Elementary teachers, particularly in the lower grades, should be trained to treat the simpler forms of articulation defects (lisping), while the larger cities or counties should employ qualified teachers who should devote their time exclusively to the correction of speech defects.

G. UNSTABLE AND PSYCHOPATHIC CHILDREN I. The Present Situation

The potently insane or mentally disordered children of the state are committed to the state or municipal hospitals for the insane or the state institution for the feeble-minded and epileptic. Undoubtedly unrecognized insane children are to be found in the homes, in the state institutions for juvenile delinquents, and in the county infirmaries. While custodial care can be provided for children who have already become mentally disordered,- although it is to be feared the children are not always properly grouped in the wards,- little attempt has been made in the state toward discovering unstable children who are developing mental disorders, the progress of which could frequently be arrested by the timely application of proper preventive measures.

1. There should be established in connection with the hospitals for the insane, observation or psychopathic wards where mentally unstable or incipiently insane children (as well as adults of the same type) may be sent for observation and study, and for preventive and curative treatment, both educational and hygienic. Public-school authorities should be urged to make special efforts, through their departments of medical inspection and psycho-educational clinics, to discover children of this type, in order that they may be referred for skilled observation or in order that the school work may be adapted to meet their peculiar needs.

2. Insane children now confined in improper institutions or retained in their homes should be transferred to proper wards in the institutions for the insane. Restorable types should not be confined with incurable adults. Children so confined should be given appropriate educational training by qualified teachers, to be supported out of the state school funds.

H. MISCELLANEOUS RECOMMENDATIONS

Educational Supervision of State Schools

The educational work in the state institutions for the feebleminded, epileptic, crippled (if established), blind, deaf (this has been done for the deaf), and delinquent children should be placed under the supervision of the state department of education. At the present time the educational work in these schools is without any supervision or control by some higher state educational authority.

The Control and Elimination of Defective Children

I. The Present Situation

The state of Missouri has taken no steps as yet toward the control, reduction, or elimination of its neuropathically tainted, or hereditarily defective or degenerate classes, except that it has made partial provision for the temporary or permanent segregation in separate wards in institutions of some of its defective males and females. But institutionalization offers a means for the prevention of the mating of degenerates only so long as they are effectively confined. It is recognized, however, that the reduction of the degenerate classes cannot be wholly accomplished by institutional restraint, partly be cause we shall probably never obtain enough institutions to care for all of our degenerates. Further aid can be obtained from the practice of enforced sterilization of degenerates and the enforced prevention of the mating of persons suffering

from transmissible diseases. Vasectomy (and possibly the more recent X-ray treatment) offers a rapid and painless means of effectively sterilizing the male, which is not only harmless, so far as present evidence indicates, but frequently improves the physical and mental condition of the person so treated. The corresponding surgical operation on the female is harmless, although more cumbersome.

II. Recommendations

1. The sterilization by vasectomy and the corresponding operation on the female, or by any other method which may later be found equally effective, expeditious, and harmless, should be legalized and enforced on the following anti-social classes who are hereditary degenerates or social and industrial incompetents: the feeble-minded, the insane, the epileptic, sexual perverts, rapists, confirmed drunkards, confirmed criminals, and so-called moral imbeciles. Persons to be thus operated upon under state auspices must be officially certified as hereditary degenerates or as unfit to assume the responsibility of parenthood, by an official commission to consist of the secretary of the state board of charities and correction, the director of the bureau for mental defectives, if established, the superintendent of the institution in which the person may be an inmate, and the secretary of the State Board of Health or a properly qualified physician selected in his place, or by properly qualified persons at least one of whom must be a qualified physician, deputized to serve in the place of the above officials. This statute should not be construed as requiring state certification of persons who voluntarily seek sterilization at the hands of private medical specialists.

2. Marriage should be prohibited between persons suffering from transmissible disease of a sexual nature, until cured of such disease, between blind and deaf persons who have not first been sterilized, between the feeble-minded, and between the incurable and degenerate types of the insane and epileptic.

3. Persons suffering from syphilitic infection in its active form should be placed under quarantine until free from the danger of transmitting the infection. It shall be the duty of physicians to report all such cases coming under their observation to the nearest public-health officer, under penalty of fine or imprisonment for failure so to do.

CHAPTER SEVEN

THE HYGIENE OF EUGENIC GENERATION 1

IN

THE PROBLEM OF PREVENTION

N Chapters IV and VI we discussed the obligation of society toward the feeble-minded already born into the state. In this chapter we shall consider the question of the prevention or elimination of the feeble-minded.

Eugenics or generative hygiene is preventive individual and race hygiene raised to the nth power. No measures for individual or collective betterment are more fundamental than the hygiene of generation. To be well born is the fundamental prerequisite of being well bred. Generative hygiene contemplates not only the regulation of the function of mating, but also the establishment of those conditions which will insure normal healthy generative processes in the father and mother. In addition to the requirement of eugenic marriages, it is also necessary to safeguard the health and development of the fetus. Moreover, since the prenatal and postnatal child are one and the same indivisible person, we should not draw the line of cleavage too sharply between the eugenical and euthenical factors of development. We do not think that it is practicable to draw a sharp eugenic line between, on the one hand, the hereditary prenatal factors and, on the other hand, the environmental prenatal (congenital) and postnatal factors of normal development. We believe with Tredgold that it is "absurd to contend that the germ

1 An address delivered, in part, before the Eugenics Section of the Pittsburgh Academy of Arts and Sciences, May 15, 1914. Reprinted, with alterations and additions, from The Psychological Clinic, 1914, October and November.