MANCHESTER MEDICAL SOCIETY.

925 or

her mate.

Individual liberty

was

constantly being and might

never

require

institutional treatment.

Dr. McCann had said that Nature eliminated the mentally unfit in time, but could not we do something to help Nature ? Voluntary sterilisation would not do much ; even parental consent would not be easy to get if the parents were usually unstable people. If The inhibitions-if any-unaffected. operations supervision were to prevent sexual intercourse it Too were not dangerous and did not affect the sexual would have to be as close as in an institution. functions. In California 3232 vasectomies and 2588 much attention was paid to the sick and too little to salpingectomies had caused only three deaths-two the healthy; we should encourage the breeding of from the anaesthetic and one from premature removal healthy stock. Sterilisation of the obvious case was of dressings by the patient. The results had been a very small infringement of personal liberty. Dr. NATHAN RAw said that the increase of insanity highly satisfactory in California and compulsory sterilisation had now been prescribed by law in one called for preventive measures. Segregation would of the Swiss cantons and in Alberta, Canada. At be satisfactory, if it were possible, but sterilisation present the interest and happiness of the individual was the only feasible method for certain cases. It patient were put before the general interest of the should be carefully safeguarded and the consent of community ; the whole subject required statesmanlike the guardians or of the Board of Control or some attention. authority should be required. It was the only Discussion. scientific remedy we could apply to redress this great A letter from Lord ATKIN was read, suggesting burden on the State. At first it should be advocated discussion of the following points : selection of patients only for the weak-minded boys and girls who reproand who should make it; what consents, if any, were duced freely, without really being responsible. Dr. T. B. HYSLOP reviewed his experience and to be required ; whether theieshould be any judicial or other appeal: whether incurable cases only should thought the progress of sterilisation had been delayed be sterilised ; at what age the operation should be by fetish-worship of the liberty of the subject. He performed; and whether the patient must show some thought consent of both patient and relatives ought to be obtained to guard the operator against subsepropensity to bear or beget children. Dr. F. J. MCCANN said that sterilisation was of little quent legal action. Dr. TEMPLE GRAY was convinced that Nature knew or no value ; his objections were that it did not affect the source of supply, that it did not make the unfit quite well how to look after evolution without the clean, sober, righteous, or worthy, that it returned to intervention of Boards of Control. It was not true society sterilised persons liable to transmit venereal that defectives were disastrously prolific ; while their of others, disease, and that the sterilised would still require birth-rate might be a little higher than that " supervision. Sterilisation was very attractive to their death-rate was five times the normal. Consent " those who had a superficial knowledge of the problem. from a mental defective was a contradiction in terms. Half the defectives born were begotten by parents who Lord RIDDELL, in reply, contrasted the economy were not defective and, if alcohol, syphilis, and other with the enormous expenditure proposed by the talk germ-plasm poisons were eradicated. more would be done for the race than by any other means. Nature experts in mental defect; if the nation was not going had her own way of eliminating the unfit; defective- to spend this money, what was it going to do ? Were we going to sit down and let the race be ness appeared earlier in each generation, so that poisoned and crippled inquietly the markets of the world ? insanity became imbecility in three or four genera- Was it with housing conditions what they were, right, a of and there was tions, high percentage developmental defect in aborted ova. It was exceptional for the to contemplate spending 20 millions on a class of feeble-minded to marry into healthy stocks. The people who would never be any use to the nation, and to keep mental defectives at 42s. a week when surgical results claimed by enthusiasts were hard to normal children were being taught in classes of 60 in did not that no and he believe change justify, and under utterly unsuitable conditions ? kept testis or ovary followed sterilisation. The subject of no little understood at that was so heredity present suitable for one could decide which cases were MANCHESTER MEDICAL SOCIETY. sterilisation. Where segregation was permanent and supervision close all the advantages claimed for sterilisation were obtained without it. AT a of this Society, held on April 3rd Dr. R. A. GiBBONS said that sterilisation offered an at the meeting Manchester University, with Dr. R. W. effective means of preventing the birth of an enormous President of the Society, in the chair, number of defective children, 70-80 per cent. of MARSDEN, Dr. CHARLES H. MELLAND read a paper on the whom owed their condition to neuropathic heredity. Treatment of Pernicious Anaemia by Liver. Most people agreed that nothing could be better than thorough segregation, but it was quite impossible to Dr. MELLAND gave an epitome of his experience segregate all our defectives. Sterilisation was comple- of the treatment of some 40 cases of pernicious anaemia mentary and not alternative to segregation. Paul by liver in the last two years. With certain exceptions Popenoe in California had found no evidence whatever the results were almost uniformly good, but it is too that sterilisation played a part in increasing sexual soon yet to say definitely how much better than the delinquency or venereal disease. In 21 years 23 States older methods of treatment. These older methods, had adopted sterilisation laws. After discussing the if effectively handled, were undoubtedly very successful legal implications of a sterilising operation, Dr. in many cases, and Dr. Melland gave instances of Gibbons urged the importance of preventing the patients who had lived for 17, 9, 8 years, and so on, marriage of defectives. When there was no hope of with more or less complete freedom from symptoms improvement sterilisation ought to be compulsory, over long periods, as the result of treatment by such like vaccination, but no operation should be performed methods. In order to achievesuch results, however, without the consent of the Board of Control. If the very great care in carrying out the details of the consent of the patient or his parents were required treatment was called for, and it was often difficult it would be a long time before advance was made. to secure this careful attention, with the result that Earl RUSSELL was appalled at the large sums being relapse and early death was only too common. spent on these comparatively useless members of the Although it was too soon as yet to draw final concommunity while the healthy and useful were in great clusions, Dr. Melland was of opinion that the addition need. It was worth while, he said, to pay some of the liver treatment to the older methods was attention to the healthy as well as to the diseased, undoubtedly of the greatest value, the results were and employment and proper housing were quite as attained more speedily, the recovery was more important as the treatment of defectives. Bricks and complete, the improvement was maintained more mortar should be provided for those who did not yet easily, and with much less tendency to relapse.

restricted for the safety of the community, as in vaccination and segregation for infectious disease. Sterilisation would not increase promiscuity and venereal disease ; the sterilised would still be under supervision and the operation would leave their