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It cannot be too strongly emphasised that-forthe present at any rate-the proposal is simply.and solely to sterilise the quite hopeless but fertileand well-behaved cases of mental defect. No

physician of experience has the slightest difficulty ingiving a prognosis for a feeble-minded youth or girl,and few doctors who have to do with these youngpeople would quail before the responsibility ofadvising sterilisation for a large number. InCalifornia no inmate of the State home for the feeble-minded is allowed out unless sterile. Another objectionis that the sterilised defective would be a source ofimmorality and venereal disease. The answer given isthat sterilisation makes little difference one way oranother to the habits of a defective. If selection iscareful and supervision reasonably adequate, no

defective of immoral habits will be returned to the.community. That this is a feasible policy is shownby a careful follow-up of 605 patients from theCalifornia State home. Only one boy-an exhibitionist-showed any sexual delinquency and only 3-8 percent. of the total were found incompatible, for otherreasons, with free social life and the public welfare.Social workers and other trained observers are unani-mous in denying any signs in this group of viciousnessor tendency to spread disease. These tendencies are.still further decreased by the possibility of marriagewhich-the tragedy of the fertile defective-is to bewelcomed for the sterilised as it stabilises their lifeand increases their happiness. Inquiry showed thatof 136 marriages among Californian sterilised.defectives two-thirds were successful in that thecouple were monogamous, law-abiding, self-supporting,and reasonably happy. Questionaires showed thatsocial workers, parents and relatives, physicians,eugenists and patients were all alike satisfied withthe experiment.2 This fact in itself answers a goodmany of the honest fears of opponents of sterilisation, Iand these published results fall into a very differentcategory from speculations of what might happenand unsupported rumours of what does happen16 over in America." A cogent objection which the

Californian experiment does not counter is thatsterilisation can produce so little effect on the numberof defectives born that it is not worth doing. It mayreasonably be argued, even so, that if it increases thehappiness of living defectives and decreases theirexpense to the nation it is still worth while. On theother hand, Mr. R. A. Fisher has claimed that itmight well reduce the incidence of mental defect by36 per cent. in one generation and though thevalidity of such figures can only be judged bystatisticians, the plain man cannot forget that thechildren of defectives ought never to be born.Sometimes cruel by nature, more often cruel fromignorance, generally without self-control, the feeble-minded parent is utterly unfit to nurse and trainchildren of tender years. As Mrs. Pinsent has said," The condition of the children of mental defectivesis enough to make the most cynical ashamed of ourcivilisation." A recent investigation into the clienteleof birth control clinics 4 has shown that these do nottouch the problem ; the defective mother has not theforesight and sense of responsibility required toattempt prevention on her own initiative.About the condition of the defective’s home and

the magnitude of the problem there are no twoopinions. We have drawn attention again and againto the terrible disparity between the institutionalaccommodation available and the numbers needingit. At the latest estimate there are nearly 300,000irremediable defectives at large, many of thempropagating rapidly. Segregation must be slow andenormously expensive. The argument of thesteriliser is : Since these people are not on thewhole antisocial but their reproduction is a personal.and national tragedy, let us submit them to a simple,safe operation which will do nothing to them save

2 Popenoe, Paul: Jour. Nerv. Ment. Dis., 1928, Ixvii., 17;and Jour. Heredity, 1928, xix., 73, et al.

3 Eugenics Review, 1924-25, xvi., 114.4 Hines, N.: Eugenics Review, 1928, xx., 157.

prevent conception. The liberty of the individual isinfringed daily to protect the community frominfectious disease, but mental defect is a graver thingthan small-pox or yellow fever, for it threatens thefuture of the race. The Californian experiment hasshown that sterilisation can be carried out on a largescale without any of the evil results feared by thecautious. To object to a measure because it does notsolve the whole problem is surely the weakest of allarguments for doing nothing at all. Nobody claimsthat sterilisation will abolish the need for colonies,institutions, and supervision, but it will give freedomto those who are worthy of it, will reduce publicexpenditure, and will take its place as an essentialelement in a complete and well-organised programmeof mental hygiene. These arguments deserve a

more general and a more thoughtful considerationthan they usually receive.

BRITISH CONGRESS OF OBSTETRICS AND

GYNÆCOLOGY.

THE Seventh British Congress of Obstetrics andGynaecology opened in Dublin on April 24th underthe presidency of Dr. Gibbon FitzGibbon. Thefirst day was devoted to a discussion on The Manage-ment of Cases of Pelvic Disproportion, when Prof.Munro Kerr opened with a paper on The Diagnosisof Pelvic Disproportion, by (a) instrumental,(b) manual, (c) radiographic methods. He pointedout that there is by all methods great difficulty inarriving at exact measurements of the pelvic inlet,but that deformities of the outlet could be exactlydetermined. The selection of treatment for deformityof the pelvis at the inlet therefore depended on anexact estimation of the relative size of the head to thepelvis ; but for the outlet treatment should be based

on exact measurement of the outlet. He emphasisedthe importance of recognising minor deformities, asfailure to do so resulted so often in unsuitable treat-ment being employed. He believed that the largestproportion of disasters occurred in this group. Inconclusion, he pointed out that the practical questionwas-will the head pass ? He referred to the factorswhich influenced spontaneous delivery : (a) previousobstetric history ; (b) any irregularity in pelvic brim;(c) size of foetal head ; (d) degree of ossification ;(e) variety of biparietal obliquity ; (f) strength ofuterine contractions. A report of the proceedingswill follow in our next issue.Members of the Congress were entertained at

luncheon at the Royal Hibernian Hotel on theopening day by the local council, and, in the eveningthe President and Mrs. FitzGibbon held a reception inthe Royal College of Surgeons, which was largelyattended. The Congress Dinner was held on April 25that the College with the President in the Chair.

Sir George Blacker has been appointed President ofthe Radium Institute in succession to Sir AnthonyBowlby (deceased), and Sir Hugh Rigby’s name hasbeen added to the Committee of the Institute.

I THE 161st exhibition of the Royal Academy of Artsis on the eve of being open to the public. Two of theoutstanding portraits in the exhibition are of distinctmedical interest, namely, that of Lord Moynihan byMr. Richard Jack, and that of the Rt. Hon. NevilleChamberlain, the Minister of Health, by Sir WilliamOrpen. Both are admirable presentations.

THE amount of the Central Practitioners’ Fund forthe year 1928 has been finally determined at6,191,750, of which the London Insurance Com-mittee’s share is ;1;882,079. The amount due to thisCommittee in final settlement is 230,752. The totalpayment for the year works out at 8s. 11-725. perunit of credit ; the corresponding figure for theyear 1927 was 8s. 10’447d. This represents an

average capitation fee in 1928 of 9s. 0-031d., as com-pared with 8s. 10-87d. in 1927.