Heredity & Consumption

On 19th May 1922, the Westminster Gazette published Heredity & Consumption by Dr Halliday Sutherland. In it, he berated eugenists for their views on the disease in which he was a specialist.

HEREDITY & CONSUMPTION

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MARRIAGE PROBLEM

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A CHALLENGE TO THE EUGENISTS

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By Halliday G. Sutherland,
M.D. (Edin)

(Hon. Physician to St. Marylebone Hospital;
Ex-President of the Tuberculosis Society of Gt. Britain)

The modern mind is ever seeking for plain answers to complicated questions. When a doctor is asked if consumptives should marry he replies that the answer depends on circumstances, which he attempts to explain. But the modern mind, impatient of all contingencies, leaves the doctor in the midst of explanations, and hastens to the Eugenist. Now a Eugenist is one who believes that the health of the race could be improved if, in the matter of marriage, the free choice of men, especially of poor men, were constrained by positive law. Should consumptives marry? No, says the Eugenist, they have no right to marry.

That answer is important because it denies to a particular class something that Christendom has hitherto regarded as one of the inborn rights of man. These rights were never held to be absolute, but only under very serious circumstances have they ever been forfeited in the past. By murder a man forfeits his right to live, and every human right may thus be overruled by a greater right. We must therefore inquire whether there is anything in the nature of tuberculosis that warrants the denial of the right of marriage to Consumptives.

Consumption Not Inherited.

The disease is not inherited. No child is born tuberculous, but every tuberculous child is infected after birth. Although the disease is not inherited, a belief arose in the nineteenth century that there is an inherited predisposition, without which the malady cannot develop. This belief was natural. Tuberculosis appears more often in children than in the consort of a patient. The whole household may be exposed to infection, but the children have an inherited predisposition that is absent in the consort.

At first glance that argument is convincing. As a practical test I examined the households of 204 consumptives some infectious and others non-infectious. Of the children of infectious parents 60 per cent were infected, and of the children of non-infectious consumptives 26.4 per cent were infected. Moreover, the late Dr. J. Edward Squire found that amongst 275 families in which the parents were healthy, 24.87 per cent of the children developed tuberculosis. These figures suggest that there is as much tuberculosis amongst the children of healthy parents as amongst the children of non-infectious consumptives, that there is no inherited predisposition, and that exposure to infection is a more important cause of the malady.

Determining Factors

At the beginning of the illness, a patient is not infectious. Later on his expectoration contains the tubercle bacilli, and thus the careless consumptive scatters infection. Now, of those who are infected, some will remain healthy, but others will develop the disease. To some extent the amount of infection determines the result, because the disease is likely to follow infection than by a small number of tubercle bacilli. Another determining factor is the natural resistance of the body. Children are most susceptible to infection, and the resistance of adults increases with years. That is why the disease appears more often in the children than in the consort of a tuberculous patient. Again, assuming that all are equally exposed to infection, those who are well housed, well fed, and in good health have a greater resistance than those who are half starved, overcrowded and whose health is poor. For that reason the amount of tuberculosis amongst the poor is four times greater than amongst the rich.

There is massive infection when a child is reared by a mother with advanced disease. She coughs and the air around her is sprayed with droplets of secretion containing tubercle bacilli. This air the child breathes. Millions of bacilli are deposited on the skin and clothing, and are carried to the mouth by the hands. She coughs over the child’s food. Everything, including the table utensils, is infected, and the child swallows infection at every meal. Again, when a husband is consumptive, it is a serious handicap in his work. He loses time and employment through sickness, his family tends to become poorer, and their resistance to the infection, of which he is the source, is lowered. When anyone is suffering from tuberculosis a sanitorium is better than a honeymoon, and the patient should defer marriage until the disease has been well healed, as proved by a lapse of two years without recurrence. In that event there is no serious reason why a cured consumptive should not marry.

A Modern Heresy

No one who is suffering from tuberculosis should marry. Now, marriage is the last thing on which humanity will accept advice, and there are many imprudent consumptives. The Eugenist maintains that because imprudent patients will marry, no consumptive should be allowed to marry. That illustrates a great modern heresy—namely, that if some men choose evil rather than good, no man should be allowed to choose at all. Because one man may become a drunkard, all men shall abstain. Nevertheless, if predisposition and infection from parents were the only causes of tuberculosis, Eugenists could argue that if these marriages were forbidden the disease would disappear. Now, over 90 per cent of the population have been infected by the bacillus and yet do not develop the disease. Those who live overcrowded in our industrial and rural slums are most vulnerable. And parents are not the only source of infection. Thousands of gallons of tuberculous milk are sold every day. Even if a Super-Eugenist, greatly daring, were to slay every consumptive in the land tonight, we should breed the disease afresh before tomorrow’s morn.

Given that “Super-Eugenists, greatly daring” did start to kill the “unfit” in the decade that followed, the last sentence was particularly prescient.