REGULATION OF MARRIAGE. Dr. T. J. Garner, Washington, Ark. Society begins its self-contamination at the marriage license window. Here is the fountain head of the stream of degeneracy that sweeps through all social systems. The foundation stone of society is the matrimonial relation. Its assumption is the most important step that a human being can possibly take, and upon the conditions surrounding it depend the most important interests of our social system. Taking this into consideration and laying aside the selfish apparent interests of the individual it is astonishing that no rational effort at the regulation, control, or supervision of the marriage relation is made by society. The license window is a place where the honest citizen and the criminal, the sane and the insane, the diseased and the healthy, the pauper and the millionaire, the learned and the ignorant, the intellectual and the weak minded may meet upon common ground. The criminal, the insane, the epileptic, the syphilitic, and the drunkard are here authorized by law to begin the procreation of their kind, the number of their progeny being limited entirely by the volition and physical capacity of the individuals immediately concerned. The marriage license is the agent that sets in operation the individual and social machinery for the manufacture of degenerates. That the degenerates are a menace and expensive burden to society is everywhere admitted. Has society a right to protect itself against its own vicious off-scourings? I believe it has. But until the public mind awakes to the scientific causes that produce the neuropsychic aberrations of the degenerate, little may we expect to be done. The sanitary marriage is possibly an idealist's dream, and it may never be practicable to altogether eliminate from society the assumption of the matrimonial relation by individuals to whom it should be by no means permitted, but a wise control and regulation upon rational scientific principles is certainly practicable and likely to achieve wonderful results. That society eventually will, for its own protection, adopt some method of regulation and restriction of matrimony I believe to be inevitable. Society assumes the right to defend itself against the finished product of its matrimonial factory of de generates, and there is no logical reason why it should not also assume the right to protect itself from the conditions which set the machinery of evil in operation. I firmly believe that the time will come when it will be no longer possible for our army of recognizable degenerates to procure a license to marry. I believe that it should be, and one day will be, a statutory crime for a person in the active stages of infective disease of a venereal character to marry, and thus risk the almost inevitable infection of innocent persons. There can be no greater crime against an individual than inoculation with contagion, the effects of which may perhaps outlast several generations and carry affliction and misery to unborn innocence. The rights of the unborn will one day be considered. In brief, I believe that man will one day devote to the breeding of human beings some of the knowledge he has acquired in the breeding of the lower animals. Stirpiculture will be the solution of the race, and is the rational antidote for degeneracy and its trains of evils-social and individual. The law stipulates as to the age of candidates for matrimony. In certain states consanguineous marriages, even to the fourth degree of consanguinity, are forbidden; in all states consanguinity up to the third degree is a bar to matrimony. In many of our states, both northern and southern, miscegenation is prohibited. It will be seen, therefore, that sentimental objections to the regulation of matrimony are even now sometimes honored in the breach rather than in the observance. Inasmuch as sentiment has hitherto been no bar to the demand for license, it should not be a bar to the demand for proper qualifications on the part of candidates for matrimony. Mr. Reeve, of Illinois, in a masterly discussion of the marriage question in its relation to criminality says: "If the vilest mortal that lives sees proper to marry, the law issues the license for the asking, takes the fee, makes the record, and leaves the offspring and society to shift for themselves the best they can. Even paupers, while in the poorhouse, and criminals while in jail are in every way encouraged and given license to marry, and are protected by the law; no thought is taken for the unfortunate offspring, or for the body politic or social, and the irreparable evils that must fall upon all. The church adds its sanction, and its ministers aid in making the civil contracts by per forming a ceremony with prayers and benedictions. If it is wise to prohibit polygamy, marriage between relations and between persons whose insanity or idiocy is self-evident, it is equally wise to prohibit it in all cases where evil may follow. If the law has the power to prohibit and punish in the one case, it has an equal right in all others. There is an endless procession of children from all these sources coming into the mass of population to live lives of crime, immorality, want, suffering, misfortune and degeneracy, transmitting the taint in constantly widening streams to generation after generation, with the ultimate certainty of the deterioration of the race and final irreparable degeneracy." Previous to the issuance of a marriage license, statutory law should demand that both the persons immediately concerned obtain a certificate as to their physical and mental condition from non-political and therefore non-partisan board of medical examiners, which should be an appendage of the health board of the district in which the application for license is made.-Jour. Ark. Med. Soc. ANOTHER VIEW OF MARRIAGE. Eugenics has again caused a flutter of popular interest. This time the idea has been advanced that we can breed up a race of superior men in the same way that Luther Burbank is creating such wonderful plants. Of course we can. He simply raises a hundred thousand plants, finds among them one or two with the proper variations, saves these two and destroys all the rest. We can do the same. Let us examine all the children in each congressional district-about 100.000 more or less -select the two we consider the best, and hang all the rest. It is simplicity itself, but there is one slight difficulty. Burbank's plants have no voice in the matter, but every human father has a vote on this proposition, and will decide that his type is the best and the other children should beso the system itself will be hung up. All this nonsense about eugenics will cease when the silly season is over. Stirpiculture is a most accurate and scientic process as applied to domestic animals and the more it is investigated the better. Yet here, too, there is not the slight est chance of applying it to man. The stock breeder selects for his purpose only a few of the thousands born, and sterilizes the others, or keeps them from breeding, or kills them. As we have before explained, he usually emphasizes one trait, like speed in the horse or wool in the sheep, at the expense of all other characters. If we could try the same methods we would only succeed in breeding types of men, noted for one character-say muscularity without sense, or brains without physique. We do not know what types could survive in the future environment civilization is building up, and the types we produced might not be suitable at all. Future man will be as different from us as we differ from the caveman, and nature will attend to the matter without any suggestions from us. She will simply destroy the unsuitable. A commission to study heredity has been formed by the American Breeders' Association under the initiative of its secretary, the Hon. W. M. Hays, assistant secretary of agriculture. As it is a vital matter to the human race also, their investigations should be given the widest publicity. They are evidently not impressed with the ill-considered suggestions about eugenics, because they are well aware that young folks will continue to select their own life partners in obedience to an instinct which we do not pretend to understand. The only thing we do know is the fact that human animals, like lower animals, tend to select partners somewhat different from themselves, probably because of an inherited tendency to keep the species nearer the average. Aberrart types perish, so that the desire to magnify traits, as the stock breeders do, is distinctly unnatural. The cause of variations will naturally be the main point to investigate, for if stock breeders can tell what causes desirable traits to appear, they have the situation in their grasp. They can leave to the biologists to discover why the offspring do as the parents did in like environments-indeed that seems to be a necessary result of the fact that the offspring is merely a buddedoff piece of the parent. What physicians want to know is why children differ from parents and why certain defects and diseases appear. The trend-perhaps too much the trend-of modern thought is in the direction of searching for the causes in an unwholesome environment. Every bad result must have a cause, which might be removed to prevent future cases. Bad offspring usually die off, if not early, at least in a generation or two. Consequently the present criminal class will not leave many descendants. More than half of them are children of respectable parents. The criminals of the year 1925 or 1930 are now being born in respectable households. It is our duty to find out why they will not grow into good citizens and why we cannot compel normal development. That is the only practical eugenics, and it will surely become a possibility in the future, so that one generation will not suffer for the ignorant sins of the previous one. Every study in heredity and its perversions is a step in cleaning the human race. To only that extent can we uplift the race. People will marry whom they select, and not whom society selects, so let us accept the inevitable and teach them how to raise good offspring, from which nature can select the proper types. If part of the money now spent on children's hospitals could be devoted to finding out the causes of their illnesses and deformities, perhaps we might so far prevent them that we would not need so many hospitals for them. Every encouragement, therefore, should be given to this new commission on heredity, for every discovery it makes takes us a step nearer to the prevention of human diseases and deformities.-American Medicine. CONTRACT PRACTICE. Horace M. Alleman, M.D., Hanover, Pa. The subject of this paper is one of many phases and to be considered from many points of view, and gives much promise to the profession for future contention. We have in this country contract practice, seemingly only in its beginning but with many signs of rapid growth, as evidenced by the occasional wails from every section. In looking for causes for this form of practice we find the chief and most important one in the profession itself. We are not only seeing but feeling the crowded membership rapidly increasing, making the total increase more than commensurate with our increase in population. This ratio of increase is far in excess of a few years since, brings competition to the highest pitch and entices the beginner to accept contract work with its promising prospects of immediate occupation and remuneration. Then, also, we have those older in experience, who, because of lack of success, whether from incompetence or fault of vice, see luring prospects in this line with patients of corpulsion rather than those with a voice in their physician's selection. It would be well before going further to divide contract practice into contract practice proper, and order or club practice. While the former has for its end cheapness as well as a thought to efficiency, the latter has not even that to commend it, but only seeks the cheapest services possible, regardless of ability, skill, or experience. In the former there are not a few instances where, because of necessity, it is justifiable. This, however, can not be said of the latter. In cutlying districts with sparse settlements, like remote and isolated mining districts, the employment of a physician at a stipulated sum per month per capita, whether sick or well, guaranteed by the company may be the only means of securing a physician, for here the loss would be so great by poor or no pay that an existence would be impossible. Again, the same can be said of some manufacturing or other companies with a large foreign element, for here, under certain restrictions both as to pay and number to be attended, it may work to the benefit of physician as weil as employe, and not prove, as some believe, a restriction to trade. In turning now to the main cause or reason for this method from the laity's standpoint we are forced to the conclusion given above; namely, that all order and club contracts have for their aim cheap services only. It is the same whether one or the other is spoken of. Both offer so little per month per capita that a physician's time, if he is to make even a fair living, will be completely occupied by his being compelled to render services to so many more patients than he can serve with justice to himself or his patients, and many more than he would attempt to treat in private practice except under different conditions. The contract or club physician is much more frequently called when his services are not required than he would be by the same clientele were each call to be paid for as in private practice. In defense of this form it can not be said that the mechanic, the laborer, or the poor can be the better served, for are they not served more efficiently and with better results by physicians of their own choice? The statement has been made that "there are thousands of physicians in this country. who are working for an income less than the average skilled laborer receives"; this statement must necessarily apply to many in private practice, and unrestricted contract work gives the gloomiest prospects for any improvement. Just as club practice tends to pauperize the profession, so also does it place a premium on pauperism in general. There are doubtless among us some who have been approached by a representative of some order or organization, with name euphonious and philanthropic, seeking a physician for such, and offering one to five dollars per year per member for attendance on the member and family. One hundred members, then, would give from one hundred to five hundred dollars for services to not less than five hundred people according to the usual average. A most fascinating and glorious prospect for the physician with a most gloomy outlook for his profession-a profession which is now making more progress for the healing and prevention of ills and the betterment of mankind, and doing more for charity's sake than all others combined, demanding of its members a more careful and selective preliminary education, a more thorough and practical medical education, with a more rigid and complete license examination. Is what I have stated an extreme case? Has it not the ear-marks of truth? The labor organizations with their increasing strength and importance are now among us, with a ready eye and ear to their own interests, and that they are ever alert is shown by the contest now going on between one or two county societies in California and a labor order with company contract physicians. When a company makes a reduction of from one dollar to ten cents per month per capita to its physicians, and they blindly accept, and when the county society steps in and demands that such physicians should be ostracised by their more capable and better thinking brethren, then certain organizations stand amazed at such usurpa tion of individual rights; for by what right and by what authority does the society dare interfere? Should not the contract physician be allowed to serve whom and for what he sees fit? Nevertheless, do we not all know with what vehemence any reduction in the laborer's wages is fought? A reduction of an amount such as stated applying to themselves would in a few hours cause such a strike as has never occurred in the country's history. There is no doubt that any physician who gives himself to this form of work unmodified, is forging another link in the chain which will the more surely bind this honored body in utter servitude to the masses, and while those of the more enlightened have always held and will always hold this as the noblest and most respected of callings, it will none the less lighten the burdens put upon it. County and state societies should give some thought to this question, and while it may seem so unimportant and its apparent dangers and abuses so far away that we will never be within its radius, nevertheless, it will be well to be prepared and ready to repel them as they appear. The endeavor to increase the membership in our county societies should continue unceasingly, for by uniform membership we have the strongest and most effectual weapon against any indignities and hardships put upon the profession. But after all that can be said for or against this method, it yet remains with the physician himself to make or destroy it: if, however, each will think of this question, not alone from a self-interested or worldly point, but as well from that broader principle which should be the governing force. in our professional lives, dealing honorably and charitably with one another and with others, remembering that each has a place here with equal rights, when, then, we take up this question it will be safe to predict that soberness of mind and fairness of spirit will so modify it that individual preferences to the detriment of the many will fade away to be no longer a threatening cloud to the profession.-Pennsylvania Medical Journal. After tracheotomy the air of the patient's room should be kept reasonably warm and moist. Draughts of cold air provoke much irritation.-American Journal of Surgery. Medical Journal. CANNOT WE HAVE A PURE FOOD The West Virginia Medical Journal. COMMITTEE ON PUBLICATION. S. L. JEPSON, M.D., CH'n. L. D. WILSON, M.D., JNO. L. DICKEY, M.D. All communications to this Journal must be made to it exclusively. Communications and items of general interest to the profession are invited from all over the State. Notices of deaths, removals from the State, changes of location, etc., are requested. Our readers are requested to send us marked copies of local newspapers containing matters of interest to members of the medical profession. Name of sender should be given. CONTRIBUTIONS TYPEWRITTEN. It will be satisfactory to all concerned if authors will have their contributions typewritten before submitting them for publication. The expense is small to the author-the satisfaction is great to the editor and printer. ADVERTISEMENTS. Advertising forms will go to press not later than the 20th of July, September, November, January, March and May. Advertisements of proprietary medicines must be accompanied with formula. We have recently passed through the season of "peace on earth and good will to men," followed by the days of new resolutions which are only too often quickly forgotten. Since our profession is "growing in grace" and good feeling among its members, isn't it a good time to memorize the somewhat familiar lines below, and try daily to practice the lesson contained in them! "There's so much bad in the best of us, LAW? It is a great satisfaction to note the increasing interest manifested by legislators in matters that concern the public health, and especially in the subjects so intimately related thereto as those of pure food and drug legislation and medical practice regulation. Unquestionably these two subjects, in their larger aspect, comprehend between them much the greater part of that which is potential for good in such legislation. The first aims to secure and guarantee the purity and efficiency of that which is essential to the maintenance of healthful conditions. and to the eradication or control of diseaseproducing influences, our foods and drugs. The second seeks to maintain at a high standard the fitness and qualifications of those to whom, almost of necessity, must be committed the selection and command of these agencies, our medical practitioners. The people, in their law-making capacity, have been slow to grasp the fact that the power to legislate in such matters is not only within the province of their prerogative, but that it is of the highest importance that it should be freely and intelligently exercised. Law-making bodies have been accustomed, until recently, to deal with questions of revenue, corporate and individual rights, the safeguarding of property and life, dissemination of education, maintenance of highways, etc., almost to the exclusion of public health and sanitary concerns. These, along with the care of individual cases of disease, and all that relates to their management, have been tacitly turned over to the medical profession, but without the power being given it either to maintain its own efficiency in personnel or qualification, or to enforce any regulation, no matter how urgent the need, which the interests of the public health might require. It is surely as desirable to protect the citizen from life-imperilling disease as it is to guard him against crimes of violence. One can be done as efficiently as |