Tag: transmitted

  • Billions worldwide living with herpes

    Billions worldwide living with herpes

    About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show, highlighting the need to improve awareness and scale up services to prevent and treat herpes.

    About 13% of the world’s population aged 15 to 49 years were living with herpes simplex virus type 2 (HSV-2) infection in 2016, the latest year for which data is available.  HSV-2 is almost exclusively sexually transmitted, causing genital herpes. Infection can lead to recurring, often painful, genital sores in up to a third of people infected.

    Herpes simplex virus type 1 (HSV-1) is mainly transmitted by oral to oral contact to cause oral herpes infection – sometimes leading to painful sores in or around the mouth (“cold sores”). However, HSV-1 can also be transmitted to the genital area through oral sex, causing genital herpes.

    Around 67% of the world’s population aged 0 to 49 had HSV-1 infection in 2016 – an estimated 3.7 billion people. Most of these infections were oral; however, between 122 million to 192 million people were estimated to have genital HSV-1
    infection.

    Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive
    health” says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at the World Health Organization (WHO). 

    Herpes and HIV

    People with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. Thus, HSV-2 likely plays a substantial role in the spread of HIV globally. Women are more susceptible to both HSV-2 and HIV. Women living in
    the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection.

    No cure: vaccine needed

    There is no cure for herpes. Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.

    Better awareness, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally. In addition, development of better treatment and prevention interventions is needed, particularly
    HSV vaccines.  

    “A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
    and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.

    Authored by staff at the University of Bristol, the WHO, and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization, this new study estimates the global infection prevalence and incidence of HSV-1 and HSV-2
    in 2016. 

    Billions worldwide living with herpes
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  • Massive proportion of world’s population are living with herpes infection

    Massive proportion of world’s population are living with herpes infection

    Virus causing genital herpes may put millions of people at greater risk of infection with HIV

    About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show.

    Authored by staff at the University of Bristol, World Health Organization (WHO), and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization,
    the new study estimates the global infection prevalence and incidence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) in 2016. 

    “Herpes infection affects millions of people across the globe and can have far-reaching health effects. We need more investment and commitment to develop better treatment and prevention tools for this infection.” says Dr Sami Gottlieb, Medical
    Officer at WHO and an author of the study.

    Prevalence and incidence

    An estimated 491.5 million people were living with HSV-2 infection in 2016, equivalent to 13.2% of the world’s population aged 15 to 49 years. HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area (genital
    herpes).

    An estimated 3.7 billion people had HSV-1 infection during the same year – around 66.6% of the world’s population aged 0 to 49. HSV-1 is mainly transmitted by oral to oral contact to cause infection in or around the mouth (oral herpes). However,
    HSV-1 can also be transmitted to the genital area through oral-genital contact – during oral sex – to cause genital herpes. Most HSV-1 infections were oral; however, between 122 million to 192 million people were estimated to have genital
    HSV-1 infection, depending on the assumptions used in the estimation model.

    Because herpes is a lifelong infection, estimated prevalence increased with age; HSV-2 prevalence was also higher among women and in the WHO African Region.

    Health and social impacts

    Most people living with herpes, caused by either HSV-1 or 2, are unaware they have the infection.

    When symptoms do occur however, oral herpes infection can lead to painful sores around the mouth (“cold sores”). Genital herpes infection can cause recurring, often painful, genital sores, often referred to as genital ulcer disease. 

    WHO and partners published a study in March 2020 estimating that around 5% of the world’s population (187 million people) suffered from at least one episode of herpes-related genital ulcer disease in 2016 (1). Most of these episodes were due to
    HSV-2, which can recur frequently over many years.

    Recurrent symptoms of genital herpes can lead to stigma and psychological distress, and can have an important impact on quality of life and sexual relationships. However, in time, most people with herpes adjust to living with the infection.

    “Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive health”
    says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at WHO. 

    Herpes and HIV

    A strong association exists between HSV-2 infection and HIV infection. In 2019, WHO commissioned a modeling study to estimate how much HSV-2 infection might contribute to HIV incidence. The study estimated that almost 30% of new sexually acquired HIV
    infections in 2016 worldwide were likely attributable to HSV-2 infection (2). 

    Evidence shows that people with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. HSV-2 leads to inflammation and small breaks in the genital and anal skin that can make it easier for HIV to cause infection.
    In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others.

    Women have higher biologic susceptibility to both HSV-2 and HIV. Women living in the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection, with negative implications for their health
    and well-being. 

    For people living with HIV (or who are living with other conditions that compromise their immune systems) as well as HSV-2, the symptoms of herpes can be more severe and more frequent. 

    Neonatal herpes

    Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. This is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, but can lead to lasting neurologic disability or death. The risk
    for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants.

    No cure – better treatment and prevention needed

    There is no cure for herpes. At present, antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.

    As well as increasing awareness about HSV infection and its symptoms, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally. 

    In addition, development of better treatment and prevention interventions is needed, particularly HSV vaccines. WHO and partners are working to accelerate research to develop new strategies for prevention and control of HSV infections. Such research includes
    the development of HSV vaccines and topical microbicides. Several candidate vaccines and microbicides are currently being studied.

    “A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
    and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.

    Related publications

    WHO guidelines for the treatment of Genital Herpes Simplex Virus

    WHO preferred product characteristics for herpes simplex virus vaccines

     

    ———————-

    (1) Looker KJ, Johnston C, Welton NJ, et al. The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study. BMJ Glob Health. 2020;5(3):e001875. doi: 10.1136/bmjgh-2019- 001875.

    (2) Looker KJ, Welton NJ, Sabin KM, et al.Global and regional estimates of the contribution of herpes simplex virus type 2 infection to HIV incidence: a population attributable fraction analysis using published epidemiological data. Lancet Infect Dis.2020;20(2):240-249. doi: 10.1016/S1473-3099(19)30470-0.

    Massive proportion of world’s population are living with herpes infection
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  • Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

    Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

    Indonesia recently completed the last of its annual large-scale treatment for lymphatic filariasis (also known as elephantiasis or Penyakit Kaki Gajah) in Malaka District located in its southernmost province, East Nusa Tenggara. Unprecedented
    progress by the National Lymphatic Filariasis Elimination Programme has strongly placed the country on the path to achieving the elimination of lymphatic filariasis as a public health problem.

    “We reached an estimated number of 40.7 million people living in the 118 high-risk districts during this month-long treatment campaign in October 2019” said Dr Anung Sugihantono, who recently retired as Director General of Diseases
    Prevention and Control, Ministry of Health Indonesia. “
    Single doses of diethylcarbamazine citrate and albendazole facilitated by WHO were delivered to all eligible populations.”

    In 2010, an estimated 125 million Indonesians were still at risk of the disease and required treatment.

    But things changed considerably in 2015 when Indonesia mounted an annual national campaign to resolutely address transmission of the disease and to tackle the morbidity and disability associated with it. The results were apparent as early as 2017, with
    remarkable progress.

    In Indonesia, LF is considered a significant public health concern. In 2009, risk mapping identified a population of 124.5 million people needing treatment for LF. The country initiated a national level LF elimination campaign in 2015, addressing both
    disease prevention and management. 

    “In 2017 and in just two years we managed to achieve 100% geographical coverage of all people requiring treatment” said Dr Sugihantono. “It meant achieving more than 78% epidemiological coverage – much higher than the generally recommended 65% to stop transmission.”

    Transmission of lymphatic filariasis can be stopped through large-scale treatment (or mass drug administration – MDA) of entire at- risk communities with recommended medicines once a year. These medicines kill the microfilariae in an infected patient’s
    blood preventing mosquitoes to transmit1 the disease to others. Through mass treatment, the aim is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector.

    This strategy to interrupt transmission is the corner-stone of the World Health Organization’s (WHO) Global Program to Eliminate Lymphatic Filariasis (GPELF). Indonesia has been using the GPELF’s strategy since 2002 using a district or city
    as its implementation unit.

    In 2005, it listed the elimination of LF as a national priority for controlling infectious diseases and the medicines it has been using in large-scale treatment programmes are diethylcarbamazine citrate (DEC) and albendazole2 which are
    largely distributed by volunteer community health workers3.

    “Community health volunteers are themselves members of the community and know how to reach people effectively to improve compliance” said Dr. Stefanus Bria Seran, the Regent of Malaka District, one of LF endemic district in Indonesia. “Besides ensuring every single person ingests the medicine given to them, these community workers help in disseminating information well before a large-scale treatment campaign and also assist in reporting activities related to each treatment campaign”. 

    Indonesia’s efforts to eliminate lymphatic filariasis began in the 1970s but faced numerous challenges including programme coordination in the many inhabited islands, conducting information, education and awareness programmes, lack of capacity and
    insufficient medicines.

    Furthermore, the situation in Indonesia is unusual than in many other countries endemic for lymphatic filariasis as the country is endemic for all three species of thread-like filarial worms – Brugia malayi, Brugia timori, and Wuchereria bancrofti –
    that cause the disease. Most of the infections in Indonesia, however, are caused by B. malayi.

    In the past, some of the factors that prevented access to the medicines (DEC and albendazole) were social stigmatization linked to the disease, the vast geography of the territory and challenges in reaching remote populations.

    With an estimated population of 242 million, Indonesia is the world’s largest island nation and consists of approximately 17,000 islands, of which 5,000–6,000 are inhabited. It is the fourth most populated nation behind China, India, and the United
    States.

    Indonesia is endemic for many other neglected tropical diseases and an estimated 110 million Indonesians are believed to suffer from at least one neglected tropical disease (NTD), including lymphatic filariasis and soil-transmitted helminth infections.
    Leptospirosis (not classified as NTD) is also widespread.

    Indonesia is the only country of WHO’s South East Asia Region with endemic schistosomiasis. Like many other countries of the Region, it also faces recurrent threats of dengue outbreaks.

    Global progress

    The world has made significant progress towards the elimination of lymphatic filariasis as a public health problem.

    Sixteen countries4 and one territory are now acknowledged by WHO to have achieved elimination of lymphatic filariasis as a public health problem.  

    Seven additional countries have successfully implemented recommended strategies, stopped large-scale treatment and are under surveillance to demonstrate that elimination has been achieved.

    The disease

    Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The larval stages of the parasite (microfilaria) circulate in the blood and are transmitted from person to person by mosquitoes.

    Infection involves asymptomatic, acute, and chronic conditions. Most infections are asymptomatic, showing no external signs while contributing to transmission of the parasite. Although asymptomatic, these infections still cause damage to the lymphatic
    system and the kidneys and alter the body’s immune system.

    When lymphatic filariasis develops into chronic conditions it leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (scrotal swelling). Involvement of breasts and genital organs are common.

    Manifestation of the disease after infection takes time and can result in an altered lymphatic system, causing abnormal enlargement of body parts, and leading to severe disability and social stigmatization of those affected.

     


    1Lymphatic filariasis is transmitted by different types of mosquitoes – e.g the Culex mosquito which widespread across urban and semi-urban areas; Anopheles, mainly found in rural areas; and, Aedes, mainly
    in endemic islands in the Pacific.

    2In 2017, WHO recommended an alternative three drug treatment to accelerate the global elimination of lymphatic filariasis. The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate and albendazole.
    It is recommended annually in settings where its use is expected to have the greatest impact.

    3Community health workers, also called ‘cadres’, are volunteers who form part of the communities they serve and work with local
    communities to educate families. Their contribution in promoting health has been significant in the country.

    4Cambodia, The Cook Islands, Egypt, Kiribati, Maldives, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Viet Nam, Wallis and Futuna, and Yemen

    Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem
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  • New FAQs address healthcare workers questions on breastfeeding and COVID-19

    New FAQs address healthcare workers questions on breastfeeding and COVID-19

    Mothers and healthcare workers who support them have many questions and concerns about whether it is safe for mothers with confirmed or suspected COVID-19 to be close to and breastfeed their babies during the pandemic.

    To address their questions, WHO has released a list of Frequently asked questions: Breastfeeding and COVID-19. The FAQ complements the WHO interim guidance: Clinical management of severe acute respiratory infection when COVID-19 is suspected and draws upon other WHO recommendations on infant and young child feeding.

    The FAQs aim to provide information to healthcare workers supporting mothers and families in maternity services and community settings, and communicate how the interim guidance should be implemented. Additionally, the FAQs provide information about the protective effects of breastfeeding and skin-to-skin contact, and the harmful effects of inappropriate use of infant formula milk.

    Accompanying the FAQs is a decision tree which provides step-by-step guidance to health workers on how to support mothers with confirmed or suspected COVID-19 to breastfeed. It provides advice on what to do if mothers are not well enough to breastfeed, as well as appropriate hygiene measures for mothers, including wearing a medical mask if available, to reduce the possibility of the COVID-19 virus being spread to her infant.

    Benefits of breastfeeding outweigh potential risks

    The COVID-19 virus has not been detected in the breastmilk of any mother with confirmed and suspected COVID-19 and there is no evidence so far that the virus is transmitted through breastfeeding. Researchers continue to test breastmilk from mothers with the infection.

    WHO recommends that all mothers with confirmed or suspected COVID-19 continue to have skin-to-skin contact and to breastfeed. In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also reduces the risk of breast and ovarian cancer for the mother. Skin-to-skin contact, including kangaroo mother care, reduces neonatal mortality, especially for low birth weight newborns.

    While infants and children can contract COVID-19, they are at low risk of infection. The few confirmed cases of COVID-19 in young children to date have experienced only mild or asymptomatic illness.

    WHO’s recommendations on the care and feeding of infants whose mothers have confirmed or suspected COVID-19 aim to improve the immediate and lifelong survival, health and development of their newborns and infants. These recommendations consider the likelihood and potential risks of COVID-19 in infants and also the risks of serious illness and death when infants are not breastfed or when infant formula milk are used inappropriately.

    WHO’s Q&A on breastfeeding and COVID-19 also provides additional infection prevention advice to mothers with confirmed or suspected COVID-19.

    New FAQs address healthcare workers questions on breastfeeding and COVID-19
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  • EUGENICS AND CHARACTER

    EUGENICS AND CHARACTER

    The rapidly growing interest in Eugenics, and the scientific consideration of the world-wide decline in the birth-rate have drawn attention to the study of the eugenic factors which determine the production of high ability in offspring. Many distinguished investigators have conducted long and exhaustive investigations for the purpose of ascertaining and summarizing all possible biological data concerning the parentage and birth of the most notable persons born in European countries, and to a lesser extent in America.

    The investigations are now acquiring a fresh importance, because, while it is becoming recognized that we are gaining a control over the conditions of birth, the production of children has itself gained an importance. The world is no longer to be bombarded by an exuberant stream of babies, good, bad, and indifferent in quality, with mankind to look on calmly at the struggle for existence among them. Whether we like it or not, the quantity is steadily diminishing, and the question of quality is beginning to assume a supreme significance. The question then is being anxiously asked: “What are the conditions which assure the finest quality in our children?”

    A German scientist, Dr. Vaerting, of Berlin, published just before the War a treatise on the subject of the most favorable age in parents for the production of offspring of ability. He treated the question in an entirely new spirit, not merely as a matter of academic discussion, but rather as a practical matter of vital importance to the welfare of modern society. He starts by asserting that “our century has been called the century of the child,” and that for the child all manner of rights are now being claimed. But, he wisely adds, there is seldom considered the prime right of all the child’s rights, i. e., the right of the child to the best ability and capacity for efficiency that his parents are able to transmit to him. The good doctor adds that this right is the root of all children’s rights; and that when the mysteries of procreation have been so far revealed as to enable this right to be won, we shall, at the same time renew the spiritual aspect of the nations.

    The writer referred to decided that the most easily ascertainable and measurable factor in the production of ability, and efficiency in offspring, and a factor of the greatest significance, is the age of the parents at the child’s birth. He investigated a number of cases of men of ability and efficiency, along these lines, and made a careful summary of his results. Some of his results are somewhat startling, and may possibly require the corroboration of other investigators before they can be accepted as authoritative; but they are worthy of being carefully considered at the present time, pending such further investigation.

    Vaerting found that the fathers who were themselves not notably intellectual have a decidedly more prolonged power of procreating distinguished children than is possessed by distinguished fathers. The former may become the fathers of eminent children from the period of sexual maturity up to the age of forty-three or beyond. When, however, the father is himself of high intellectual distinction, the records show that he was nearly always under thirty, and usually under twenty-five years of age at the time of the birth of his distinguished son, although the proportion of youthful fathers in the general population is relatively small. The eleven youngest fathers on Vaerting’s list, from twenty-one to twenty-five years of age, were with one exception themselves more or less distinguished; while the fifteen oldest, from thirty-nine to sixty years of age, were all without exception undistinguished.

    Among the sons on the latter list are to be found much greater names (such as Goethe, Bach, Kant, Bismarck, Wagner, etc.) than are to be found among the sons of young and more distinguished fathers, for here is only one name (Frederick the Great) of the same caliber. The elderly fathers belonged to the large cities, and were mostly married to wives very much younger than themselves. Vaerting notes that the most eminent men have frequently been the sons of fathers who were not engaged in intellectual avocations at all, but earned their living as humble craftsmen. He draws the conclusion from these data that strenuous intellectual energy is much more unfavorable than hard physical labor to the production of marked ability in the offspring. Intellectual workers, therefore, he argues, must have their children when young, and we must so modify our social ideals and economic conditions as to render this possible.

    Vaerting, however, holds that the mother need not be equally young; he finds some superiority, indeed, provided the father is young, in somewhat elderly mothers, and there were no mothers under twenty-three on the list. The rarity of genius among the offspring of distinguished parents he attributes to the unfortunate tendency to marry too late; and he finds that the distinguished men who marry late rarely have any children at all. Speaking generally, and apart from the production of genius, he holds that women have children too early, before their psychic development is completed, while men have children too late, when they have already “in the years of their highest psychic generative fitness planted their most precious seed in the mud of the street.”

    The eldest child was found to have by far the best chance of turning out distinguished, and in this fact Vaerting finds further proof of his argument. The third son has the next best chance, and then the second, the comparatively bad position of the second being attributed to the too brief interval which often follows the birth of the first child. He also notes that of all the professions the clergy come beyond comparison first as the parents of distinguished sons (who are, however, rarely of the highest degree of eminence), lawyers following, while officers in the army and physicians scarcely figure at all. Vaerting is inclined to see in this order, especially in the predominance of the clergy, the favorable influence of an unexhausted reserve of energy and a habit of chastity on intellectual procreativeness.

    It should be remembered, however, that Vaerting’s cases on his list were all those of Germans, and, therefore, the influence of the characteristic social customs and conditions of the German people must be taken into account in the consideration.

    Havelock Ellis in his well known work “Study of British Genius” dealt on a still larger scale, and with a somewhat more precise method, with many of the same questions as illustrated by British cases. After the publication of Vaerting’s work, Ellis re-examined his cases, and rearranged his data. His results, like those of the German authority, showed a special tendency for genius to appear in the eldest child, though there was no indication of notably early marriage in the parents. He also found a similar predominance of the clergy among the fathers, and a similar deficiency of army officers and physicians.

    Ellis found that the most frequent age of the father was thirty-two years, but that the average age of the father at the distinguished child’s birth was 36.6 years; and that when the fathers were themselves distinguished their age was not, as Vaerting found in Germany, notably low at the birth of their distinguished sons, but higher than the general average, being 37.5 years. He found fifteen distinguished sons of distinguished British fathers, but instead of being nearly always under thirty and usually under twenty-five, as Vaerting found it in Germany, the British distinguished father has only five times been under thirty, and among these only twice under twenty-five. Moreover, precisely the most distinguished of the sons (Francis Bacon and William Pitt) had the oldest fathers, and the least distinguished sons the youngest fathers.

    Ellis says of his general conclusions resulting from this investigation: “I made some attempts to ascertain whether different kinds of genius tend to be produced by fathers who were at different periods of life. I refrained from publishing the results as I doubted whether the numbers dealt with were sufficiently large to carry any weight. It may, however, be worth while to record them, as possibly they are significant. I made four classes of men of genius: (1) Men of Religion, (2) Poets, (3) Practical Men, (4) Scientific Men and Sceptics. (It must not, of course, be supposed that in this last group all the scientific men were sceptics, or all the sceptics scientific.) The average age of the fathers at the distinguished son’s birth was, in the first group, 35 years; in the second and third group, 37 years; and in the last group, 40 years. (It may be noted, however, that the youngest father of all the history of British genius, aged sixteen, produced Napier, who introduced logarithms.)

    “It is difficult not to believe that as regards, at all events, the two most discrepant groups, the first and last, we come upon a significant indication. It is not unreasonable to suppose that in the production of men of religion in whose activity emotion is so potent a factor, the youthful age of the father should prove favorable; while for the production of genius of a more coldly intellectual and analytic type more elderly fathers are demanded. If that should prove to be so, it would become a source of happiness to religious parents to have their children early, while irreligious parents should be advised to delay parentage.

    “It is scarcely necessary to remark that the age of the mothers is probably quite as influential as that of the fathers. Concerning the mothers, however, we always have less precise information. My records, so far as they go, agree with Vaerting’s for German genius, in indicating that an elderly mother is more likely to produce a child of genius than a very youthful mother. There were only fifteen mothers recorded under twenty-five years of age, while thirteen were over thirty-nine years; the most important age for mothers was twenty-seven.

    “On all these points we certainly need controlling evidence from other countries. Thus, before we insist with Vaerting that an elderly mother is a factor in the production of genius, we may recall that even in Germany the mothers of Goethe and Nietzsche were both eighteen at their distinguished son’s birth. A rule which permits of such tremendous exceptions scarcely seems to bear the strain of emphasis.”

    The student, however, must always remember that while the study of genius and exceptionable talent is highly interesting, and even, as is quite probable, not without significance for the general laws of heredity, still we must beware of too hastily drawing conclusions from it to bear on the practical questions of eugenics. Genius is rare—and, in a certain sense, abnormal. Laws meant for application to the general population must be based on a study of the general population. Vaerting, himself, realized how inadequate it was to confine our study to cases of genius.

    Another investigator, Marro, an Italian scientist, in his well-known book on puberty which was published several years ago, brought forth some interesting data showing the result of the age of the parents on the moral and intellectual characters of school-children in Northern Italy. He found that children with fathers below twenty-six at their birth showed the maximum of bad conduct and the minimum of good; they also yielded the greatest proportion of children of irregular, troublesome, or lazy character, but not of really perverse children—the latter being equally distributed among fathers of all ages. The largest number of cheerful children belonged to the young fathers, while the children tended to become more melancholy with ascending age of the fathers. Young fathers produced the largest number of intelligent, as well as of troublesome children; but when the very exceptional intelligent children were considered separately, they were found to be more usually the offspring of elderly fathers.

    As regarded the mothers, Marro found that the children of young mothers (under twenty-one) are superior, both as regards conduct and intelligence, though the more exceptionally intelligent children tended to belong to more mature mothers. When the parents were both in the same age-groups, the immature and the elderly groups tended to produce more children who were unsatisfactory, both as regards conduct and intelligence—the intermediate group yielding the most satisfactory results of this kind.

    Havelock Ellis makes the following plea for further investigations along these lines, in the interest of the well-being of the race: “But we have need of inquiries made on a more wholesale and systematic scale. They are no longer of a merely speculative character. We no longer regard children as the ‘gifts of God’ flung into our helpless hands; we are beginning to realize that the responsibility is ours to see that they come into the world under the best conditions, and at the moments when their parents are best fitted to produce them. Vaerting proposes that it should be the business of all school authorities to register the ages of the pupils’ parents. This is scarcely a provision to which even the most susceptible parent could reasonably object, though there is no cause to make the declaration compulsory where a ‘conscientious’ objection existed, and in any case the declaration would not be public.

    “It would be an advantage—although this might be more difficult to obtain—to have the date of the children’s marriage, and of the birth of previous children, as well as some record of the father’s standing in his occupation. But even the ages of the parents alone would teach us much when correlated with the school position of the pupil in intelligence and conduct. It is quite true that there are unavoidable fallacies. We are not, as in the case of genius, dealing with people whose life-work is complete and open to the whole world’s examination.

    “The good and clever child is not necessarily the forerunner of the first-class man or woman; and many capable and successful men have been careless in attendance at lectures, and rebellious to discipline. Moreover, the prejudice and limitations of the teachers have to be recognized. Yet when we are dealing with millions most of these fallacies would be smoothed out. We should be, once for all, in a position to determine authoritatively the exact bearing of one of the simplest and most vital factors of the betterment of the race. We should be in possession of a new clue to guide us in the creation of the man in the coming world. Why not begin today?”

    Considerable attention on the part of the American thinking public has been directed toward the investigations and researches of Casper L. Redfield. Mr. Redfield combats the orthodox scientific position that the acquired qualities are not transmitted to offspring; and he most positively states that such characteristics are transmitted to offspring, and are really the causes which have tended toward the evolution and progress of the race. But he insists upon this vital point, namely, that the parent must already have acquired improved quality before he can transmit improvement to the offspring—and that before he can have acquired this improved quality, he must have lived sufficiently long to have experienced the causes which have developed improvement in himself. Consequently, he holds that delayed parentage produces great men.

    Mr. Redfield several years ago offered a prize of two hundred dollars to anyone who could show that a single one of the great men of history was the product of a succession of young parents, or was produced by a line of ancestry represented by more than three generations to a century. But no one ever claimed the prize money. According to Mr. Redfield’s doctrine, race improvement is and will be accomplished as the result of effort, physical and mental, upon the part of prospective parents, particularly if the period of effort is sustained over a considerable number of years previous to reproduction.

    The following quotations from Mr. Redfield’s writing will give a general idea of his lines of thought and his theories. He says:

    “At some time in the past there was a common ancestor for man and the ape. At that time the mental ability of the man was the same as that of the ape, because at that time man and the ape were the same person. From that common ancestor there have been derived two main lines of descent, one leading to man and the other to the ape of today. In the line leading to man, mental ability has increased little by little so that today the mental ability of the man is far above that of the ape. While it may not be literally true for each and every generation between that common ancestor and man of the present time, still we will commit no error if we divide the total increase in mental ability by the number of intervening generations and say that each generation in turn was a little superior to that which produced it. Now it happens that mental ability is something which is inherited—is transmitted from parent to offspring. Take that fact with the fact that there has been a regular (or irregular) increase in mental ability in the generations leading to man, and it will be seen that each generation in succession transmitted to its offspring more than it inherited from its parents. But a parent cannot transmit something which he did not have. Where and how did those generations get that ability which they transmitted but did not inherit?”

    Mr. Redfield in his writings shows that what is true of the human race is true of high-bred domesticated animals, namely, the cow of high milk producing breeds; the fast running and trotting horses; and the highly developed hunting dogs. To each case he applies his question: “Where and how did those generations of animals get that power which they transmitted but did not inherit?” In his investigations he claims to have discovered the secret, namely, that the ancestors, throughout several generations, had each acquired the power which it transmitted, which added to the inherited power raised the general power of the stock. This arose from careful breeding, and directly from the fact that the average age of the parent was much higher in the highly-bred stock than in the “scrub” or ordinary run of stock. In other words, delayed parentage produced better offspring.

    Mr. Redfield proceeds to argue from these facts as follows: “At one time man and ape reproduced at the same average age, whereas now they reproduce at widely different ages. Going back to the time when man and ape separated, our ancestors survived by physical and mental activity in securing food and escaping from enemies. As time went on man reproduced at later and later average age until now he reproduces at about thirty years from birth of parent to birth of offspring. When time between generations stretched out in the man line more than it did in the ape line, the man acquired more mental development before he reproduced than did the ape, and he did this because he was mentally active more years before reproducing. The successive generations leading to modern man transmitted to offspring more than they inherited from their parents, and the generations which did this are the same generations which acquired, before reproducing, the identical thing which they transmitted in excess of inheriting.

    “Coming now to those rare men of whom we have only a few in a century, how were they produced? It should be noted that each one had two parents, four grandparents, and eight great-grandparents. Also that they are certainly improvements over their great-grandparents. If they were not such improvements, then there would be many ‘rare’ cases in a century. In looking into the pedigrees of these great men it is found that they were sons of parents of nearly all ages, but were predominantly sons of elderly parents. While we sometimes find comparatively young parents in the pedigree of a great man, we never find a succession of young parents. Neither do we find an intellectually great man produced by a pedigree extending over three generations. The great man is produced only when the average for three generations is on the elderly side of what is normal. The average age of one thousand fathers, grandfathers, and great-grandfathers in the pedigrees of eminent men was found to be over forty years. Great men rise from ordinary stock only when several generations in succession acquire mental efforts in excess amounts before reproducing.”

    It is the opinion of the present writer that the theories of Mr. Redfield are in the main true, and that in the future much valuable information will be obtained along the same lines, which will tend to corroborate his general conclusions. One’s attention needs but to be plainly directed to the matter, and then he will see that it is absurd to think of a creature transmitting to his offspring qualities which neither he or his mate had inherited or acquired. If there were no transmission of acquired qualities there would be no improvement—and in fact, we know that the bulk of inherited qualities were at some time in the history of the race “acquired.” And, reasoning along the same line, we may see that the young parents who have not had as yet an opportunity to acquire mental power cannot expect to transmit it to their offspring—all that they can do is to transmit the inherited stock qualities plus the small acquired power which they have gained in their limited experience. And, finally, it is seen that offspring produced at a riper age of parenthood, continued over several generations, tend toward unusual ability and powers. Consequently, the people or nation with a higher average age of parenthood may logically expect to attain greater mental powers than the peoples lacking that quality. And what is true of a people or nation is of course true of a particular family.

    The subject touched upon in this part of our book is one of the greatest interest to careful students of Eugenics; and is one which calls for careful and unprejudiced consideration from all persons having the interest of the race at heart.

    PRIVATE Sex Advice to Women By R. B. Armitage, M. D.

    For Young Wives and those who Expect to be Married.

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