THE MULTIPLICATION OF THE UNFIT.
[COMMUNICATED.]
ACONSIDERABLE amount of discussion has been going on lately with regard to the proper method of treating the insane and feeble-minded. How far the points at issue between the critics and the defenders of existing practice are only matters of detail it is impossible for an outsider to judge. But there is one matter of supreme importance to the nation, to which neither side in the current controversies seems to have given the least atten- tion, namely, the question of how far our present methods, with or without improvements, tend actually to increase the numbers of the feeble-minded.
The Royal Commission • on the Care and Control of the Feeble-Minded estimated in 1908 the total number of mentally defective persons, including certified lunatics, at 271,607 or .83 per cent. of the population. The figures are to-day even more serious. The Board of Control reported in 1920 that before the War there was an average yearly increase of 2,098 in the number of patients in county and borough asylums alone. In the year 1920 the number rose to over 4,000. This latter figure may have been to some extent abnormal, but there is no doubt that the increase -in the various phases of lunacy is persistent and serious. One of the causes is without doubt the transmission of certain types of mental disease from parent to child.
That feeble-mindedness is hereditary nearly all the scientific witnesses before the Commission of 1908 were agreed, and the Commission itself accepted that view. Yet .when it came to the question of how to prevent the feeble-minded from multiplying their numbers, the Com- mission hesitated to make any sufficiently drastic recom- mendation. More than one witness urged the necessity for immediate action. The late Sir Edward Fry, whom the ComMissioners quote with approval, pointed out that in earlier generations the imbeciles and the feeble-minded were allowed to die off, but that in modern times we had protected them from their own calamities, with the result that they survived and produced offspring like unto them- selves. In so doing, he continued, " It appears to me we have incurred another responsibility, namely, that of preventing, so far as we reasonably can, the perpetuation of a low type of humanity, for otherwise the beneficence of one generation becomes the burden and the injury of all succeeding ones." He demanded the segregation of imbeciles in childhood and youth and throughout life.
Following the report of the Royal Commission of 1908, a Bill was introduced into the House of Commons in 1912 to provide for extended control over lunatics and feeble-minded persons. This Bill did not go so far as many of the witnesses before the Royal Commission would have liked, but it went too far for the extreme Radical-elements in the House of Commons. It was denounced by them as providing for the " perpetual imprisonment " of the feeble-minded, and, owing largely to the opposition of one particular individual, the progress of the Bill through Committee was so blocked that it had to be abandoned. In the following year, 1913, a modified Bill was introduced. The previous Bill had been attacked partly because of the expenditure involved under it and partly because it did make some concessions to the demand so well expressed by Sir Edward Fry in the passage above quoted that we should prevent, as far as possible, the perpetuation of a low type of humanity. In defending his modified Bill Mr. McKenna, then Home Secretary, said : " We have omitted any reference to what might be regarded as the eugenic idea. . . . As the measure now stands it exists for the protection of individual sufferers." In this form the Bill passed, in spite of continued opposition from the same quarter, by an overwhelming majority. An examina- tion of the Act shows that the measure was correctly described by the Home Secretary. In effect it only provides for the detention of persons who might be a danger to themselves or to others if left at large, and even in the case of such dangerous persons the detention is only temporary, so that if they partially recover, they can be set free again to produce more feeble-minded children. It was this measure that created the Board of Control, and the expenditure incurred by that Board has now become so considerable that the Treasury has been obliged to cut it down. As a result several Members of Parliament who are interested in the subject sent an indignant protest to the Press (see Times, December 9th, 1921), declaring that one of the results would be " more illegitimate and defective children, more girls and boys leading lives of degradation and crime."
The fact is that we have allowed feeble-minded persons to multiply so rapidly in proportion to the general growth of population that the cost of their maintenance has now become a very serious burden. To prevent their further multiplication, the only definite scheme hitherto suggested has been their permanent detention throughout life. The objection to that proposal is that, though it is fully justified as regards those persons whose mental deficiency is so great that they are a danger to themselves and to the public if left at large, it becomes a gross cruelty when applied to the very large number of feeble-minded persons who, though their minds are defective, are, generally speaking, harmless, and can only do mischief to the com- munity by perpetuating their kind. To lock up such persons as these for the whole of their lives would be an act of cruelty. Moreover, it would involve a very con- siderable expenditure. The existing institutions would have to be enlarged, or new ones built, in order to make room for these perpetual inmates. It is true that at the present moment there is a good deal of vacant space in the asyliuns of the country, the reason being, as the report of the Board of -Control for 1920 states; that during the War a very large number of the inmates of asylums died off as a result of war conditions. But as far as can be gathered, the asylums are rapidly filling up again. The question arises whether there is any other possible alternative to permanent detention, and it may here be suggested that if the Board of Control wishes to render a real service to the country, it should take into considera- tion the experience of the United States in this matter. During the past ten or fifteen years several of the States of North America have passed laws providing for the sterilization of persons who are mentally defective or afflicted with other heritable diseases. In some States, as often happens with American legislation, the laws have been put on the Statute Book and never enforced. In other States many hundreds of operations have already been performed. It is well to explain at once that the operation described as sterilization does not imply castra- tion. It is technically known as vasectomy in the case of males and salpingectomy in the case of females. It does not affect the normal functions of life in any way. All it does is to prevent fecundation. It cannot therefore be called in any way cruel. Indeed, the medical evidence shows that the operation, especially in the case of the male, tends to an improvement in the general health. It certainly is most desirable that this question should be taken up without further delay by the Ministry of Health. The value of the operation is not indeed limited to cases of mental deficiency. There are many other diseases which i might be greatly diminished in future generations if the persons afflicted would consent to an operation which prevented them from passing on to posterity the mental or physical ill from which they are themselves suffering.
HAROLD COX.
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