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 belong there 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 the United 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]
There are idiots, imbeciles, morons and backward children. The morons and the backward children are found in the public schools in large numbers. Goddard's studies showed twelve per cent. of an entire school district below the high school to be two or three years behind their grades, and three per cent. four or more years behind.