Idiocy, perhaps more than any other disease or defect, has long been connected in the popular mind with the marriage of cousins. This fact is not surprising when we consider that until very recent times idiots were looked upon with a kind of superstitious awe, and the affliction was supposed to be a curse of God. For this reason, when idiocy did follow consanguineous marriage as it sometimes would, it was believed to be the fit punishment of some violation of divine law. Insanity also frequently has been attributed to consanguineous marriage, but not so frequently as idiocy, since its occurrence later in life is not so obviously connected with pre-natal conditions.
The terminology of mental and nervous disorders has been so loosely applied that some definition may be necessary. By the term "idiocy," is meant a condition of undeveloped mentality. Idiocy exists in various degrees, from the complete absence of intellectual faculties to a condition of mere irresponsibility in which the subject is capable of self-help, and sometimes of self-support under the careful guidance of other. Under the generic term "idiot" may be included the "complete idiot," the imbecile, the "feeble-minded" and the "simpleton," all of whom suffer in a greater or less degree from arrested mental development.
Insanity, on the other hand, is a disease which destroys or clouds an intellect which has once been developed.It is true that certain conditions of idiocy and imbecility do resemble that phase of insanity known as dementia—a reversion to the original mental state of childhood—in reality a form of second childhood. But the states are not identical, although one may lapse into the other. One is defect, the other disease; the imbecile in the former being the counterpart of the dement in the latter, just as the moral imbecile is the analogue of the paranoiac.[61]
Of the strong inheritability of idiocy there can be no doubt. Dr. Martin W. Barr of the Pennsylvania Training School for Feeble Minded Children has published an etiological table embodying the results of a careful examination of 4050 cases of mental defect. Of these, 2651 or 65.45 per cent resulted from causes acting before birth, including 1030 or 25.43 per cent with a family history of idiocy and imbecility, and 529 more (13.06 per cent) with a family history of insanity, epilepsy and minor neuroses. Dr. Barr gives many instances illustrating the heredity of imbecility, especially where both parents were imbeciles, and had imbecile relatives. One case in particular forcibly illustrates the disastrous results of the marriage of such unfortunates. It is taken from the reports of the Connecticut Lunacy Commission:
In one instance, where a pauper female idiot lived in one town, the town authorities hired an idiot belonging to another town, and not then a pauper, to marry her, and the result has been that the town to which the male idiot belongs has for many years had to support the pair and the three idiot children.[62]
In one instance, where a pauper female idiot lived in one town, the town authorities hired an idiot belonging to another town, and not then a pauper, to marry her, and the result has been that the town to which the male idiot belongs has for many years had to support the pair and the three idiot children.[62]
Neuroses may remain latent for a generation and reappearin the grandchildren of the person affected, or the latent tendency may never reappear unless some disturbing factor such as scarletina, meningitis or other acute disease attacks the weak spot. This possibility suggests that the influence of heredity may be vastly greater than the etiological tables would indicate. The apparent causes may be only agents which assist in developing the evil really engendered by an inheritance of imbecility.
It is not at all certain that there is any well marked boundary line between genius and some forms of imbecility. Many quite irresponsible idiots have marvelous verbal memories, and can repeat parrot-like, page after page of books of which they have no comprehension. Dr. Barr tells of cases of prodigies, musical, mathematical and mechanical, who except in their specialty were almost totally deficient mentally.[63]Many of the world's most brilliant musicians, mathematicians and even military leaders have been men of one-sided mental development, whose ability in other lines was so slight that they were little better than imbeciles, and it is not at all surprising that their children are sometimes truly idiotic.
The best writers of the present day no longer recognize consanguinity as a causeper se, of idiocy. The heredity of neuroses, however, is so strongly established that few would dispute the proposition that where the morbidity is inherited through both parents it appears more frequently and in a more marked degree than where one parent is entirely free from taint. This is what occurs when a consanguineous marriage takes place between descendants of a neurotic family. The percentage of idiotic children would then be somewhat higher from consanguineous marriages than from the average marriage purely through the action of the laws of heredity.
Dr. Barr finds 49 out of 4050 cases of idiocy or 1.21 per cent, in which there was a family history of consanguinity. This is little higher than the average frequency of first cousin marriage, and an analysis of 41 of these cases does not show one case that can be attributed to consanguinity alone. To quote: "Two were the result of incestuous connection—one of brother and sister, the other of father and daughter, and in the others there was an undoubted history, of grave neuroses."[64]"Beach and Shuttleworth find in the consideration of their 100 cases (out of 2,380 idiots), giving 4.2 per cent (of consanguineous parentage) that the bad effects are due rather to the intensification of bad heredity common to both parents."[65]
Dr. Arthur Mitchell examined all idiots in nine counties of Scotland and found that 42 out of 519 or 8.1 per cent of whom the parentage was known, were children of first cousins.[66]Dr. Down found 46 out of 852 or 5.4 per cent to be children of first cousins.[67]Dr. Grabham of the Earlswood Idiot Asylum in Surrey, England, stated that 53 out of 1388 patients were the offspring of first cousins. The facts, he adds, were obtained from the parents and are "therefore tolerably trustworthy."[68]Other investigations give percentages as follows: Kerlin, 7; Rogers, 3.6; Brown, 3.5 and C.T. Wilbur, 0.3.[69]
The earlier American writers, Drs. Howe and Bemiss, believed that consanguinity was a cause of idiocy. Dr. Howe inquired into the parentage of 359 idiots and found that in 17 families the parents were nearly related; in one of thesecases there were 5 idiotic children; in 5 families there were 4 idiots each; in 3 families 3 each; in 2 families 2 each; and in 6 families i each. In all 17 families there were 95 children of whom 44 were idiots, 12 were scrofulous and puny, 1 was deaf, 1 dwarf—58 in low health or defective, and only 37 fairly healthy. These of course are selected cases and do not indicate at all, as Dr. Howe supposed, that consanguinity was the cause of the disasters. He adds that in each case one or both of the parents were either intemperate or scrofulous, and that there were also other predisposing causes.[70]Dr. Bemiss found that 7.8 per cent of his 3942 children of consanguineous marriages were idiots, while but 0.7 per cent of the children of non-consanguineous parentage were idiotic.[71]A more detailed examination reveals the fact that in a large number of these, one or both of the parents were mentally defective. For example, in a marriage of double cousins the wife was "feeble minded" and the six children were of inferior mentality. In a case of first-cousin marriage the wife became insane and two of the children were idiotic. In a case of the marriage of cousins, themselves the offspring of cousins the husband was a hypochondriac, and seven children idiotic. In another marriage of the same class both parents were feeble-minded and the children idiotic. These are simply taken at random, and many others might be given. When we find also that in a majority of cases no report is given of the ancestry, it is very obvious that consanguinity alone could not have been the cause of any large proportion of the 308 cases of idiocy in the Bemiss report.
My own investigations show that out of 600 children of first cousin marriage (from correspondence) 26 or 4.3 per cent are mentally defective—10 are reported as "idiots,"13 as "weak-minded" and 3 as "imbeciles." In at least five of these cases there is evidence of bad heredity, in two others the father was intemperate and in two more causes acting after birth are mentioned.
The statistics of the insane and idiotic in Prussia presented by Mayet clearly indicate the large part which heredity plays in the production of mental disorders. Tables XX and XXI set forth the most important results of his work. Mayet considers a case hereditary if any near relative of the subject suffered from mental or nervous disorder, or was intemperate, suicidal, criminal or eccentric.[72]
Table XXI gives the proportion of the mentally defective who are the offspring of consanguineous marriages. Theterm "cousin" in both these tables probably means first cousins. It will be remembered that Prussian statistics of consanguineous marriages are very imperfect, but that at least 6.5 in every thousand are consanguineous (first cousins or nearer).
From these tables we may infer that consanguinity influences idiocy far more than it does insanity, but it is not entirely clear why the number of hereditary cases should be relatively smaller among the idiotic. Since insanity is more likely to have some more definitely assignable cause than idiocy, we should expect the percentage due to heredity to be lower and consequently the influence of consanguinity less.
It is generally admitted that a tendency toward insanity is inheritable, and it seems probable that this tendency as well as other neuroses may be intensified through doubleheredity. A case in point can be found in the Shattuck genealogy.[74]For four generations in the S. family there is no indication of neurosis. The average number of children to a family had been eight, few children died young and all were prosperous farmers. But in 1719 J.S. married E.C. and their son Z.S. is thus described: "He was sometimes subject to depression of spirits; and some peculiar traits of character in a few branches of his family seem to have originated with him." He married A.C., a niece of his mother. They both lived to be over 80 and had ten children, of whom three were insane; only six married, and of these only two are known to have left surviving children. One of these a daughter, S.S., married E.S., a nephew of her father, and himself the offspring of a second cousin marriage within the S. blood. E.S. and S.S. had five children, all of whom married, and there is no further mention of insanity. We may suppose, then, that the C. stock was neurotic, and that a consanguineous marriage within that stock, although of the S. surname, intensified the tendency into insanity, but with a further infusion of the normal S. blood the morbidity was eliminated. It is very evident that the heredity and not the consanguinity was the cause of these three cases of insanity.
The most important source for this chapter is the special report on the Blind and the Deaf in the Twelfth Census of the United States.[75]This report was prepared under the direction of Dr. Alexander Graham Bell, as Expert Special Agent of the Census Office.
The enumerators of the Twelfth Census reported a total of 101,123 persons as blind, and to each of these Dr. Bell addressed a circular of inquiry. By this method he obtained verified returns of 64,763 cases of blindness in continental United States or 85.2 per 100,000 of the total population. In the same way he obtained data in regard to 89,287 persons with seriously impaired powers of hearing, or 117.5 Per 100,000 of the total population.
In each case the following questions among others were asked: "Were his (or her) parents first cousins? If not first cousins were they otherwise related by blood to each other, before their marriage? Were any of his relatives blind? If yes, what relatives? (Father, mother, grandparents, brothers, sisters, uncles, aunts, and how many of each, so far as known)." The results of this inquiry give us the best and most reliable statistical material which has ever been compiled on any phase of the problem of consanguineous marriage. The investigation of the deaf was similar to that of the blind, but even more complete.
I. The Blind. The question as to the relationship of the parents was answered in 56,507 cases, in 2,527 or 4.47 per cent of which the parents were reported as cousins. Of the 57,726 who answered the question in regard to blind relatives, 10,967 or 19 per cent replied in the affirmative.[76]The blind relatives were divided into two groups: (a) blind brothers, sisters or ancestors, and (b) blind collateral relatives or descendants. Table XXII concisely expresses the results most fundamental for this study.
Of the 2527 blind persons whose parents were cousins, 993 or 39.3 per cent have blind relatives, 33.4 per cent having blind brothers, sisters or ancestors, and 3.9 per cent having blind collateral relatives or descendants. And 9 per cent of the blind who have blind relatives are of consanguineous parentage, while but 3.1 per cent of the blind who have no blind relatives are the offspring of cousins. These figures alone indicate a decided intensification of blindness through consanguinity, although it should be remembered that a relationship "works both ways," so that when a brother has a blind sister, the sister would have a blind brother. This fact has probably diminished the apparent number of sporadic cases of blindness.
Considered with reference to the degree of blindness the table shows that 1291 or 51.1 per cent of the blind of consanguineous parentage are totally blind, and 1236 or 48.9 per cent are partially blind. Among those whose parents were not cousins, 55.4 per cent were totally and 44.6 per cent were partially blind.
Of the 2527 blind of consanguineous parentage, 632 or 25.0 per cent were congenitally blind, of whom 350 or 55.4 per cent also had blind relatives of the degrees specified. Not counting those who did not answer the question in regard to blind relatives, we have 615 cases of which 51.5 per cent had blind relatives of class (a), and 5.4 per cent blind relatives of class (b). Taking the 53,980 blind whose parents were not so related the number of congenitally blind was 3666 or but 6.8 per cent, of whom 1023 or 27.9 per cent had blind relatives. Omitting as before the "blind relatives not stated," we have 23.4 per cent who had blind relatives of class (a), and 4.3 per cent relatives of class (b).
On the hypothesis that consanguinity in the parents intensifies a tendency toward blindness we should expect to find among the congenitally blind a larger proportion ofconsanguineous parentage than among those blind from specific causes. In Table XXIII a general classification of the causes of blindness is given together with the consanguinity of parents. Specific causes in which the percentage of consanguinity differs in a marked degree from the average, are given parenthetically.
To quote from the Report:
The only specific causes, other than congenital, to which is due a greater proportion of the total cases of blindness among those whose parents were cousins than among those whose parents were not related, are: Catarrh (parents cousins 28.1,parents not cousins 8.7 per 1,000), scarlet fever (parents cousins 10.7, parents not cousins 10.1 per 1,000), scrofula (parents cousins 28.9, parents not cousins 19 per 1,000), and measles (parents cousins 28.9, parents not cousins 23.5 per 1,000). The difference in these proportions is but slight, and the relative number of cases of blindness attributed to each of the other causes is greater among those whose parents were not related.[77]
The only specific causes, other than congenital, to which is due a greater proportion of the total cases of blindness among those whose parents were cousins than among those whose parents were not related, are: Catarrh (parents cousins 28.1,parents not cousins 8.7 per 1,000), scarlet fever (parents cousins 10.7, parents not cousins 10.1 per 1,000), scrofula (parents cousins 28.9, parents not cousins 19 per 1,000), and measles (parents cousins 28.9, parents not cousins 23.5 per 1,000). The difference in these proportions is but slight, and the relative number of cases of blindness attributed to each of the other causes is greater among those whose parents were not related.[77]
It will be noted that the greatest proportion is in the case of scrofula.
Since it is probable that a part of those who did answer the question as to consanguinity are in fact the offspring of cousins, the percentage in each case should be somewhat increased. Allowing for these the same proportion as for those who did answer the question we should have of all the blind 4.47 per cent as the offspring of cousins; of the totally blind 4.14 per cent and of the partially blind 4.88. While of the congenitally blind we should have 14.7 per cent as offspring of cousins.
It is interesting to note in this connection that in 1900, Dr. Lee Wallace Dean, of the University of Iowa examined the 181 blind children in the Iowa College for the Blind, and found that 9 or nearly 5 per cent were the offspring of first cousin marriages.[78]Dr. Dean continues,
If we exclude from the list those blind children who were blind because of blennorrhea neonatorum, sympathetic opthalmia, trachoma, etc., and consider only those who suffered because of congenital conditions, we should find that 14 per cent were the result of consanguineous marriage of the firstdegree.... Among the pupils who have entered the college since 1900 the percentage is about the same.
If we exclude from the list those blind children who were blind because of blennorrhea neonatorum, sympathetic opthalmia, trachoma, etc., and consider only those who suffered because of congenital conditions, we should find that 14 per cent were the result of consanguineous marriage of the firstdegree.... Among the pupils who have entered the college since 1900 the percentage is about the same.
This was written in 1903, three years before the publication of Dr. Bell's report.
Statistics from foreign sources give even larger percentages of the blind as the offspring of consanguineous marriage. Dr. Feer quotes fourteen distinct investigations of the etiology of retinitis pigmentosa, embodying in all 621 cases, of which 167 or 27 per cent were the offspring of consanguineous parents.[79]Retinitis pigmentosa is perhaps more generally attributed to consanguineous marriage than any other specific disease of the eye, and it is to be regretted that the Census report does not give any data in regard to this cause. Retinitis pigmentosa in known to be strongly inheritable, as is albinism and congenital cataract.
Looking now at the other side of the problem, that of the probability of consanguineous marriages producing blind offspring, we have as our data the 2527 blind whose parents were cousins, and a conservative estimate which may be made from the data in Chapter II that 1,000,000 persons in continental United States are the offspring of cousins within the degrees included in the Census report.[80]In the general population 852 per million are reported as blind, and 63 per million as congenitally blind. The actual figures for the offspring of cousin marriages are 2527 per million for all blind and 632 per million for the congenitally so. In other words only 0.25 per cent of the offspring of cousin marriages are blind and only 0.05 per cent are congenitallyblind. Although the probability that a child of related parents will be born blind is ten times as great (632 per million vs. 63 per million) as when the parents are not related, the numbers are so small that there seems to be very little basis for a belief that consanguinity does more than to intensify an inherited tendency, especially since over one half of the congenitally blind of consanguineous parentage are known to have blind relatives.
2. The Deaf. The extent to which the connection between consanguineous marriage and deaf-mutism has been studied is indicated by a table given by Mr. Huth, in which are set forth the results of fifty distinct investigations.[81]In this table the percentages of deaf-mute offspring of consanguineous marriage to the total number of deaf-mutes investigated, varies from 30 per cent to none at all. Of these studies not more than ten or eleven have the slightest statistical value, and four of these—the most reliable—are from the reports of the Census of Ireland in the years 1851, 1861, 1871 and 1881.
The Irish censuses of 1891 and 1901 give similar data, though not so detailed as in 1871 and 1881. Thus we have in these reports a census inquiry into a phase of the consanguineous marriage problem extending over the period of six successive censal years. Although we can hardly suppose that these figures are accurate in all respects, they throw a great deal of light upon the problem, and are worth quoting in some detail. The tables as given by Mr. Huth contain a number of errors of detail, the correction of which changes the results materially.[82]
Table XXIV summarizes the most important points in the Irish data. It will be seen that while there has been an absolute diminution in the number of deaf-mutes in Ireland with the decrease in population, there has been a relative increase of deaf-mutism. There are two possible explanations for this phenomenon, both of which may have operated in part; first that in the great emigration the deaf-mutes have been left behind, and second that with the introduction of improved methods of census taking, the returns are more complete than a half century ago. Mr. Huth believes that there is still room for improvement in Irish census methods, and thinks there is reason to believe that in the enumeration of the deaf all children born deaf in a family are included whether living or not.
Since Ireland is strongly Roman Catholic, the proportion of consanguineous marriages is probably small, so that the percentage of deafmutes derived from consanguineous marriages, varying from 5.86 to 11.56 is very much greater than the percentage of these marriages in the general population. The average number of deaf children to a family in Table XXIV varies less than any other part of the table, and clearly shows a much higher average number of deaf children where the parents were cousins. They reveal the interesting fact that the occurrence of two or more deafmutes in a family is more than twice as probable where the parents are related as where they are not. Table XXV still better illustrates this point. Of the families where there was but one deaf-mute, only 4.3 per cent were the offspring of cousin marriages; where there were two in a family 12.9 per cent were of consanguineous parentage; three in a family, 13.3 per cent; four in a family, 19.0 per cent; more than four in a family, 21.1 per cent.
In 1871 and 1881 the inquiry was more minute and the degrees of consanguinity were specified. Mr. Huth quotes some of the figures for these years, probably derived from the same sources as Table XXVI, and comments as follows: "An examination of this table will show that the statistics so much relied upon as proving the causation of deaf-mutism by consanguineous marriages show nothing of the sort. In 1871 fourth cousins produced more deaf-mutes per marriage than any nearer relationship. In 1881 third cousins produced more than any nearer relationship."[83]Mr. Huth forgets that he is basing these statements on five and nine families respectively, and does not take into consideration the probability that if the returns are biased, as he suspects, this bias would affect the more distantly related, relatively more than the first cousin marriages, for the same reason that this would be true of the cases collected by Dr. Bemiss.[84]Combining the figures of the two censal years helps to correct these averages, and the distantly related show approximately the same average as the first cousin marriages in spite of the vastly greater selection which must have obtained in the distantly related cases.
In Table XXVI it will be seen that 52.5 per cent of the deaf-mute offspring of consanguineous parents were the offspring of first cousin marriages. On the assumption that this percentage is fairly typical of each set of returns we may say that from three to six per cent of the Irish deaf-mutes are the offspring of first cousin marriages. If, then, the proportion of first cousin marriages is no greater than in England, the percentage of deaf-mute offspring is several times as great as in the average non-related marriage.
In Scotland Dr. Arthur Mitchell made inquiry of the superintendents of a number of deaf-mute asylums, and found that of 544 deaf-mutes, 28 were the offspring of 24 consanguineous marriages.[85]There were 504 families represented in all, so that the average per family was 1.17 among the consanguineous to 1.07 among the non-consanguineous.
In Norway, according to Uchermann, while 6.9 per cent of all marriages are consanguineous within and includingthe degree of second cousins, and in single cantons the percentages range as high as 31.0, only in one single district does the number of the deaf-mutes harmonize with that of the marriage of cousins. The district of Saeterdalen has the greatest number of consanguineous marriages (201 out of 1250), but not a single case of deaf-mutism. Hedemarken, which has the fewest consanguineous marriages has a great many deaf-mutes. Where deaf-mutism exists it seems to be intensified by consanguinity, but where it is not hereditary it is not caused by consanguinity. Of the 1841 deaf-mutes in Norway, 919 were congenitally deaf, and of these 212 or 23 per cent were of consanguineous parentage.[86]
Dr. Feer gives a table containing the results of a number of studies of deaf-mutism, which shows an average of 20 per cent as of consanguineous origin. Four investigations give the number of children to a family. Table XXVII from Feer seems to indicate that the Irish census is fairly accurate at this point.[87]
In the American Census the instructions to enumerators have been so diverse that statistics of the deaf have been very poor until recent years. Not until the Twelfth Census was the inquiry put upon a really scientific basis.
This reform, as also the more intelligent attitude of the American people in general towards the affliction of deafness, is due largely to the work of Dr. Alexander Graham Bell. An enumeration of Dr. Bell's services directly, and through the agency of the Volta Bureau, in this cause, cannot be given here. For our purpose the most important of his contributions is embodied in the Special Report of the Twelfth Census of the United States already referred to.
As in the investigation of the Blind, the circular letter sent to each person reported by the enumerators as deaf contained questions in regard to parentage and the existence of deaf relatives. It is unfortunate that in these returns it is impossible to distinguish between degrees of relationship, but in such an extensive compilation it was doubtless impracticable to attempt to unravel the intricacies of consanguinity. Judging from the returns of the Census of Ireland we may assume that about half of the cases returned as "cousins" were first cousins.
The replies to the inquiry as to deaf relatives were more carefully analyzed, and were divided into four groups, which are referred to throughout as (a), (b), (c) and (d) relatives. These groups are: (a), deaf brothers, sisters or ancestors; (b), deaf uncles, aunts, cousins or other relatives not (a), (c) or (d); (c), deaf children, (sons or daughters); (d), deaf husbands or wives. Thus a large proportion of the hereditary cases would be included in the first two categories, (a) and (b).[88]
The causes of deafness are given in detail, but as might be expected the returns are not as definite or as accurate as we should desire. The causes given have been grouped under five main heads; these again are subdivided, often into divisions numerically too minute for real statistical value.Table XXVIII includes the main groups and those specific causes which number more than 3000 cases. The extreme variation in the percentages of those who are the offspring of consanguineous marriages cannot be attributed to mere chance. There is clearly some fundamental connection between consanguinity and congenital deafness if 11.8 per cent of all the congenitally deaf are the offspring of consanguineous marriages, while of the adventitiously deaf but 3.1 per cent are the offspring of such marriages. In fact we are tempted to jump at the conclusion that consanguinity is in itself a cause of deaf-mutism. Furthermore 42.1 per cent of the deaf whose parents were cousins were congenitallydeaf, while this was true of but 15 per cent of those whose parents were unrelated.
But on the other hand, 53.4 per cent of the deaf whose parents were cousins had deaf relatives of the (a) and (b) groups, while of those whose parents were not cousins, only 29.9 per cent in these groups had deaf relatives. In Table XXIX the close connection between deaf relatives of these groups and consanguinity is shown. For the sake of simplicity no account is taken of (c) relatives (deaf children), and (d) relatives (deaf husbands or wives), for in the first case only 370 deaf are reported as having deaf children and at the same time no (a) or (b) relatives, and in the Second case (d) relatives are not ordinarily blood relatives at all.
Table XXIX shows unmistakably that the connection between consanguinity and hereditary deafness is very close. Where there is the largest amount of deafness in the family the percentage of consanguinity is the highest. That is, of those who had both (a) and (b) relatives ten per cent were the offspring of cousins, while of those who had neither (a) nor (b) relatives only three per cent were the offspring of cousins. It is natural to assume that as a rule where the deaf have either (a) or (b) deaf relatives, deafness is hereditary, for the probability of two cases of deafness occurring in the same family, uninfluenced by heredity would be very small. It is likely also that a great many of the deaf who stated that they had no deaf relatives were mistaken, for few people are well enough informed in regard to their ancestry to answer this question definitely. Not one man in thousands can even name all of his great-grandparents, to say nothing of describing their physical or mental traits. Others may have understood the inquiry to refer only to living relatives and therefore have omitted almost all reference to their ancestors. These possible errors might easily explain all the excess of the percentage of consanguinity among those reported as having no deaf relatives over the probable percentage of consanguineous marriage in the general population. But this very probability that comparatively few deaf ancestors have been reported increases the probability that the greater part of the (a) relatives were brothers and sisters rather than ancestors. Now of the 26,221 deaf having deaf relatives, 17,345 have only (a) relatives, and if these are largely living brothers and sisters the relationship would "work both ways," so that if there were two deaf children in a family, each would have an (a) deaf relative. In the Census of Ireland figures above quoted it will be remembered that among families which were the offspring of cousins the proportion having two ormore deaf children was three times as great as among those who were not the offspring of consanguineous unions. If this follows in America, it largely accounts for the high percentage of the congenitally deaf who are the offspring of cousin marriages, and especially of those who have (a) deaf relatives.
A further analysis of the congenitally deaf according to consanguinity of parents and deaf relatives, as in Table XXX, helps to determine to what extent the greater number of deaf children to a family among the offspring of consanguineous marriages has influenced the totals. From the report it cannot be determined how many of the congenitally deaf had (a), (b) or (c) relatives alone, but the existence of (b) and (c) relatives would almost certainly indicate thatthe deafness was hereditary. Of these 14.6 per cent were the offspring of cousins, while of those having (a) relatives 18.6 per cent were the offspring of consanguineous unions. Thus it would seem to be a more reasonable conclusion that where two or more deaf-mutes appear in the same family, at least a tendency toward deaf-mutism is hereditary in the family and is intensified by the marriage of cousins, rather than that consanguineous marriage is in itself a cause. The fact that in many cases the relationship would "work both ways" would not greatly affect the percentage of the offspring of cousins having (b) and (c) relatives, for the chance would be slight that the (b) or (c) relative would be himself the offspring of a consanguineous marriage. Among the congenitally deaf who reported no deaf relatives, the percentage of consanguineous parentage is still high, (7.3 per cent), but this excess can easily be accounted for by the ignorance of deaf relatives on the part of the informant, without contradicting the hypothesis of heredity.
Basing now our percentages on the totals of consanguineous and non-consanguineous parentage respectively, and including only those who answered the inquiry as to deaf relatives, it will be seen (Table XXXI) that while of all the deaf less than one third are returned as having deaf relatives, of the deaf who were the offspring of cousins over one half (55.5 per cent) were returned as having (a) or (b) deaf relatives.
Again taking into consideration only the congenitally deaf the results are still more striking. Table XXXII shows that 66.5 per cent of the congenitally deaf who are of consanguineous parentage are known to have deaf relatives.