HV
UC-NRLF
553
Reprinted from "PROBLEMS IN EUGENICS/' being
Papers communicated to the First International Eugenics
Congress, London, igi2.
HEREDITY AND EUGENICS
IN
RELATION TO INSANITY,
BY DR. F. W. MOTT, F.R.S.
Pathologist to the London County Asylums.
Physician to Charing Cross Hospital.
PRICE SIXPENCE.
EUGENICS EDUCATION SOCIETY,
6, YORK BUILDINGS, ADELPHI, LONDON, w.c.
Reprinted from "PROBLEMS IN EUGENICS/' being
Papers communicated to the First International Eugenics
Congress , London, 19/2.
HEREDITY AND EUGENICS
IN
RELATION TO INSANITY,
BY DR. F. W. MOTT, F.R.S.
Pathologist to the London County Asylums.
Physician to Charing Cross Hospital.
EUGENICS EDUCATION SOCIETY,
6, YORK BUILDINGS, ADELPHI, LONDON, w.c.
HEREDITY AND EUGENICS IN RELATION
TO INSANITY.
DR. F. W. MOTT, F.R.S.,
Pathologist to the London County Asylums.
Physician to Charing Cross Hospital.
Allow me to thank the Eugenics Society for doing me the honour of
asking me to fill the place of so distinguished a physician as Sir Wm. Osier,
the Regius Professor of Medicine at Oxford. The subject of Heredity and
Eugenics in relation to Insanity is one which I, as Pathologist to the
London County Asylums, have been studying in a practical manner for
many years, and the more deeply I consider the question the more I find
there is to be done before we shall be safe in drawing ultimate conclusions
regarding certain practical questions dealing with the prevention of insanity.
The subject of Heredity in its broad aspect is one of national importance
and interest, as it affects many social and legislative questions. The interest
taken by the general public in the question of heredity is a sign of social
progress. People are beginning to recognise the truth of Professor Arthur.
Thomson's dictum: '^The present is the child of the past ; _our_ start in
life is no haphazard affair, but is vigorously determined by our parentage
and ancestry ; all kinds of inborn characteristics may be transmitted from
generation to generation."
All the modern doctrines of Human Heredity were foreshadowed by the
ancient philosopher Lucretius, who, in de serum nature?, says: "Some-
times, too, the children may spring up like the grandfathers, and often re-
semble the forms of their grandfather's fathers, because the parents often
keep concealed in their bodies many first beginnings mixed in many ways,
which, first proceeding from the original stock, one father hands down to
the next father, and then proceeding from them Venus produces
forms after a manifold chance, and repeats not only the features but the
voice and hair of forefathers, and the female sex equally springs from the
father's and males go forth equally from the mother's body, since these
distinctions no more proceed from the fixed seed of one or other parent,
than our face and bodies and limbs. Again we perceive that the mind is
begotten along with the body and grows up together with it, and grows old
along with it."
301558 ,
Sir Francis Galton. the founder of Eugenics, and to whom the nation
/ owes so much, established the Law of Ancestral Inheritance. According
/ to this law each germ, male or female, contains on an average representative
/ particles or germinal determinants derived from the two ancestral stocks in
I definite proportions. Thus one quarter comes from each parent, one-sixteenth
| from each grand-parent, and one-sixty-fourth from each great grand-parent.
Thus an inheritance is not merely dual, it is multiple. Galton himself
recognised, however, that this law only applied to masses of people and not
to individual cases, for he says : " Though one half of each child may
be said to be derived from either parent, yet he may receive a heritage from
a distant progenitor that neither of his parents possessed as personal char-
acteristics." Again, speaking of Particulate Inheritance, he remarks; " All
living beings are individuals in one aspect, composite in another. We seem
to inherit bit by bit this element from one progenitor, that from another,
in the process of transmission by inheritance elements derived from the
same ancestor are apt to appear in large groups, just as if they had clung
together in the pre-embryonic stage, as perhaps they did." They form
what is well expressed by the word traits traits of feature and character,
that is to say, continuous features, not isolated points. The offspring of
parents possess a mosaic of inheritance bearing usually a more or less
similarity, yet the mosaics of character, whether bodily or mental, are
not in any way identical, except in the case of identical twins. Now,
there is a reason for this. Identical twins are the result of fertilization of
one ovum containing two germs of identical substance, and this leads me
to refer to Galton's remarkable inquiry into the History of Twins in con-
nection with Nature and Nurture. He found that similar twins living in a
different environment nevertheless remained similar in temperament and
character, while dissimilar twins brought up and living in the same environ-
ment remained dissimilar ; these dissimilar twins, however, were the product
of two separate ova with dissimilar germs. This shows that every germ has
a specific energy of its own, as manifested by a different potential
inheritance.
Galton also made a statistical inquiry into good and bad tempers, and
as a result of this inquiry he says : "It now becomes clear enough and
may be taken for granted that the tempers of progenitors do not readily
blend in the offspring, but that some of the children take mainly after one
of them, some after another, but with a few threads, as it were, of
various ancestral tempers woven in, which occasionally manifest themselves.
If no other influences intervened, the tempers in the children of the same
family would on this account be almost as varied as those of their ancestors.
To recapitulate briefly, one set of influences tends to mix good and bad
tempers in a family at haphazard ; another tends to assimilate them, or
that they shall all be good or all be' bad ; a third set tends to divide each
family into contracted portions. These facts, ascertained by Galton, are
of great interest in connexion with the inheritance of the predisposition to
nervous and mental diseases, a predisposition which is termed the neuro
pathic taint. Gallon's law of filial regression again seems to explain
many facts regarding the inheritance of feeble-mindedness as well as ability.
In respect to the latter, Galton showed that only a few out of many children
would be likely to differ from mediocrity as their mid parent, and still
fewer would differ as widely as the more exceptional of the two parents.
The more bountifully the parent is gifted by nature, the more rare will be
his good fortune if he begets a son as richly endowed as himself, and still
more so if he begets a son who is endowed yet more largely. But the law
is even-handed, it levies an equal succession tax on the succession of badness
as of goodness. If it discourages the extravagant hopes of a gifted parent
that his children will inherit all his powers, it no less discountenances
extravagant fears that they will inherit all his weaknesses and tendencies to
disease." This tendency to revert to the normal average of the race is
tEus a great factor in heredity. Amphimixis, or the blending of the in-
heritances of two individuals, is claimed by Weismann as the great factor
in the production of variation and evolution, but when a functional and
structural dynamic equilibrium has been established in all the organs and
tissues of the body for a species and race, amphimixis would act in an
opposite manner in tending to prevent the perpetuation of variation, patho-
logical or otherwise. Change of type comes about through inheritance of
modification, and many abnormalities and defects, arising we know not why,
are transmitted through successive generations, and apparently are not
swamped out by dilution unless they interfere with self-preservation or with
marriage selection and propagation. I may cite the following as examples :
Polydactylism, six fingers and six toes ; brachydactylism, short fingers, lobster
claw hand, white tufts of hair, various eye and skin diseases. A remark-
able example of an hereditary visual defect is congenital stationary night
blindness which has continued through nine generations, affecting 135
members out of close on 2,000 descendants (Nettleship and Cunier).
Colour blindness, and the tendency to bleed (haemophilia) are curious affections
limited to the male sex but transmitted by the females. Then we have
those tendencies to disease affecting stocks, e.g., tuberculosis, rheumatism,
diabetes, gout, and nervous and mental diseases, or neuropathic tendency.
In the case of tuberculosis and rheumatism the tendency is shown by a weak-
ness in defence against specific and ubiquitous microganisms. In gout
and diabetes there is a tendency in the stock to disease arising from
a disturbance of the bio-chemical equilibrium of the blood in relation
to the functions of the organs and tissues of the body and nutrition.
The neuropathic diathesis may also be due to an inherent tendency
to a disturbance of the bio-chemical equilibrium of the blood and the
nervous system occurs, especially in the brain, or the potential energy stored is
nervous and mental diseases, a predisposition which is termed the neuro-
unstable, consequently there is an inherent failure to control its conversion
into active energy as in epilepsy and other paroxysmal nervous states.
The discovery of Mendelism has opened up a new and vast field of investi-
gation, and although so far Mendelian analysis is as yet imperfectly developed
in respect to human inheritance, yet as Bateson says : " Organisms may be
regarded as composed to a great extent of separate factors, by virtue of
which they possess their various characters or attributes. These factors
are detachable, and may be recombined in various ways. It thus becomes
possible to institute a factorial analysis of an individual." How far such
analysis can be carried we do not yet know, but we have the certainty that
it extends far, and ample indications in supposing that we should probably
be right in supposing that it covers most of the features, whether of mind or
body, which distinguish the various members of a mixed population like that
of which we, form a part. From such a representation we pass to the
obvious conclusion .that an individual parent is unable to pass on to off-
spring a factor which he or she does not possess. Since thqse individuals
only which are possessed of the factors can pass them on to their offspring,
so the offspring of those that are destitute of those elements do not acquire
them in subsequent generations, but continue to perpetuate the type which
exists by reason of the deficiency. It should be explicitly stated, however,
that in .the case of the ordinary attributes of normal men we have as yet
unimpeachable evidence of the manifestation of this system of descent for
one set of characters only, namely, the colour of the eyes. Moreover,
if the evidence as to normal characteristics of man is defective which in
view of the extreme difficulty of applying accurate research to normal
humanity is scarcely surprising there is in respect of numerous human
abnormalities abundant evidence that a factorial system of descent is
followed." (Bateson: Biological Fact and the Structure of Society.)
This may be, as Bateson claims, true for certain well defined abnormali-
ties, e.g., polydactylism, brachydactylism, xeroderma pigmentosa, or
for night blindness, but as applied to the inheritance of a diathesis or
tendency, e.g., the neuropathic, Mendelian proportions are not shown as a
rule, although there is evidence of segregation of the factor underlying the
diathesis or tendency.
With this brief introduction to my subject, allow me to consider the
problem of Heredity and Eugenics in relation to insanity. Let me first
define my terms : Heredity has been defined by Thomson as*" the genetic
relation between successive generations, and inheritance includes all that the
organism is or has tQ^start with in vktii^HtS~""rieTe~ditary relation; r>
Heredity is a relation in successive generations which is sustained by^X
more or less visible material basis, the germinal substance. i.Eugenics_is
the science of racial improvement by the application of ihe laws p*
heredity, viz., by encouraging the survival and the propagation of the
fittest in all classes of society, and by seeking to cut off the lines of
7
inheritance of the unfit in all classes of society. rHowever, we do not
know en^gh^abput human genetics to predict always the fittest and Ae
(imfittest. Some of the greatest men the world has seen have sprung
from the most humble and unknown stocks. Eugenics, therefore,
should aim at giving every individual that is worth preserving in every
class a chance of survival. A living wage, enough to ensure a sanitary
dwelling and a sufficiency of nourishing food for parents and family, should
be possible for every labourer and artisan. For if the rich and the intel-
lectuals will in a progressive manner restrict their birth-rate, natural selec-
tion is deprived of its rights among these classes, and Eugenists can have no
sympathy with such but rather with the masses of the people. The wealth
of the nation depends upon labour, and labour demands a'sufficiencv. to live
and propagate under far more favourable conditions than now exist in our
great cities, where the poorer the people and the more uncertain their wages
the higher is the rent demanded for the miserable tenements in which they
have to bring up a family. It is a fact, as Professor Karl Pearson keeps
urging, that at the present time in Great Britain restriction of families is
occurring in one-half or two-thirds of the people, including nearly all the
best, while children are being freely born to the feeble-minded, the
criminal, the pauper, the thriftless casual labourer, and other denizens, of
the one-roomed tenemen'ts of our great cities. The alien Jew and Irish
Roman Catholic have large families as their religion prohibits restriction,
perhaps unfairly in the case of the Irish, for the poorest classes of the
population in some of our large cities are largely of Irish extraction. Profes-
sor Pearson keeps warning us that 25% of our population, made up mainly
of the above-mentioned poor types, is producing 50% of our children, and
if this goes on must lead to degeneracy. If the better classes will not
propagate they must pay for the propagation of the poorer classes, and
natural selection, aided by human effort, must encourage the propagation
of the fit and the cutting off the lines of inheritance of the unfit.
Yv In considering the subject of Heredity and Eugenics in relation to
insanity, we have to ask ourselves what constitutes insanity at the present
time. It is often extremely difficult to draw the line between sanity and
insanity. jTt~mayr~nTTW'eveT, be asserted that a/person is insane who, on
< aeeotmt of disease or disordered function of the brain, can no longer feel,
thirik or act in accordance with the customs and social usages of the com
miinity in which he lives. /K An individual is judged to be sane or insane
by his conduct, but behaviour by itself without consideration of the social
environment is an insufficient criterion. Every case of msanity is _a
biological problem, the solution of which depends_ u^on__a_jgiowjedge_gf
what a rpan^wa^J^T^wtr^'ji^iirp-^ and what has happened after birth
" nurture." ^^o^.child^is born insane, though it may be born feeble-
minded, either from actual organic (Use-age or an inborn germinal cerebral
deficiency. The__former, being an acquired character.^ not transmissible ;
it is better to speak of such mental defects as congenital^ (Qprigenital
defect is not heritable, a fact of very considerable importance in (diagnosis,
especially as regards segregation with the view of prevention of transmission
of feeble-mindedness./
Registered Insanity in London.
The registered pauper insanity in London is 5*5 per 1,000 of the total
population, whereas for England and Wales it is 3*4 per 1,000; naturally
a widespread belief that insanity is greatly on the increase.
there is
ana.
1883 1890 183 lax J8
LL
:s JEW i3o IK
Fig. i
If we look at the accompanying Fig. i it will be observed that while
the population of the county of London has been nearly stationary,
registered insanity has practically doubled. It will be observed that
pauperism also showed a marked rise for 10 years, while it has fallen for
the last three years, but although there has been this fall in pauperism
during the last three years there has been a steady rise in registered insanity.
It might be thought, therefore, there was no correlation between pauperism
and insanity. This is not so. No doubt the fall in the curve of pauperism
has been due to old-age pensions. Now, old-age pensions will not affect
9
registerable insanity in London the same as it will in rural and urban
districts where the housing conditions are more favourable for the retention
at home of old-age pensioners suffering from senile decay. Twenty per
cent, of the admissions to the London asylums are old people, most of them
suffering with senile decay. The great increase of insanity, in my opinion,
is apparent rather than real, and for the following three reasons :
Firstly, the standard of sanity has been raised ; a great number of
harmless idiots and feeble-minded persons who were formerly allowed to
roam at large are now gathered into the London asylums through the agency
of the Special Schools. The increase of accommodation for the insane has
been doubled in the county of London during the last 12 years. There
is not the slightest reason for supposing that insanity has doubled in a
stationary population ; no doubt numbers were formerly discharged as re-
covered on account of pressure of new cases. Correlated with the provision
of adequate accommodation by the authorities, the necessity of discharging
patients to make room for urgent admissions has steadily diminished in
recent years ; and probably this explains the fact that the number of
patients- discharged as recovered shows a constant and continuous diminution
of numbers. According to the report of the Clerk of the Asylums
Committee, out of the large mass of registered lunacy in London only 2*9
per cent, according to the medical superintendents have a favourable prospect
of recovery, 5*42 per cent, are doubtful, and 92*19 per cent, are unfavour-
able. By thus providing such increased accommodation for the permanent
segregation of incurable insanity the London County Council have been
practical Eugenists^ for as I shall show you, heredity isjthe most potent^
cause ofjjasaoity.
lother and very important cause of increase of asylum accommodation
is a diminishing death rate in asylums from tuberculosis, dysentery,
pneumonia, and other microbial infectious diseases. There is, therefore, a
constant tendency to silt up the asylums with chronic incurable cases.
That this is so, is shown by the fact, that at the present time nearly one-
half of the inmates of the London County Asylums have been resident in
asylums more than ten years. Again, at the end of 1910 no less than 4,238
patients, known to have been insane more than twenty years, were in the
London asylums ; moreover, such long standing cases have been accumu-
lating during the last four years at rates varying from 125-200 per annum.
The third cause of the increase of registered insanity rests with those
who certify paupers. The degree of mental unsoundness necessitating
asylum treatment depends largely upon the provision obtainable for nursing
and taking care of incipient cases of insanity and aged persons who are
suffering from senile decay. In the report of the Asylums Committee,
1910, p. no, it is stated that as many as 4,762, or 23 per cent, of the
inmates of the London County Asylums were suffering from dementia,
senile and secondary ; this indicates that a number of these aged persons
10
who were formerly treated in the infirmaries are now sent to the asylums
where they can be better cared for. An inducement to send these cases by
the Guardians is the fact that the Government pays the Guardians 43. per
week for each pauper lunatic. It is hardly fair, however, to cast the stigma
of insanity on a stock in the case of simple senile decay.
The Correlation of Pauperism, Insanity, and Feeble-Mindedness.
The registered insane in London is 5 per 1,000, whereas in England and
Wales it is only 3*5 per 1,000 (Fig. 2). On the face of it, this would
1 I 1 I i 1 i i i i :j
Fig. 2.
appear to show that conditions existed in London which led to insanity that
were not so intense, or did not exist in the rest of the country. But more
probable is it, that London during the last 15 years by doubling its asylum
accommodation has gone far ahead of the rest of the country in this practical
method of applied eugenics.
Nevertheless, when we compare the registered pauper lunatics in different
boroughs as this table which I exhibit shows, we shall be struck not only with
the variable percentage for the different boroughs of the County of London,
but also by the fact that in boroughs with a poor population there is a much
higher percentage. You will observe the relative low percentage of Hamp-
stead 2'6 per 1,000, Lewisham 2*8, Wandsworth 3*5; whereas it is 7*9 per
1,000 in St. Pancras, Westminster 8'i, St. Giles-in-the- Fields and Blooms-
bury 9- 2, Strand 12*7. The explanation of the high percentage of these
latter, excepting the Strand, is that the pauper population is largely
composed of the denizens of one-roomed tenements with a low wage earning
capacity, and in districts where we should, owing to improvements and the
pulling down of slum property, expect a diminution of pauperism and in-
sanity, there is no decrease, and in many instances an increase. Owing to better
and cheaper means of locomotion an increasing number of the better classes
and more desirable members of the lower classes, e.g., artisans and those
in continuous employment, have migrated to the suburbs, the result being
that in many boroughs large houses, which were formerly occupied by one
family of the better classes, are now converted into flats and tenements
1 1
accommodating a number of families generally very poor and relying upon
casual labour. Woolwich has a relatively low percentage, 4*6 per 1,000,
and I should attribute this to the fact that the majority of the householders,
although not possessing high wage earning capacity, are more or less skillled
artisans in comparatively continuous employment, whereas at Stepney (6*6),
Poplar (6*2), and St. George's (6'4) casual labour and lower wage-
earning capacity predominate, with a proportionately higher rate of over-
crowding in one-roomed tenements and pauperism. It is probable that
those parishes which had a high rate of registered pauper lunacy would
also have a high rate of births, of infant mortality, and of tuberculosis.
While yielding to no one in the desire to see temperate measures adopted
for the control and regulation of the liquor traffic and the segregation of the
chronic inebriate, who, in my judgment, is more dangerous to society than
the lunatic ; nevertheless, I am of opinion that there is no proof that
certifiable insanity would diminish to anything like the extent that is fondly
cherished by total abstainers if alcohol were abolished. I feel certain,
however, triere would be less disease and far less crime and pauperism
than now exists in the general population of this country. Dr. Bevan
Lewis and Dr. Sullivan, by careful analysis and tables, have shown that in
the regional distribution of insanity it is difficult to trace any evidence of
alcoholic influence such as might be expected if alcoholism really accounted
for a sixth of the total cases of registered insanity. They have shown
that inland and agricultural communities were the least inebriate, but
had the highest ratios of pauperism and insanity ; inland and maritime
mining and manufacturing communities above all others were the most in-
temperate, yet revealed the lowest ratios of pauperism and insanity. Dr.
Sullivan concludes that alcohol, as the essential cause of certified insanity,
falls a good deal short of the 1.6 per cent, at which it is rated in the
official statistics. This entirely conforms with my observations on post-
mortem examinations in hospital and asylum practice. There is a correla-
tion, however, between the wage-earning capacity of a population,
pauperism, insanity, and tuberculosis. As the mentally and physically
more fit migrate from the agricultural districts to the industrial centres, or
emigrate, a progressively, mentally, and physically enfeebled rural popula-
tion must result. Like tends to beget like, and so Eugenists should urge
back to the land as one of the most pressing calls for legislation if we do'
not want a complete mental and physical deterioration of our rural popula-
tion. It is a well-known fact that the feeble-minded are especially prone
to tuberculosis, which is one of Nature's methods of eliminating the unfit.
Imbeciles and idiots are often sterile, which is one mode by which a
completely degenerate stock may die out, but degenerate stocks generally
contain feeble-minded of all grades, the majority of which will not die out,
but propagate freely, and no class of the community is responsible for
registered insanity, and (at present) unregistered feeble-mindedness to such
12
an extent as the mentally feeble. The progeny begotten of a feeble-minded
mother by a drunken father, according to my experience, is much more
likely to be born mentally defective or become insane in later life than
when both parents are intemperate, but neither of inherent mental defi-
ciency. I have many pedigrees which seem to indicate that a perfectly
sound stock may degenerate from a combination of pathogenic factors, viz.,
stress of town life, alcoholism, syphilis, and tuberculosis occurring in the
progenitors in successive generations. Wage-earning capacity of the masses
depends upon two factors, energy and sagacity, and the feeble-minded are
usually deficient in both, but their deficiency in energy, physical and
mental, is largely due to an inborn deficiency, but not always, or alto-
gether, for owing to their low wage-earning capacity, the environmental
conditions are correspondingly poor, especially is this the case with the
denizens of the one-roomed tenements of our great cities. Bad sanitation,
insufficient food, air and sunlight, alcoholism, syphilis, tuberculosis, and
infectious diseases all conspire together to sap the vital energy of the un-
employed, the casual labourer, the women, especially mothers, and the
children. By no means all these people are of the eugenically unfit; many
by improvement of their environment may have that restoration of vital
energy which is essential for will power and the exercise of an inborn
sagacity which chance, opportunity, or ill fortune has denied them. In
proof of this you have only to visit such schools as Shenfield, or even
Barnardo's Homes, to see that environment plays a very important part in
the development of energy, sagacity, and character. You cannot make
good material out of bad raw material, but fairly good material or even
good material may be spoiled by a bad environment. Even an inborn virtue
may, by evil surroundings, become the source of the worst vices.
The Effects of Poisons, e.g., Alcohol, Syphilis, and Tuberculosis, upon the
Germ-plasm.
An important racial question is this : Do poisons, such as syphilis, alcohol,
and tuberculosis, diminish the vital energy of the male and female germ
prior to conjugation and cause pathological variations?
It is a known fact that toxins weaken cells, and therefore why not
germ-cells? For although the sexual cells are segregated in the body,
they are of the body and nourished by the same blood and lympth, and
there is consequently reason for supposing that these most potent and pre-
valent poisons, alcohol, syphilis, and tuberculosis, may, without killing the
germ-cells diminish their specific vital energy and thus lead to various patho-
logical conditions of the body, and especially of the nervous system.
There can be no doubt that syphilis of the parents may lead to infantilism
in the offspring evidenced by arrest of development of the secondary sexual
characters. If syphilis can produce arrest of development of the reproduc-
tive organs, there is no reason why it should not lead to arrest of develop-
13
ment of the brain, and if syphilis of the parent can produce an arrest of
development of the sexual organs in the offspring so that there is sterility,
there is no reason why the specific energy of the germ-cells should not be
affected without actually destroying them. It is an established fact that if
congenital syphilis were not so fatal to infant life, the number of people
suffering from paralysis of various kinds and insanity from this cause would
be appalling. A olood test tends to show that syphilis is the cause of a larger
number of idiots and imbeciles than was formerly believed. ^Acquired
syphilis, and in rare cases congenital syphilis, are now acknowledged to be
the cause of the most terrible form of insanity :" general paralysis. * This
disease is fatal a few years after the onset of symptoms ^Xheredity plays
relatively an unimportant part in its causation ^fit affects all classes in pro-
portion to their liability to syphilitic infection. There are no reliable statistics
to show whether syphilitic infection is more prevalent at the present time
than formerly ; severe obvious affections are not nearly so prevalent owing
probably to a racial immunity or partial immunity, but there is no assurance
that the late manifestations affecting especially the brain and spinal cord are
not more numerous than formerly. It is certain that with the conversion
of the rural into an urban population, the more ready mingling of the town
and country population, the short military service, and the frequency
with which soldiers were syphilized by service in India, and other causes
incidental to life in large cities with their armies of professional prostitutes
and clandestine prostitutes, the possibilities of a general and widespread
syphilization of the race has occurred since the development of the railway
system in England. This has probably led to a partial racial immunity r
and the widespread existence of the disease in a latent form.
The Eugenics Education Society, recognising the great import-
ance of this vital public health question, has endeavoured to
obtain an enquiry regarding the prevalence of this disease and the effects
of treatment. As the Insurance Act has wisely not deprived sufferers from
this disease of medical benefits, an opportunity will shortly arise of ascer-
taining the prevalence of the disease, at any rate, in active form, among
15 million of the population. New methods of treatment make one have
the greatest hope of combating this scourge of the unborn millions who
are either killed off before birth, shortly after birth, or who later suffer
from terrible diseases of the nervous system, viz., blindness, deafness,
idiocy, imbecility, and paralysis. It is a notifiable disease in Scandinavian
countries, and I am informed it has recently been made notifiable in Aus-
tralia. Our first duty, in the hope of prevention, is the scientific study of
the cause. This has not been barren, for one of the greatest advances
preventive medicine has made was the discovery of the organism of
syphilis by the biologist Schaudinn ; this has led to experiments of the
greatest value, and an outcome was a bio-chemical test whereby the syphilitic
virus can be detected in the body, even when there are no obvious symp-
14
toms. This test enables us to detect not only the active virus, but those
late manifestations of syphilis, locomotor ataxy, and general paralysis of
the insane. Moreover, it confirms the view I have always maintained of the
syphilitic origin of these two diseases.
A sufficient time has not yet elapsed to show whether the widespread
use of the new drug, " 606," introduced by Ehrlich after a long series of
carefully contrived experiments, may not diminish the number of cases of
this terribly fatal disease (general paralysis of the insane) and of locomotor
ataxy, which is the same pathological change, affecting a different part of
the nervous system.
If there were time I could give logical arguments in favour of this
hypothesis, but I must be content with saying that since we now know the
cause of 20 per cent, of the deaths in the London County Asylums is due
to general paralysis, therefore one very important preventable cause has
been discovered. Not only is it important as regards numbers afflicted by
this terrible malady, but it is important- because the sufferers from this
disease are drawn from all grades of society, and as a rule are of civic
worth ; the same cannot be said of the feeble-minded.
We might add another 5 to 10 per cent, of cases of brain disease
dying in asylums with softening of the brain due directly or indirectly to
syphilis. In congenital syphilis it is appalling to think what a number of
feeble-minded adults there would be from this cause did it not happen
that when the syphilitic organism invades the brain it is fatal in the great
majority of cases. The congenital syphilitic offspring of diseased parents
as a rule die before birth or in early infancy. Still, the bio-chemical test
that I have referred to shows that a considerable percentage of the feeble-
minded may owe their defect to this preventable cause.
Neuropathic Inheritance.
Three years ago I initiated a card system of relatives who are at
present, or have been discharged from, or have died in, the London
County Asylums. The ball once set rolling has grown to enormous
dimensions, and I have at present considerably over 3,000 cards, most of
them referring to persons closely related in the direct line. There are
at the present time about 750 closely-related persons inmates of the London
County Asylums; namely, 3*5 per cent, of the total population. A -priori
this is a strong argument in favour of the importance of heredity as a cause
of insanity, for it cannot be supposed that if we took 20,000 people from
the 4,522,961 inhabitants of London for some random cause we should
find 3' 5 per cent, of them so closely related, as parents and offspring,,
brothers and sisters.
TABLE I.
Statistics of 3,042 Related Cases in the London County Asylums.
Discharged.
Transferred.
Died.
Resident.
Total.
Males
Females
2 5 6
I9'2%
353
20-6%
60
4.5%
59
3-4%
392
29-4%
389
22-8%
626
46-9%
907
53-i%
i,334
1,708
Total males and females
609
20-0%
119
3'9%
781
25'6%
i,533
5-04%
3,042
The above table shows the proportion of males to females; the latter
are much more numerous ; it will be observed that owing to a lower death-
rate of the females, they tend to accumulate. This is no doubt due to
the fact that general paralytic males are three times as numerous as
females, whereas other non-fatal forms of insanity are much commoner in
females. It will be observed that of the 3,042 relatives who are at present
or have been in the London Asylums 1,533 still remain resident, a little
more than half. I shall have occasion later to refer at length to some
important deductions made from the age incidence of the first attack of
insanity in these insane relatives.
Nature and Nurture.
)C No child is born insane, though it may be born feeble-minded either
from actual organic disease or inborn germinal cerebral deficiency^ The^
fojrmer being an acquired character is not heritable^Ca fact of verjrcorF^
^siderable importance in diagnosis and segregation witrrtrie~ view of pre-?
^-vention of transmission of feeble-mindedness.
We should endeavour to study every case of nervous or mental disease
as a biological problem, ascertaining as far as possible what the individual fc
^as born with, ancestral inheritance (Nature) ; what happened during.,
development after conception (congenital) ; finally what happened at
<va^ter^bnj;j! . (mirlur.^. The collection of statistics and pedigrees merely
relating to the question of certifiable insanity or epileptic fits is quite
inadequate for scientific purposes, as the neuropatJtic predisposition mani-
fests itself in many ways ; and it is necessary to seek the first stages and
less obvious conditions of degeneration in a stock. Morel, who studied
this question more than fifty years ago, pointed out that nervous irritable
weakness, the neurotic temperament, neurasthenic predisposition, may be
the first evidence of degeneration of a stock. The inborn morbid neurotic
temperament may be manifested in a variety of ways by the behaviour
and conduct observed in various members of the stock. The signs of
degeneracy which may be exhibited are self centred narrow-mindedness in
i6
religious beliefs, fanaticism, mysticism, spiritism, an unwholesome con-
tempt for traditional custom, social usages, and morality, a vain spirit of
spurious art and culture, a false self -loving vanity in the pursuit of a
sentimental altruism, or by eccentricities of all kinds; such signs of
degeneracy are often combined with talent and even genius, especially of
the constructive imaginative order; but the brilliant intellectual qualities
of a degenerate are invariably associated with either a lack of moral sense
or of sound judgment and highest control. ^Time, chance, circumstances,
and opportunities play an especially important part in moulding and
determining the career of a neurotic stock; circumstances and environ-
ment may favour one member and he rises on the tide of fortune to an
eminent position, whereas another, unfortunate or less fortunate, but with
a similar inborn temperament, dies in an asylum or commits suicide in
despair. X
I have often found in the collecting of pedigrees the association of
insanity and suicide in a stock preceded by, or associated with, the exist-
ence of individuals possessing the melancholic, suspicious, brooding, self-
centred, hypochondriacal temperament; and it is not uncommon for
suicide of one or more members of the stock in successive generations to
occur. Associated with these temperamental evidences of degeneracy of
a stock may be chronic alcoholism, dipsomania, hysteria, hypochondriasis,
exophthalmic goitre, neurasthenia, psychasthenia, migraine, petit mal, or
neuroses of an epileptic character, often unrecognised because not mani-
festing fits of the major form of the disease. In searching for the neuro-
pathic tendency there are, therefore, many possibilities of missing the
inborn factor of a neurosis or psychosis though a careful inquiry be made,
even when aided by intelligent co-operation on the part of the friends.
Some Illustrative Pedigrees Showing Various Manifestations and Results
of the Neuropathic Taint.
Fig- 3- A. B., an alien Jew, aged 54, was admitted to an asylum for
the first time suffering with involutional melancholia ; he has a sister who
has not been in an asylum, but, as events turned out, bore the latent seeds
of insanity. The man is married to a nealthy woman who bore him a large
family ; the first five are quite healthy, then comes a congenital imbecile
666666^66^6
I. 4
epileptic (cong.), then two healthy children followed by a daughter who
becomes insane at 23, then a son insane at 22, and lastly two children
who are up to the present free from any taint. The sister of A. B. is
married and has a family of ten, seven girls and three boys; one of the
females was admitted to the asylum at the age of 19, and since this pedigree
was constructed a brother of hers has been admitted, aged 24. Half -black
circles are insane.
The pedigree is instructive ; it shows direct and collateral heredity ; it
also shows remarkably well the signal tendency to the occurrence of insanity
at an early age in the children of an insane and potentially insane parent.
Fig. 4. A very comprehensive and interesting pedigree obtained for me
i8
by Dr. Wilson White, showing the result of marriage of a nearly sound
stock in which the temperament was, generally speaking, of the sanguine
type; there was only one member insane at 55; she was unmarried; her
four sisters, who were all married, had some healthy, grown-up children.
The brother himself, perfectly sane and healthy, married a woman de-
scended from stocks in one of which there were many members suffering
with epilepsy (E.); indeed, her father and her grandfather suffered with it.
On the maternal side there was suicide (S.) of an aunt and insanity of a
grandfather; most of the members of this stock were of a melancholy,
brooding temperament. The result of the mating of these two neuropathic
stocks is shown. There were nine children, of which three, marked with
deep, black-rimmed circles, suffered with some form of neurosis, a male
congenital imbecile, a healthy male who has five healthy children, a child
who died in early life of convulsions, the patient's mother who became
insane at the age of 40, a female who became insane at the age of 20,
two females also suffered with some form of neurosis, lastly, a male who
died in early infancy.
The next generation shows the result of mating this unsound stock
with an almost healthy, sound stock. There are not as many unsound
members as in the last generation, and we observe that the four members
that became insane at 19, 25, 30, and 20, all had their first attack at a
much earlier age than their mother, one of these committed suicide and
two were found dead ; this pedigree illustrates well the signal tendency to
the occurrence of antedating. The sound members of the stock apparently
inherited their temperament from the father's side, and the one member that
is married has quite healthy children ; this looks as if the unsound elements
of this degenerate stock had been cleared out by segregation of the unsound
germinal determinants, causing intensification of the disease and occurrence
of the onset at an early age, thus preventing propagation.
Fig. 5. This pedigree shows the result of marriage of first cousins, in
X
Fig. 5
both of whom there was a latent neuropathic taint. The family consisted
of three individuals, two sisters, A. and B., and an elder brother who was
married but had no family.
_JL_ married a^first cousin, and although neither of them was insane
nor epileptic, yet they had two children epileptic and one a congenital
imbecile /> this terminated the stock on that side. That there was latent
insanity was shown by the result of the marriage and the fact that a sister
became insane. A., however, married into a healthy, virile stock; she
became insane at 38, although living many years after she never recovered,
the exciting cause was the death of a son by suicide (S.) at 18. There were
two daughters who became mothers of families, the eldest son of one
suffered with a marked epilepsy, but no other evidence of neuropathy was
shown in this generation. The taint seems to have disappeared, inasmuch
as there are healthy, grown-up members of the fourth generation.
Fig. 6. A pedigree illustrating marriage of first cousins. A genius
was the product who married a healthy woman, and the family consisted of
an eldest son, committed suicide (S) ; a second son, epileptic (E) ; a daughter,
healthy, unmarried; and a fourth son a genius. This man was a genius,
Fig. 6
but had an extremely well-balanced mind ; all his five children are healthy
in spite of collateral insanity.
Fig- 7- A family of drunken and insane people. The figures with
half black circles are insane; the same with the cross indicates drink and
insanity; the circles with only a cross indicate excessive drinking. The
two stocks show a marked difference; one side the maternal is practically
free from any taint ; almost every member of the paternal stock is unsound.
20
Fig. 7
The degeneracy commenced with a N drunken woman whose sisterjjied,
age 53, in Colney Hatch Asylum, where she had been 20 years; she had
a congenital imbecile daughter in Leavesden.
The result of mating a sound individual with a drunken woman with
insane predisposition is shown in the members of the family born : a son
tto tears
21
healthy, then two sons who were insane at the ages of 36 and 27, then a
healthy son, then another son who also was insane at 27, finally five children
who died in early life, probably through the neglect of a drunken mother,
indicated by small, shaded, circular figures. One member of this drunken
and insane family married into a healthy, sound stock. Seven children
were the fruit of this marriage; of these, two sons and a daughter were
normal and three were insane, two of them having become insane at the age
of 13. The clear circle with a black centre indicates bodily disease.
I used to give this pedigree as an instance of drink causing insanity,
but after the establishment of the card system of relatives I found the notes
of the sister of the drunken grandmother ; she was an inmate of Colney
Hatch for 20 years. It sometimes happens that the one is taken and the
other left, and it would have been a benefit to society if the drunken pro-
genitor of this degenerate stock had been taken.
Fig. 8. The ending of a degenerate stock is illustrated in this pedigree.
A very distinguished man had a dissolute daughter, drunken and immoral
(figure with a cross) ; she had a daughter who behaved in a similar manner,
was married twice, then became insane; by her first husband she had two
children born dead.
Fig. 9. A pedigree showing pauperism, fecundity, insanity, and infant
mortality. Shaded circles indicate infants dying in early life.
CM?
Fig. 9
22
Fig. 10. A pedigree showing pauperism, insanity (black half circles),
and blindness in four generations (Lidbetter.)
6
Fig. 10
Figs, n, 12, and 13. Three pedigrees to illustrate " antedating "; the
onset of insanity in the offspring is shown to occur at a much earlier age than
in the parents. These pedigrees also illustrate extreme cases of hereditary
transmission of the neuropathic taint; as a rule not more than one insane
*
$
l>
42
Fig. ii
Fig. 12
Fig- 13
offspring of an insane parent occurs in four or five. The occurrence of in-
sanity in all the children is probably due to the fact that there is a
double insane inheritance in all these instances, although it is only shown
in one completely, and one partially.
Fig. 14. Two total abstainers, but born of drunken parents (circles
with cross and with direct and collateral insanity in stocks (black figures),
give birth to eight children, the first two are healthy and grown up, the
second with numerous children ; then come two children (shaded circles)
dying in early life, followed by a son and two daughters (black figures)
all suffering from dementia of adolescence, and lastly a healthy daughter
with children. What we want to know is this : have all the unsound elements
been segregated out? This can only be ascertained by following up the
children of the sound or apparently sound members.
9
66666^
Fig. 14
Importance of Ancestral Inheritance. ^
Everybody knows the value of coming from a good stock or a bad stock t
and in judging whether an individual who is insane should marry and pro-
pagate or not it is absolutely necessary as the study of a large number of
pedigrees shows that we should consider (i) the nature of the insanity, and
(2) what was the cause. Certain forms of insanity are much more likely
to be transmitted than others either in the same form or still more fre-
quently in some other form indicative of the neuropathic taint. The card
system of relatives which I shall refer to in detail, investigated for me by
Dr. Edgar Schuster showed that /epilepsy, recurrent insanity, and delu-
sional insanity are especially liable to be transmitted in the same form, but
general paralysis, which is now recognised as an organic brain disease due
to syphilis, -is not due to heredity, knd the cases consequently do not figure
largely in these relative cases.
In considering the question of marriage and - propagation a study of
these relatives and pedigrees convinces me of the importance of looking
back into the stocks and ascertaining whether there are many lines of
defective heredity, and whether with some lines of defective heredity there
are lines of sterling worth, for often enough with insanity and epilepsy we
find great talent, even genius and members of civic worth. The very fact
that a person would come and consult the physician as to whether he should
marry or not is a sign of civic worth and high moral character, and in giving
advice we should be guided by a consideration of the stock into which he
or she proposes to marry. <4jf there is a neuropathic tendency in that stock,
marriage into it should be discountenanced, for I shall show you that the
chances of insane offspring arising are much greater, y Let me illustrate my
remarks by two pedigrees, one is that of a man of genius and remarkable
mental stability with a bad collateral heredity (Fig. 6), the other is that in
which pauperism, tuberculosis, and blindness in successive generations occur.
24
(Fig. 10.) It would have been a national calamity had the former not been
allowed to propagate j to cut off the lines of propagation in the latter would
have been a national benefit. The popular expression, " He comes from a
good stock or a bad stock," then, is the result of experience and quite
scientific according to the laws of ancestral inheritance, yet now and then
even from an apparently unknown or even bad stock a great man arises.
Are we to say that^because a parent is insane that therefore the children
must necessarily be insane or useless to the race? God forbid ! The
parents of some of the most eminent men became insane and genius with
insanity frequently occurs in the same stock indicative of a variation from
the normal average. V.
The great point in any scientific investigation is not to try and prove some-
thing, and to avoid any propagandist tendency ; thus the question of alcohol
and insanity is an illustration in point. The Council of Fifty in Massachu-
setts investigated the number of patients admitted to asylums in which there
was an alcoholic history ; it was then suggested that they might investigate the
number of total abstainers, it was found that they were as numerous.
The scientific way to approach this question is to carefuly investigate the
pedigrees of patients admitted, selected not because they show a large number
of members of the ancestral stocks as being degenerate or insane, but selected
because a complete family history can be obtained for three generations.
This has been most successfully done by Dr. Hill Wilson White,
formerly at the Manor Asylum. The pedigrees he has obtained show con-
clusively that we must judge the right of a patient to propagate who has
had an attack of insanity by a full consideration of his pedigree. Certain
pedigrees which I have are of interest in relation to the question of alcohol ;
they are numerically insufficient to draw any conclusions, all we can say is
they are indicative of a devitalisation of the germ when chronic poisoning
occurs in successive generations. (Figs. 7, 14.)
Statistics Relating to 3,118 Relatives.
They show the following facts :
1. In the insane offspring of insane parents, daughters are much more
numerous than sons.
2. Amongst insane members of the same family (brothers and sisters)
sisters are more numerous than brothers.
This may be correlated with the fact that more women are in asylums
than men. There are several reasons for this : general paralysis, which
is a fatal disease, is three times more frequent in men than in women ; the
recoveries in women do not bear the same proportion as in men. Now,
why should women be more liable to become insane than men ? I will briefly
summarize the causes which, in my opinion, are operative :
i. The physiological emergencies connected with reproduction, i.e.* the
2 5
menstrual periods, child-bearing, and the cessation of the period of repro-
duction, the climacterium.
I would also add as an important and perhaps the only cause in many
instances the enforced suppression by modern social conditions of the repro-
ductive functions and the maternal instincts in women of an emotional
temperament and mental instability.
Anticipation or Antedating.
Dr. Maudsley has observed that Nature tends to mend or end a de-
generate stock/C Now, how could Nature best end or mend a degenerate
stock? Obviously by segregating in a relatively few germs all the unsound
elements, leaving the others as it were free. The accompanying figure 15
helps to explain this theory.
Assuming the intensity of inheritance is constant for each chromosome or
other unit of germ-plasm, but to vary with the number of the germinal
units tainted, we have as a result of the mating of these two tainted stocks
all degrees of manifestation of ancestral characters from perfect normality
to the most profound disease. /CThe more numerous the tainted germinal
units the greater will be the chance of the disease appearing in the offspring.^
On the other hand, the oftener reduction, with its possible random arrange-
ment, has occurred i.e., the greater the number of generations the less
will be the chance of any particular character finding a place in the inheri-
tance (Nettleship).
A M&1< Parent 8. Fern* It &Tnt
ft
rtnl.
Not-I.
P.t.l
M.fc.1
; <
MO
AAAA
|
8
tnmatur*
[ 0000
iiana 1
T~
r<lu<4 to
1
AA
21
SS
SS2
52
4-
mature
i
SB
"
*
c
A c
f
9
h
C. Son,. ..ltt .1 ft X 6
* * ChTO "'" t "" d * h
} 3 ( QAA 00oa )
wAMUU
fifi
Fig. 15
A represents the male parent ; his immature germ-cells have derived their chromosomes,
germinal determinants or representative particles (Galton) from his father and mother, and
they are respectively represented b) different figures. The eight germ-mature chromosomes
are reduced to four during maturation, two from each parent ; the figures a-f indicate the
combination of two maternal with two paternal, all diseased, but in different degrees and
modes. B represents the female parent, in which there is an inherited taint, but only to a
slight degree, coming from the maternal side ; in the mature germ-cells only one containing
number 13 will be tainted. C shows some of the results which may arise from the
conjugation of A X B.
Certainly this idea of the scheme explains certain facts which have been
observed in the pedigrees I have shown ; it shows why the offspring of
26
parents derived from two tainted ancestral stocks are more likely to suffer
with an intense form of the disease ; it shows also why more of the offspring
are liable to be affected, (and it shows why a certain proportion of the off-
spring may escape entirely; but according to the hypothesis thus advanced
it does not explain why only relatively few of the offspring are tainted as
compared with the numbers born, even though there be convergent neuro-
pathic inheritance, that is, the germinal determinants of both parents may
be largely tainted and yet fewer offspring are affected by the disease than
would be expected. tfln neuroses and psychoses it is not a disease that is
transmitted but a predisposition or tendency^ and. some other factor than
\ the inborn is required to produce the disease./^ If we ask ourselves the ques-
tion : How could Nature best purify an urisouno! stock? the obvious answer
would be to cause coalescence or crystallization out of the unsound germinal
determinants into a few of the offspring, leaving the germ-plasm of the
others free." This would not only purify the stock by segregation but by
concentration in one or two offspring ; it would lead to intensification and
anticipation of the disease. The .diseased offspring would be unfit for the
struggle for existence and propagation. In putting forward this coalescence
theory of similar diseased germinal determinants, I may mention in support
of it a statement made by Galton in his great work on Natural Inheri-
tance. In the process of transmission by inheritance elements derived
from the same ancestors are apt to appear in large groups, just as if they
had clung together in the pre-embryonic stage, as perhaps they did. &
Statistical Data Relating to Inheritance and Insanity, especially in Relation
to Anticipation.
Six months ago data referring to 508 pairs of parent and offspring had
been collected from the records of 464 insane parents whose 500 insane
offspring have been also resident in the London County Asylums, and in
these the age of the first attack has been ascertained.
Direct Heredity.
The following table is compiled from 217 pairs of father and offspring
and 291 pairs of mother and offspring. The figures denote the percentage
of cases whose first attack occurred within the given age periods.
TABLE I.
Age Periods.
Father.
Offspring.
Mother.
Offspring
Under 20 years...
I '4
26-2
0-6
27-8
20-24 ,,
0-4
18-0
3'4
157 A ^
25-29
1*4
18-0
4 '4
18-2 | |
30-34 n
9'6
13-0
7*8
I3-4 **
35-39
"'5
7'3
9-2
10 -o
40-44
9-2
6-4
10-3
5 '8
45-49 ,,
I4-3
6-0
12 '0
37 i^^
50-54
I7'5
0-9
12-3
2 '4 ^o'g
55-59
i3'8
37
I 4 -0
17 ~~^
60-64
IO'I
11-6
i '3
65-69
5'o
8-8
70-74 n
4-6
0-4
3'i
75-79
0-4
1-3
80
0-4
0-6
This table is represented graphically in the subjoined Figs. 16 and 17,
the abscissae representing the age periods and the ordinates the percentage
of cases whose age at the time of first attack falls within the given periods.
FATHER
OFFSPRING
MOTHER
OFFSPWM4.
Fig. 1 6.
*x
CURVES SHOWING ANTEDATING.
Fig. 17.
Figs. 1 6 & 17 represent diagrammatically the age incidence of first attack in parents and offspring.
The first peak in the curve of the parent is due to the incidence of a larger number of cases of
general paralysis in the male as compared with the female at this age period. It would be
much more marked were it not for the fact that the cases of general paralysis among relatives
are not numerous comparatively with other forms of insanity. This is as we should expect,
for it is an acquired disease, and heredity plays a far less important part in its etiology than in
the true insanities. It will be observed that the parent curves, male and female, attain their
maximum in the involutional period. There is an obvious difference in the male and female
28
parent curves. There is a greater incidence of insane mothers under 30 than fathers ; this is
due to puerperal cases, of which there were a fair number. These figures (16 and 17) are
constructed upon the data contained in Table I. The abscissae represent the age periods and
the ordinates the percentages of cases whose ages at the time of attack is first given.
Collateral Heredity.
The following table is compiled from 193 pairs of uncles and aunts with nephews and nieces
in which only collateral heredity is manifested, and 231 pairs of uncles and aunts with nieces or
nephews, in which are included those instances where one or both parents of the nieces and
nephews are also insane. The figures denote the percentage of cases whose first attack occurred
within the given age periods.
TABLE II.
Collateral Only.
Collateral and Direct.
Age Periods.
Uncle
Niece
Uncle
Niece
or Aunt. j or Nephew.
or Aunt.
or Nephew.
Under 20 years
5'2
207 5-2
25*5
20-24
3'i
i 19*2
3*4
177
25-29
6'2
18-6
7-8
19-0
30-34
12-9
17-1
H;3
I5' 1
35-39
11-9
12-4
1 1 "2
40-44
ii*3
12-4
io'4
4'3
45-49
12-4
I2-I
2-6
50-54
14-5
2'I
2*1
17
55-59
77
rs
8-6
60-64
8.0
8'2
65-69
1-5
'5
17
'4
70-74
I'D
75-79
3*i
2*6
.
80
-
UNCLES Ann AUNTS
;wS/N4oWilcS
COLLATERAL ONLY
V
Fig. 1 8 Fig. 19
Fig. 1 8 shows the curves of uncles and aunts and nephews and nieces constructed from the
percentages in Table II. Fig. 19 shows the curves of uncles and aunts and nephews and
nieces, including those cases where one of the parents was also insane, so that there is direct
and collateral heredity. It will be observed that there is a considerable difference in the
offspring curves. When there is only collateral heredity there are a far larger number of
offspring in which the first attack occurred in the later periods of life, There is antedating,
but it is not nearly so marked as is shown in Fig. 19; nor is it nearly so marked as in parents and
offspring, Figs. 16 and 17. These figures are constructed from the daca contained in Table II.
29 '. ' >-V.
This tendency of certain diseases to occur at an earlier age in the off-
spring of diseased parents was termed by Darwin " antedating " or
"anticipation," and I have found, as the above statistics show, that
there is a singular tendency in the insane offspring of insane
parents for the insanity to occur at an earlier age and in a more intense
form, either as congenital imbecility or the primary dementia of adolescence,
an incurable disease; not that all the cases are of this nature, but a large
proportion of them. First let me call attention to certain facts regarding
the age at first attack in 508 pairs of parents and offspring. Some of the
parents had more than one insane offspring; there were only 464 parents.
You will observe that 47*8% of the 500 offspring had their first attack
at or before the age of 25 years, and as you see in the curves of parents
and offspring the liability to the child of an insane parent becoming insane
tends rapidly to fall. (Figs. 16 and 17.) Now, besides the fact that this shows
Nature's method of eliminating unsound elements of a stock, it has another
important bearing, for it shows that after 25 there is a greatly decreasing
liability of the offspring of insane parents" to become insane, and therefore
in the question of advising marriage of the offspring of an insane parent
is of great importance. Sir Geo. Savage recently said that this statistical
proof entirely accorded with his own experiences, and that if an individual
who had an hereditary history had passed 25 and never previously shown
any signs he would probably be free, and he would recommend marriage.
Another important fact was elicited, viz., that in 58 8% of the 508 off-
spring of insane parents the first attack in the offspring occurred at an age
20 or more years earlier than in the parent. Similar tables and curves
(Figs. 1 8 and 19) compiled from 193 pairs of uncles or aunts and nephews
and nieces show the same fact but not to so marked a degree.
As a leading article in a recent number of the British Medical
Journal refers to this question of anticipation tending to the ending or
mending of a degenerate stock being used as an argument against measures
being taken to prevent the propagation of the unfit, I particularly desire
to impress upon my audience the fact that I have always laid great stress
upon the necessity of segregating congenital imbeciles now that Nature, by
man's aid, does not kill them off as formerly. Moreover, it is highly desir-
able to follow up those members of the family who are sane, and par-
ticularly those who are discharged as cured, in order to see whether Nature
has really mended that degenerate stock.
Recurrent Insanity and Propagation.
One of the great arguments advanced for sterilization has been that
recurrent cases of insanity breed lunatics between their respective dates of
admissions to asylums. I have no doubt this is the case, but before Parlia-
ment would consider such a procedure it would require the strongest and
3
soundest evidence that life segregation or sterilization would appreciably
diminish the numbers of the insane.
I have endeavoured to ascertain some facts relating to this question.
The inference that can be drawn is that about one-fifth of the recurrent
cases or approximately one-twentieth of the female admissions have children
after their first attack of insanity and of 31 such cases examined, 73
children were born after the first attack of insanity in the parent. A
number of these were cases of puerperal insanity. I am unable to give
exact figures as to the fate of these children, but a good proportion of them
died in infancy, and the majority of them would be too young to decide
which might become insane.
Recurrent insanity and epilepsy, with which it is closely allied, in relation
to hereditary transmission, is one of the most important problems requiring
scientific investigation by complete family histories and construction of
pedigrees, and I can conceive no more important work on the relation of
heredity to insanity than the following up, systematically, the history of
children born in the sane intervals of cases admitted to the asylum and
subsequently discharged.
From the statistics of relatives a computation has been made of the pro-
portion of offspring who were born after the the first attack of insanity in
the parent; it was found that 46 offspring out of 581 were born after the
first attack of insanity in the parent, i.e., 7 '9%. That is to say, in the
case of 529 insane parents, the birth of only one-twelfth of their 590 off-
spring would have been prevented by sterilization or life segregation of the
parent after the first attack of insanity. These figures refer to the offspring
which become insane, but there are a large number of offspring who do not
become insane, and these would be cut off if life segregation or sterilization
were adopted.
Single and Dual Neuropathic Inheritance.
Every pedigree is a study in itself and occupies a whole book if sys-
tematically carried out as regards inheritance of characters, and the classi-
fication of the same is a matter of considerable difficulty. We have not
enough systematic pedigrees yet to form precise data and conclusions upon,
but perhaps I may be permitted to refer to indications from the examination
of pedigrees of three generations which I have obtained myself and com-
bined with those obtained by Dr. Wilson White and Dr. Daniel. I will
divide them into two groups :
Group i. Those with a double pathological inheritance, that is, both
ancestral stocks show insanity, feeble-mindedness, drunkenness, epilepsy,
suicide, or nervous disease of various kinds, direct or collateral, within two
generations. In these 18 families there were 116 children born alive, and
100 reached adolescence, and among them were 39 insane, suicides, or
sufferers with nervous disease, and 61 apparently normal. Thus 39% of
the offspring reaching adult age were affected. But these are probably
selected pedigrees, and are not numerous enough to draw definite conclusions
from.
Group 2, in which there was an insane inheritance on one side only.
Ninety families were examined. Of 384 children born alive 40 died in
early life; there were 33 insane, suicide, or nervous disease, and 311 normal.
Thus 9-6% of the offspring reaching adult age were affected.
The conclusion which possibly might be drawn is that a_ghilj horn r>f a
dual neuropathic inheritance^ stands on an average a chance of being insane
four H^ a^-great aVjySere only one stock is infected. This, however,
applies to the mass and not the individual.
It might be argued that there are a certain number of imbeciles who
could be allowed all social privileges excepting reproduction ; this would
be on the ground that they could pick up a living, and sterilization would in
no way interfere with their doing this. The objections are: The cry of
one law for the rich and another for the poor ; and the legalisation of an
operation that is fraught with many hidden social dangers. I often think
that a number of people who are crying out about the monetary burden of
supporting the unfit are themselves not doing their duty to the race. Many
have no children or they restrict the births ; moreover, one does not find the
numbers in a family increase with the income. When hereditary health as
shown by longevity, fertility, and mental stability in a stock is regarded as
a greater asset for happiness in the family and the nation than hereditary
wealth, then will be the time for the rich and comparatively prosperous to.
suggest the desirability of sterilization of the insane 'pauper. For no one
supposes that it would be carried out in all classes..
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