The female type, from the standpoint of bodily and nervous development, most nearly approximates the promise of the child type, and checks of development will result in masculinism and feminism. In the first the female has proceeded so far in development as to have female organs and their functions while retaining traces of a predominant character of the lower male type. In the second, the male has proceeded along the line of evolution toward the female type, but ere s.e.x has been fixed, further development has been checked and the male type is finally a.s.sumed as the predominant one. Both s.e.xes proceed embryologically from an indifferent type nearly resembling the hermaphroditic type found in the lower vertebrates. The arrest of development may therefore take place at any point in the embryonic evolution. The male may preserve only the female b.r.e.a.s.t.s[232] (Fig. 102), while normal in other respects; or, again (Fig.

103), present cryptorchidism or sloping shoulders, and be otherwise masculine. On the other hand, his nervous system may have taken such a ply that at the period of p.u.b.erty the s.e.xual instincts may be female in type.

In some instances, this may extend merely to an extreme modesty toward males, to an intense liking for female occupations and disgust for male occupations. In the female precisely a.n.a.logous conditions may occur. In certain cases the s.e.x side is entirely dormant until awakened at p.u.b.erty.

Education of these cases of arrested development may give the s.e.x direction rather than any in-born tendency. In one case, a male who had undergone arrest of development in his evolution towards the female type was brought up as a girl, had unusually pleasing womanly qualities; as a result was married twice to intensely devoted husbands, and the real s.e.x was never even suspected until post-mortem examination revealed that the supposed woman was a male. In other cases where the nervous system has taken one s.e.xual ply, while the body has taken another, an exceedingly unfortunate cla.s.s of beings results. This cla.s.s of beings needs especially careful training during p.u.b.erty and adolescence. In some instances in addition to the s.e.xual distortion there exist in these beings conditions of mental defect and moral obliquity. In the last case they approximate the criminal type. In the first case residence in an insane hospital protects the community and these beings against themselves. In some instances no mental defect nor, in a strict sense, moral obliquity occurs.

Here the patient requires very careful study from every standpoint.[233]

There is in the higher and lower races a tendency in different directions as to the predominance of s.e.x. The woman of the lower races more nearly resembles the male of the race. The male of the higher races more nearly resembles in structure the female of his race than does this female the females of the lower race. This is in part due, in the course of evolution, to the intrusion of the male on female occupations, since all occupations, other than war, hunting, and fishing, were created by women.[234] The male, however, in the higher races, while thus taking on the female intellectual and aesthetic qualities, retains the male s.e.xual characteristics, mentally and physically, but in accordance with the law of evolution, these manifest themselves less explosively as in the case of the female. As the victim of masculinism or feminism is a degenerate the explosive manifestations are more marked. Every one of the stigmata of degeneracy already described may coexist with any one of the three conditions named: infantilism, masculinism, and feminism.

[Ill.u.s.tration: FIG. 103.]

[Ill.u.s.tration: FIG. 104.]

Among the most striking manifestations arising from arrest of development in certain directions with possible hypertrophy in others, are the conditions known as giantism and dwarfism (_see_ Frontispiece). Both these conditions may be expressions of atavism to no very remote ancestors and present little if any evidences of degeneracy. In other cases degeneracy may be well marked, and the condition be due to imperfect gland action, such as disorder of the pituitary body, which causes very frequently an enlargement of many of the bones of the body, and very often a uniform enlargement of all the bones. Indeed, as Marie has said, giantism is acromegaly occurring during the period of adolescence. In many instances the opposite condition, dwarfism, occurs during infancy from causes which check the further growth of the body, although the general functions remain unchanged. Dwarfism is very apt to be attended by preservation of the intellectual faculties without evidence of degeneracy, other than the egotism shown in extreme vanity. Moral defects are, however, more apt to occur in dwarfism than in giantism, in which last condition mental defect is apt to occur, varying from a simple good-humoured stupidity to feeble-mindedness. In proportion as the central nervous system has been affected will the stigmata of degeneracy appear in both conditions. As the line between disease and disordered function is not thinly drawn in these cases, disorders like rickets or local bony tendencies to extensive growth may coexist with both conditions. Infantilism is peculiarly apt to occur with giantism, and while less frequent in dwarfism it also occurs, but is then especially apt to be a.s.sociated with rickets.

Closely akin to these conditions are leontiasis ossium and acromegaly, both of which are characterised by similar trophoneurotic defects. The first of these conditions may occur precedent to p.u.b.erty and cease in its completion. Kiernan has observed this in the case of an imbecile on Ward's Island, who lived until the age of 75, after spending more than sixty years in the charitable inst.i.tutions of New York. His ancestry was of the criminal and defective cla.s.ses. Acromegaly is characterised by abnormal growth, chiefly in the bones of the head, face, and extremities. As a rule, the disorder begins at the completion of p.u.b.erty, although it occasionally occurs at the onset of the climacteric. The ill.u.s.tration given (Fig. 104) presents the characteristic features of the disease. In this case there are local evidences of congenital defect. The prevailing trend of opinion is that this condition is due to irregular action of the pituitary body which controls osseous development.

[Ill.u.s.tration: FIG. 105.]

As already pointed out in the chapter on Heredity and Atavism, the arrests of development may affect one side of the body, while the other pursues the direct course of development. This may show itself in over-growth, as well as in under-growth, on the affected side. The person may appear, even from the centre of the forehead down, as if the halves of the bodies of two different persons had been joined in one. Conditions may vary from this extreme type to a state in which a lack of proper nerve and blood supply on the undeveloped side predisposes to attacks of disease, as already pointed out.

Not rarely does it happen that acromegaly attacks the side most deficient in nerve supply. The same is true of allied disorders affecting the growth of the muscles.

The conditions of development may be such that both sides are equally defective in nerve supply, so that when acromegaly occurs it may attack both sides equally. This is particularly apt to be the case with the lower extremities, and enlarged feet (Fig. 105) are not an uncommon result.

[Ill.u.s.tration: FIG. 106.]

The feet, in addition to the condition already described as being common in both extremities, exhibit special stigmata of their own in consonance with the evolutionary advance which the foot has shown as compared with the hand in man's evolution. In the lower races the hollow of the foot does not exist, and the condition known as flat-foot occurs (Fig. 106).

This is usually a.s.sociated with low instep. It occurs among the stigmata of degeneracy, and is not rarely a.s.sociated with grave moral defects and intellectual distortions. It and other feet degeneracies have been found frequently among paranoiacs, moral imbeciles, and prost.i.tutes. This is particularly true of the prehensile power of the foot.[235]

CHAPTER XV

DEGENERACY IN REVERSIONAL TENDENCIES

The hair of the head and body may never develop from the condition of down (lanugo) present in the new-born. The hair over the s.e.xual organs may alone remain in this condition, not showing itself at p.u.b.erty. In women the hair may be unusually developed on the face and chest. It may also cover the whole body, a condition which is normal in the Ainus of j.a.pan.

It may develop, as already shown, very markedly in the lumbar regions.

Speech may be markedly disturbed, reverting to the condition of Haeckel's h.o.m.o-alalus in the shape of deaf-mutism, which is one of the extreme expressions of degeneracy. Not less than 93 per cent. of the cases of congenital deaf-mutism possess deformities of the head, face, jaws, and teeth. The mere fact of the exceedingly primitive structure of the internal auditory mechanism has abnormal or defective hearing power as a consequence. Many cases of congenital deaf-mutism owe their origin to this, inasmuch as the auditory mechanism is not in a condition to appreciate sound, even though the individual may not have been born deaf, and the whole auditory apparatus subsequently degenerates. A mental defect is sometimes superadded, thus aggravating the case. Upon general principles, since deformities of the head, face, jaws, nose, antra, vaults, &c., are common in neurotics and degenerates, stigmata of the ear-bones must occasionally take place. From the complicated structure of the ear, lesions must often result from such deformities. The deaf-mutism here considered is the result of congenital conditions not produced by disease. Dumbness may result from congenital defects of the tongue or deformities of the larynx of an atavistic or a degenerate type, but degeneracy rarely extends so deeply into the organism as in the case of deaf-mutism. No greater error is committed than the confusion of deaf mutism secondary to ear disease with the congenital type.

The most prominent reversional tendencies occur in the genitals. One very common condition is retention of the t.e.s.t.i.c.l.es within the abdomen (_cryptorchidism_), which has been already pointed out, and may represent the last expiring trace of degeneracy. The t.e.s.t.i.c.l.es may, however, be perfectly normal in structure and function. In the female the uterus may present every type of mammalian uterus from the marsupial up. The female may also revert (as more rarely the male) to the condition of the reptiles and oviparous mammals in which the urinary organs and bowels empty into a single opening, the cloaca. This condition has been found in the female offspring of degenerate families, who are otherwise normal and who have produced children, despite the cloaca.

Another reversion is the occurrence of b.r.e.a.s.t.s without nipples, resembling those found in the oviparous mammals. The b.r.e.a.s.t.s in degenerates, as already shown, are frequently multiple, sometimes because the law of individuation is reversed, but more often as a reversion to the many-breasted condition (_polymastia_) of the precursor of man.[236] The human kidney and liver may revert not merely in function alone to the sauropsida, but also in structure.

The human heart may present in degenerates all types from the pulsating vessel found in the lancelet up to that of the mammal. The imperfect types of these sometimes perform their functions properly, except under strain.

In other cases mixture of arterial and venous blood results, producing the so-called "blue babies."

Under the teachings of the extreme disciples of Morel, it has been a.s.sumed that the family of the degenerate tends to irrevocable extinction. On the principle of individuation already outlined from Spencer, degeneracy, through its tendency to generalise rather than specialise function, causes too rapid development of cells which tend to extinguish each other, thus preventing proper ovulation; and, in the next place, the same condition prevents proper development of the ovum if formed and fecundated; and, finally, causes too numerous simultaneous developments of ova, which would tend to destroy each other. The same cause produces also premature extrusion of ova. At the same time, however, under given conditions, this principle also tends to produce reversions in type in the shape of too frequently repeated and abnormally multiple births. It has been noted that even the ancestors of those predisposed to phthisis have numerous families and many children at a birth albeit most of these die ere reaching the sixth year. Marandon de Monteyel[237] finds that multiple and frequently repeated pregnancies often occur among the families of hereditary lunatics. This has been corroborated by Kiernan[238] and Harriet C. B.

Alexander,[239] of Chicago, in connection with the hereditary lunatics in Cook County. They found that 90 families of the hereditary insane averaged 11 children each. Six families had 5 children, 4 had 7 children, 8 had 8, 10 had 9, 14 had 10, 8 had 11, 4 had 12, 4 had 13, 4 had 14, 3 had 16, 3 had 17, 4 had 18, 3 had 19, 5 had 20, and 1 had 21 children, each. Twins, triplets, and quadruplets were six times as frequent as among normal families. Manning has found similar conditions among the hereditary insane in Australia. Valenta, of Vienna,[240] has noted this also among epileptics. He reports the case of an epileptic mother who had 36 children, including six twins, four times quadruplets, twice triplets. Her daughter, also an epileptic, bore 32 children before she was 40, including quadruplets twice, triplets four times, and twins once. Similar, though less striking, statistics occur with other cla.s.ses of degenerates with proportionate frequency when the sterilising effect of certain diseases to which they are specially liable is taken into account. The general acceptance of the opinion as to large families being a test of advance in evolution seems strange when the extent and force of the action of the principle of individuation is taken into account, and when it is remembered how prolific are the lower vertebrates as compared with the higher.

The origin of tumours on the principle now adopted depends essentially on that reverse of the principle of individuation, ill.u.s.trated in plural births.

One most striking expression of nutritive degeneracy is haemophilia or the diathesis of the "bleeders." This, as Potain has pointed out, is not met with except in families which are subject to nutritive or graver degeneracies. Dent has shown that definite mental peculiarities, especially an inability (stronger than unwillingness) to tell the truth, are especially common in bleeders.[241] Haemophilia was frequently encountered in the Valois[242] family, and has been met with in the descendants of Ernest the Pious of Hanover. The condition, as Osler,[243]

of Baltimore, points out, is characterised by a tendency to uncontrollable bleeding, either spontaneous or from slight wounds. The hereditary transmission in this disorder is decided. In the Appleton-Swain family, of Reading, Ma.s.s., there have been cases for nearly two centuries. Instances have already occurred in the seventh generation. The usual mode of transmission is through the mother, who is not herself a bleeder, but the daughter of one. Atavism through the female is the rule. The daughters of a bleeder, though healthy and free from any tendency, are almost certain to transmit the disposition to the male offspring. The affection is much more common in males than in females, the proportion being estimated at 11 to 1, or even 13 to 1. The tendency usually appears within the first two years of life. It is rare for manifestations to be delayed until the tenth or twelfth year. Families in all conditions of life are affected.

Bleeders, like other degenerates, may have large families; the members usually have fine soft skin. In all probability, as the researches of Cohn show, this condition is due to incomplete inhibition, resultant in excessive activity of the blood-making organs. Such inhibition is, of course, cerebral, and hence, as a later acquirement, readily affected by degeneracy which may find its chief expression in this defect.

Among the conditions that have been recognised as an expression of degeneracy is gout, which, as Fothergill long ago pointed out, is a reversion to the condition found in the sauropsidian liver and kidneys.

Cullen had previously expressed the opinion that gout is a neurosis. Later researches tend to show that this neurosis is one controlling nutritive tissue change. The condition may occur early in childhood as well as at the periods of stress. The same is true of conditions like arthritis deformans, all of which may be the sole expression of degeneracy in an individual who exhibits many marked stigmata. Another expression of nutritive degeneracy is the senile atrophy of the skin described by Souques.[244] In a case of this kind under my care the patient, a twenty-six-year-old man, was born with club-foot. He has some musical talent. He is a marked degenerate. The skin is thick, coa.r.s.e, and dry, giving him a very old appearance on account of its shrivelled condition.

The ears are undeveloped, eyes small and sunken; excessive development of the cheek-bones; hair coa.r.s.e and stiff; face arrested in development, possessing a partial V-shaped arch. The width outside first molar is 2; outside second bicuspid, 175; width of vault, 150; height of vault, 58. One of the prominent features of degeneracy noticed in this case was the lack of hair upon the face.

Disorder of the thyroid produces both dwarfing cretinism, and a myxoedematous condition of the subcutaneous tissues, increasing the quant.i.ty of the jelly-like material in these, and therefore approximating some conditions found in the invertebrates. Ichthyosis (the skin disorder producing the "fish men" of shows) is frequently an expression of degeneracy, often a.s.sociated with deficient limbs and monsters in the same family.

[Ill.u.s.tration: FIG. 107.]

A condition due to heredity (involving an arterial change called arterio-capillary fibrosis) underlies many disorders like cirrhosis of the liver, kidneys, and other organs. It is usually an expression of premature senescence. Certain families for this reason exhibit a tendency to an early appearance of old age (Fig. 107), a tendency which, as Osler remarks, cannot be explained in any other way than that in the make-up of the machine bad material was used for tubing.

Obesity or lipomatosis is a nutritive expression of degeneracy especially noticeable in the second dent.i.tion, at p.u.b.erty, and sometimes at the climacteric. As Fere has shown, lipomatosis (first noticed by Cruveilhier) is an expression of stress at the period of evolution. Youthful obesity occurs in descendants of degenerates. In my experience it is attended by great liability to disease and systemic weakness when under morbid influence. These lipomatosic children are liable to rheumatism (more properly gout) and great hemorrhage from slight causes. Youthful obesity is sometimes, as Fere remarks, a.s.sociated with precocious maturity and resultant early senescence, but more often with extended infantilism, as in the case of d.i.c.kens's "fat boy."

In connection with this question of obesity I examined 267 corpulent school children and adults. Nearly all had marked stigmata of degeneracy; 92 per cent. had deformed ears to a marked degree; 66 per cent. had arrested development as compared with their age, while 12 per cent.

presented excessive development; 34 were too young to show the final form and size of the jaw. Of the 34, in about 33-1/3 per cent., the molars, incisors, cuspids and bicuspids were present; 96 per cent. of these had small teeth. Of the remaining 233, 87 per cent. had arrested development of the upper jaw, 22 per cent. of the lower jaw, 64 per cent. had V or saddle-shaped arches or their modifications and protruding teeth; 17 per cent. had hypertrophy of the alveolar process; 83 per cent. had small teeth; 27 per cent. had extra tubercles upon the molars; 82 per cent. had stenosis of the nasal cavity more or less marked; 36 per cent. had deflection of the nasal septum to the left, and 29 per cent. to the right; 21 per cent. wore gla.s.ses for eye defects. In 58 per cent. there was enlargement of the thyroid gland, and in 7 per cent. arrest of development of the same.

[Ill.u.s.tration: FIG. 108.]

[Ill.u.s.tration: FIG. 109.]

[Ill.u.s.tration: FIG. 110.]

Among the structures of reversionary type that have attracted most attention of late years is the appendix vermiformis. This, as elsewhere shown, is a rudimentary offshoot which is extremely variable. Man retains this structure as a relic of having been at one time a vegetable feeder.

In the koala (Australian native bear), a vegetable-feeding marsupial, it is more than thrice the size of the body. In the carnivora it has entirely vanished. In man, where it is sometimes absent and sometimes is as largely developed as in the orang, it is commonly from four to five inches in length and about a third of an inch in diameter. The appendix is poorly supplied with blood, which predisposes it to attacks by microbes because of the absence of leucocytes to fight these, and also because being, so to speak, a blind ally of the intestine, microbes find in it a suitable culture medium for them. The secretions of the appendix are very apt to decompose: hence a culture medium. The extreme variability of this disappearing organ may be judged from the Figs. 108, 109, 110. As it is best developed in degenerates, it const.i.tutes in them one source of predisposition to death from blood poisoning or from sudden shock. The location of this organ also tends to facilitate disease. In degenerates it may be situated at any point upon the end of the big bowel, varying from two to three inches. This little bowel is worse than useless in man, being a source of serious danger. It is an instance of checked development of the same kind which causes the human liver to take on sauropsidian peculiarities. Man in this particular as well as the orang is lower than the carnivora, who have lost this worse than useless organ. Its tendency to disappearance in man indicates once more the truth that degeneracy of an organ is often, through the law of economy of growth, for the benefit of the organism as a whole.

I may conclude this outline of human reversionary tendencies by mentioning that merycism, or rumination, has been very frequently found among imbeciles, paranoiacs, hysterics, and epileptics.

CHAPTER XVI