=Exophthalmic Goiter= (=Basedow's Disease=)

Exophthalmic goiter is a disease characterised by enlargement of the thyroid gland, protrusion of the eyeb.a.l.l.s, and rapid beating of the heart. The disease is confined almost entirely, though not exclusively, to women, and I should not advise any exophthalmic woman to marry; neither should I advise a man to marry an exophthalmic goiter woman. It is a very annoying disease, while s.e.xual intercourse aggravates all the symptoms, particularly the palpitation of the heart. The children, if not affected by exophthalmic goiter, are liable to be very neurotic.

_Simple goiter_, that is, enlargement of the thyroid gland (chiefly occurring in certain high mountainous localities, such as Switzerland), is not so strongly dysgenic as is exophthalmic goiter.

Still, goiter patients are not good matrimonial risks.

Of course, there are always exceptions. I know an exophthalmic goiter woman who brought up four children, and very good, healthy children they are. But in writing we can only speak of the average and not of exceptions.

=Obesity=

Obesity, or excessive stoutness, is an undue development of fat throughout the body. That it is hereditary, that it runs in families, there is no question whatsoever. And, while with great care as to the diet and by proper exercise, obesity may, as a rule, be avoided in those predisposed, it none the less often will develop in spite of all measures taken against it. Some very obese people eat only one-half or less of what many thin people do; but in the former, everything seems to run to fat.

Obesity must be considered a dysgenic factor. The obese are subject to heart disease, asthma, apoplexy, gallstones, gout, diabetes, constipation; they withstand pneumonia and acute infectious diseases poorly, and they are bad risks when they have to undergo major surgical operations. They also, as a rule, are readily fatigued by physical and mental work. (As to the latter, there are remarkable exceptions. Some very obese people can turn out a great amount of work, and are almost indefatigable in their constant activity.) Each case should be considered individually, and with reference to the respective family history. If the obese person comes from a healthy, long lived family and shows no circulatory disturbances, no strong objections can be raised to him or to her. But, as a general proposition, it must be laid down that obesity is a dysgenic factor.

But bear in mind that obesity and stoutness are not synonymous terms.

=Arteriosclerosis=

Arteriosclerosis means hardening of the arteries. All men over fifty are beginning to develop some degree of arteriosclerosis; but, if the process is very gradual, it may be considered normal and is not a danger to life; when, however, it develops rapidly and the blood pressure is of a high degree, there is danger of apoplexy.

Consequently, arteriosclerosis and high blood pressure must be considered decided bars to marriage.

It must be borne in mind that the s.e.xual act is, in itself, a danger to arteriosclerotics and people with high blood pressure, because it may bring about rupture of a blood-vessel. There are many cases of sudden death from this cause of which the public naturally never learns. Married persons who find that they have arteriosclerosis or high blood pressure should abstain from s.e.xual relations altogether or indulge only at rare intervals and moderately.

=Gout=

A consideration of gout in connection with the question of heredity will show how near-sighted people can be, how they can go on believing a certain thing for centuries without a.n.a.lyzing, until somebody suddenly shows them the absurdity of the thing. Gout was always considered a typical hereditary disease; for it was seen in the grandfathers, fathers, children, grandchildren, and so on. So, certainly, it must be hereditary! It did not come to our doctors'

minds to think that perhaps, after all, it was not heredity that was to blame, but simply that _the same conditions_ that produced gout in the ancestors likewise produced it in their descendants.

We know now that gout is caused by excessive eating, excessive drinking, lack of exercise, and faulty elimination. And, since, as a general thing, children lead the same lives that their fathers did, they are likely to develop the same diseases as their fathers did. A poor man who leads an abstemious life doesn't develop gout, and if his children lead the same abstemious lives they do not develop gout.

(There are some cases of gout among the poor, but they are very rare.) But if they should begin to gorge and live an improper life they would be p.r.o.ne to develop the disease.

The disease, therefore, cannot in any way be considered hereditary. In matrimony, gout in either of the couple is not a desirable quality, but it is not a bar to marriage; and, if the candidate individually is healthy and free from gout, the fact that there was gout in the ancestry should play no role.

=Mumps=

Mumps is the common name for what is technically called parot.i.tis (or parotiditis). Parot.i.tis is an inflammation of the parotid glands. The parotid glands are situated, one on each side, immediately in front and below the external ear, and they are between one-half and one ounce in weight. They belong to the salivary glands; that is, they manufacture saliva, and each parotid gland has a duct through which it pours the saliva into the mouth. These ducts open opposite the second upper molar teeth.

We might be surprised to be told that these parotid glands can have anything to do with the s.e.x organs, but there is no other remote organ that has such a close and rather mysterious relationship with the s.e.x-glands as have the parotids. When the parotid glands, either one or both, are inflamed, the t.e.s.t.i.c.l.es or ovaries are also liable to be attacked by inflammation. The inflammation of the t.e.s.t.i.c.l.es may be so severe as to cause them to shrivel and dry up; or, even when no shrivelling, no atrophy of the t.e.s.t.i.c.l.es occurs, they may be so affected as to become incapable of producing spermatozoa. Moreover, in cases where the t.e.s.t.i.c.l.es of a mumps patient seemingly were not attacked--that is, where the patient was not aware of any inflammation, having no pain and no other symptoms--the t.e.s.t.i.c.l.es may have become incapable of generating spermatozoa.

Besides the t.e.s.t.i.c.l.es, the prostate gland, the secretion of which is necessary to the fertility of the spermatozoa, may also become affected and _atrophied_.

It is, therefore, a very common thing for men who had the mumps in their childhood to be found sterile.

As to the s.e.xual power of mumps patients, that differs. Some patients lose their virility entirely; others remain potent, but become sterile.

The same thing happens to girls attacked by mumps. They may have a severe inflammation of the ovaries (ovaritis or oophoritis) or the inflammation may be so mild as to escape notice. In either case, the girl when grown to womanhood may find herself sterile.

A man who never had any venereal disease, but who has had mumps, should have himself examined for sterility before he gets married. As explained in the chapter "Marriage and Gonorrhea," we can, in the case of a man, easily find out whether he is fertile or sterile. But, in the case of a woman, we can not. Time, necessarily, has to answer that question. In all cases, mumps reduces the chances of fertility, and no man or woman who once had mumps should get married without informing the respective partner of the fact. There should be no concealment before marriage. When the partners to the marriage contract know of the facts, they can then decide as to whether or not the marriage is desirable to them.

=Hemophilia, or Bleeders' Disease=

Hemophilia is a peculiar disease, consisting in frequent and often uncontrollable hemorrhages. The least cut or the pulling of a tooth may cause a severe or even dangerous hemorrhage. The slightest blow, squeeze or hurt will cause _ecchymoses_, or discolorations of the skin. The peculiarity of this hereditary disease is, that it attacks almost exclusively the males, but is transmitted almost exclusively through the female members. For instance, Miss A., herself _not_ a bleeder, comes from a bleeder-family. She marries and has three boys and three girls; the three boys will be bleeders, the three girls will not; the three boys marry and have children; their children will _not_ be bleeders; the three girls marry, and _their male_ children will be bleeders.

What is the lesson? The lesson is, that boys who are bleeders may marry, because they will most likely _not_ transmit the disease; but girls who come from a hemophilic family, irrespective of whether they themselves are hemophilics or not, must not marry, because most likely they _will_ transmit the disease.

=Anemia=

Anemia is a poor condition of the blood. The blood may contain an insufficient number of red blood cells or an insufficient percentage of the coloring matter of the blood, that is, hemoglobin. A special kind of anemia affecting young girls is called chlorosis.

Anemia and chlorosis cannot be considered contra-indications to marriage, because they are usually amenable to treatment. In fact, some cases of anemia and chlorosis are due to the lack of normal s.e.xual relations, and the subjects get well very soon after marriage.

But it is best and safest to subject anemic patients to a course of treatment and to improve their condition before they marry.

=Epilepsy=

While epilepsy--known commonly as fits or falling sickness--is not as hereditary as it was one time thought to be, its hereditary character being ascertainable in only about 5 per cent. of cases, nevertheless, it is a decidedly dysgenic agent, and marriage with an epileptic is distinctly advised against. Where both parents are epileptics, the children are almost sure to be epileptic, and such a marriage should be prohibited by law. Under no circ.u.mstances should parents who are both epileptic bring children into the world. It should be the duty of the State to instruct them in methods of preventing conception.

=Hysteria=

Hysteria is a disease the chief characteristics of which are a _lack of control_ over one's emotions and acts, the _imitation_ of the symptoms of various diseases, and an _exaggerated_ self-consciousness.

The patient may have extreme pain in the region of the head, ovaries, spine; in some parts of the skin there is extreme hypersensitiveness (hyperesthesia), so that the least touch causes great pain; in others, there is complete anesthesia--that is, absence of sensation--so that when you stick the patient with a needle she will not feel it. A very frequent symptom is a choking sensation, as if a ball came up the throat and stuck there (globus hystericus). Then there may be spasms, convulsions, retention of urine, paralysis, aphonia (loss of voice), blindness, and a lot more. There is hardly a functional or organic nervous disorder that hysteria may not simulate.

Of late years our ideas about hysteria have undergone a radical change, and we now know that most, if not all, cases of hysteria are due to a repression or non-satisfaction of the s.e.xual instinct or to some shock of a s.e.xual character in childhood. Only too often a girl who was very hysterical before marriage loses her hysteria as if by magic upon contracting a _satisfactory_ marriage. On the other hand, a healthy girl can become quickly hysterical if she marries a man who is s.e.xually impotent or who is disagreeable to her and incapable of satisfying her s.e.xually.

While hysteria, in itself, is not hereditary, it, nevertheless, is a question whether a strongly hysterical woman would make a satisfactory mother. The entire family history should be investigated. If the hysteria is found to be an isolated instance in the given girl, it may be disregarded, if not extreme; but if the entire family or several members of it are neuropathic, the condition is a dysgenic one.

Marriage may be contracted, provided no children are brought into the world until several years have elapsed and the mother's organization seems to have become more stable. In some cases, a child acts as a good medicine against hysteria. In short, every case must be examined individually on its merits, and the counsel of a good psychologist or psychoa.n.a.lyst may prove very valuable.

=Alcoholism=

A good deal depends upon what we understand by alcoholism. The fanatics consider a person an alcoholic who drinks a gla.s.s of beer or wine with his meals. This is nonsense. This is not alcoholism, and cannot be considered a dysgenic factor. But, where there is a distinct habit, so that the individual _must_ have his alcohol daily, or if he goes on an occasional drunken "spree," marriage must be advised against. And where the man (or woman) is what we call a real drunkard, marriage not only should be advised against, but most decidedly should be prohibited by law.

Alcoholism, as a habit, is one of the worst dysgenic factors to reckon with. First, the offspring is liable to be affected, which is sufficient in itself to condemn marriage with an alcoholic. Second, the earning powers of an alcoholic are generally diminished, and are likely gradually to diminish more and more. Third, an alcoholic is irritable, quarrelsome, and is liable to do bodily injury to his wife.

Fourth an alcoholic often develops s.e.xual weakness or complete s.e.xual impotence. Fifth, alcoholics are likely to develop extreme jealousy, which may become pathological, even to the extent of a psychosis.

If both the husband and wife are alcoholics, then marriage between them which results in children is not merely a sin, but a crime.

We do not now come across cases so often as we used to of women marrying drunkards in the hope or with the hope of reforming them. But such cases still happen. This is a very foolish procedure. Let the man reform first, let him stay reformed for two or three years, and then the woman may take the chance, if she wants to.

=Feeblemindedness=