The means that have been suggested for combating bad heredity are legal restriction of marriage, surgical sterilization, and segregation. This would, perhaps, hardly be the place for a full discussion of the advantages and disadvantages of these measures; nor is it to be assumed that any one of them is to be adopted necessarily to the complete exclusion of the others. Suffice it to say here that the main drawback of marriage laws in this connection is their ineffectiveness;l and that to sterilization there are moral, religious, legal, and even scientific objections which render it largely unacceptable to public opinion. On the other hand, segregation, though also opposed by some, is evidently much more generally acceptable, as is shown by the fact that, quite independently of any consciously eugenic movement, its practice has made great headway during the past several decades.

We may conclude, therefore, that, unlike other eugenic measures that have been proposed, segregation is an old practice which has been tried out everywhere and to which no effective objections have been raised either on religious, legal, or humanitarian grounds; it has had of late a remarkable growth; and it may be anticipated that with the growth of urban centers, progress in popular education, improvement of methods of financing, and the rise in standards of institution care will come vast possibilities of further growth.2

If mental disorders are to so large an extent a heritage from past generations, resulting from untold centuries of neglect of segregation; and if the very incomplete segregation that has been practiced in but two or three generations can already be shown to have made an impression on this ancient problem (see p. 164); then it would seem that we have at last arrived at a point where we need to consider but ways and means; for we are in a position to say to the people and to legislatures, Mental health is purchasable; the prevalence of mental disorders can be reduced for coming generations with the aid of dollars and cents spent for segregation in this generation.

1 Adolf Meyer. The Right to Marry. What Can a Democratic Civilization Do About Heredity and Child Welfare? The Survey, Vol. xxxvi, No. 10. Re-published in Mental Hygiene, Jan., 1919.

2 A. J. Rosanoff. A Study of Eugenic Forces: Particularly of Social Conditions which Bring about the Segregation of Neuropathic Persons in Special Institutions. Amer. Journ. of Insanity, Oct., 1915.

In discussing the feasibility of segregation the questions are often raised, What persons should be selected for segregation? How should the selection be made? How can errors be avoided? - The implication is that, inasmuch as it is not possible to sharply distinguish mentally abnormal from normal persons, segregation might in practice entail much arbitrariness and injustice.

The answer is that these questions are purely academic; in practice they do not arise in any troublesome manner. For instance, out of a total of 8700 cases admitted to the New York State hospitals during the year ending June 30, 1915, 96 were eventually classified as "Not insane." These, however, were thus classified not because they presented no mental abnormality, but because their abnormality was of such nature as not to be included within the statutory definition of cases entitled to treatment in state hospitals. They were further classified as follows:l

Table 7

Not insane,epilepsy...

2

" " alcoholism....

22

" " drug addiction....

6

" "constitutional psychopathic inferiority. .

17

mental deficiency....................

19

others..............................

30

1 Thirtieth Annual Report of the N. Y. State Hospital Commission, Albany, 1919.

The experience of institutions for the feeble-minded, epileptic, and inebriate has been the same.

Moreover, there are many safeguards in the practice of segregation to rectify errors made in rare cases. The admission of a patient to an institution is not an irrevocable step. It is but the beginning of a more intensive investigation, observation and treatment of his case, the object of which is to help him, if possible, to such a readjustment as would enable him to return to normal life again. Through a liberal parole system he is given opportunities of trying life outside again under the most favorable conditions of supervision, employment, and assistance that could be created for him. Under such conditions many patients are after a short time discharged from institutions. If eventually, after repeated trials of this kind, the patient has to return to the institution for permanent segregation, it is not because a certain diagnosis of mental disorder has been made; or because someone, however expert, has judged him to require segregation; but because the need of segregation in his case has forced itself to recognition by a full demonstration of his utter incapability of achieving a social adjustment.

To-day the great obstacle to more complete segregation is to be found not in any difficulty of selection. The obstacle is an economic one, limiting the states' facilities for segregation. Not even the most progressive states possess as yet adequate institutional capacity. "Thus, the State of New York had, according to the Thirteenth U. S. Census in 1910, institutional provision for 396.3 insane, epileptic, and mentally defective persons per 100,000 of its total population. In Nassau County it was estimated that 816.7 persons per 100,000 of total population require institutional custody." 1

It will be judged, from what has already been said, that the proposal to extend the scope and practice of segregation does not imply the forced segregation of every person in whom the existence of a neuropathic condition might be established by medical diagnosis. It is well known that grave neuropathic conditions, notably manic-depressive psychoses and epilepsy, are not incompatible with the highest degree of intellectual efficiency. As striking instances might be mentioned the cases of William Cowper, the English poet, who suffered from many severe manic-depressive attacks; Julius Robert Mayer, the physicist and discoverer of the principle of conservation of energy, who was similarly afflicted; and Gustave Flaubert, the great French novelist, who suffered from epilepsy.1

1 A. J. Rosanoff. Survey of Mental Disorders in Nassau County, N. Y. Report published by The National Committee for Mental Hygiene, New York, 1917.

Not insanity, epilepsy, or mental deficiency, as such, but lack of capacity for social adjustment is the proper basis for segregation.