Certainly the one fact which stands out conspicuously when we face most concrete cases, is that at present we need more urgently than sterilization laws for the insane, exhaustive studies of the inheritability of specific mental infirmities that we may know with some degree of certainty which warrant sterilization.
Yet on the other hand one of the most disquieting facts that confronts us to-day is the large number of patients who are on parole from our hospitals for the insane, subject to recall. What shall we do with them? Shall we submit them to the tremendous hardship of still remaining under custodial care although to all intents and purposes sane, or shall we make their release contingent upon their submission to vasectomy or salpingectomy?
In a few cases such as Huntington’s chorea (Figs. 26, 27, [pp. 114], [115]) we can proceed with a fair degree of assurance, for we know that this dreadful malady is transmitted as a positive trait and that in all probability half of the children of an afflicted individual will inherit the defect. Such patients, if they ever rally sufficiently temporarily to leave the hospital, or where encountered outside the hospital should certainly be restrained from procreation. It is questionable if even their children, though apparently normal, should be allowed to have offspring, for usually the disorder does not manifest itself until middle life and then it is too late to try to prevent its transmission since the affected individual has already probably married and had children. But Huntington’s chorea is a comparatively rare form of insanity, and one of only a few about which our knowledge as regards its transmissibility is fairly satisfactory.
In Feeble-Mindedness.—When we come to institutions for the feeble-minded, however, there seems to be much more unanimity of opinion among physicians in charge of such institutions that sterilization would be an effective and satisfactory disposition to make of many cases, if we are to release the patients in question from custody. Unquestionably in cases of imbecility it is easier than in insanities to pass conclusive judgment on the inheritability of the condition in a large class of cases. Practically all are agreed that either permanent custodial care through the reproductive period or sterilization should be enforced. Some maintain that such individuals should remain permanently in institutions anyway and that therefore to sterilize them is needless, while others urge that if sterilized many capable of making their own living could be freed and allowed to do so.
According to Goddard the feeble-minded woman is about three times as likely to find a mate as a feeble-minded man, hence it would seem to be of much greater importance to sterilize the woman than the man.
Again it might be urged with much justification, that even though sterilized, the feeble-minded individual because of lack of self-control will transgress sexually and will thus certainly become a menace to society in the spread of venereal diseases. If Mr. Hart’s estimate is anywhere near correct, that there are 60,000 feeble-minded women in the United States of child-bearing age, and that 13,000 are already in custody, then the task of getting all women of this class into custody is not so insurmountable as would at first appear.
In Cases of Epilepsy.—As to epilepsy, I find a very decided difference of opinion among physicians. Some consider it, on account of its apparently strong inheritability, together with the shocking crimes perpetrated by epileptic criminal types, one of the most serious menaces, while others point out that we know nothing of the real cause of epilepsy, that there are all degrees and shades, that it is probably referable to different causes in different cases and that no one is able to say what the offspring of any given epileptic will be.
As to criminal types, here again we face the difficulty of deciding any particular case. Let us suppose that twenty-five per cent. of criminals are mental defectives, how shall we sift them out from the seventy-five per cent. who are supposed to be eugenically normal? Doubtless in many of the twenty-five per cent. class, the indications of defective mentality are sufficiently evident to prevent mistakes, but a considerable number of uncertain status must also remain near the border-line.
Sterilization Laws.—Although twelve of our states already have sterilization laws, only two, Indiana and California, seem to have made any active attempt to enforce them. The situation is too new yet in Wisconsin, Michigan and Pennsylvania for these states to have shown what they intend to do. Although the Indiana law says, “it shall be compulsory for each and every institution” to maintain the practise, it has fallen into disuse since 1911, presumably because the governor believed the law unconstitutional. It is of interest to see the motive underlying the law in various states. In the majority it is purely eugenic. In Connecticut it is mainly eugenic though partly therapeutic. In California it is apparently in part therapeutic, since it is stated as being for the physical, mental or moral benefit of inmates of various state institutions, and in part punitive and eugenic, since individuals twice committed for sexual offenses or three times for other crimes are subject to the operation.
In Washington and Nevada the object is purely punitive, the persons specified being habitual criminals and persons adjudged guilty of carnal abuse of female persons under ten years of age, or of rape. In these states also the court orders the operation instead of leaving it to the decision of a board of medical experts.