286 The Eugenics Review
his opinion the reverse would be the case. Apparently the experience in Sweden with voluntary sterilization has been very disappointing, only a few hundreds having been sterilized since the introduction of the law a few years ago.
Practising doctors in general are inclined to object to the law, and to the increase in their duties, and to the increasedly police nature of these duties which the law entails. The doctor must notify all cases of the hereditary disorders named in the law, as far as these become known to him through the practice of his profession. For instance, were he, on a professional visit, to see the patient's brother have an epileptic fit, he would not be bound to notify him, though he could do so if he wished. If the patient himself were to have the fit, and it could not be referred to definite exogenous causes, then he must notify. If, on the other hand, the doctor passing casually along the street were to see a patient of his having a fit, he would not be bound to notify him. Presumably, however, if he were to proceed to his assistance, the duty to notify would reappear.
The keenness with which doctors carry out their duties varies greatly from place to place. In small country villages, with only one doctor, he generally does it satisfactorily, because he neither loses nor gains by it. In places with two or more doctors they usually notify only where it is obviously unavoidable. The doctor slackest in notifying will tend to profit at the expense of the others. On the other hand in Thuringia and Baden these duties were carried out with the greatest enthusiasm. In the latter place, the doctors seemed possessed of the notion that the more cases they notified, the better pleased would they be in high quarters. At length a circular had to be sent round, telling them that they were only to notify cases properly capable of reproduction.
In clinics, the duty of notification is carried out conscientiously, and proceeds for the most part automatically. The chief difficulties are those of diagnosis. The diagnosis should be of such a degree of certainty that the clinician would be prepared to back it in a court of law, or alternatively for the Professor to be able to demonstrate the case as such to a class of students. Many authorities find difficulty in fitting their cases into the official scheme of classification - particularly , for instance, Kleist. According to Kleist's classification there are a number of syndromes, for instance - motility and confusion psychoses, which would by most clinicians be considered schoziphrenic, but which he treats as separate entities. As in these cases his researches in the heredity have shown no connection with schizophrenia, he does not hold them to be schizophrenic, nor covered by the law, nor in his clinic are they notified.
Difficulties of diagnosis must necessarily occur, and may have unfortunate effects. The following is such a case.
The daughter of a doctor had had in childhood an obscure febrile complaint, accompanied by some minor neurological signs. At puberty she developed periodical but rare and slight "absences"; but with the years these increased in frequency and severity until they were major epileptic fits. In the course of treatment her father was informed she would have to be notified for sterilization. He objected very much, and took her from doctor to doctor in the vain attempt to get her recognized as a case of fits of exogenous origin. At last she was seen by one of the best neurological surgeons of the country, who after an encephalography operated on her and removed a large cyst from the brain, with complete recovery and cessation of the fits.
Such cases cannot be published, owing to the disrepute in which they might bring the law, if they were at all frequent.
In the first few months after the law was passed, there was a considerable amount of overcrowding in clinics and hospitals, because cases of recovery from schizophrenia and manic-depressive psychosis had to be held pending decision on the matter of sterilization. This is the case no longer. Once the case is notified, he may be discharged and wait at home for the notice