably associated with an abnormally high rate of fertility. Modern conditions of civilization, as we are continually being reminded, furnish the most favorable breeding-ground for the mental defective, the moron, the imbecile. "We protect the members of a weak strain," says Davenport, "up to the period of reproduction, and then let them free upon the community, and encourage them to leave a large progeny of `feeble-minded': which in turn, protected from mortality and carefully nurtured up to the reproductive period, are again set free to reproduce, and so the stupid work goes on of preserving and increasing our socially unfit strains."

The philosophy of Birth Control points out that as long as civilized communities encourage unrestrained fecundity in the "normal" members of the population—always of course under the cloak of decency and morality—and penalize every attempt to introduce the principle of discrimination and responsibility in parenthood, they will be faced with the ever-increasing problem of feeble-mindedness, that fertile parent of degeneracy, crime, and pauperism. Small as the percentage of the imbecile and half-witted may seem in comparison with the normal members of the community, it should always be remembered that feeble-mindedness is not an unrelated expression of modern civilization. Its roots strike deep into the social fabric. Modern studies indicate that insanity, epilepsy, criminality, prostitution, pauperism, and mental defect, are all organically bound up together and that the least intelligent and the thoroughly degenerate classes in every community are the most prolific. Feeble-mindedness in one generation becomes pauperism or insanity in the next. There is every indication that feeble-mindedness in its protean forms is on the increase, that it has leaped the barriers, and that there is truly, as some of the scientific eugenists have pointed out, a feeble-minded peril to future generations—unless the feeble-minded are prevented from reproducing their kind. To meet this emergency is the immediate and peremptory duty of every State and of all communities.

The curious situation has come about that while our statesmen are busy upon their propaganda of "repopulation," and are encouraging the production of large families, they are ignoring the exigent problem of the elimination of the feeble-minded. In this, however, the politicians are at one with the traditions of a civilization which, with its charities and philanthropies, has propped up the defective and degenerate and relieved them of the burdens borne by the healthy sections of the community, thus enabling them more easily and more numerously to propagate their kind. "With the very highest motives," declares Dr. Walter E. Fernald, "modern philanthropic efforts often tend to foster and increase the growth of defect in the community.... The only feeble-minded persons who now receive any official consideration are those who have already become dependent or delinquent, many of whom have already become parents. We lock the barn-door after the horse is stolen. We now have state commissions for controlling the gipsy-moth and the boll weevil, the foot-and-mouth disease, and for protecting the shell-fish and wild game, but we have no commission which even attempts to modify or to control the vast moral and economic forces represented by the feeble-minded persons at large in the community."

How the feeble-minded and their always numerous progeny run the gamut of police, alms-houses, courts, penal institutions, "charities and corrections," tramp shelters, lying-in hospitals, and relief afforded by privately endowed religious and social agencies, is shown in any number of reports and studies of family histories. We find cases of feeble-mindedness and mental defect in the reports on infant mortality referred to in a previous chapter, as well as in other reports published by the United States government. Here is a typical case showing the astonishing ability to "increase and multiply," organically bound up with delinquency and defect of various types:

"The parents of a feeble-minded girl, twenty years of age, who was committed to the Kansas State Industrial Farm on a vagrancy charge, lived in a thickly populated Negro district which was reported by the police to be the headquarters for the criminal element of the surrounding State.... The mother married at fourteen, and her first child was born at fifteen. In rapid succession she gave birth to sixteen live-born children and had one miscarriage. The first child, a girl, married but separated from her husband.... The fourth, fifth and sixth, all girls, died in infancy or early childhood. The seventh, a girl, remarried after the death of her husband, from whom she had been separated. The eighth, a boy who early in life began to exhibit criminal tendencies, was in prison for highway robbery and burglary. The ninth, a girl, normal mentally, was in quarantine at the Kansas State Industrial Farm at the time this study was made; she had lived with a man as his common-law wife, and had also been arrested several times for soliciting. The tenth, a boy, was involved in several delinquencies when young and was sent to the detention-house but did not remain there long. The eleventh, a boy... at the age of seventeen was sentenced to the penitentiary for twenty years on a charge of first-degree robbery; after serving a portion of his time, he was paroled, and later was shot and killed in a fight. The twelfth, a boy, was at fifteen years of age implicated in a murder and sent to the industrial school, but escaped from there on a bicycle which he had stolen; at eighteen, he was shot and killed by a woman. The thirteenth child, feeble-minded, is the girl of the study. The fourteenth, a boy was considered by police to be the best member of the family; his mother reported him to be much slower mentally than his sister just mentioned; he had been arrested several times. Once, he was held in the detention-home and once sent to the State Industrial school; at other times, he was placed on probation. The fifteenth, a girl sixteen years old, has for a long time had a bad reputation. Subsequent to the commitment of her sister to the Kansas State Industrial Farm, she was arrested on a charge of vagrancy, found to be syphilitic, and quarantined in a state other than Kansas. At the time of her arrest, she stated that prostitution was her occupation. The last child was a boy of thirteen years whose history was not secured...."(1)

The notorious fecundity of feeble-minded women is emphasized in studies and investigations of the problem, coming from all countries. "The feeble-minded woman is twice as prolific as the normal one." Sir James Crichton-Browne speaks of the great numbers of feeble-minded girls, wholly unfit to become mothers, who return to the work-house year after year to bear children, "many of whom happily die, but some of whom survive to recruit our idiot establishments and to repeat their mothers' performances." Tredgold points out that the number of children born to the feeble-minded is abnormally high. Feeble-minded women "constitute a permanent menace to the race and one which becomes serious at a time when the decline of the birth-rate is... unmistakable." Dr. Tredgold points out that "the average number of children born in a family is four," whereas in these degenerate families, we find an average of 7.3 to each. Out of this total only a little more than ONE-THIRD—456 out of a total of 1,269 children—can be considered profitable members of the community, and that, be it remembered, at the parents' valuation.

Another significant point is the number of mentally defective children who survive. "Out of the total number of 526 mentally affected persons in the 150 families, there are 245 in the present generation—an unusually large survival."(2)

Speaking for Bradford, England, Dr. Helen U. Campbell touches another significant and interesting point usually neglected by the advocates of mothers' pensions, milk-stations, and maternity-education programs.

"We are also confronted with the problem of the actually mentally deficient, of the more or less feeble-minded, and the deranged, epileptic... or otherwise mentally abnormal mother," writes this authority. "The `bad mothering' of these cases is quite unimprovable at an infant welfare center, and a very definite if not relatively very large percentage of our infants are suffering severely as a result of dependence upon such `mothering."'(3)

Thus we are brought face to face with another problem of infant mortality. Are we to check the infant mortality rate among the feeble-minded and aid the unfortunate offspring to grow up, a menace to the civilized community even when not actually certifiable as mentally defective or not obviously imbecile?

Other figures and studies indicate the close relationship between feeble-mindedness and the spread of venereal scourges. We are informed that in Michigan, 75 per cent. of the prostitute class is infected with some form of venereal disease, and that 75 per cent. of the infected are mentally defective,—morons, imbeciles, or "border-line" cases most dangerous to the community at large. At least 25 per cent. of the inmates of our prisons, according to Dr. Fernald, are mentally defective and belong either to the feeble-minded or to the defective-delinquent class. Nearly 50 per cent. of the girls sent to reformatories are mental defectives. To-day, society treats feeble-minded or "defective delinquent" men or women as "criminals," sentences them to prison or reformatory for a "term," and then releases them at the expiration of their sentences. They are usually at liberty just long enough to reproduce their kind, and then they return again and again to prison. The truth of this statement is evident from the extremely large proportion in institutions of neglected and dependent children, who are the feeble-minded offspring of such feeble-minded parents.

Confronted with these shocking truths about the menace of feeble-mindedness to the race, a menace acute because of the unceasing and unrestrained fertility of such defectives, we are apt to become the victims of a "wild panic for instant action." There is no occasion for hysterical, ill-considered action, specialists tell us. They direct our attention to another phase of the problem, that of the so-called "good feeble-minded." We are informed that imbecility, in itself, is not synonymous with badness. If it is fostered in a "suitable environment," it may express itself in terms of good citizenship and useful occupation. It may thus be transmuted into a docile, tractable, and peaceable element of the community. The moron and the feeble-minded, thus protected, so we are assured, may even marry some brighter member of the community, and thus lessen the chances of procreating another generation of imbeciles. We read further that some of our doctors believe that "in our social scale, there is a place for the good feeble-minded."

In such a reckless and thoughtless differentiation between the "bad" and the "good" feeble-minded, we find new evidence of the conventional middle-class bias that also finds expression among some of the eugenists. We do not object to feeble-mindedness simply because it leads to immorality and criminality; nor can we approve of it when it expresses itself in docility, submissiveness and obedience. We object because both are burdens and dangers to the intelligence of the community. As a matter of fact, there is sufficient evidence to lead us to believe that the so-called "borderline cases" are a greater menace than the out-and-out "defective delinquents" who can be supervised, controlled and prevented from procreating their kind. The advent of the Binet-Simon and similar psychological tests indicates that the mental defective who is glib and plausible, bright looking and attractive, but with a mental vision of seven, eight or nine years, may not merely lower the whole level of intelligence in a school or in a society, but may be encouraged by church and state to increase and multiply until he dominates and gives the prevailing "color"—culturally speaking—to an entire community.

The presence in the public schools of the mentally defective children of men and women who should never have been parents is a problem that is becoming more and more difficult, and is one of the chief reasons for lower educational standards. As one of the greatest living authorities on the subject, Dr. A. Tredgold, has pointed out,(4) this has created a destructive conflict of purpose. "In the case of children with a low intellectual capacity, much of the education at present provided is for all practical purposes a complete waste of time, money and patience.... On the other hand, for children of high intellectual capacity, our present system does not go far enough. I believe that much innate potentiality remains undeveloped, even amongst the working classes, owing to the absence of opportunity for higher education, to the disadvantage of the nation. In consequence of these fundamental differences, the catchword `equality of opportunity' is meaningless and mere claptrap in the absence of any equality to respond to such opportunity. What is wanted is not equality of opportunity, but education adapted to individual potentiality; and if the time and money now spent in the fruitless attempt to make silk-purses out of sows' ears, were devoted to the higher education of children of good natural capacity, it would contribute enormously to national efficiency."

In a much more complex manner than has been recognized even by students of this problem, the destiny and the progress of civilization and of human expression has been hindered and held back by this burden of the imbecile and the moron. While we may admire the patience and the deep human sympathy with which the great specialists in feeble-mindedness have expressed the hope of drying up the sources of this evil or of rendering it harmless, we should not permit sympathy or sentimentality to blind us to the fact that health and vitality and human growth likewise need cultivation. "A LAISSER FAIRE policy," writes one investigator, "simply allows the social sore to spread. And a quasi LAISSER FAIRE policy wherein we allow the defective to commit crime and then interfere and imprison him, wherein we grant the defective the personal liberty to do as he pleases, until he pleases to descend to a plane of living below the animal level, and try to care for a few of his descendants who are so helpless that they can no longer exercise that personal liberty to do as they please,"—such a policy increases and multiplies the dangers of the over-fertile feeble-minded.(5)

The Mental Survey of the State of Oregon recently published by the United States Health Service, sets an excellent example and should be followed by every state in the Union and every civilized country as well. It is greatly to the credit of the Western State that it is one of the first officially to recognize the primary importance of this problem and to realize that facts, no matter how fatal to self-satisfaction, must be faced. This survey, authorized by the state legislature, and carried out by the University of Oregon, in collaboration with Dr. C. L. Carlisle of the Public Health service, aided by a large number of volunteers, shows that only a small percentage of mental defectives and morons are in the care of institutions. The rest are widely scattered and their condition unknown or neglected. They are docile and submissive, they do not attract attention to themselves as do the criminal delinquents and the insane. Nevertheless, it is estimated that they number no less than 75,000 men, women, and children, out of a total population of 783,000, or about ten per cent. Oregon, it is thought, is no exception to other states. Yet under our present conditions, these people are actually encouraged to increase and multiply and replenish the earth.

Concerning the importance of the Oregon survey, we may quote Surgeon General H. C. Cumming: "the prevention and correction of mental defectives is one of the great public health problems of to-day. It enters into many phases of our work and its influence continually crops up unexpectedly. For instance, work of the Public Health Service in connection with juvenile courts shows that a marked proportion of juvenile delinquency is traceable to some degree of mental deficiency in the offender. For years Public Health officials have concerned themselves only with the disorders of physical health; but now they are realizing the significance of mental health also. The work in Oregon constitutes the first state-wide survey which even begins to disclose the enormous drain on a state, caused by mental defects. One of the objects of the work was to obtain for the people of Oregon an idea of the problem that confronted them and the heavy annual loss, both economic and industrial, that it entailed. Another was to enable the legislators to devise a program that would stop much of the loss, restore to health and bring to lives of industrial usefulness, many of those now down and out, and above all, to save hundreds of children from growing up to lives of misery."

It will be interesting to see how many of our State Legislatures have the intelligence and the courage to follow in the footsteps of Oregon in this respect. Nothing could more effectually stimulate discussion, and awaken intelligence as to the extravagance and cost to the community of our present codes of traditional morality. But we should make sure in all such surveys, that mental defect is not concealed even in such dignified bodies as state legislatures and among those leaders who are urging men and women to reckless and irresponsible procreation.

I have touched upon these various aspects of the complex problem of the feeble-minded, and the menace of the moron to human society, not merely for the purpose of reiterating that it is one of the greatest and most difficult social problems of modern times, demanding an immediate, stern and definite policy, but because it illustrates the actual harvest of reliance upon traditional morality, upon the biblical injunction to increase and multiply, a policy still taught by politician, priest and militarist. Motherhood has been held universally sacred; yet, as Bouchacourt pointed out, "to-day, the dregs of the human species, the blind, the deaf-mute, the degenerate, the nervous, the vicious, the idiotic, the imbecile, the cretins and the epileptics—are better protected than pregnant women." The syphilitic, the irresponsible, the feeble-minded are encouraged to breed unhindered, while all the powerful forces of tradition, of custom, or prejudice, have bolstered up the desperate effort to block the inevitable influence of true civilization in spreading the principles of independence, self-reliance, discrimination and foresight upon which the great practice of intelligent parenthood is based.

To-day we are confronted by the results of this official policy. There is no escaping it; there is no explaining it away. Surely it is an amazing and discouraging phenomenon that the very governments that have seen fit to interfere in practically every phase of the normal citizen's life, dare not attempt to restrain, either by force or persuasion, the moron and the imbecile from producing his large family of feeble-minded offspring.

In my own experience, I recall vividly the case of a feeble-minded girl who every year, for a long period, received the expert attention of a great specialist in one of the best-known maternity hospitals of New York City. The great obstetrician, for the benefit of interns and medical students, performed each year a Caesarian operation upon this unfortunate creature to bring into the world her defective, and, in one case at least, her syphilitic, infant. "Nelly" was then sent to a special room and placed under the care of a day nurse and a night nurse, with extra and special nourishment provided. Each year she returned to the hospital. Such cases are not exceptions; any experienced doctor or nurse can recount similar stories. In the interest of medical science this practice may be justified. I am not criticising it from that point of view. I realize as well as the most conservative moralist that humanity requires that healthy members of the race should make certain sacrifices to preserve from death those unfortunates who are born with hereditary taints. But there is a point at which philanthropy may become positively dysgenic, when charity is converted into injustice to the self-supporting citizen, into positive injury to the future of the race. Such a point, it seems obvious, is reached when the incurably defective are permitted to procreate and thus increase their numbers.

The problem of the dependent, delinquent and defective elements in modern society, we must repeat, cannot be minimized because of their alleged small numerical proportion to the rest of the population. The proportion seems small only because we accustom ourselves to the habit of looking upon feeble-mindedness as a separate and distinct calamity to the race, as a chance phenomenon unrelated to the sexual and biological customs not only condoned but even encouraged by our so-called civilization. The actual dangers can only be fully realized when we have acquired definite information concerning the financial and cultural cost of these classes to the community, when we become fully cognizant of the burden of the imbecile upon the whole human race; when we see the funds that should be available for human development, for scientific, artistic and philosophic research, being diverted annually, by hundreds of millions of dollars, to the care and segregation of men, women, and children who never should have been born. The advocate of Birth Control realizes as well as all intelligent thinkers the dangers of interfering with personal liberty. Our whole philosophy is, in fact, based upon the fundamental assumption that man is a self-conscious, self-governing creature, that he should not be treated as a domestic animal; that he must be left free, at least within certain wide limits, to follow his own wishes in the matter of mating and in the procreation of children. Nor do we believe that the community could or should send to the lethal chamber the defective progeny resulting from irresponsible and unintelligent breeding.

But modern society, which has respected the personal liberty of the individual only in regard to the unrestricted and irresponsible bringing into the world of filth and poverty an overcrowding procession of infants foredoomed to death or hereditable disease, is now confronted with the problem of protecting itself and its future generations against the inevitable consequences of this long-practised policy of LAISSER-FAIRE.

The emergency problem of segregation and sterilization must be faced immediately. Every feeble-minded girl or woman of the hereditary type, especially of the moron class, should be segregated during the reproductive period. Otherwise, she is almost certain to bear imbecile children, who in turn are just as certain to breed other defectives. The male defectives are no less dangerous. Segregation carried out for one or two generations would give us only partial control of the problem. Moreover, when we realize that each feeble-minded person is a potential source of an endless progeny of defect, we prefer the policy of immediate sterilization, of making sure that parenthood is absolutely prohibited to the feeble-minded.

This, I say, is an emergency measure. But how are we to prevent the repetition in the future of a new harvest of imbecility, the recurrence of new generations of morons and defectives, as the logical and inevitable consequence of the universal application of the traditional and widely approved command to increase and multiply?

At the present moment, we are offered three distinct and more or less mutually exclusive policies by which civilization may hope to protect itself and the generations of the future from the allied dangers of imbecility, defect and delinquency. No one can understand the necessity for Birth Control education without a complete comprehension of the dangers, the inadequacies, or the limitations of the present attempts at control, or the proposed programs for social reconstruction and racial regeneration. It is, therefore, necessary to interpret and criticize the three programs offered to meet our emergency. These may be briefly summarized as follows:

(1) Philanthropy and Charity: This is the present and traditional method of meeting the problems of human defect and dependence, of poverty and delinquency. It is emotional, altruistic, at best ameliorative, aiming to meet the individual situation as it arises and presents itself. Its effect in practise is seldom, if ever, truly preventive. Concerned with symptoms, with the allaying of acute and catastrophic miseries, it cannot, if it would, strike at the radical causes of social misery. At its worst, it is sentimental and paternalistic.

(2) Marxian Socialism: This may be considered typical of many widely varying schemes of more or less revolutionary social reconstruction, emphasizing the primary importance of environment, education, equal opportunity, and health, in the elimination of the conditions (i. e. capitalistic control of industry) which have resulted in biological chaos and human waste. I shall attempt to show that the Marxian doctrine is both too limited, too superficial and too fragmentary in its basic analysis of human nature and in its program of revolutionary reconstruction.

(3) Eugenics: Eugenics seems to me to be valuable in its critical and diagnostic aspects, in emphasizing the danger of irresponsible and uncontrolled fertility of the "unfit" and the feeble-minded establishing a progressive unbalance in human society and lowering the birth-rate among the "fit." But in its so-called "constructive" aspect, in seeking to reestablish the dominance of healthy strain over the unhealthy, by urging an increased birth-rate among the fit, the Eugenists really offer nothing more farsighted than a "cradle competition" between the fit and the unfit. They suggest in very truth, that all intelligent and respectable parents should take as their example in this grave matter of child-bearing the most irresponsible elements in the community.