_HEALTH FIRST AND MATRIMONY AFTERWARD. By Edward C. Spitzka, M.D. The Semi-Monthly Magazine Section of the Boston Globe, the Washington Post, the Philadelphia North-American, the Pittsburgh Dispatch, the Chicago Tribune, the St. Louis Globe-Democrat, the Cincinnati Enquirer, etc. May 11, 1913._ We cannot tell men and women how they should mate in order to insure positive types of offspring. But we can state, emphatically, and without reserve, that persons suffering from certain diseases should not enter into the marriage relationship, at peril of the health and happiness of children that may be born to them and the well being of the community at large. I believe that municipal and state governments should take cognizance of this fact. Eventually it will be regarded as a matter for Federal, perhaps for international action. Every candidate, man or woman, applying for a marriage license should be required to present a physician’s certificate declaring him or her to be free from insanity and certain virulent transmissible diseases. What then are these diseases? I will list them in the order of importance as menaces to humanity. 1. Constitutional insanity. 2. The two great forms of constitutional venereal disease: syphilis and gonorrhoea—the former as a source of danger to both the marriage partner and offspring, the latter to the marriage partner only. 3. Deformities that are likely to be associated with the transmission of serious defects of the nervous system, such as cleft palate, hermaphroditism, etc. 4. Epilepsy of the standing of more than one generation. Medical statistics prove that a proportion of three out of every five children born to imbecile parents are certain to be weak-minded, and that the marriage of such unfortunates is a calamity to the race. Syphilis persists from generation to generation. Any sufferer from this disease who marries before he is certain that it has been eradicated from his system is guilty of a crime against society. I have hesitated about including epilepsy in this list. It is undoubtedly transmissible to the offspring, though transmission does not occur in every case. A conservative ruling would be that an epileptic who is believed to be the first of his line to contract the disease should be permitted to marry, in the event of his being declared cured. But the epileptic sons and daughters of epileptic parents should, under no circumstances, be licensed to marry. NOTE: The late Dr. Spitzka, along with other authorities quoted as being opposed to the marriage of the unfit, was concerned with the diseased offspring which almost invariably result from such marriages. Except in the case of gonorrhoea, which can be transmitted to the marriage partner, he did not object to the union itself, provided the latter remained childless. He would have recommended the use of contraceptives, as the solution of the problem, had he not been prohibited by the law from doing so.