The voluntary method is the only sound way of approach in this matter. Duclaux considered that the candidate for marriage should possess a certificate of health in much the same way as the candidate for life assurance, the question of professional secrecy, as well as that of compulsion, no more coming into one question than into the other. There is no reason why such certificates, of an entirely voluntary character, should not become customary among those persons who are sufficiently enlightened to realize all the grave personal, family, and social issues involved in marriage. The system of eugenic certification, as originated and developed by Galton, will constitute a valuable instrument for raising the moral consciousness in this matter. Galton's eugenic certificates would deal mainly with the natural virtues of superior hereditary breed—"the public recognition of a natural nobility"—but they would include the question of personal health and personal aptitude.[[457]]
To demand compulsory certificates of health at marriage is indeed to begin at the wrong end. It would not only lead to evasions and antagonisms but would probably call forth a reaction. It is first necessary to create an enthusiasm for health, a moral conscience in matters of procreation, together with, on the scientific side, a general habit of registering the anthropological, psychological, and pathological data concerning the individual, from birth onwards, altogether apart from marriage. The earlier demands of Diday and Bertillon were thus not only on a sounder but also a more practicable basis. If such records were kept from birth for every child, there would be no need for special examination at marriage, and many incidental ends would be gained. There is difficulty at present in obtaining such records from the moment of birth, and, so far as I am aware, no attempts have yet been made to establish their systematic registration. But it is quite possible to begin at the beginning of school life, and this is now done at many schools and colleges in England, America, and elsewhere, more especially as regards anthropological, physiological, and psychological data, each child being submitted to a thorough and searching anthropometric examination, and thus furnished with a systematic statement of his physical condition.[[458]] This examination needs to be standardized and generalized, and repeated at fixed intervals. "Every individual child," as is truly stated by Dr. Dukes, the Physician to Rugby School, "on his entrance to a public school should be as carefully and as thoroughly examined as if it were for life insurance." If this procedure were general from an early age, there would be no hardship in the production of the record at marriage, and no opportunity for fraud. The dossier of each person might well be registered by the State, as wills already are, and, as in the case of wills, become freely open to students when a century had elapsed. Until this has been done during several centuries our knowledge of eugenics will remain rudimentary.
There can be little doubt that the eugenic attitude towards marriage, and the responsibility of the individual for the future of the race, is becoming more recognized. It is constantly happening that persons, about to marry, approach the physician in a state of serious anxiety on this point. Urquhart, indeed (Journal of Mental Science, April, 1907, p. 277), believes that marriages are seldom broken off on this ground; this seems, however, too pessimistic a view, and even when the marriage is not broken off the resolve is often made to avoid procreation. Clouston, who emphasizes (Hygiene of the Mind, p. 74) the importance of "inquiries by each of the parties to the life-contract, by their parents and their doctors, as to heredity, temperament, and health," is more hopeful of the results than Urquhart. "I have been very much impressed, of late years," he writes (Journal of Mental Science, Oct., 1907, p. 710), "with the way in which this subject is taking possession of intelligent people, by the number of times one is consulted by young men and young women, proposing to marry, or by their fathers or mothers. I used to have the feeling in the back of my mind, when I was consulted, that it did not matter what I said, it would not make any difference. But it is making a difference; and I, and others, could tell of scores of marriages which were put off in consequence of psychiatric medical advice."
Ellen Key, also, refers to the growing tendency among both men and women, to be influenced by eugenic consideration in forming partnerships for life (Century of the Child, Ch. I). The recognition of the eugenic attitude towards marriage, the quickening of the social and individual conscience in matters of heredity, as also the systematic introduction of certification and registration, will be furthered by the growing tendency to the socialization of medicine, and, indeed, in its absence would be impossible. (See e.g., Havelock Ellis, The Nationalization of Health.) The growth of the State Medical Organization of Health is steady and continuous, and is constantly covering a larger field. The day of the private practitioner of medicine—who was treated, as Duclaux (L'Hygiène Sociale, p. 263) put it, "like a grocer, whose shop the customer may enter and leave as he pleases, and when he pleases"—will, doubtless, soon be over. It is now beginning to be felt that health is far too serious a matter, not only from the individual but also from the social point of view, to be left to private caprice. There is, indeed, a tendency, in some quarters, to fear that some day society may rush to the opposite extreme, and bow before medicine with the same unreasoning deference that it once bowed before theology. That danger is still very remote, nor is it likely, indeed, that medicine will ever claim any authority of this kind. The spirit of medicine has, notoriously, been rather towards the assertion of scepticism than of dogma, and the fanatics in this field will always be in a hopelessly small minority.
The general introduction of authentic personal records covering all essential data—hereditary, anthropometric and pathological—cannot fail to be a force on the side of positive as well as of negative eugenics, for it would tend to promote the procreation of the fit as well as restrict that of the unfit, without any legislative compulsion. With the growth of education a regard for such records as a preliminary to marriage would become as much a matter of course as once was the regard to the restrictions imposed by Canon law, and as still is a regard to money or to caste. A woman can usually refrain from marrying a man with no money and no prospects; a man may be passionately in love with a woman of lower class than himself but he seldom marries her. It needs but a clear general perception of all that is involved in heredity and health to make eugenic considerations equally influential.
A discriminating regard to the quality of offspring will act beneficially on the side of positive eugenics by substituting the pernicious tendency to put a premium on excess of childbirth by the more rational method of putting a premium on the quality of the child. It has been one of the most unfortunate results of the mania for protesting against that decline of the birthrate which is always and everywhere the result of civilization, that there has been a tendency to offer special social or pecuniary advantages to the parents of large families. Since large families tend to be degenerate, and to become a tax on the community, since rapid pregnancies in succession are not only a serious drain on the strength of the mother but are now known to depreciate seriously the quality of the offspring, and since, moreover, it is in large families that disease and mortality chiefly prevail, all the interests of the community are against the placing of any premium on large families, even in the case of parents of good stock. The interests of the State are bound up not with the quantity but with the quality of its citizens, and the premium should be placed not on the families that reach a certain size but on the individual children that reach a certain standard; the attainment of this standard could well be based on observations made from birth to the fifth year. A premium on this basis would be as beneficial to a State as that on the merely numerical basis is pernicious.
This consideration applies with still greater force to the proposals for the "systematic endowment of motherhood" of which we hear more and more. So moderate and judicious a social reformer as Mr. Sidney Webb writes: "We shall have to face the problem of the systematic endowment of motherhood, and place this most indispensable of all professions upon an honorable economic basis. At present it is ignored as an occupation, unremunerated, and in no way honored by the State."[[459]] True as this statement is, it must always be remembered that an indispensable preliminary to any proposal for the endowment of motherhood by the State is a clear conception of the kind of motherhood which the State requires. To endow the reckless and indiscriminate motherhood which we see around us, to encourage, that is, by State aid, the production of citizens a large proportion of whom the State, if it dared, would like to destroy as unfit, is too ridiculous a proposal to deserve discussion.[[460]] The only sound reason, indeed, for the endowment of motherhood is that it would enable the State, in its own interests, to further the natural selection of the fit.
As to the positive qualities which the State is entitled to endow in its encouragement of motherhood, it is still too early to speak with complete assurance. Negative eugenics tends to be ahead of positive eugenics; it is easier to detect bad stocks than to be quite sure of good stocks. Both on the scientific side and on the social side, however, we are beginning to attain a clearer realization of the end to be attained and a more precise knowledge of the methods of attaining it.[[461]]
Even when we have gained a fairly clear conception of the stocks and the individuals which we are justified in encouraging to undertake the task of producing fit citizens for the State, the problems of procreation are by no means at an end. Before we can so much as inquire what are the conditions under which selected individuals may best procreate, there is still the initial question to be decided whether those individuals are both fertile and potent, for this is not guaranteed by the fact that they belong to good stocks, nor is even the fact that a man and a woman are fertile with other persons any positive proof that they will be fertile with each other. Among the large masses of the population who do not seek to make their unions legal until those unions have proved fertile, this difficulty is settled in a simple and practical manner. The question is, however, a serious and hazardous one, in the present state of the marriage law in most countries, for those classes which are accustomed to bind themselves in legal marriage without any knowledge of their potency and fertility with each other. The matter is mostly left to chance, and as legal marriage cannot usually be dissolved on the ground that there are no offspring, even although procreation is commonly declared to be the chief end of marriage, the question assumes much gravity. The ordinary range of sterility is from seven to fifteen per cent. of all marriages, and in a very large proportion of these it is a source of great concern. This could be avoided, in some measure, by examination before marriage, and almost altogether by ordaining that, as it is only through offspring that a marriage has any concern for the State, a legal marriage could be dissolved, after a certain period, at the will of either of the parties, in the absence of such offspring.
It was formerly supposed that when a union proved infertile, it was the wife who was at fault. That belief is long since exploded, but, even yet, a man is generally far more concerned about his potency, that is, his ability to perform the mechanical act of coitus, than about his fertility, that is, his ability to produce living spermatozoa, though the latter condition is a much more common source of sterility. "Any man," says Arthur Cooper (British Medical Journal, May 11, 1907), "who has any sexual defect or malformation, or who has suffered from any disease or injury of the genito-urinary organs, even though comparatively trivial or one-sided, and although his copulative power may be unimpaired, should be looked upon as possibly sterile, until some sort of evidence to the contrary has been obtained." In case of a sterile marriage, the possible cause should first be investigated in the husband, for it is comparatively easy to examine the semen, and to ascertain if it contains active spermatozoa. Prinzing, in a comprehensive study of sterile marriages ("Die Sterilen Ehen," Zeitschrift für Sozialwissenschaft, 1904, Heft 1 and 2), states that in two-fifths of sterile marriages the man is at fault; one-third of such marriages are the result of venereal diseases in the husband himself, or transmitted to the wife. Gonorrhœa is not now considered so important a cause of sterility as it was a few years ago; Schenk makes it responsible for only about thirteen per cent. sterile marriages (cf. Kisch, The Sexual Life of Woman). Pinkus (Archiv für Gynäkologie, 1907) found that of nearly five hundred cases in which he examined both partners, in 24.4 per cent. cases, the sterility was directly due to the husband, and in 15.8 per cent. cases, indirectly due, because caused by gonorrhœa with which he had infected his wife.