In prophylaxis of the family the first indication is to stop the production of degenerates. Two measures have attracted considerable attention, and from their seeming simplicity have met with much favour.

The first is regulation of marriage. This, as a means of preventing degeneracy, has been much over-estimated. Laws claiming to regulate marriage have ignored two factors. In the first place the graver degeneracies only are taken into account. From what has been shown as regards the tendency of the degenerate to intermarry, and from the fact that restraints on marriage inevitably result in illicit relationships of permanent character (equally productive of degenerates whose defects have been increased by the condition in which they are born), the only procedure likely to be of value in this relation is to regard marriage simply as a contract designed for certain ends and permit its annulment for fraud, for concealment of defects (intentionally or otherwise) incompatible with the procreation of healthy children. In its essence this is the English common law theory. Its principle is recognised by the divorce codes of various continental European countries. Furthermore, it is on this principle that the Pope not infrequently annuls marriages, divorce not being recognised by the Church of which he is the head. It is certainly best for the stability of the family that unhealthy unions should have the least permanency possible.

Another element in prophylaxis, castration, ignores completely the rights of individuals under the English common law (and, so far as the United States is concerned, a provision of its const.i.tution). Although sacrificing these important guards against that degeneracy in the body politic which inevitably reflects itself in degeneracy in the individual, this procedure fails to accomplish its end, since it ignores completely the principle of transformation in heredity. The distance between the criminals (whom it is proposed to castrate) and the hysteric offspring of good family is not so great that the progeny of one will not be as degenerate as the progeny of the other. Whatever may be said of the value of this procedure as a deterrent, its use as a prophylactic is comparatively small.

Much better results are obtainable by guarding women from the factors of degeneracy during p.u.b.erty and during matronhood. Many nations whose laws ostentatiously regulate marriage in a manner most oppressive to individual liberty entail by their customs over-work in a spasmodic manner during p.u.b.erty and during matronhood. Nations whose customs permit women and dogs to be harnessed together as beasts of burden, to carry the hod and to dig trenches for sewers, gas, and waterpipes, cry out very loudly against the dangerous license of the English-speaking nations in permitting women to intrude on male occupations. There is no doubt but that women (and it may be said a large majority of men) are now through evolution unsuited to occupations involving spasmodic expenditure of force, and well suited to those implying continuity. As Bachhofen, Reclus, and Otis T. Mason have shown, two-thirds of the occupations of this last type have been created by women. Man, as Havelock Ellis demonstrates, in accordance with the law of evolutionary advance, is adjusting himself to these occupations.

Attempts to regulate employment of women in unhealthy trades are a step in the right direction so far as prevention of a factor of degeneracy is concerned, since it can be carried out without that disregard of personal liberty which is more dangerous in such attempts at regulation than the defect to be regulated.

The periods of menstruation and pregnancy in degenerate women require (from what has been said on maternal impressions) special attention suited to the individual, and not prescribed indiscriminately for all cla.s.ses. An excellent ill.u.s.tration of the dangers of Procrustean prescription is the instance where the vegetarianism of the mother during pregnancy was followed by the production of ill-nourished offspring. Diet during pregnancy undoubtedly can exercise a great influence for good, but this diet must ignore the "longings" of pregnant women, which are simply the bulimia, or abnormal appet.i.te for food, produced by irritation of the medulla.

In dealing with the toxic factors the question of legal regulation of the opium and alcohol habits requires attention. There is very little doubt but that the routine prescription of alcohol and opium (in the shape of paregoric and soothing syrup) by the laity for painful menses, teething, toothache, &c., underlies many cases of degeneracy in the offspring. This prescription is the more dangerous because it is recommended in the hidden guise of nostrums by hysterics with blatant alcoholophobia. One of the most energetic female advocates of the legal prohibition of alcohol beverages endorsed very emphatically the nostrum of one of her hysteric supporters which contained 50 per cent. alcohol and 1 per cent. each of cocaine and morphine. As the persons largely under the influence of such endors.e.m.e.nt were hysterics whose zeal for reform was largely an expression for desire for notoriety, the dangers of its use during menstruation cannot well be over-estimated. To reach this serious source of degeneracy from alcohol and the narcotics, statement on each bottle of the exact composition of nostrums should be exacted by law.

Government could exercise a potent influence for good on alcohol abuse by improvement of sanitary conditions in the tenement or apartment house districts. Experience in New York and elsewhere has shown that improvement in tenement houses produces decided decrease in the number of dram shops in tenement-house neighbourhoods. The earlier tenement-houses in New York, as elsewhere, were originally dwellings intended for one family. As these were replaced by houses specially built for tenements, with proper sanitary arrangements and improved ventilation, not only did a tremendous decrease occur in the infantile death-rate, but a decrease also in the patronage of dram shops. In many instances it was apparent that alcoholic abuse had grown out of poverty. Foul air and crowded quarters had begotten not only a desire for stimulants but a desire for social intercourse. The dram shop met social needs as a club. It is along this line that Government can make best use of its police powers.

The Government, in exercise of its police powers directed to sanitary ends, could enable the trade unions to secure improved sanitation in shops in which occupations unhealthy by themselves or because of environment, are carried on. In this way improved sanitation of unhealthy occupations could be best secured.

The prophylaxis of degeneracy in the mother and father may be summed up as simply the prevention of a state of neurasthenia, or nervous exhaustion, whether this condition (involving the functions of growth, motion and sensation, which, as Marinesco has shown, exist in every neuron and its processes) exhibit itself in the general nervous system or in the organs connected with alimentation, elaboration, and excretion. Every factor of acquired degeneracy produces what is practically this condition of neurasthenia ere exerting any influence in the production of degeneracy.

In other words, the neurasthenia of the ancestor becomes the neurosis of the descendant. Therefore the neurasthenia requires in its treatment in the ancestor the removal of the exciting cause and the treatment of the effect by physiologic rest in the truest sense of the word. In a general way, therefore, the ordinary principles of hygiene applied to each individual case will suffice to prevent development of this neurasthenia.

The part of Government in this is very small. It is true here that, as remarked by Johnson--

"How small of all that human hearts endure, That part which kings or laws can cure!"

Training of the individual rather than governmental regulation must be the factor to prevent degeneracy in the ancestor. Indeed governmental regulation by injuring self-reliance (that factor so easily destroyed and so hardly regained) may itself be a potent factor in degeneracy.

Prophylaxis of degeneracy in the individual should commence with the birth of the child. Whatever may be said of hypothetical ante-natal training, there is no doubt that considerable benefit can be accomplished during the first months of life. As the great aim of training is to secure self-control, it must be obvious that to accustom an infant to expect attention at every moment it cries, whether the cry be the expression of need or not, is to weaken, not to strengthen, its self-control.

Furthermore, regularity in bodily functions is a great source of strength.

The child can be trained during the first months of life by careful attention to its wants on the one hand, and as careful inattention to its caprice on the other, so that all its functions become equably regular and automatic. With this regularity many of the factors underlying caprice, peevishness, and anger can be prevented in the earliest months of life.

Unless there be enormous deficiency in the a.s.sociating fibres a good start can then be made toward the creation of a secondary ego. It is at this period and during that of the first dent.i.tion that training is too often neglected or perverted in such a way as to strengthen the primary ego at the expense of the secondary. At this period the extent of training needed may be judged by the amount of stigmata, few though they be, present in the child. With the period of the first dent.i.tion certain mental and nervous stigmata manifest themselves. If the child be liable to convulsions on the slightest causes, if it manifest screaming fits without apparent reason, if it be frequently a.s.sailed by night terrors, serious attention is needed, and this attention should be directed not only to its mental and nervous condition, but also to its functions of a.s.similation, elaboration, and excretion. Here dangerous degeneracy may show itself which is not apparent elsewhere. The training of the child should be conducted along the lines recommended during the first months of life. The essential principles governing this have been excellently outlined by Jules Morel.[264] The treatment of all degenerates, and consequently their preservation from the evils that threaten them, ought to begin in their earliest infancy. First avoid exaggerating hereditary predisposition when serious neurosis has occurred in the parental line. Too often such a conclusion is adopted, and hope of recovery in the descendants is abandoned because one of the parents or the grandparents was affected with insanity by reason of organic disease of the brain. Preliminary examination of the neurotic needs to be made before one is enabled to judge as to the effects of heredity. Only after a careful examination can the extent of heredity be determined. The proof will be beyond doubt when in parents and in their children stigmata of anatomic and physical degeneration are abundantly found.

In dealing with the question of the education of the child, the signs of fatigue expressed in the ears and face should receive attention. Attempts are being made in the schools of Chicago and elsewhere to determine these.

The following schedule prepared by Colin A. Scott for the Chicago Public Schools is an excellent means towards this end:--

_Eye_:--Each eye should be examined separately and in a good light.

Hold a card over one eye while the other is being examined. In using the optometer, find the place where vision of the dots is the easiest and most distinct. In using Snellen's test card, place the pupil at the distance marked upon the card. Have him begin at the top and read down as far as he can, first with one eye and then with the other. He should be able to read a majority of the test type. Test with optometer, and in reporting use the number on the stem preceded by F for far-sightedness, and N for near-sightedness.

Place the card for astigmatism at the distance marked upon it. Cover one eye and ask pupil to indicate, without moving nearer, the circles which appear blacker or lighter than the others. Bring the card nearer and find at how many feet distant he still sees any of the circles darker or lighter than the others. At a sufficient distance every one betrays some degree of astigmatism, which is of consequence as a defect only when capable of detection within the distance indicated upon the card. Outside of this point astigmatism may be reckoned as absent and marked 0 in the report. Note if the pupil suffers habitually from inflamed eyelids, and inquire if he complains of tired and painful eyes or headaches after reading, studying, or using his eyes in other similar ways. Note any other defect of formation or position of either eye. Test the movement of the eyes by moving a coin to about eighteen inches of the eyes.

Test each ear with the same watch in the same place and position.

Establish the normal degree of hearing for your room under these conditions. Describe each ear in the report as--(1) normal; (2) slightly hard of hearing; (3) hard of hearing; (4) considerably deaf; or (5) deaf. As a further test, place the pupil at a distance and ask him to repeat a number of words or letters. In all of these tests care must be taken to avoid the possibility of suggestion in asking questions or by other means. Note if the child is a mouth-breather, or gives other signs of adenoids or enlarged tonsils. Notice circulation in each ear.

_Signs of Fatigue, &c._:--In no case should it be said in the presence of a young child that he is nervous or defective in development or nutrition.

Note the position and balance of the body in standing and sitting, and whether the movements are--(1) habitually restless and fidgety; (2) note especially the balance of the head; and (3) position and occupation of the hands, showing nervousness or not; (4) note any twitching or marked lack of motor control in any part of the body; (5) note whether the pupil flushes periodically or frequently; is the pupil (6) easily excited or (7) fatigued by task in school or at home?

Inquire if the pupil has frequent "morning tire" (number of days per month) or headaches not connected with serious defects of the eyes.

(8) Is he unduly irritable or irascible? Are there any other signs of lack of emotional control--for example, (9) being too easily impressed; or (10) with an undue tendency to tears, or uncontrollable laughter?

Note the general condition of bodily nutrition (this by no means depends directly upon food), and the number of signs of failure in physical development (height, weight, &c.)

Researches along this line in Germany and England have shown that the fatigue produced by studies varies, and that it is possible by arranging sequence of studies to remove fatigue produced by one study through the rest furnished by another. It has been found that biology exhausts least and mathematics and grammar most. While there is undoubtedly a spirit of emulation stirred by these last two studies which is injurious, the limited a.s.sociations affected by them are further a source of fatigue as well. The numerous a.s.sociations of biology afford points of rest on the one hand while not tending to emulation on the other. It is this spirit of emulation, with its attendant alternation of worry and hope, that causes so many of the acquired nervous disorders of the adult, and which hence is obviously much more potent for evil in the child.

Physical and mental training in the special asylums for imbeciles and idiots gives such splendid results that it is surprising that parents, and especially those charged with bad heredity, are not encouraged and advised by their physicians and friends to try from the first year of the child's life special measures for their preservation. If a persevering physical and psychic management of the weak-minded gives such admirable results in asylums, it would be still better if the child could be trained from the earliest period of its life. This subject is ignored by the public, and in every case not sufficiently appreciated. First of all try to preserve patients of a nervous or of a weak const.i.tution. They should know in what state of health they are living, they must be informed of the great danger of matrimonial union with a person of the same tendencies, and especially when consanguinity exists between them. The greatest care is to be given to children of this cla.s.s. Experience has already led to the conclusion that mental and physical overwork increases this defect: hence young brains must not be over-excited with worry or emotionalism. The will of children ought to be cultivated and strengthened. Their minds should be methodically educated. The bodily functions should never be artificially stimulated in any way, to increase unduly the a.s.similation of the food.

Development of the intelligence, the sensibility and the physical training, should be looked after in the same way. Once a plan of living is laid down it should be followed. Success depends on this. The great influence of hygienic conditions (air, light, food, dress, habitation, sleep, muscular exercise, &c.) should not be forgotten, for without them efforts made for mental training are useless. By putting these methods into execution an increase of the congenital taint is prevented, and such methods perceptibly amend the psychopathic depreciation which in the usual way of living would certainly become worse. The object very often thus secured is double; aggravation has been prevented, amelioration has been obtained.

In dealing with nervous exhaustion produced by the infectious diseases, the dangers of the convalescent period are not sufficiently taken into account. Parents are but too apt from mistaken motives of economy to dismiss the physician at the onset of convalescence. It is precisely at this period that the system hovers between permanent systemic defect and recovery. Proper diet and proper training at this time will often prevent the checking of p.u.b.erty development, and hence a breakdown under the stress of that period. The same is true of the convalescent period from such diseases in adults. Many a mother has thus injured her const.i.tution and given birth to degenerate children in marked contrast with the normality of the children born before.

Frequently efforts are unsuccessful either because the family physician and the educator have no time to superintend treatment, or because they are unable, for many reasons, to individualise treatment properly. Hence the high value of well-organised special boarding schools for the degenerate.

The special aim, says Koch, is to teach the patient to govern himself, to repose confidence in himself. To reach this end a great deal is required of him who undertakes the treatment. He has to exercise himself with patience. He must know how to divide the time for work and the time for rest. For many of these ill-balanced subjects variety is wanted as well in physical work as mental training.

Those charged with these remedies, exercising good judgment, are soon able to distinguish the more favourable cases from the more difficult. They can soon say that a favourable remedy for the one may be noxious for another, and _vice versa_. Tonics, spirits, cold baths, &c., and even hypnotism may be tried, but great caution is to be exercised, and these remedies should never be employed except by prescription of physicians.

Even subjects of congenital mental instability suffering from obsession (imperative ideas) without delusions are not inaccessible to treatment. In these cases naturally the most important part belongs to the medical treatment as in most mental cases. The more serious cases, dating from the first youth and aggravated in proportion to the age, are not to be completely cured. The progressive evolution can be stopped and patients ameliorated in such a way that improvement makes their life bearable.

The same results can be obtained with less degenerate subjects. Success occurs often when patients are enabled to understand the nature of their sufferings, to discern that their disease does not belong to insanity, that it is unlikely to lead to mental disease. This understanding is one of the best of all anodynes. Donders, of Utrecht, said to one of his patients suffering from optic hyperaesthesia of neurasthenic origin: "What medicine cannot do, time and oftentime hygiene realise." The intelligent patient having thus received a.s.surance of his sight, good hygiene and mental rest soon after produced a cure. Acquired mental depreciation may exist from the first years of the child's life. These depreciations in proportion to their intensity are characterised by fatigue and even nervous exhaustion accompanied with physical weakness and functional trouble in one or more organs of sense, by pathological debility of the intelligence and impaired memory especially for recent facts, difficulty of comprehension and of a.s.sociating ideas and judgment, as well as worries, fears, despairs, especially in cases of intoxications by morphine, cocaine, bromides, coffee, &c. These are increased by irritability and excitability when the troubles arise from onanism, p.u.b.erty, or other periods of transformation in the s.e.xual life.

Fight from the first the symptoms of predisposing and occasional causes, because if aggravation be prevented recovery is possible. Especially in these depreciations must the physician utilise all his knowledge and prove that only mental science is sufficient to cure such patients. Not only has he to guide the intellectual life, and life of sensibility and will, but he has also to remedy the morbid physical conditions, to superintend the general regime, times of work and rest, air, light, dressing, preservation from alcoholic and other excesses.

One great element of possible danger of the first importance is training in the s.e.xual sphere. To avoid and at the same time to enlighten is the problem presented. In dealing with this problem the great requirement, balance, not repression, must be kept in mind. Masturbation is very frequently an expression not of mental or moral deficiency, but of purely local (first in at least most cases) physical conditions. Irritation (from the presence of worms in the r.e.c.t.u.m or v.a.g.i.n.a, an intensely acid state of the urine, or constipation) to male foreskin and female c.l.i.toris has produced a local itching, the attempt to relieve which has led to masturbation. Granting all that has been said about the deteriorating effects, especially in degenerates, the source should first be sought here. Attention to these physical states will often prevent the development of this practice and its resultant moral deterioration.

In dealing with the s.e.xual appet.i.te the fact should be remembered that encouragement of healthy modesty is a duty in both s.e.xes, and pre-eminently so in the male. Too much of what is called "s.e.xual purity"

is very often an expression of s.e.xual perversity. While great stress has been laid on the evil effects of a.s.sociation between boys, too little stress has been laid on the danger of the training of boys by women. The s.e.xual history of boys often demonstrates that their initiation into the s.e.xual life was first at the instance of women older than themselves, often servants, but not rarely s.e.xual "purists" or persons whose ostentatious religiosity covered a s.e.xual perversity. In the healthy a.s.sociation of the s.e.xes there is very little danger, but in such morbid a.s.sociation there is great danger, the more that the morbid conceals itself under religiosity and the allied phases of s.e.xual perversion. Great stress has been laid on the dangers of co-education, but the growing opinion is that education limited to one s.e.x is the source of even greater dangers to both boy and girl. It is a matter of common observation among genito-urinary specialists, alienists and gynecologists, that much of the alleged "purity" so ostentatiously displayed by graduates of colleges limited to one s.e.x, is often the offspring of a s.e.xual perversion which, whether congenital or not, has been fostered by the environment of one s.e.x without the modifying, healthy influence of the other.

In dealing with these cases the stigmata first likely to attract the physician's attention are in the milder cases those of the jaws, teeth, nose, throat, ear, and eye. Rapid decay of the teeth often leads to the discovery not merely of const.i.tutional degeneracy, but also of the effects of certain strains which aggravated this. Dentists, mouth, throat, ear, and to a lesser degree eye specialists, are hence in a position to detect degeneracy at its outset. If they do not put the cart before the horse, and refer the const.i.tutional symptoms to the local disturbances, they are in a position to be of eminent service to the race.

What Jules Morel has said of the more evident degenerates is equally true of the others. Education should be conducted along the lines which Froebel indicated when he pointed out that play is the child's work, and that a development of this work is the natural problem for education. Extension of the general training of the whole body, from the properly conducted kindergarten to the school, is the principle on which all education should be conducted. This is recognised by advanced educators, as previously it had been recognised by the physician confronted with the effects of school strain resulting from the opposite theory. Manual training is a principle long adopted by idiot schools, where training of certain muscles through both mental and physical methods precedes intellectual training alone.

Manual training may, however, be the source of equal dangers with the excessive abuse of intellectual training which preceded it. In the education of the degenerate, as in the education of the other members of the race, the true source of success is to avoid "the falsehood of extremes."