April,
1930.
THE STERILIZATION OF MENTAL DEFECTIVES.
Sir, I have read Dr. C.
to offer is It obvious that before measures can be taken following any successfully to prevent Mental Deficiency, we must have an accurate knowledge of its underlying nature and causation. It is generally agreed that the majority of cases are due to a germinal change and probably the most important question is, as Dr. Bond says, whether this change is one which is specific to mental defect, or one which is of the nature of a general impairment of germ cell vitality affecting not only the development of the brain but the condition of the organism as a whole." Now, although many fervid devotees of Mendelism have attempted to prove the former, nevertheless, as I stated in my article on Sterilization in this Journal, and as I have shown more fully in the chapter on Causation in my book on Mental Deficiency, these attempts have hitherto been quite unsuccessful. Dr. Bond brings forward no new " evidence. Beyond the vague statement that the way in which mental deficiency may be latent in one generation and segregate out among the children of the next. strongly suggests the influence of a specific element," he not only fails to adduce any reason in favour of the germ change being a specific one, but he accepts and actually quotes certain facts which are strongly opposed to " other this view. Thus, the fact that the germ change can show itself in forms of mental instability, for instance, dementia precox," knocks a very big hole in the theory that the nature of the germ change is a specific one. When, in addition to this, we bear in mind the undoubted facts that the relatives of defectives may, and do, not only suffer from mental instability, but from almost every variety of minor or major psychosis, that even mental defectives differ amongst themselves enormously in the degree and kind of their defect, and that many of them show signs indicative of a defect, not only of mind, but of the organism as a whole," it clearly becomes impossible to regard the change in the germ material as a specific one.
the
"
.
"
J. Bond's letter with great interest, and desire
comments.
.
MENTAL WELFARE
51
I think it is true that Mendelism affords a satisfactory of the of many qualities, a consideration of the above inheritance explanation facts and the study of many hundreds of family histories of defectives, caused me long ago to come to the conclusion that it was quite inadequate to explain the nature and mode of transmission of mental defect. On the other hand, the view that the germ change is not specific, but is of the nature of a vitiation which may vary considerably in degree in different cases does explain the clinical facts. Consequently, in the present state of our knowledge, I hold it to be the best working hypothesis. If we accept this hypothesis, we see at once that Mental Deficiency need not have as its precursor, mental defect; but that the ancestors and collaterals of defectives may suffer from many other manifestations of this impairment of the neuronic determinant within the germ cell. There is ample evidence that this is so. Everyone with any considerable practical experience of defectives will agree that whilst in the majority of cases the parents present some nervous abnormality, that they may, in fact, be " carriers," very few of them, in relation to the whole, are mentally deficient. It follows, and this is the important point, that neither the sterilization nor the segregation of all defectives would have any considerable influence in diminishing the incidence of mental defect. In order to do this, it would be necessary to prevent the propagation, not only of all defectives, but, and much more important, of all carriers." It is for this reason I have urged that the popular idea that mental deficiency would be eliminated by the sterilization of defectives is a pure delusion. Dr. Bond raises another point, namely, that sterilization might still be made use of in certain selected defectives for whom suitable occupation could be found in the community, and in whose case the chief danger is procreation. I gather from his letter that he does not go so far as to advocate the sterilization of such persons, but merely suggests that the question is one which should be considered. With this view we shall all be in agreement. I dealt with the point in my article, and the Central Association some time ago passed a resolution urging the need for an enquiry into the causation of Mental Defect, and into any means, including sterilization, by which it might be prevented. Unfortunately, a good many individuals and some societies show more of zeal and less of judgment in the matter. They either urge that sterilization should be enforced without any preliminary investigation at all, or, if they admit the need for such enquiry, they prejudge the issue by embarking upon an extensive propaganda before the enquiry has been made. This is surely as illogical as it is deplorable. Let us press for an enquiry by all means, but do not let us advocate any change in the law until all the facts appertaining to this very difficult question have been subject to thorough and impartial in-
Whilst, therefore,
"
vestigation.
Yours
faithfully, A. F. Tredgold.
1930.
THE STERILIZATION OF MENTAL DEFECTIVES.
Sir, I have read Dr. C.
to offer is It obvious that before measures can be taken following any successfully to prevent Mental Deficiency, we must have an accurate knowledge of its underlying nature and causation. It is generally agreed that the majority of cases are due to a germinal change and probably the most important question is, as Dr. Bond says, whether this change is one which is specific to mental defect, or one which is of the nature of a general impairment of germ cell vitality affecting not only the development of the brain but the condition of the organism as a whole." Now, although many fervid devotees of Mendelism have attempted to prove the former, nevertheless, as I stated in my article on Sterilization in this Journal, and as I have shown more fully in the chapter on Causation in my book on Mental Deficiency, these attempts have hitherto been quite unsuccessful. Dr. Bond brings forward no new " evidence. Beyond the vague statement that the way in which mental deficiency may be latent in one generation and segregate out among the children of the next. strongly suggests the influence of a specific element," he not only fails to adduce any reason in favour of the germ change being a specific one, but he accepts and actually quotes certain facts which are strongly opposed to " other this view. Thus, the fact that the germ change can show itself in forms of mental instability, for instance, dementia precox," knocks a very big hole in the theory that the nature of the germ change is a specific one. When, in addition to this, we bear in mind the undoubted facts that the relatives of defectives may, and do, not only suffer from mental instability, but from almost every variety of minor or major psychosis, that even mental defectives differ amongst themselves enormously in the degree and kind of their defect, and that many of them show signs indicative of a defect, not only of mind, but of the organism as a whole," it clearly becomes impossible to regard the change in the germ material as a specific one.
the
"
.
"
J. Bond's letter with great interest, and desire
comments.
.
MENTAL WELFARE
51
I think it is true that Mendelism affords a satisfactory of the of many qualities, a consideration of the above inheritance explanation facts and the study of many hundreds of family histories of defectives, caused me long ago to come to the conclusion that it was quite inadequate to explain the nature and mode of transmission of mental defect. On the other hand, the view that the germ change is not specific, but is of the nature of a vitiation which may vary considerably in degree in different cases does explain the clinical facts. Consequently, in the present state of our knowledge, I hold it to be the best working hypothesis. If we accept this hypothesis, we see at once that Mental Deficiency need not have as its precursor, mental defect; but that the ancestors and collaterals of defectives may suffer from many other manifestations of this impairment of the neuronic determinant within the germ cell. There is ample evidence that this is so. Everyone with any considerable practical experience of defectives will agree that whilst in the majority of cases the parents present some nervous abnormality, that they may, in fact, be " carriers," very few of them, in relation to the whole, are mentally deficient. It follows, and this is the important point, that neither the sterilization nor the segregation of all defectives would have any considerable influence in diminishing the incidence of mental defect. In order to do this, it would be necessary to prevent the propagation, not only of all defectives, but, and much more important, of all carriers." It is for this reason I have urged that the popular idea that mental deficiency would be eliminated by the sterilization of defectives is a pure delusion. Dr. Bond raises another point, namely, that sterilization might still be made use of in certain selected defectives for whom suitable occupation could be found in the community, and in whose case the chief danger is procreation. I gather from his letter that he does not go so far as to advocate the sterilization of such persons, but merely suggests that the question is one which should be considered. With this view we shall all be in agreement. I dealt with the point in my article, and the Central Association some time ago passed a resolution urging the need for an enquiry into the causation of Mental Defect, and into any means, including sterilization, by which it might be prevented. Unfortunately, a good many individuals and some societies show more of zeal and less of judgment in the matter. They either urge that sterilization should be enforced without any preliminary investigation at all, or, if they admit the need for such enquiry, they prejudge the issue by embarking upon an extensive propaganda before the enquiry has been made. This is surely as illogical as it is deplorable. Let us press for an enquiry by all means, but do not let us advocate any change in the law until all the facts appertaining to this very difficult question have been subject to thorough and impartial in-
Whilst, therefore,
"
vestigation.
Yours
faithfully, A. F. Tredgold.
