OF
STERILIZATION
THE
UNFIT.*
BY
H. C. Bristowe, M.D.
subject of sterilization has been so much in the public eye of late that it may be as well to consider The
whether there from
adopting
are
it
any real benefits method of dealing with a certain
likely
as a
to
accrue
I do not propose to give my own views to the utility of it, as (to tell the truth) they are still
class of as
case.
but rather is it my intention to give some of the arguments both for and against its adoption, and
fluid
;
try and gather what the general opinion of the profession in Bristol is. This subject must be considered from the religious, legal, ethical, scientific and social aspects before any to
definite conclusion
can
be arrived
at
as
to whether
powers should be obtained to legalize such an operation. The religious point of view need not detain us
long. dead
The Roman Church
against
moral
no
as
The view taken
it.
or
is,
religious right
to
one
by
would
it is that
interfere
expect, we
with
have the
procreation of children, or in any way to prevent an}^ The one exception man or woman becoming a parent. is that if it is necessar}^ for the health of a man or woman that a diseased organ should be removed, which is incidentally one of the organs of generation it is *
May,
permissible.
But it must be for that definite
Communicated to the Bristol 1931.
Medico-Chirurgical Society,
13th
Dr. H. C. Bristowe
190
not for the purpose of preventing The other churches have not spoken
and
purpose,
procreation. definitely; indeed, judging
from the
so
it
the Lambeth Conference
objections
this is
by the Anglican Church probably not true of all its
must, however, be taken into account, if the the
should
public legalization of
consider that
is
position
we
Are
creatures ?
profession
to Parliament for the
apply a
more
difficult
extent linked up with the
some
risks of
ever
sterilization.
The ethical to
no
The attitude of the Churches
individual members.
or
that
appear
of
would be raised
whole, though
as a
would
findings
operation
to say to anyone
?
It is Do
religious.
we
right to mutilate our fellowjustified in subjecting them to the Do we think that we have a right
have
we
one.
"
:
a
Thou shalt not breed
"
?
Have
"
the
Thou shalt right to say to any woman : not enjoy the joys of motherhood ? Have we any ethical right to say to any man : Thou shalt not have the pleasures of a family life in a home of thine
we
"
"
"
own
Then is it wise to let loose
?
who
women,
are
in
who would
possibly
Would
not be in
certain
they
type,
disease ?
danger
no
have
no
of
a
number of
motherhood, and
motives for
chastity
?
great demand among men of a and thus become carriers of venereal
Also I would
ask, in
a more
tentative way,
would not sterilized
men be in request among women moral of a poor type ? I know that the Eugenic maintain that such men are not attractive to Society
this may be so, but safety might well give attraction which the man himself had not. It is
women ; an
suggested
that efficient
these risks to
a
minimum.
guardianship
would reduce
I wonder how these efficient
Sterilization
guardians would
set about
of
the
making
Unfit their
191
guardianship
efficient ?
legal position is very definite. The law says very plainly that sterilization, qua, sterilization, is illegal, and that mutilation is an offence. The British Medical Association took the opinion of counsel on this question of legality. Sir Travers Humphreys gave his opinion in the following terms : I am clearly of opinion that any medical man who performs the operation described upon a defective within the meaning of that term, as defined within the Mental Deficiency Act 1913, would in the present state of the law be acting illegally and without any legal justification. I assume the consent of both The
"
parents and the excellence of the motives of all concerned, but the fact remains that the operation assault upon and the wounding of the person operated upon. The only legal justification for such an action in regard to a of sterilization involves
an
person who, either from extreme youth or old age, as mental or from any other cause such weakness, is be or
the
giving a reasoned consent, would that the operation was necessary to the health well-being of the patient. I do not gather from incapable
case
of
that it is contended that sterilization would the condition,
improve
physical
or
mental, of the
defective. "
legal risks involved in such an operation would attach equally to all persons concerned?the doctor who performs it, and the parent or guardian who requested or sanctioned it. The doctor would have, in my opinion, no The
"
answer
to
an
indictment for the offence of unlawful
Dr. H. C. Bristowe
192
wounding contrary to Section 20 of the Offences Against the Persons Act 1861." This is only a portion of the written opinion, but the rest strengthens and supports what I have extracted from it. As to the question of voluntary sterilization, Lord Riddell is of opinion that this would be equally illegal. Such, then, is the legal position of sterilization as
the law stands at I
now come
much
present.
to the social side.
importance
as
It is of every bit as the scientific side ; in fact, it may
well be that the social is the most
important aspect
question. There cannot be any doubt sterilization, such as may be necessary for the removal of disease or for the saving of life, is not only justifiable but imperative. There is, however, of the whole
that incidental
another class of case, where the answer is not so clear. Are we justified in sterilizing a woman because her mental health would be If
a
each
woman
pregnancy ? has suffered from mental disease after
endangered by
confinement, would sterilization be
operation
?
I feel inclined here to make
to my intention of not
Such
a course seems
eventually
an
justifiable exception
expressing my opinion. to be quite a proper one, attack following each successive
since every mental parturition leaves the until
a
to
own
me
woman
there is
at
a
lower mental
risk of
level,
dementia.
complete right Failing that, but even here employed, accidents happening, which
a
No doubt abstinence is the
course.
contraceptives might be there is a possibility of may endanger the sanity of the patients. It has been urged that sterilization of defectives would effect a great saving of expenditure by local authorities, in that there would no longer be any
Sterilization
necessity
Unfit
of the
to erect and maintain institutions for these
grave danger. If sterilization with that idea in view, Here there is
cases.
ourselves in with are
us a
now
193
a
predicament.
a
we are
to have
shall find
we
We should still have
considerable number of persons at large who safe in public institutions?safe as regards their
but also the
public safety. Many of these persons, if not almost all who are already in institutions, are quite unable to earn their own living not
or
only
own
to take proper
care
of
treatment would still be
I have
already
themselves, and institutional
discussed the
I should say the immoral, the ethical aspects. And has
a
it is
social as
as
well
must admit that this
ethical side.
It
immorality
of
seems
a
from the
as
anything
that
which will
certain section of
community. We
now come
preventing,
or
scientific side chiefly pressed least limiting,
to the
Sterilization has been of
we
objectionable from the social
add to the natural the
as an
moral, or perhaps question under
side of the
We do not want to do
ethical.
for them.
required
at
of the for
as
question. a
means
the number of
defectives, which is at the present time stated to be 011 the increase. I do not for a moment say that mental
the increase, I am not in a position to make any definite statement on this subject. It is argued that if mental defectives were sterilized, mental
it is not
on
deficiency, even if greatly reduced. There are, to be
not
stamped out,
would at least be
however, several difficulties which have
overcome.
What classes of defectives is it
suggested should be sterilized ? If the answer is all," then we may ask what is the use of sterilizing "
Dr. H. C. Bristowe
194
It must remain necessary that he should be dealt with either in an institution or an
idiot who does not breed ?
under very efficient guardianship, since according to the statutory definition he is a person who is unable to
protect himself against
physical dangers. nothing for himself, not even capable defending himself against an ordinary blow. He common
He is able to do of
cannot feed himself.
and cannot read,
They the in
quite
are
ordinary
an
These
we
have the various
very unlikety to breed, write or understand the value of money.
of imbeciles.
grades
Next in order
unable
to
necessaries of
institution for their
are
provide
themselves with
and must be detained
life, protection, if there is
own
not
very efficient guardianship. The lower grade imbecile cannot fend for himself, he is often vicious, and unfit to be at
large.
mental
We
defective,
now come
performed
higher grades?the
and it must be for these and these
alone that sterilization what age is it
to the
suggested
can
be asked for.
that this
Again,
operation
at
should be
?
It must be remembered that in childhood there
complete development of the mind any more than there has been of the body, and that at puberty a mental defective may either show signs of rapid deterioration, when sterilization would be a work of supererogation, as institutional treatment, or effective guardianship, is essential for his own safety. On the other hand, at that age there may begin a
has not been
improvement in his mental activities, and in such cases sterilization would be unjustifiable. Then, distinct
again, that How
we
we are
shall have to decide consider would we
on
the
justify
to arrive at that ?
grade
such
of
an
deficiency operation.
What may appear
Sterilization to be defective in
normal,
as
pass
defective is
or even
the
of
above
Unfit
195
society might possibly normal, in others. We
surroundings
in which
a
mental
up may to no small extent affect " When Herd,1 in his book, says :
brought
his mental state. native
grade
one
must admit that the
of
intelligence
is not fostered
by
a
normal contact
with the outer world of persons and events, both it and specific capacities do not develop as they should
normally, to
a
and certain
greater
or
capacities may even atrophy degree." Also :2 The mental ratio
less
normal child whose education, either formal or natural, is seriously interfered with is liable to fall, of
a
and
usually does fall." Again, quoting from
in his
report
higher
are
own
two
:
"
Dr.
Lewis,
survey, says that for every more others only slightly
or
in mental and educational
mental welfare of the
his
on
defective there
Herd's work
capacity,
and at
a
conference, held just after the issue
report, he stated that for every defective there subnormal, that is, enough to make
ten others
were
them
relatively and in various degrees incapable of coping with the elementary school curriculum." It seems quite obvious from the above quotations
that the
question of what defectives shall be sterilized
and what shall not be is Nor
are
any,
are
by
no
means
an
easy
one.
say to what extent, if these various degrees of mental deficiency
we
in
a
position
to
hereditary. Thej^ may all be hereditar}^. If so, is proposed that all persons showing some incapacity of imbibing knowledge or exercising wisdom and it
prudence
are
to be
subject
to sterilization ?
I admit
compulsory sterilization of all such, as phj^sical degenerates, is certainly Utopian,
that the
well
all
but
as
196 it
Dr. H. C. Bristowe
can
hardly
be considered
practical
as
in the
present
time. Once
are
more,
sterilize
to
we
those
who
are
educationally defective, but who are quite capable of earning their own living. Or are we to advise it only for those who are socially defective, that is, those who, though showing some power of imbibing knowledge, are yet incapable of adjusting themselves to modern civilized conditions, including the erratic genius who has much wit and power in some directions, and
yet is quite unable
adjust himself
to
surroundings and so earn his own But supposing we can arrive standard, it does
seem
to
his
to
bread ? at
some
definite
that it will have to be
me
very low standard. What, may I ask, is the standard, not of education, but of mentality of the greater a
proportion Is it not
our
from the
one
Are
public elementary
standard, low
same
standard more
our
to take
schools ?
It
ours
?
standard
take them
to
we
seems
must be
or
our
professional classes,
are
high, adopted for
to the
we
Or
schools ?
some
once
?
universities, from
from the from
of the inhabitants of these islands of very low
a
to
me
that
taken, and the
I refer you I have taken from Dr.
all classes.
quotations
It does appear that what may be taken standard for some classes would be a very
Herd's book. as
a
low
high one
for others.
Those who
advocate sterilization maintain that
the result of it would be to diminish the incidence of mental
deficiency, and believe that in the
course
of
This years this incidence would be much reduced. based on a belief that mental deficiency is argument is
hereditary
on
Mendelian
principles.
It is for these
Sterilization advocates to
produce
of
some
Unfit
the
sort of
197 that their
proof
theories are correct. At present there is very little evidence that can be produced. I do not think that I
do better than
can
quote from
the
a
brochure
published
Eugenics Society,3 very moderatefy-wiitten 14 Some think brochure in favour of sterilization: by
a
transmitted
along Mendelian lines by a single recessive factor, or by a number of different factors. Others, such as Myerson, Devine and Tredgold, think that defectiveness is largely produced by toxins acting upon the spermatozoon or ovum or early embryo according to the so-called law of blastophoria." Tredgold,4 in a note published in Mental Welfare, that
defectiveness
says:? "It is of
now
cases
are
is
generally recognized result
a
of
'
that the
inheritance.'
majority It
has
unnaturally, been assumed by those who have no great experience of defectives, and who are unacquainted with the subject of heredity, that the mentally defective child must necessarily be the offspring of mentally defective parents. It is of the utmost importance to realize that this is not so, and consequently,
not
without its
parents
child may be due to inheritance being similarly defective. The
explanation
of this
paradox
that the defect of
a
inheritance of these
chiefly
in
mental
deficiency
cases.
America, have
lies in the
nature
of
Although some writers, attempted to prove that
is due to the absence in the ancestral
germ cells of certain definite constituents, and that transmission is in accordance with the laws formulated
by Mendel, successful.
attempts have been entirely unOn the contrary, there is every reason these
198
Dr. H. C. Bristowe
to conclude that mental defect is not due to the absence
from the germ of a definite factor or series of factors ; but that it is the expression of an impairment of
developmental potentiality. In other words, it is due to a qualitative rather than a quantitative change ; this change being in the nature of a germinal vitiation. There is
think, however, that the
to
reason
of this vitiation varies not different individuals of the
only
same
amount
in the germ cells of stock, but also in the
Moreover, it is germ cells of the same individual. even with vitiated that highly probable germ cells the condition of the be to
extent
some
nature of the
The result is
that, although
ante-natal environment. the
majority
of mental defectives
whose
therefrom will
offspring resulting influenced by the
come
of families
germ undergone vitiation, this change shows itself in many other ways than mental In some individuals it may be manifest defect. cells
as
dementia
in
others
instability. these
defect,
as .
classes
have
precox certain .
or
other
forms
forms
of
dementia;
of
insanity or it is probable Nevertheless,
.
mental that all
'
of
carriers' of mental persons are and that a chance combination of adverse
circumstances may at any time so embarrass the development of the impaired germ cells as to result in
mentally deficient offspring." Again I may ask the question : Is
a
mental
deficiency
the result of germ cells which are defective primarily Is the impairment of the germ cell or secondarily ? due to defects inherited from one or both parents, or is it due to
some
impregnation,
or
do know that
damage
in the
some
course
diseases
germ cell after of development ? We
to
the
occurring in
the
developing
Sterilization brain
will
mental
cause
to
inherited
rate, be of
number of defectives mental
for
as,
instance,
are
then sterilization
defects,
at any
theoretically
defects,
If mental defects
encephalitis lethargica. due
199
Unfit
of the
in
use
the future.
in
chiefly should, the
limiting
If, however,
deficiency injury of the germ cells, or to developmental errors, then sterilization would be of no value. Sterilization is legal and has been is due to
practised in some of the American states, and the results, so far, have not been very encouraging. Shrubsall5 to
states that
show that the
are
only 5 offspring of
in these the
parents
that would have been
they
of those was
"
several lines of
rarely
were
were
less than those who which
can
seems
mental status
were
called
one
proportion investigation
forms of mental
clear that
hereditary. mentally unfit is we
considered
to be
must obtain much
have at present. information than there are such differences among those who we
give
Some
superior."
are no
be considered
more
able to
had
even
The
defective in
If, then, sterilization of the
approved, it
a
of certification
authorities consider that there
deficiency
of
to be dealt with.
parents who
seem
per cent, of defective children defective parents, though even
permitted
subject
inquiry
judgments
on
this
In
fact,
are
best
subject
agree that we are not in to form any opinion evidence possession of sufficient of value. We require much information before we that
can
we
must at
ask for
present
legislation
to
give
effect to sterilization.
What, then, are the conclusions at which we must necessarily arrive ? First, we require and must obtain more knowledge as to the cause of mental deficiency than we have at present. Next, it must be clearly N
Vol. XLVIII.
No.
181.
Dr. H. C. Bristowe
200
all the authorities that at its best
to
out
pointed
be
sterilization
can
segregation,
that
the
need
of
of
no
use
an
as
alternative to
sterilization will do away with institutional treatment and efficient no
guardianship, and that whatever range of sterilization may be permissible in the future, the amount of money spent on the segregation of mental defectives cannot be reduced, but will have to be increased. This will be increasingly clear when it is fully understood that
large percentage of recidivists are of the mentally defective classes?persons who are unable from mental a
defect to lead useful lives outside almost
take to criminal lives.
perforce
Of course, if attitude
(as
logically
:
institutions, and
we
we are
choose to at
liberty
adopt quite
to
We consider that
do)
we
a
different
may say quite should permit and we
all
degenerates whether mental or physical, and thus prevent the breeding of the large masses that at present bring numbers of undersized, under-intelligent and criminal persons into this world only to be kept at the expense of those who are not degenerates. For there can be but little doubt that at present we are helping to bring about a
try
to enforce sterilization
course
that is
unfit.
This would
that the
contrary
public
mean
to
on
nature, the survival of the
such
a
would not for
wholesale sterilization
one
moment hear of
it,
as so many would be honestly wondering if their own It is not within the turn would not be coming next.
range of practical politics. I will close by reading to
passed by
you the resolution the Executive of the Central Association
for Mental Welfare in I agree
:?
London,
a
resolution with which
Sterilization "
That
selected
might
they
cases
be
of
the
opinion
Unfit
that there
201 are
certain
of mental defect in which sterilization
appropriate
an
if there is
are
of
and desirable
procedure
;
any doubt as to the legality of the in such cases, the Committee are of
operation opinion that the Association should favour legislation to admit of such selective sterilization,
adequate safeguards can be devised to prevent its improper use and to restrict its performance in such cases. That in regard to the question of the wholesale sterilization of defectives as a means of greatly reducing the incidence of mental deficiency, the provided
that
"
support of for altering their opinion
Medical Committee know of
this, and
see
no
reason
no
evidence in
that such would be attended with
insignificant
comparatively
results." Discussion.
Dr. R. J. A.
congratulated on
Berry, in opening the discussion,
the
Society
on
having
three members
Deficiency. He favourably impressed
the B.M.A. Committee for Mental
stated that he had been very by the way in which the results of sterilization in California had been stated in Sterilization Betterment.
for Human
He did not think that sterilization would
deficiency, although he had no doubt of the strong hereditary factor in its causation, and he thought sterilization would do little to prevent
stamp
out
mental
feeble-mindedness.
This
question is
one
of the
greatest
problems of the modern state, and all methods so far employed to check its increase had failed. He would like to
see
the medical
profession given
the
right
to
Dr. H. C. Bristowe
202
sterilization under conditions determined
perform
the State.
He felt that females
than males when not under
high
or
medium
were more
dangerous
control, especially those of
of mental
grades
by
deficiency.
Mr. C. F. Walters considered that the
question
not, "Dare we perform sterilization ?" but rather "Dare we not ?" He thought that the first step was
was
to educate the medical
influence
profession played by heredity, by
in all medical be
was
a
means
of discussions
lay public should opinion the first duty
In his
to the race, and not to the individual.
Dr. J. R. Charles said that in his
capacity
medical visitor to Stoke Park
nearly gave
a
every
the
knowledge of
and then the
educated.
similarly
of medicine
societies,
to
case
Colony he found deficiency that he
of mental
of
that saw
strong family history. He found the question of free from control
very responsible one, and he did not think that sterilization would do away with the need of institutional treatment,
letting patients
since the liberation
of
mental defectives would
large soon
a
numbers
result in
a
of sterilized
large
increase
in venereal disease. Dr. J. 0. Symes considered that the certification
degrees of mental deficiency was very difficult, and he thought that if sterilization was involved in certification it would make the certifying officers chary of labelling a child mentally defective unless the case
of mild
was
extreme.
Moreover, these
extreme
cases
needed
supervision, so that in these cases sterilization He did not agree that there was a was superfluous. large element of heredity in the etiology of mental deficiency, but thought that a lot of the trouble was environmental in origin, many of the children being
care
and
Sterilization
of
the
Unfit
203
up in institutions where they In better lived very difficult and cramped lives. class families he found no hereditary history of the
illegitimate
and
brought
condition, and the the
family.
cases
should mental
Why
Finally,
sterilization
was
an
deficiency
freaks in be
singled
more
the sentimental
Dr. R. G. Gordon as
as
than any other physical he considered the great objection to
out for sterilization any
defect ?
regarded
were
one.
regarded voluntary
sterilization
very foolish idea, as the only result would be If the profession increase in venereal disease.
a
justifiable, he urged them to go all out for it, and to drop such half measures as voluntary schemes. He personally did not approve considered sterilization
of it, as he did not see how it could in any way lessen the need for institutional treatment. Dr.
H.
hereditary this factor that the
Carleton, while
H.
factor in mental
probably a original delinquent was
agreeing with the deficiency, thought that
Mendelian was now
recessive, and
far back in the
that he
regarded sterilization at the present time as merely pruning the periphery. Dr. A. G. Moris on quoted figures showing that in mentally defective families only 33 per cent, of the
common
children
stock
were
prevent 100
;
so
mentally deficient, cases
of mental
so
that in order to
deficiency
200 normal
children would have to be sacrificed. He thought that sterilization would be very slow in its effects. Dr. W. R. Dawson found mental
deficiency
in the lower
larger incidence grade schools, and a
of
of he
hereditary thought that while the majority all were not. Sterilization might prevent the birth of a certain number but by no means all, and in any caso cases were
204
Sterilization
of the
Unfit
institutional treatment would be necessary for life. He considered that the Scotch method of boarding out these
cases
merited consideration.
Dr. A. M. B. Milner
evolution,
as
thought that possibly creative taught by Bernard Shaw, might
counteract the Mendelian factor in the inheritance of mental
aenciency. Dr. F. Bodman stated that the
over-populated, would be the
and
that
discovery
of
country
better
than
sterilization
fool-proof
a
grossly
was
method of
contraception. Dr. Preston King did not doubt the element in the causation of mental
hereditary deficiency, and
breeding from defective stocks should be avoided. He suggested that sterilization should apply to all cases well enough to be discharged from thought
that
institutions. Dr. could
Bristowe, in reply, agreed that sterilization
never
replace segregation. REFERENCES.
1
Herd, H., The Diagnosis of Mental Deficiency, London,
2
Herd, H., The Diagnosis of Mental Deficiency, London, 1930.
3
Eugenic Sterilisation, second edition, The Eugenic Society.
4
Tredgold,
5
A. F., Mental "
Welfare,
Conference Shrubsall, F. C., Session, 12th December, 1930.
on
xi.
9-14,
1930.
1930.
Mental Welfare,"
Report of
STERILIZATION
THE
UNFIT.*
BY
H. C. Bristowe, M.D.
subject of sterilization has been so much in the public eye of late that it may be as well to consider The
whether there from
adopting
are
it
any real benefits method of dealing with a certain
likely
as a
to
accrue
I do not propose to give my own views to the utility of it, as (to tell the truth) they are still
class of as
case.
but rather is it my intention to give some of the arguments both for and against its adoption, and
fluid
;
try and gather what the general opinion of the profession in Bristol is. This subject must be considered from the religious, legal, ethical, scientific and social aspects before any to
definite conclusion
can
be arrived
at
as
to whether
powers should be obtained to legalize such an operation. The religious point of view need not detain us
long. dead
The Roman Church
against
moral
no
as
The view taken
it.
or
is,
religious right
to
one
by
would
it is that
interfere
expect, we
with
have the
procreation of children, or in any way to prevent an}^ The one exception man or woman becoming a parent. is that if it is necessar}^ for the health of a man or woman that a diseased organ should be removed, which is incidentally one of the organs of generation it is *
May,
permissible.
But it must be for that definite
Communicated to the Bristol 1931.
Medico-Chirurgical Society,
13th
Dr. H. C. Bristowe
190
not for the purpose of preventing The other churches have not spoken
and
purpose,
procreation. definitely; indeed, judging
from the
so
it
the Lambeth Conference
objections
this is
by the Anglican Church probably not true of all its
must, however, be taken into account, if the the
should
public legalization of
consider that
is
position
we
Are
creatures ?
profession
to Parliament for the
apply a
more
difficult
extent linked up with the
some
risks of
ever
sterilization.
The ethical to
no
The attitude of the Churches
individual members.
or
that
appear
of
would be raised
whole, though
as a
would
findings
operation
to say to anyone
?
It is Do
religious.
we
right to mutilate our fellowjustified in subjecting them to the Do we think that we have a right
have
we
one.
"
:
a
Thou shalt not breed
"
?
Have
"
the
Thou shalt right to say to any woman : not enjoy the joys of motherhood ? Have we any ethical right to say to any man : Thou shalt not have the pleasures of a family life in a home of thine
we
"
"
"
own
Then is it wise to let loose
?
who
women,
are
in
who would
possibly
Would
not be in
certain
they
type,
disease ?
danger
no
have
no
of
a
number of
motherhood, and
motives for
chastity
?
great demand among men of a and thus become carriers of venereal
Also I would
ask, in
a more
tentative way,
would not sterilized
men be in request among women moral of a poor type ? I know that the Eugenic maintain that such men are not attractive to Society
this may be so, but safety might well give attraction which the man himself had not. It is
women ; an
suggested
that efficient
these risks to
a
minimum.
guardianship
would reduce
I wonder how these efficient
Sterilization
guardians would
set about
of
the
making
Unfit their
191
guardianship
efficient ?
legal position is very definite. The law says very plainly that sterilization, qua, sterilization, is illegal, and that mutilation is an offence. The British Medical Association took the opinion of counsel on this question of legality. Sir Travers Humphreys gave his opinion in the following terms : I am clearly of opinion that any medical man who performs the operation described upon a defective within the meaning of that term, as defined within the Mental Deficiency Act 1913, would in the present state of the law be acting illegally and without any legal justification. I assume the consent of both The
"
parents and the excellence of the motives of all concerned, but the fact remains that the operation assault upon and the wounding of the person operated upon. The only legal justification for such an action in regard to a of sterilization involves
an
person who, either from extreme youth or old age, as mental or from any other cause such weakness, is be or
the
giving a reasoned consent, would that the operation was necessary to the health well-being of the patient. I do not gather from incapable
case
of
that it is contended that sterilization would the condition,
improve
physical
or
mental, of the
defective. "
legal risks involved in such an operation would attach equally to all persons concerned?the doctor who performs it, and the parent or guardian who requested or sanctioned it. The doctor would have, in my opinion, no The
"
answer
to
an
indictment for the offence of unlawful
Dr. H. C. Bristowe
192
wounding contrary to Section 20 of the Offences Against the Persons Act 1861." This is only a portion of the written opinion, but the rest strengthens and supports what I have extracted from it. As to the question of voluntary sterilization, Lord Riddell is of opinion that this would be equally illegal. Such, then, is the legal position of sterilization as
the law stands at I
now come
much
present.
to the social side.
importance
as
It is of every bit as the scientific side ; in fact, it may
well be that the social is the most
important aspect
question. There cannot be any doubt sterilization, such as may be necessary for the removal of disease or for the saving of life, is not only justifiable but imperative. There is, however, of the whole
that incidental
another class of case, where the answer is not so clear. Are we justified in sterilizing a woman because her mental health would be If
a
each
woman
pregnancy ? has suffered from mental disease after
endangered by
confinement, would sterilization be
operation
?
I feel inclined here to make
to my intention of not
Such
a course seems
eventually
an
justifiable exception
expressing my opinion. to be quite a proper one, attack following each successive
since every mental parturition leaves the until
a
to
own
me
woman
there is
at
a
lower mental
risk of
level,
dementia.
complete right Failing that, but even here employed, accidents happening, which
a
No doubt abstinence is the
course.
contraceptives might be there is a possibility of may endanger the sanity of the patients. It has been urged that sterilization of defectives would effect a great saving of expenditure by local authorities, in that there would no longer be any
Sterilization
necessity
Unfit
of the
to erect and maintain institutions for these
grave danger. If sterilization with that idea in view, Here there is
cases.
ourselves in with are
us a
now
193
a
predicament.
a
we are
to have
shall find
we
We should still have
considerable number of persons at large who safe in public institutions?safe as regards their
but also the
public safety. Many of these persons, if not almost all who are already in institutions, are quite unable to earn their own living not
or
only
own
to take proper
care
of
treatment would still be
I have
already
themselves, and institutional
discussed the
I should say the immoral, the ethical aspects. And has
a
it is
social as
as
well
must admit that this
ethical side.
It
immorality
of
seems
a
from the
as
anything
that
which will
certain section of
community. We
now come
preventing,
or
scientific side chiefly pressed least limiting,
to the
Sterilization has been of
we
objectionable from the social
add to the natural the
as an
moral, or perhaps question under
side of the
We do not want to do
ethical.
for them.
required
at
of the for
as
question. a
means
the number of
defectives, which is at the present time stated to be 011 the increase. I do not for a moment say that mental
the increase, I am not in a position to make any definite statement on this subject. It is argued that if mental defectives were sterilized, mental
it is not
on
deficiency, even if greatly reduced. There are, to be
not
stamped out,
would at least be
however, several difficulties which have
overcome.
What classes of defectives is it
suggested should be sterilized ? If the answer is all," then we may ask what is the use of sterilizing "
Dr. H. C. Bristowe
194
It must remain necessary that he should be dealt with either in an institution or an
idiot who does not breed ?
under very efficient guardianship, since according to the statutory definition he is a person who is unable to
protect himself against
physical dangers. nothing for himself, not even capable defending himself against an ordinary blow. He common
He is able to do of
cannot feed himself.
and cannot read,
They the in
quite
are
ordinary
an
These
we
have the various
very unlikety to breed, write or understand the value of money.
of imbeciles.
grades
Next in order
unable
to
necessaries of
institution for their
are
provide
themselves with
and must be detained
life, protection, if there is
own
not
very efficient guardianship. The lower grade imbecile cannot fend for himself, he is often vicious, and unfit to be at
large.
mental
We
defective,
now come
performed
higher grades?the
and it must be for these and these
alone that sterilization what age is it
to the
suggested
can
be asked for.
that this
Again,
operation
at
should be
?
It must be remembered that in childhood there
complete development of the mind any more than there has been of the body, and that at puberty a mental defective may either show signs of rapid deterioration, when sterilization would be a work of supererogation, as institutional treatment, or effective guardianship, is essential for his own safety. On the other hand, at that age there may begin a
has not been
improvement in his mental activities, and in such cases sterilization would be unjustifiable. Then, distinct
again, that How
we
we are
shall have to decide consider would we
on
the
justify
to arrive at that ?
grade
such
of
an
deficiency operation.
What may appear
Sterilization to be defective in
normal,
as
pass
defective is
or even
the
of
above
Unfit
195
society might possibly normal, in others. We
surroundings
in which
a
mental
up may to no small extent affect " When Herd,1 in his book, says :
brought
his mental state. native
grade
one
must admit that the
of
intelligence
is not fostered
by
a
normal contact
with the outer world of persons and events, both it and specific capacities do not develop as they should
normally, to
a
and certain
greater
or
capacities may even atrophy degree." Also :2 The mental ratio
less
normal child whose education, either formal or natural, is seriously interfered with is liable to fall, of
a
and
usually does fall." Again, quoting from
in his
report
higher
are
own
two
:
"
Dr.
Lewis,
survey, says that for every more others only slightly
or
in mental and educational
mental welfare of the
his
on
defective there
Herd's work
capacity,
and at
a
conference, held just after the issue
report, he stated that for every defective there subnormal, that is, enough to make
ten others
were
them
relatively and in various degrees incapable of coping with the elementary school curriculum." It seems quite obvious from the above quotations
that the
question of what defectives shall be sterilized
and what shall not be is Nor
are
any,
are
by
no
means
an
easy
one.
say to what extent, if these various degrees of mental deficiency
we
in
a
position
to
hereditary. Thej^ may all be hereditar}^. If so, is proposed that all persons showing some incapacity of imbibing knowledge or exercising wisdom and it
prudence
are
to be
subject
to sterilization ?
I admit
compulsory sterilization of all such, as phj^sical degenerates, is certainly Utopian,
that the
well
all
but
as
196 it
Dr. H. C. Bristowe
can
hardly
be considered
practical
as
in the
present
time. Once
are
more,
sterilize
to
we
those
who
are
educationally defective, but who are quite capable of earning their own living. Or are we to advise it only for those who are socially defective, that is, those who, though showing some power of imbibing knowledge, are yet incapable of adjusting themselves to modern civilized conditions, including the erratic genius who has much wit and power in some directions, and
yet is quite unable
adjust himself
to
surroundings and so earn his own But supposing we can arrive standard, it does
seem
to
his
to
bread ? at
some
definite
that it will have to be
me
very low standard. What, may I ask, is the standard, not of education, but of mentality of the greater a
proportion Is it not
our
from the
one
Are
public elementary
standard, low
same
standard more
our
to take
schools ?
It
ours
?
standard
take them
to
we
seems
must be
or
our
professional classes,
are
high, adopted for
to the
we
Or
schools ?
some
once
?
universities, from
from the from
of the inhabitants of these islands of very low
a
to
me
that
taken, and the
I refer you I have taken from Dr.
all classes.
quotations
It does appear that what may be taken standard for some classes would be a very
Herd's book. as
a
low
high one
for others.
Those who
advocate sterilization maintain that
the result of it would be to diminish the incidence of mental
deficiency, and believe that in the
course
of
This years this incidence would be much reduced. based on a belief that mental deficiency is argument is
hereditary
on
Mendelian
principles.
It is for these
Sterilization advocates to
produce
of
some
Unfit
the
sort of
197 that their
proof
theories are correct. At present there is very little evidence that can be produced. I do not think that I
do better than
can
quote from
the
a
brochure
published
Eugenics Society,3 very moderatefy-wiitten 14 Some think brochure in favour of sterilization: by
a
transmitted
along Mendelian lines by a single recessive factor, or by a number of different factors. Others, such as Myerson, Devine and Tredgold, think that defectiveness is largely produced by toxins acting upon the spermatozoon or ovum or early embryo according to the so-called law of blastophoria." Tredgold,4 in a note published in Mental Welfare, that
defectiveness
says:? "It is of
now
cases
are
is
generally recognized result
a
of
'
that the
inheritance.'
majority It
has
unnaturally, been assumed by those who have no great experience of defectives, and who are unacquainted with the subject of heredity, that the mentally defective child must necessarily be the offspring of mentally defective parents. It is of the utmost importance to realize that this is not so, and consequently,
not
without its
parents
child may be due to inheritance being similarly defective. The
explanation
of this
paradox
that the defect of
a
inheritance of these
chiefly
in
mental
deficiency
cases.
America, have
lies in the
nature
of
Although some writers, attempted to prove that
is due to the absence in the ancestral
germ cells of certain definite constituents, and that transmission is in accordance with the laws formulated
by Mendel, successful.
attempts have been entirely unOn the contrary, there is every reason these
198
Dr. H. C. Bristowe
to conclude that mental defect is not due to the absence
from the germ of a definite factor or series of factors ; but that it is the expression of an impairment of
developmental potentiality. In other words, it is due to a qualitative rather than a quantitative change ; this change being in the nature of a germinal vitiation. There is
think, however, that the
to
reason
of this vitiation varies not different individuals of the
only
same
amount
in the germ cells of stock, but also in the
Moreover, it is germ cells of the same individual. even with vitiated that highly probable germ cells the condition of the be to
extent
some
nature of the
The result is
that, although
ante-natal environment. the
majority
of mental defectives
whose
therefrom will
offspring resulting influenced by the
come
of families
germ undergone vitiation, this change shows itself in many other ways than mental In some individuals it may be manifest defect. cells
as
dementia
in
others
instability. these
defect,
as .
classes
have
precox certain .
or
other
forms
forms
of
dementia;
of
insanity or it is probable Nevertheless,
.
mental that all
'
of
carriers' of mental persons are and that a chance combination of adverse
circumstances may at any time so embarrass the development of the impaired germ cells as to result in
mentally deficient offspring." Again I may ask the question : Is
a
mental
deficiency
the result of germ cells which are defective primarily Is the impairment of the germ cell or secondarily ? due to defects inherited from one or both parents, or is it due to
some
impregnation,
or
do know that
damage
in the
some
course
diseases
germ cell after of development ? We
to
the
occurring in
the
developing
Sterilization brain
will
mental
cause
to
inherited
rate, be of
number of defectives mental
for
as,
instance,
are
then sterilization
defects,
at any
theoretically
defects,
If mental defects
encephalitis lethargica. due
199
Unfit
of the
in
use
the future.
in
chiefly should, the
limiting
If, however,
deficiency injury of the germ cells, or to developmental errors, then sterilization would be of no value. Sterilization is legal and has been is due to
practised in some of the American states, and the results, so far, have not been very encouraging. Shrubsall5 to
states that
show that the
are
only 5 offspring of
in these the
parents
that would have been
they
of those was
"
several lines of
rarely
were
were
less than those who which
can
seems
mental status
were
called
one
proportion investigation
forms of mental
clear that
hereditary. mentally unfit is we
considered
to be
must obtain much
have at present. information than there are such differences among those who we
give
Some
superior."
are no
be considered
more
able to
had
even
The
defective in
If, then, sterilization of the
approved, it
a
of certification
authorities consider that there
deficiency
of
to be dealt with.
parents who
seem
per cent, of defective children defective parents, though even
permitted
subject
inquiry
judgments
on
this
In
fact,
are
best
subject
agree that we are not in to form any opinion evidence possession of sufficient of value. We require much information before we that
can
we
must at
ask for
present
legislation
to
give
effect to sterilization.
What, then, are the conclusions at which we must necessarily arrive ? First, we require and must obtain more knowledge as to the cause of mental deficiency than we have at present. Next, it must be clearly N
Vol. XLVIII.
No.
181.
Dr. H. C. Bristowe
200
all the authorities that at its best
to
out
pointed
be
sterilization
can
segregation,
that
the
need
of
of
no
use
an
as
alternative to
sterilization will do away with institutional treatment and efficient no
guardianship, and that whatever range of sterilization may be permissible in the future, the amount of money spent on the segregation of mental defectives cannot be reduced, but will have to be increased. This will be increasingly clear when it is fully understood that
large percentage of recidivists are of the mentally defective classes?persons who are unable from mental a
defect to lead useful lives outside almost
take to criminal lives.
perforce
Of course, if attitude
(as
logically
:
institutions, and
we
we are
choose to at
liberty
adopt quite
to
We consider that
do)
we
a
different
may say quite should permit and we
all
degenerates whether mental or physical, and thus prevent the breeding of the large masses that at present bring numbers of undersized, under-intelligent and criminal persons into this world only to be kept at the expense of those who are not degenerates. For there can be but little doubt that at present we are helping to bring about a
try
to enforce sterilization
course
that is
unfit.
This would
that the
contrary
public
mean
to
on
nature, the survival of the
such
a
would not for
wholesale sterilization
one
moment hear of
it,
as so many would be honestly wondering if their own It is not within the turn would not be coming next.
range of practical politics. I will close by reading to
passed by
you the resolution the Executive of the Central Association
for Mental Welfare in I agree
:?
London,
a
resolution with which
Sterilization "
That
selected
might
they
cases
be
of
the
opinion
Unfit
that there
201 are
certain
of mental defect in which sterilization
appropriate
an
if there is
are
of
and desirable
procedure
;
any doubt as to the legality of the in such cases, the Committee are of
operation opinion that the Association should favour legislation to admit of such selective sterilization,
adequate safeguards can be devised to prevent its improper use and to restrict its performance in such cases. That in regard to the question of the wholesale sterilization of defectives as a means of greatly reducing the incidence of mental deficiency, the provided
that
"
support of for altering their opinion
Medical Committee know of
this, and
see
no
reason
no
evidence in
that such would be attended with
insignificant
comparatively
results." Discussion.
Dr. R. J. A.
congratulated on
Berry, in opening the discussion,
the
Society
on
having
three members
Deficiency. He favourably impressed
the B.M.A. Committee for Mental
stated that he had been very by the way in which the results of sterilization in California had been stated in Sterilization Betterment.
for Human
He did not think that sterilization would
deficiency, although he had no doubt of the strong hereditary factor in its causation, and he thought sterilization would do little to prevent
stamp
out
mental
feeble-mindedness.
This
question is
one
of the
greatest
problems of the modern state, and all methods so far employed to check its increase had failed. He would like to
see
the medical
profession given
the
right
to
Dr. H. C. Bristowe
202
sterilization under conditions determined
perform
the State.
He felt that females
than males when not under
high
or
medium
were more
dangerous
control, especially those of
of mental
grades
by
deficiency.
Mr. C. F. Walters considered that the
question
not, "Dare we perform sterilization ?" but rather "Dare we not ?" He thought that the first step was
was
to educate the medical
influence
profession played by heredity, by
in all medical be
was
a
means
of discussions
lay public should opinion the first duty
In his
to the race, and not to the individual.
Dr. J. R. Charles said that in his
capacity
medical visitor to Stoke Park
nearly gave
a
every
the
knowledge of
and then the
educated.
similarly
of medicine
societies,
to
case
Colony he found deficiency that he
of mental
of
that saw
strong family history. He found the question of free from control
very responsible one, and he did not think that sterilization would do away with the need of institutional treatment,
letting patients
since the liberation
of
mental defectives would
large soon
a
numbers
result in
a
of sterilized
large
increase
in venereal disease. Dr. J. 0. Symes considered that the certification
degrees of mental deficiency was very difficult, and he thought that if sterilization was involved in certification it would make the certifying officers chary of labelling a child mentally defective unless the case
of mild
was
extreme.
Moreover, these
extreme
cases
needed
supervision, so that in these cases sterilization He did not agree that there was a was superfluous. large element of heredity in the etiology of mental deficiency, but thought that a lot of the trouble was environmental in origin, many of the children being
care
and
Sterilization
of
the
Unfit
203
up in institutions where they In better lived very difficult and cramped lives. class families he found no hereditary history of the
illegitimate
and
brought
condition, and the the
family.
cases
should mental
Why
Finally,
sterilization
was
an
deficiency
freaks in be
singled
more
the sentimental
Dr. R. G. Gordon as
as
than any other physical he considered the great objection to
out for sterilization any
defect ?
regarded
were
one.
regarded voluntary
sterilization
very foolish idea, as the only result would be If the profession increase in venereal disease.
a
justifiable, he urged them to go all out for it, and to drop such half measures as voluntary schemes. He personally did not approve considered sterilization
of it, as he did not see how it could in any way lessen the need for institutional treatment. Dr.
H.
hereditary this factor that the
Carleton, while
H.
factor in mental
probably a original delinquent was
agreeing with the deficiency, thought that
Mendelian was now
recessive, and
far back in the
that he
regarded sterilization at the present time as merely pruning the periphery. Dr. A. G. Moris on quoted figures showing that in mentally defective families only 33 per cent, of the
common
children
stock
were
prevent 100
;
so
mentally deficient, cases
of mental
so
that in order to
deficiency
200 normal
children would have to be sacrificed. He thought that sterilization would be very slow in its effects. Dr. W. R. Dawson found mental
deficiency
in the lower
larger incidence grade schools, and a
of
of he
hereditary thought that while the majority all were not. Sterilization might prevent the birth of a certain number but by no means all, and in any caso cases were
204
Sterilization
of the
Unfit
institutional treatment would be necessary for life. He considered that the Scotch method of boarding out these
cases
merited consideration.
Dr. A. M. B. Milner
evolution,
as
thought that possibly creative taught by Bernard Shaw, might
counteract the Mendelian factor in the inheritance of mental
aenciency. Dr. F. Bodman stated that the
over-populated, would be the
and
that
discovery
of
country
better
than
sterilization
fool-proof
a
grossly
was
method of
contraception. Dr. Preston King did not doubt the element in the causation of mental
hereditary deficiency, and
breeding from defective stocks should be avoided. He suggested that sterilization should apply to all cases well enough to be discharged from thought
that
institutions. Dr. could
Bristowe, in reply, agreed that sterilization
never
replace segregation. REFERENCES.
1
Herd, H., The Diagnosis of Mental Deficiency, London,
2
Herd, H., The Diagnosis of Mental Deficiency, London, 1930.
3
Eugenic Sterilisation, second edition, The Eugenic Society.
4
Tredgold,
5
A. F., Mental "
Welfare,
Conference Shrubsall, F. C., Session, 12th December, 1930.
on
xi.
9-14,
1930.
1930.
Mental Welfare,"
Report of
