In a rural part of Pennsylvania lives the L. family. Three generations studied "all show the same drifting, irresponsible tendency. No one can say they are positively bad or serious disturbers of the communities where they may have a temporary home. Certain members are epileptic and defective to the point of imbecility. The father of this family drank and provided little for their support. The mother, though hard working, was never able to care for them properly. So they and their 12 children were frequent recipients of public relief, a habit which they have consistently kept up. Ten of the children grew to maturity, and all but one married and had in their turn large families. With two exceptions these have lived in the territory studied. Nobody knows how they have subsisted, even with the generous help they have received. They drift in and out of the various settlements, taking care to keep their residence in the county which has provided most liberally for their support. In some villages it is said that they have been in and out half a dozen times in the last few years. First one family comes slipping back, then one by one the others trail in as long as there are cheap shelters to be had. Then rents fall due, neighbors become suspicious of invaded henroosts and potato patches, and one after another the families take their departure, only to reappear after a year or two.
"The seven children of the eldest son were scattered years ago through the death of their father. They were taken by strangers, and though kept in school, none of them proved capable of advancement. Three at least could not learn to read or handle the smallest quantities. The rest do this with difficulty. All but two are now married and founding the fourth generation of this line. The family of the fourth son are now county charges.Of the 14 children of school age in this and the remaining families, all are greatly retarded. One is an epileptic and at 16 can not read or write. One at 15 is in the third reader and should be set down as defective. The remainder are from one to four years retarded.
"There is nothing striking in the annals of this family. It comes as near the lowest margin of human existence as possible and illustrates how marked defect may sometimes exist without serious results in the infringement of law and custom. Its serious menace, however, lies in the certain marriage into stocks which are no better, and the production of large families which continue to exist on the same level of semi-dependency. In place of the two dependents of a generation ago we now find in the third generation 32 descendants who bid fair to continue their existence on the same plane—certainly an enormous multiplication of the initial burden of expense."[75]
From cases of this sort, which represent the least striking kind of bad breeding, the student may pass through many types up to the great tribes of Jukes, Nams, Kallikaks, Zeros, Dacks, Ishmaels, Sixties, Hickories, Hill Folk, Piney Folk, and the rest, with which the readers of the literature of restrictive eugenics are familiar. It is abundantly demonstrated that much, if not most, of their trouble is the outcome of bad heredity. Indeed, when a branch of one of these clans is transported, or emigrates, to a wholly new environment, it soon creates for itself, in many cases, an environment similar to that from which it came. Whether it goes to the city, or to the agricultural districts of the west, it may soon manage to reëstablish the debasing atmosphere to which it has always been accustomed.[76]Those whosee in improvement of the environment the cure for all such plague spots as these tribes inhabit, overlook the fact that man largely creates his own environment. The story of the tenement-dwellers who were supplied with bath tubs but refused to use them for any other purpose than to store coal, exemplifies a wide range of facts.
SHANTY
A CHIEFTAIN OF THE HICKORY CLANA CHIEFTAIN OF THE HICKORY CLAN
Although conditions may be worst in the older and more densely populated states, it is probable that there is no state in the union which has not many families, or group of families, of this dependent type, which in favorable cases may attract little notice, but therefore do all the more harm eugenically; in other cases may be notorious as centers of criminality. Half a dozen well-defined areas of this kind have been found in Pennsylvania, which is probably not exceptional in this respect. "These differ, of course, in extent and character and the gravity of the problems they present. In some there is great sexual laxity, which leads to various forms of dependency and sometimes to extreme mental defect. In others alcoholism prevails and the people show a propensity for deeds of violence. All informants, however, practically agreed to the following characterization:
"1. Because of the thefts and depredations and the frequent applications for charitable relief from such sections they constitute a parasitic growth which saps the resources of the self-respecting, self-sustaining contingent of the population.
"2. They furnish an undue proportion of court cases, and are thus a serious expense to county and state.
"3. They are a source of physical decay and moral contamination, and thus menace the integrity of the entire social fabric."[77]
Society has long since admitted that it is desirable to restrict the reproduction of certain classes of gross defectives, and criminals, by the method of segregation. The ground for this issometimes biological, perhaps more often legal, as in the case of the insane and criminal, where it is held that the individual is legally incapacitated from entering into a contract, such as that of marriage. It would be better to have the biological basis of restriction on marriage and reproduction recognized in every case; but even with the present point of view the desired end may be reached.
From an ethical standpoint, so few people would now contend that two feeble-minded or epileptic persons have any "right" to marry and perpetuate their kind, that it is hardly worth while to argue the point. We believe that the same logic would permit two individuals to marry, but deny them the privilege of having children. The reasons for this may be considered under three heads.
1. Biological. Are there cases in which persons may properly marry but may properly be prevented by society from having any offspring, on the ground that such offspring would be undesirable components of the race?
The right of marriage is commonly, and may well be properly, regarded as an inalienable right of the individual, in so far as it does not conflict with the interests of the race. The companionship of two persons between whom true love exists, is beyond all question the highest happiness possible, and one which society should desire and strive to give its every member. On that point there will be no difference of opinion, but when it is asked whether there can be a separation between the comradeship aspect and the reproduction aspect, in marriage, whether any interest of the race can justifiably divorce these two phases, often considered inseparable, protests are at once aroused. In these protests, there is some justice. We would be the last ones to deny that a marriage has failed to achieve its goal, has failed to realize for its participants the greatest possible happiness, unless it has resulted in sound offspring.
That word "sound" is the key to the distinction which must be made. The interests of the race demand sound offspring from every couple in a position to furnish them—not only in the interests of that couple,—interests the importance of which it isnot easy to underestimate—but in the interests of the future of the race, whose welfare far transcends in importance the welfare of any one individual, or any pair of individuals. As surely as the race needs a constant supply of children of sound character, so surely is it harmed by a supply of children of inherently unsound character, physically or mentally, who may contribute others like themselves to the next generation. A recollection of the facts of heredity, and of the fact that the offspring of any individual tend to increase in geometric ratio, will supply adequate grounds for holding this conviction:—that from a biological point of view, every child of congenitally inferior character is a racial misfortune. The Spartans and other peoples of antiquity fully realized this fact, and acted on it by exposing deformed infants. Christianity properly revolted as such an action; but in repudiating the action, it lost sight of the principle back of the action. The principle should have been regarded, and civilized races are now coming back to a realization of that fact—are, indeed, realizing its weight far more fully than any other people has ever done, because of the growing realization of the importance of heredity. No one is likely seriously to argue again that deformed infants (whether their deformity be physical or mental) should be exposed to perish; but the argument that in the interests of the future of the racethey would better not be born, is one that admits of no refutation.
From a biological point of view, then, it is to the interest of the race that the number of children who will be either defective themselves, or transmit anti-social defects to their offspring, should be as small as possible.
2. The humanitarian aspect of the case is no less strong and is likely, in the present state of public education, to move a larger number of individuals. A visit to the children's ward of any hospital, an acquaintance with the sensitive mother of a feeble-minded or deformed child, will go far to convince anyone that the sum total of human happiness, and the happiness of the parents, would be greater had these children never been born. As for the children themselves, they will in many cases grow up to regret that they were ever brought into the world. We do notoverlook the occasional genius who may be crippled physically or even mentally; we are here dealing with only the extreme defectives, such as the feeble-minded, insane, and epileptic. Among such persons, human happiness would be promoted both now and in the future if the number of offspring were naught.
3. There is another argument which may legitimately be brought forward, and which may appeal to some who are relatively insensitive to the biological or even the humanitarian aspects of the case. This is the financial argument.
Except students of eugenics, few persons realize how staggering is the bill annually paid for the care of defectives. The amount which the state of New York expends yearly on the maintenance of its insane wards, is greater than it spends for any other purpose except education; and in a very few years, if its insane population continues to increase at the present rate, it will spend more on them than it does on the education of its normal children. The cost of institutional care for the socially inadequate is far from being all that these people cost the state; but those figures at least are not based on guesswork. The annual cost[78]of maintaining a feeble-minded ward of the state, in various commonwealths, is:
At such prices, each state maintains hundreds, sometimes thousands, of feeble-minded, and the number is growing each year. In the near future the expenditures must grow much more rapidly, for public sentiment is beginning to demand thatthe defectives and delinquents of the community be properly cared for. The financial burden is becoming a heavy one; it will become a crushing one unless steps are taken to make the feeble-minded productive (as described in the next chapter) and an intangible "sinking fund" at the same time created to reduce the burden gradually by preventing the production of those who make it up. The burden can never be wholly obliterated, but it can be largely reduced by a restriction of the reproduction of those who are themselves socially inadequate.
TWO JUKE HOMES OF THE PRESENT DAY
TWO JUKE HOMES OF THE PRESENT DAYTWO JUKE HOMES OF THE PRESENT DAY
Alike then on biological, humanitarian and financial grounds, the nation would be the better for a diminution in the production of physically, mentally or morally defective children. And the way to secure this diminution is to prevent reproduction by parents whose offspring would almost certainly be undesirable in character.
Granted that such prevention is a proper function of society, the question again arises whether it is an ethically correct procedure to allow these potentially undesirable parents to marry at all. Should they be doomed to perpetual celibacy, or should they be permitted to mate, on condition that the union be childless.
The eugenic interests of society, of course, are equally safeguarded by either alternative. All the other interests of society appear to us to be better safeguarded by marriage than by celibacy. Adding the interests of the individual, which will doubtless be for marriage, it seems to us that there is good reason for holding such a childless marriage ethically correct, in the relatively small number of cases where it might seem desirable.
Though such unions may be ethically justifiable, yet they would often be impracticable; the limits will be discussed in the next chapter.
It is constantly alleged that the state can not interfere with an individual matter of this sort: "It is an intolerable invasion of personal liberty; it is reducing humanity to the level of the barn-yard; it is impossible to put artificial restraints on the relationsbetween the sexes, founded as they are on such strong and primal feelings."
The doctrine of personal liberty, in this extreme form, was enunciated and is maintained by people who are ignorant of biology and evolution;[79]people who are ignorant of the world as it is, and deal only with the world as they think it ought to be. Nature reveals no such extreme "law of personal liberty," and the race that tries to carry such a supposed law to its logical conclusion will soon find, in the supreme test of competition with other races, that the interests of the individual are much less important to nature than the interests of the race. Perpetuation of the race is the first end to be sought. So far as according a wide measure of personal liberty to its members will compass that end, the personal liberty doctrine is a good one; but if it is held as a metaphysical dogma, to deny that the race may take any action necessary in its own interest, at the expense of the individual, this dogma becomes suicidal.
As for "reducing humanity to the level of the barn-yard," this is merely a catch-phrase intended to arouse prejudice and to obscure the facts. The reader may judge for himself whether the eugenic program will degrade mankind to the level of the brutes, or whether it will ennoble it, beautify it, and increase its happiness.
The delusion which so many people hold, that it is impossible to put artificial restraint on the relations between the sexes, is amazing. Restraint is already afait accompli. Every civilized nation already puts restrictions on numerous classes of people, as has been noted—minors, criminals, and the insane, for example. Even though this restriction is usually based on legal, rather than biological grounds, it is nevertheless a restriction, and sets a precedent for further restrictions, if any precedent were needed.
Fig. 1Fig. 1
It is, we conclude, both desirable and possible to enforce certain restrictions on marriage and parenthood. What these restrictions may be, and to whom they should be applied, is next to be considered.
Before examining the methods by which society can put into effect some measure of negative or restrictive eugenics, it may be well to decide what classes of the population can properly fall within the scope of such treatment. Strictly speaking, the problem is of course one of individuals rather than classes, but for the sake of convenience it will be treated as one of classes, it being understood that no individual should be put under restriction with eugenic intent merely because he may be supposed to belong to a given class; but that each case must be investigated on its own merits,—and investigated with much more care than has hitherto usually been thought necessary by many of those who have advocated restrictive eugenic measures.
The first class demanding attention is that of those feeble-minded whose condition is due to heredity. There is reason to believe that at least two-thirds of the feeble-minded in the United States owe their condition directly to heredity,[80]and will transmit it to a large per cent of their descendants, if they have any. Feeble-minded persons from sound stock, whose arrested development is due to scarlet fever or some similar disease of childhood, or to accident, are of course not of direct concern to eugenists.
The number of patent feeble-minded in the United States is probably not less than 300,000, while the number of latent individuals—those carrying the taint in their germ-plasm and capable of transmitting it to their descendants, although the individuals themselves may show good mental development—is necessarily much greater. The defect is highly hereditary innature: when two innately feeble-minded persons marry, all their offspring, almost without exception, are feeble-minded. The feeble-minded are never of much value to society—they never present such instances as are found among the insane, of persons with some mental lack of balance, who are yet geniuses. If restrictive eugenics dealt with no other class than the hereditarily feeble-minded, and dealt with that class effectively, it would richly justify its existence.
But there are other classes on which it can act with safety as well as profit, and one of these is made up by the germinally insane. According to the census of 1910, there are 187,791 insane in institutions in the United States; there are also a certain number outside of institutions, as to whom information can not easily be obtained. The number in the hospitals represented a ratio of 204.3 per 100,000 of the general population. In 1880, when the enumeration of insane was particularly complete, a total of 91,959 was reported—a ratio of 188.3 per 100,000 of the total population at that time. This apparent increase of insanity has been subjected to much analysis, and it is admitted that part of it can be explained away. People are living longer now than formerly, and as insanity is primarily a disease of old age, the number of insane is thus increased. Better means of diagnosis are undoubtedly responsible for some of the apparent increase. But when every conceivable allowance is made, there yet remains ground for belief that the proportion of insane persons in the population is increasing each year. This is partly due to immigration, as is indicated by the immense and constantly increasing insane population of the state of New York, where most immigrants land. In some cases, people who actually show some form of insanity may slip past the examiners; in the bulk of cases, probably, an individual is adapted to leading a normal life in his native environment, but transfer to the more strenuous environment of an American city proves to be too much for his nervous organization. The general flow of population from the country to large cities has a similar effect in increasing the number of insane.
But when all is said, the fact remains that there are severalhundred thousand insane persons in the United States, many of whom are not prevented from reproducing their kind, and that by this failure to restrain them society is putting a heavy burden of expense, unhappiness and a fearful dysgenic drag on coming generations.
The word "insanity," as is frequently objected, means little or nothing from a biological point of view—it is a sort of catch-all to describe many different kinds of nervous disturbance. No one can properly be made the subject of restrictive measures for eugenic reasons, merely because he is said to be "insane." It would be wholly immoral so to treat, for example, a man or woman who was suffering from the form of insanity which sometimes follows typhoid fever. But there are certain forms of mental disease, generally lumped under the term "insanity," which indicate a hereditarily disordered nervous organization, and individuals suffering from one of these diseases should certainly not be given any chance to perpetuate their insanity to posterity. Two types of insanity are now recognized as especially transmissible:—dementia precox, a sort of precocious old age, in which the patient (generally young) sinks into a lethargy from which he rarely recovers; and manic-depressive insanity, an over-excitable condition, in which there are occasional very erratic motor discharges, alternating with periods of depression. Constitutional psychopathic inferiority, which means a lack of emotional adaptability, usually shows in the family history. The common type of insanity which is characterized by mild hallucinations is of less concern from a eugenic point of view.
In general, the insane are more adequately restricted than any other dysgenic class in the community; not because the community recognizes the disadvantage of letting them reproduce their kind, but because there is a general fear of them, which leads to their strict segregation; and because an insane person is not considered legally competent to enter into a marriage contract. In general, the present isolation of the sexes at institutions for the insane is satisfactory; the principal problem which insanity presents lies in the fact that an individual isfrequently committed to a hospital or asylum, kept there a few years until apparently cured, and then discharged; whereupon he returns to his family to beget offspring that are fairly likely to become insane at some period in their lives. Every case of insanity should be accompanied by an investigation of the patient's ancestry, and if there is unmistakable evidence of serious neuropathic taint, such steps as are necessary should be taken to prevent that individual from becoming a parent at any time.
The hereditary nature of most types of epilepsy is generally held to be established,[81]and restrictive measures should be used to prevent the increase of the number of epileptics in the country. It has been calculated that the number of epileptics in the state of New Jersey, where the most careful investigation of the problem has been made, will double every 30 years under present conditions.
In dealing with both insanity and epilepsy, the eugenist faces the difficulty that occasionally people of the very kind whose production he most wishes to see encouraged—real geniuses—may carry the taint. The exaggerated claims of the Italian anthropologist C. Lombroso and his school, in regard to the close relation between genius and insanity, have been largely disproved; yet there remains little doubt that the two sometimes do go together; and such supposed epileptics as Mohammed, Julius Cæsar, and Napoleon will at once be called to mind. To apply sweeping restrictive measures would prevent the production of a certain amount of talent of a very high order. The situation can only be met by dealing with every case on its individual merits, and recognizing that it is to the interests of society to allow some very superior individuals to reproduce, even though part of their posterity may be mentally or physically somewhat unsound.
A field survey in two typical counties of Indiana (1916) showed that there were 1.8 recognizable epileptics per thousand population. If these figures should approximately hold good for the entire United States, the number of epileptics can hardly be put at less than 150,000. Some of them are not anti-social, but many of them are.
Feeble-mindedness and insanity were also included in the census mentioned, and the total number of the three kinds of defectives was found to be 19 per thousand in one county and 11.4 per thousand in the other. This would suggest a total for the entire United States of something like one million.
In addition to these well-recognized classes of hopelessly defective, there is a class of defectives embracing very diverse characteristics, which demands careful consideration. In it are those who are germinally physical weaklings or deformed, those born with a hereditary diathesis or predisposition toward some serious disease (e.g., Huntington's Chorea), and those with some gross defect of the organs of special sense. The germinally blind and deaf will particularly occur to mind in the latter connection. Cases falling in this category demand careful scrutiny by biological and psychological experts, before any action can be taken in the interest of eugenics; in many cases the affected individual himself will be glad to coöperate with society by remaining celibate or by the practice of birth control, to the end of leaving no offspring to bear what he has borne.
Finally, we come to the great class of delinquents who have hitherto been made the particular object of solicitude, on the part of those who have looked with favor upon sterilization legislation. The chronic inebriate, the confirmed criminal, the prostitute, the pauper, all deserve careful study by the eugenist. In many cases they will be found to be feeble-minded, and proper restriction of the feeble-minded will meet their cases. Thus there is reason to believe that from a third to two-thirds of the prostitutes in American cities are feeble-minded.[82]They should be committed to institutions for the feeble-minded and kept there. It is certain that many of the pauper class, which fills up almshouses, are similarly deficient. Indeed, the census of 1910 discovered that of the 84,198 paupers in institutions onthe first of January in that year, 13,238 were feeble-minded, 3,518 insane, 2,202 epileptic, 918 deaf-mute, 3,375 blind, 13,753 crippled, maimed or deformed. A total of 63.7% of the whole had some serious physical or mental defect. Obviously, most of these would be taken care of under some other heading, in the program of restrictive eugenics. While paupers should be prohibited from reproduction as long as they are in state custody, careful discrimination is necessary in the treatment of those whose condition is due more to environment than heredity.
In a consideration of the chronic inebriate, the problem of environmental influences is again met in an acute form, aggravated by the venom of controversy engendered by bigotry and self-interest. That many chronic inebriates owe their condition almost wholly to heredity, and are likely to leave offspring of the same character, is indisputable. As to the possibility of "reforming" such an individual, there may be room for a difference of opinion; as to the possibility of reforming his germ-plasm, there can be none. Society owes them the best possible care, and part of its care should certainly be to see that they do not reproduce their kind. As to the borderland cases—and in the matter of inebriety borderland is perhaps bigger than mainland—it is doubtful whether much direct action can be taken in the present state of scientific knowledge and of public sentiment. Education of public opinion to avoid marriage with drunkards will probably be the most effective means of procedure.
Finally, there is the criminal class, over which the respective champions of heredity and environment have so often waged partisan warfare. There is probably no field in which restrictive eugenics would think of interfering, where it encounters so much danger as here—danger of wronging both the individual and society. Laws such as have been passed in several states, providing for the sterilization of criminalsas such,must be deplored by the eugenist as much as they are by the pseudo-sociologist who "does not believe in heredity"; but this is not saying that there are not many cases in which eugenic action is desirable; for inheritance of a lack of emotional control makes aman in one sense a "born criminal."[83]He is not, in most respects, the creature which he was made out to be by Lombroso and his followers; but he exists, nevertheless, and no ameliorative treatment given him will be of such value to society as preventing his reproduction.
The feeble-minded who make up a large proportion of the petty criminals that fill the jails, must, of course, be excluded from this discussion except to note that their conviction assists in discovering their defect. They should be treated as feeble-minded, not as criminals.[84]Those who may have been made criminals by society, by their environment, must also be excepted. In an investigation, the benefit of the doubt should be given to the individual. But when every possible concession is made to the influence of environment, the psychiatric study of the individual and the investigation of his family history still show that there are criminals who congenitally lack the inhibitions and instincts which make it possible for others to be useful members of society.[85]When a criminal of this natural type is found, the duty of society is unquestionably to protect itself by cutting off that line of descent.
This, we believe, covers all the classes which are at this time proper subjects for direct restrictive action with eugenic intent;and we repeat that the problem is not to deal with classes as a whole, but to deal with individuals of the kind described, for the sake of convenience, in the above categories. Artificial class names mean nothing to evolution. It would be a crime to cut off the posterity of a desirable member of society merely because he happened to have been popularly stigmatized by some class name that carried opprobrium with it. Similarly it would be immoral to encourage or permit the reproduction of a manifestly defective member of society of the kinds indicated, even though that individual might in some way have secured the protection of a class name that was generally considered desirable. Bearing this in mind, we believe no one can object to a proposal to prevent the reproduction of those feeble-minded, insane, epileptic, grossly defective or hopelessly delinquent people, whose condition can be proved to be due to heredity and is therefore probably transmissible to their offspring. We can imagine only one objection that might be opposed to all the advantages of such a program—namely, that no proper means can be found for putting it into effect. This objection is occasionally urged, but we believe it to be wholly without weight. We now propose to examine the various possible methods of restrictive eugenics, and to inquire which of them society can most profitably adopt.
The means of restriction can be divided into coercive and non-coercive. We shall discuss the former first, interpreting the word "coercive" very broadly.
From an historical point of view, the first method which presents itself is execution. This has been used since the beginning of the race, very probably, although rarely with a distinct understanding of its eugenic effect; and its value in keeping up the standard of the race should not be underestimated. It is a method the use of which prevents the rectification of mistakes. There are arguments against it on other grounds, which need not be discussed here, since it suffices to say that to put to death defectives or delinquents is wholly out of accord with the spirit of the times, and is not seriously considered by the eugenics movement.
The next possible method castration. This has practically nothing to recommend it, except that it is effective—an argument that can also be made for the "lethal chamber." The objections against it are overwhelming. It has hardly been advocated, even by extremists, save for those whose sexual instincts are extremely disordered; but such advocacy is based on ignorance of the results. As a fact, castration frequently does not diminish the sexual impulses. Its use should be limited to cases where desirable for therapeutic reasons as well.
It is possible, however, to render either a man or woman sterile by a much less serious operation than castration. This operation, which has gained wide attention in recent years under the name of "sterilization," usually takes the form of vasectomy in man and salpingectomy in woman; it is desirable that the reader should have a clear understanding of its nature.
Vasectomy is a trivial operation performed in a few minutes,almost painlessly with the use of cocain as a local anæsthetic; it is sometimes performed with no anæsthetic whatever. The patient's sexual life is not affected in any way, save in the one respect that he is sterile.
Salpingectomy is more serious, because the operation can not be performed so near the surface of the body. The sexual life of the subject is in no way changed, save that she is rendered barren; but the operation is attended by illness and expense.
The general advantage claimed for sterilization, as a method of preventing the reproduction of persons whose offspring would probably be a detriment to race progress, is the accomplishment of the end in view without much expense to the state, and without interfering with the "liberty and pursuit of happiness" of the individual. The general objection to it is that by removing all fear of consequences from an individual, it is likely to lead to the spread of sexual immorality and venereal disease. This objection is entitled to some consideration; but there exists a still more fundamental objection against sterilization as a program—namely, that it is sometimes not fair to the individual. Its eugenic effects may be all that are desired; but in some cases its euthenic effects must frequently be deplorable. Most of the persons whom it is proposed to sterilize are utterly unfit to hold their own in the world, in competition with normal people. For society to sterilize the feeble-minded, the insane, the alcoholic, the born criminals, the epileptic, and then turn them out to shift for themselves, saying, "We have no further concern with you, now that we know you will leave no children behind you," is unwise. People of this sort should be humanely isolated, so that they will be brought into competition only with their own kind; and they should be kept so segregated, not only until they have passed the reproductive age, but until death brings them relief from their misfortunes. Such a course is, in most cases, the only one worthy of a Christian nation; and it is obvious that if such a course is followed, the sexes can be effectively separated without difficulty, and any sterilization operation will be unnecessary.
Generally speaking, the only objection urged against segregation is that of expense. In reply, it may be said that the expense will decrease steadily, when segregation is viewed as a long-time investment, because the number of future wards of the state of any particular type will be decreasing every year. Moreover, a large part of the expense can be met by properly organizing the labor of the inmates. This is particularly true of the feeble-minded, who will make up the largest part of the burden because of their numbers and the fact that most of them are not now under state care. As for the insane, epileptic, incorrigibly criminal, and the other defectives and delinquents embraced in the program, the state is already taking care of a large proportion of them, and the additional expense of making this care life-long, and extending it to those not yet under state control, but equally deserving of it, could probably be met by better organization of the labor of the persons involved, most of whom are able to do some sort of work that will at least cover the cost of their maintenance.
That the problem is less serious than has often been supposed, may be illustrated by the following statement from H. Hastings Hart of the Russell Sage Foundation:
"Of the 10,000 (estimated) mentally defective women of child-bearing age in the state of New York, only about 1,750 are cared for in institutions designated for the care of the feeble-minded, and about 4,000 are confined in insane asylums, reformatories and prisons, while at least 4,000 (probably many more) are at large in the community.
"With reference to the 4,000 feeble-minded who are confined in hospitals for insane, prisons and reformatories and almshouses, the state would actually be the financial gainer by providing for them in custodial institutions. At the Rome Custodial Asylum 1,230 inmates are humanely cared for at $2.39 per week. The same class of inmates is being cared for in the boys' reformatories at $4.66; in the hospitals for insane at $3.90; in the girls' reformatory at $5.47, and in the almshouse at about $1.25. If all of these persons were transferred to an institution conducted on the scale of the Rome Custodial Asylum, they would not only relieve these other institutions of inmates who do not belongthere and who are a great cause of care and anxiety, but they would make room for new patients of the proper class, obviating the necessity for enlargement. The money thus saved would build ample institutions for the care of these people at a much less per capita cost than that of the prisons, reformatories and asylums where they are now kept, and the annual per capita cost of maintenance would be reduced from 20 to 50 per cent., except in almshouses, where the cost would be increased about $1 per week, but the almshouse inmates compose only a small fraction of the whole number.
"I desire to emphasize the fact that one-half of the feeble-minded of this state are already under public care, but that two-thirds of them are cared for in the wrong kind of institutions. This difficulty can be remedied without increasing the public burden, in the manner already suggested. That leaves 15,000 feeble-minded for whom no provision has yet been made. It must be remembered that these 15,000 persons are being cared for in some way. We do not allow them to starve to death, but they are fed, clothed and housed, usually by the self-denying labor of their relatives. Thousands of poor mothers are giving up their lives largely to the care of a feeble-minded child, but these mothers are unable to so protect them from becoming a menace to the community, and, in the long run, it would be far more economical for the community to segregate them in institutions than to allow them to remain in their homes, only to become ultimately paupers, criminals, prostitutes or parents of children like themselves."
Some sort of provision is now made for some of the feeble-minded in every state excepting eleven, viz.: Alabama, Arizona, Florida, Georgia, Louisiana, Nevada, New Mexico, South Carolina, Tennessee and Utah and West Virginia. Delaware sends a few cases to Pennsylvania institutions; other states sometimes care for especially difficult cases in hospitals for the insane. The District of Columbia should be added to the list, as having no institution for the care of its 800 or more feeble-minded. Alaska is likewise without such an institution.
Of the several hundred thousand feeble-minded persons in theUnited States, probably not more than a tenth are getting the institutional care which is needed in most cases for their own happiness, and in nearly every case for the protection of society. It is evident that a great deal of new machinery must be created, or old institutions extended, to meet this pressing problem—[86]a problem to which, fortunately, the public is showing signs of awakening. In our opinion, the most promising attempt to solve the problem has been made by the Training School of Vineland, New Jersey, through its "Colony Plan." Superintendent E. R. Johnstone of the Training School describes the possibilities of action along this line, as follows:[87]